This site focuses on general information and prevention strategies to reduce excessive alcohol use and its related harms. For data on excessive alcohol use and its related harms, please see the North Carolina Alcohol Data Dashboard.
To request alcohol-related data from the Injury & Violence Prevention Branch (IVPB) please visit the Custom Injury data request page. If you have questions regarding a custom data request or our available data products, please reserve a time to chat with one of our epidemiologists.
Alcohol Environment: Core Policies
The alcohol environment can impact alcohol use. It includes the physical availability of alcohol, price of alcohol, type of alcoholic beverage available, and exposure to alcohol advertisements. Core, proven alcohol policies help to create communities that can discourage excessive alcohol use and reduce harmful effects of alcohol. These policies focus on several factors that affect excessive drinking — private control of alcohol sales, and the 4 Ps of Alcohol Access: Place, Price, Product, and Promotion. For more information on the core alcohol policies working to build healthier NC communities, please see the Reducing Excessive Alcohol Use to Build Healthier North Carolina Communities Factsheet.
State Control: Private vs. Public
Public
State-controlled alcohol sales are when government organizations directly regulate the sale and distribution of alcohol.1 North Carolina has a system of state-controlled alcohol sales where the Alcoholic Beverage Control (ABC) Commission oversees the sale, purchase, manufacturing, consumption, and possession of alcoholic beverages. State-controlled alcohol sales help regulate the number of places that sell alcohol. When there are a lot of places that sell alcohol in an area, people tend to drink more.2
Private
Evidence shows that privatizing alcohol sales by removing government control tends to increase the number of places that sell alcohol.2 This can increase excessive alcohol use and its related harms like child maltreatment and neglect, violence, and chronic diseases.2 States like North Carolina that have government-controlled alcohol sales often have less alcohol use per person, but increased state revenue from alcohol sales, when compared to states with privatized sales, such as South Carolina.3
4 P's to Alcohol Access
The places where alcohol is available can impact alcohol use. When alcohol is more available, people tend to drink more.5 [MC1] There are two main types of businesses that sell alcohol, on-premises locations and off-premises locations.4Alcohol outlet density is used to measure the physical availability of alcohol. It measures the number of businesses selling alcohol in an area and can be expressed as a count, rate per person, or rate per square mile.
When there are many locations that sell and advertise alcohol in specific areas, people tend to consume more alcohol. This can lead to more community-level problems, such as crime, noise levels, property damage, alcohol-impaired driving, and violence.6 Regulating the number of businesses that sell alcohol can improve the health, well-being, and safety of North Carolina communities.6
Alcohol is sold and available in new ways and settings that may increase accessibility. Online sales and home food delivery apps increase alcohol access, which can be associated with excessive drinking.8Alcohol social districts allow for pedestrians to carry alcohol containers away from on-premises alcohol outlets, such as bars and restaurants, where the beverage was purchased. There's limited information on how online sales, home deliveries, and alcohol social districts affect alcohol consumption, however, evidence shows that when alcohol is more accessible, both alcohol use and its related harms increase.
To learn more about alcohol social districts in NC, please see the NC Alcohol Social Districts Fact Sheet.
The price of alcohol can impact alcohol use. When alcohol is cheaper, people tend to drink more. Evidence shows that increasing the price of alcohol can decrease excessive alcohol use and its related harms, while also increasing state revenue in states with government-controlled alcohol sales. Raising the price of alcohol can be done through increased taxes on alcohol or minimum pricing policies.9
North Carolina’s current alcohol tax is an excise tax, which is based on the amount of alcohol sold and has not kept up with inflation. An excise tax is levied on alcoholic beverages sold in and/or shipping into North Carolina. Over the past 30 years, alcohol has become cheaper compared to other items. Setting a minimum price for alcohol means setting prices per standard drink of alcohol or prices based on a specific container size of specific types of alcohol.9 This, in addition to a tax on alcohol, could increase revenue for states with government-controlled alcohol sales, which could be used for community health initiatives that further reduce alcohol-related harms.10
Certain alcoholic beverage products may appeal to specific groups of people and increase the risk of alcohol-related harm for those people. For example, cheap, sweet, and high-alcohol-content beverages may appeal more to youth. Similarly, the packaging of the product can also appeal to people of certain ages or people who feel connected to specific characteristics shown on the product packaging. This could increase their likelihood of excessive alcohol consumption. Policies that limit alcohol beverage types that appeal to certain groups, such as youth, reduces excessive alcohol use and its related harms.
