Table 3

Effect of legal interventions to control alcohol on health and social outcomes

Author (year)Main results
May (1975)19
  • Arrests declined for the 2-month period of alcohol legalisation by 30% (182 in June-July of 1969 to 126 in June-July of 1970).

  • Following the repeal, arrests rose by over 30% to 189 in June-July of 197.1

  • Data pertaining to individual arrests was unavailable. However, at an aggregate level in 1969 and 1970, 88.7% of Native American arrests within and bordering the reservations were for alcohol intoxication and driving while intoxicated.

Schechter (1986)20
  • Overall importation and consumption declined significantly.

  • Number of drinks imported fell from 47 million in 1978 to 35.2 million in 1979, 30.5 million in 1980 and 36 million in 1981.

  • Litres of pure alcohol consumed dropped from 513 627 in 1978 to 406 856 in 1979, 346 384 in 1980 and 436 066 in 1981.

  • National crime rate dropped markedly particularly violent crimes (murder, attempted murder and assault).

  • After the repeal of alcohol rationing, consumption and importation rose by 60% and incidences of crime increased significantly.

Gallaher et al (1992)27
  • Over 50% excess mortality from all unintentional injuries among Native Americans resulted from hypothermia and pedestrian-motor vehicle crashes.

  • New Mexico Native Americans nearly eight times more likely to die of hypothermia compared with other New Mexico residents.

  • At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 mg/dL for pedestrian and hypothermia deaths, respectively).

  • Most deaths occurred at off-reservation sites in border towns and on roads leading back to the reservation.

Lee (1993)25
  • Of 9882 reported incidents of crime overall, Nation villages (employing traditional forms of control) reported 34.5% of the total, non-Nation villages (employing local option controls) reported 65.5% of the total.

  • Rates for felonies and misdemeanors were lower in Nation villages, with the exception of liquor violations and drunk in public and protective custody incidents.

  • In non-Nation villages, incidence of strongarm rape were 6.9 times higher, non-aggravated assault were 3.8 times higher, burglary 2.9 times higher and sexual assault 5 times higher.

  • Nation villages reported more protective custody and drunk-in-public incidents than non-Nation villages, yet serious reported crime were lower.

Chiu et al (1997)16
  • Substantial decrease in the number of alcohol-related outpatient visits when the ban on possession and importation was imposed compared with baseline.

  • When the ban was lifted, outpatient visits increased; when the ban was reimposed, the number of outpatient visits again decreased.

  • Interrupted time-series analysis confirmed that the alcohol ban, its lifting and its reimposition had a statistically significant and negative effect on the number of alcohol-related outpatient visits (p<0.05).

  • A significantly higher number of visits were made during the two non-ban periods (November 1993-October 1994) and November 1995-February 1996) compared with the two ban periods (p<0.05).

Landen et al (1997)24
  • Of 302 injury deaths, blood alcohol concentrations (BACs) were available for 200 deaths (66.2%). Of these, 130 (65.0%) had a BAC greater than or equal to 17 mmol/L (greater than or equal to 80 mg/dL) and were therefore considered alcohol-related.

  • Total injury mortality rate was greater among Alaska Natives from wet villages (rate ratio (RR), 1.6; 95% CI 1.3 to 1.2). This difference was not present for non-natives (RR, 1.1; 95% CI 0.3 to 3.8).

  • For Alaska Natives, the alcohol-related injury mortality was greater among residents of wet villages (RR, 2.7; 95% CI 1.9 to 3.8) than among residents of dry villages. The strength of this association was greatest for deaths due to motor vehicle injury, homicide and hypothermia.

Landen (1997)23
  • No significant differences across reservations with prohibition controls and those where alcohol was legal. The average age-adjusted mortality rate found that the mortality rate was higher (n=158) than prohibition (n=138) reservations.

Douglas (1998)17
  • Decrease in alcohol consumption observed for each of the 2 years following the intervention.

  • Overall, incidence of crime declined.

  • Alcohol-related presentations to the hospital and presentations resulting from domestic violence decreased relative to the equivalent quarterly period prior to the intervention. Short-term fluctuations were observed, particularly with domestic violence, where presentations (of lesser severity) became more request during several quarters.

  • Emergency evacuations as a result of injury showed a marked decrease.

D'Abbs (1998)29
  • Mean consumption levels in standard drink terms, the corresponding equivalents were 5.8 standard drinks per day for female drinkers and 9.3 for male drinkers.

  • Among both male and female drinkers, the overall mean consumption levels were ∼50% above the level designated as harmful.

  • In one community, mean consumption lay in the responsible range and the other in the hazardous range. In all others, male and females were above the harmful level.

  • Total beer sales in the seven clubs (1994-1995) amounted to 882 259 L. Assuming a retail price of $3.50 per 375 mL can of full-strength beer and $3.00 per can of light beer, the total retail turnover would amounted to ∼$8.1 million.

Berman et al (2000)22
  • Injury deaths generally lower during periods when alcohol sales, importation or possession were restricted than when no restrictions were in place (wet).

  • More restrictive controls (dry) significantly reduced homicides but had no effect on suicide rates; less restrictive control options (damp) reduced suicides but had no effect on homicide rates.

  • Accident and homicide death rates fell, on average, by 74 and 66 per 100 000, respectively, for the 89 communities that banned sale and importation or possession. Sixty-one small communities that did not change control status under the law showed no significant changes over time in accident or homicide death rates.

  • The decline in overall injury death rates was much greater in communities with less restrictive options (127 compared to 48 per 100 000). However, death rates were higher in these communities while they were wet, with the discrepancy statistically significant for suicides.

