Alcohol Sales and Service to Underage Youth and Intoxicated Patrons: Effects of Responsible Beverage Service Training and Enforcement Interventions

Drinking by underage youth and those already substantially impaired or intoxicated continue as major contributors to alcohol-related car crashes. To prevent alcohol-related problems, almost all states have made it illegal for licensed alcohol establishments to sell alcohol to underage youth or to customers who show obvious signs of intoxication. However, despite existing laws, many alcohol establishments, both off-premise (i.e., liquor and grocery stores) and on-premise (i.e., bars and restaurants), have serving practices that foster high-risk drinking behavior. Extant literature indicates that servers at alcohol establishments rarely intervene to prevent intoxication or refuse service to intoxicated patrons. This lack of intervention is reflected in studies noting that pseudo-intoxicated patrons are able to purchase alcohol in 62% to 90% of purchase attempts. Additionally, evidence suggests that approximately a third of patrons leaving bars have blood alcohol concentrations (BACs) above the legal limit for driving, and between one-third and three-quarters of intoxicated drivers consumed their last alcoholic beverage at a bar. Sales and service of alcohol to youth and those already impaired or intoxicated (also referred to as over service) contributes to many health problems, both those related to driving and others. For example, alcohol is involved in up to 39% of fatal traffic crashes, 76% of fatal traffic crashes between midnight and 3 a.m., 76% of rapes, 66% of violent incidents between intimate partners, 30% to 70% of drownings, 50% of homicides, 50% of assaults, and 38% of suicides. Preventing further service of alcohol to those already substantially impaired by alcohol is a clear avenue to reduce traffic crashes and other health and social problems resulting from heavy episodic drinking. Similarly, despite passage of the age 21 minimum legal drinking age (MLDA) legislation, underage youth can, and do, purchase and use alcohol. Seventy-seven percent of adolescents have consumed alcohol by the end of high school; and 44% have done so by the end of eighth grade. Further, purchase attempts indicate that between 45% to 50% of outlets sell to underage buyers. Alcohol use among adolescents contributes to traffic crashes, increased risk for disease, risky sexual behavior, violence, sexual assault, homicides, suicides, crime, and unintentional injury. In addition, recent research has shown that exposure to alcohol in adolescence can have detrimental effects on brain development, intellectual capabilities, and increases the likelihood for later addiction. Further, one estimate of the societal cost of underage alcohol use in the United States is $53 billion annually, attributed to loss of young lives, lost productivity, and health care costs. These findings point to a clear need for interventions to induce alcohol service staff to avoid selling alcohol to underage youth and those intoxicated, reduce the likelihood of drinkers becoming intoxicated, and prevent those who are noticeably impaired from driving. Alcohol sales and service practices often present the last clear chance of preventing alcohol-related traffic crashes and a variety of other problems.