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Alcohol – Excessive Consumption: Privatization of Retail Alcohol Sales


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 18 studies (search period through October 2007). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption.


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Summary of Results

Eighteen studies qualified for the systematic review.

  • Seventeen studies assessed the effects of privatization on per capita alcohol sales, a well-established proxy for excessive alcohol consumption and related harms.
    • Overall, there was a 44.4% median increase in per capita sales of privatized alcoholic beverages within the jurisdiction that underwent privatization during the years following privatization of retail alcohol sales (interquartile interval [IQI]: 4.5% to 122.5%; 17 studies).
    • During this same time frame, sales of nonprivatized alcoholic beverages within the jurisdiction that underwent privatization decreased by a median of 2.2% (IQI: -6.6% to -0.1%; 9 studies).
    • One study in Finland assessed the effects of privatization for groups reporting different levels of alcohol consumption. It found privatization increased consumption across all groups.
  • One study in Sweden found that re-monopolizing the sale of medium-strength beer was associated with a general reduction in alcohol-related harms.


Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF recommends against use of the intervention.


Applicability of this intervention across different settings and populations was not assessed because the CPSF recommends against use of the intervention.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

  • Additional research is needed to clarify the relationship between privatization and patterns of excessive alcohol consumption (e.g., binge drinking) and alcohol-related harms. Most useful would be cohort studies in the U.S. similar to the one conducted by Mäkelä et al.in Finland.
  • It would be useful to evaluate the impact of increased government control over alcohol sales (e.g., re-monopolization) on excessive alcohol consumption and related harms, were such events to occur in the U.S. or other high-income nations.
  • Privatization has assumed different forms in different states and localities. It would be useful to better understand how the effects of privatization observed in this review vary by the degree of government regulation and other specific parameters of the privatization.
  • The anticipated economic effects of privatization include a large, but short-term, source of revenue to states; a potential increase in healthcare and criminal justice costs; and productivity losses from expected increases in excessive alcohol consumption owing to greater availability and/or lower prices. Studies assessing these economic impacts would help inform future discussions of this issue.
  • It would be useful to assess the effects of different specific approaches to privatization on state revenues associated with sales and taxes on alcoholic beverages.


Mäkelä P. Whose drinking does the liberalization of alcohol policy increase? Change in alcohol consumption by the initial level in the Finnish panel survey in 1968 and 1969. Addiction 2002; 97(6):701-6.

Study Characteristics

  • The effects of 12 distinct privatization events were assessed as well as one study of remonopolization.
  • The privatization events assessed were in seven U.S. states; two Canadian provinces; and Finland.
  • All studies used alcohol sales data as an index of population-level alcohol consumption except one that assessed changes in individual-level consumption.
  • The privatization events assessed in these studies occurred between 1950 and 2000.