Gray et al (2000)15
  • Annual per capita consumption declined by 19.4% in the 2 years following the introduction of alcohol restrictions.

  • Hospital admissions for acute alcohol-related conditions declined.

  • Restrictions were circumvented by a shift to fortified wine purchases. Fortified wine purchases increased by 570% (573 L) offsetting 14% of the mean quarterly decline of 4173 L of cask wine immediately following the restrictions.

  • Purchases at Aboriginal-controlled licensed clubs (also not covered by the restrictions) increased by 55.7% from 2801 L to 1799 L of pure alcohol and offsetting 20% of the mean quarterly decline of 3002 L.

Ellis (2003)28
  • Following the introduction of restrictions on liquor sold, times of sale or mode of sale, a local excise tax and enhanced law enforcement measures, from 1974 to 1995, McKinley County's (MC) motor vehicle accident mortality rate declined by 60% and was matched by similar declines in mortality from homicide (58%), suicide (59%), alcohol-induced causes (30%) and drug-induced causes (50%).

  • From 1989 to 1995, alcohol-related arrests declined 42% in Gallup, and protective custody detentions were cut in half. Between 1982 and 1995, traffic crashes had declined 32% in MC. All declines experienced in MC exceeded similar trends for New Mexico and the nation.

Wood (2006)8
  • Villages prohibiting alcohol had lower age-adjusted rates of serious injury resulting from assault, motor vehicle collisions. Dry villages with a local police presence had a lower age-adjusted rate of serious injury caused by assault.

  • Local prohibition was associated with lower rates of assault injuries.

  • Local police presence was associated with lower rates of assault injuries. Contrary to expectations, there was no difference in the age-adjusted rate of injury attributed to self-harm for wet vs dry isolated Alaska Native villages. Rates of serious injury caused by assault were 36% higher in villages during periods of police absence than when police were present.

Hogan et al (2006)18
  • Over 12 months the reduction in trading hours was accompanied by decreased levels of alcohol-related harm. However, the regulation of container size was undermined by a shift to cheap cask port with sales of this product increasing by 1000%.

  • A one-third reduction was observed in instances of drunkenness and breaches of the 2 km law, as were Protective Custodies.

  • Ambulance services received 25% less alcohol-related call-outs and selected presentation to the emergency department of Alice Springs were reduced by 19%.

  • Alcohol-related assaults were 13% lower. There was a nearly 20% increase in alcohol-related offences, especially criminal damage and disturbances and indications of more acute conditions being admitted to Alice Springs Hospital. However, the author's reanalysis of these findings found that the evaluators did not provide sufficient data to ascertain whether these were significant reductions of chance phenomena.

Margolis et al (2008)13
  • Overall reduction (2 years vs 2 years before the AMP was implemented) was on average 51.9% (Community (A) 44.8% (B) 54.6% (C) 66% (D) 42.2%).

  • Retrieval rates for all other causes did not reveal any statistically significant change. Serious injury resulted in 798 retrievals during the observation period. There was a significant (p=0.021) decrease in injury after the introduction of AMP.

Wood (2011)21
  • Wet communities in Nunavut recorded rates of violent crime that were higher than dry communities.

  • Relative to dry communities, wet communities’ overall sexual assault rate was 1.48 (95% CI 1.38 to 1.60) times higher, the serious assault rate was 2.10 (95% CI 1.88 to 2.35) times higher and the homicide rate was 2.88 (95% CI 1.18 to 8.84) times higher.

  • Dry communities were safer than wet communities but still reported rates of violence that were higher than national rates, including a serious assault rate that was double the national rate (3.25 per 1000 vs 1.44 per 1000) and a sexual assault rate that was at least seven times as high as the national rate (7.58 per 1000 vs 0.88 per 1000).

  • Homicide, the rarest violent offence, was relatively more frequent in wet communities than in dry communities (RR=2.88; 95% CI 1.18 to 8.84).

Margolis et al (2011)14
  • After alcohol restrictions were introduced in 2002-2003, retrievals for serious injury dropped initially, then increased in the 2 years before further restrictions in 2008 (average increase, 2.34 per 1000 per year). This trend reversed in the 2 years after the 2008 restrictions (average decrease 7.97 per 1000 per year).

  • There was a statistically significant decreasing time trend in serious-injury retrieval rates in each of the four communities for the period 2 years before the 2002-2003 restrictions, 2 years before the 2008 restrictions and the final 2 years of observations (2009-2010) (p <0.001 for all four communities combined).

  • Overall, serious injury retrieval rates dropped from 30 per 1000 in 2008 to 14 per 1000 in 2010, and the proportions of serious-injury retrievals decreased significantly for all four communities.

Berman (2014)26
  • Suicide rates were higher in communities prohibiting alcohol importation under state law, but the effect was not significant after controlling for other community characteristics.

  • More remote communities, those with fewer non-Natives and those with evidence of cultural divides had higher suicide risks.

  • Communities with higher incomes, more married couples and traditional elders had lower risks. There was a strong association of community characteristics with the choice of alcohol status, consistent with the hypothesis that it is endogenous.

  • Communities choosing alcohol control by referendum were generally larger, with a higher percentage of Alaska Native residents and more remote.

  • Communities with lower median incomes were more likely to choose prohibition.

  • Young men's suicide risks were significantly higher (p<0.01) when alcohol was prohibited under the state local option law.

  • The association between adoption of any local alcohol control option and suicide was even stronger (p=0.01). However, communities using federal Indian law to ban alcohol had significantly lower suicide risks (p<0.5).