Paying the Tab: The Costs and Benefits of Alcohol Control
Philip J. Cook
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What drug provides Americans with the greatest pleasure and the greatest pain? The answer, hands down, is alcohol. The pain comes not only from drunk driving and lost lives but also addiction, family strife, crime, violence, poor health, and squandered human potential. Young and old, drinkers and abstainers alike, all are affected. Every American is paying for alcohol abuse.
Paying the Tab, the first comprehensive analysis of this complex policy issue, calls for broadening our approach to curbing destructive drinking. Over the last few decades, efforts to reduce the societal costs--curbing youth drinking and cracking down on drunk driving--have been somewhat effective, but woefully incomplete. In fact, American policymakers have ignored the influence of the supply side of the equation. Beer and liquor are far cheaper and more readily available today than in the 1950s and 1960s.
Philip Cook's well-researched and engaging account chronicles the history of our attempts to "legislate morality," the overlooked lessons from Prohibition, and the rise of Alcoholics Anonymous. He provides a thorough account of the scientific evidence that has accumulated over the last twenty-five years of economic and public-health research, which demonstrates that higher alcohol excise taxes and other supply restrictions are effective and underutilized policy tools that can cut abuse while preserving the pleasures of moderate consumption. Paying the Tab makes a powerful case for a policy course correction. Alcohol is too cheap, and it's costing all of us.
congressional reforms of 1927, the federal enforcement effort was staffed through the spoils system, poorly organized, and prone to corruption and malfeasance (U.S. Congress 1931, 14; Aaron and Musto 1981, 158). The reformers and moralists, who had high hopes for national Prohibition, were disappointed. It did not succeed in converting America to a nation of teetotalers. What’s more, the illicit liquor trade engendered considerable corruption and violence. John D. Rockefeller Jr., who had been a
Policy: Beyond the Shadow of Prohibition, 388–458. Washington, D.C.: National Academy Press. Mosher, James, and other contributors. (2002). Liquor Liability Law. Newark, NJ: Lexis Nexis. Mukamal, Kenneth J., Katherine M. Conigrave, Murray A. Mittleman, Carlos A. Camargo Jr., Meir J. Stampfer, Walter C. Willett, and Eric B. Rimm. (2003). “Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men.” New England Journal of Medicine 348 (2): 109–18. Mulford, Harold A.,
is the tendency of respondents to understate their true consumption. That bias in self-reporting is not surprising. People who are embarrassed about their drinking habit, or who are concerned that the survey interviewer may think less of them if they tell the truth, or are worried that the promised anonymity of the survey will be violated, will be inclined to understate their drinking. Of course it is also true that respondents may have a selective memory when it comes to recalling how much they
does not prove causation, and may be—at least in part—the result of some other causal process. For example, people who drive after drinking are being somewhat reckless, a trait that may also carry over to when they are sober. That is, people who drive drunk from time to time may tend to be reckless drivers all the time, with the willingness to drive drunk as just one manifestation. That is not just a speculation: one study of FARS data found that people with bad driving records have a higher risk
religion, and culture. But these factors, while important, are largely beyond the direct influence of public policy. The special importance of alcoholic beverage prices and availability in this array of factors is that they are under the direct control of legislatures and government agencies, and they have documented effectiveness. Effective alcohol-control measures will reduce average sales and consumption of alcohol. Average consumption is closely linked to the prevalence of heavy drinking and