The following strategies could help to address these concerns related to the products:
- Address Co-Branded Beverages: Companies that make a similar product, one with alcohol and one without, often make the packaging of their products look similar. If a product’s packaging clearly states that it contains alcohol it could help reduce underage alcohol use as well as allow of-age consumers to be aware of a product’s contents. It is important to remember that non-alcoholic beverages can still contain some alcohol. If a beverage contains alcohol, but in an amount under 0.05%, it will be considered non-alcoholic.
- Avoid Sales of Dangerous New Intoxicating Beverage Products: Certain intoxicating beverages, such as alcoholic energy drinks or THC drinks can increase the risk of related harm.
- Health Warning Labels: Alcohol use can increase the risk of injuries, chronic diseases, and other health outcomes. The Surgeon General recommends updating the warning label on alcoholic beverages to add information on the increased risk of cancer to help educate consumers.11
Alcoholic beverages can be promoted in many ways. Limiting alcohol advertising means having rules about brand signs, coupons, and ads inside and outside of stores or other places that sell alcohol, as well as advertising throughout communities (e.g., on billboards, at events). These ads may promote deals or highlight specific products. Sometimes ads might also appear to contribute to health and wellness initiatives or charities, despite alcohol increasing the risk of the same health problems. Increasing advertising limitations, like regulating the location and placement of a message, is an effective way to decrease alcohol consumption.12
Promotion of alcoholic beverages also includes the hours and days that alcohol is sold. Increased hours and days of sale increase both availability and promotion of alcohol, which can lead to increased alcohol consumption and related harms.13 Maintaining the hours and days that alcohol can be sold reduces excessive alcohol use and its related harms, such as injuries, violence, and other community disruptions like crime, noise levels, and property damage14
Consumption of Alcohol
Excessive alcohol use causes preventable public health problems. Alcohol can reduce an individual’s lifespan and affect the community through increased violence, unemployment rates, and loss of productivity.
Levels of Consumption
One drink or less in a day for women, two drinks or less in a day for men.
Four or more drinks in one occasion for women, five or more drinks in one occasion for men.
Eight or more drinks during a week from women, 15 or more drinks during a week for men.
Excessive alcohol use is not the same as alcohol dependence. Nine out of ten people who excessively drink alcohol are not dependent on alcohol.16
Moderate alcohol use is consuming one drink or less in a day for women and two drinks or less in a day for men. Overall, moderate drinking does not have health benefits, and it can increase risk of injury, chronic disease, or death when compared to not drinking at all.15 Choosing not to drink can lower overall risks from alcohol-related harms. However, if you do choose to drink, drinking less is better for your health.
To learn more about alcohol consumption in NC, please see the NC Alcohol Data Dashboard.
Key Groups & Equitable Solutions
Understanding alcohol-related harms among key groups can help develop appropriate public health interventions. Excessive alcohol use has larger negative impacts on people who are under 21 years of age, pregnant, older, or veterans, as well as people who have lower incomes, or have been historically marginalized.17, 18, 19, 20
For example, alcohol-related harms disproportionately impact Black, Hispanic, and Indigenous communities more because there are more alcohol-selling businesses in these areas compared to mostly white communities.21 Understanding these differences helps create better, more culturally aware public health solutions.
If you are looking for information on prevention strategies for youth, alcohol use during pregnancy, or other populations visit the Center for Disease Control and Prevention's Alcohol Use Page.
Alcohol-Related Harms
Alcohol use does not have health benefits, and it increases risk of injury, chronic disease, and death when compared to not drinking at all.15 Drinking less, or not at all, is better for your health and can lower your risk for alcohol-related harms. Alcohol outcomes can be sorted into two categories: harms from short-term (acute) alcohol use or those from long-term use (chronic disease).
Short Term Risks
Alcohol in combination with other drugs can cause serious harm, including an increased risk of overdose or injury.22
Drinking any alcohol affects skills needed to drive safely like focus, coordination, and quick reactions. Individuals can minimize the risks associated with operating a motor vehicle while under the influence of alcohol by:
- Planning ahead: Make a plan to ensure that you do not have to drive if you plan to drink alcohol or use drugs.
- Get a ride home: If you have used alcohol and/or drugs, get a ride home with sober friends or family members, rideshare services, or a taxi.
- Always wear a seat belt: Whether you are the driver or not, anyone in a vehicle should wear a seat belt to reduce the risk of being seriously injured or dying from a crash.
Drinking more alcohol has been linked to a higher risk of suicide. This is because alcohol can affect judgment and make it harder to think clearly. Also, some people might turn to alcohol to cope with the emotional pain that leads to suicidal ideation.23
Long-Term Health Risks
Drinking any alcoholic beverage, including red and white wine, beer, and liquor, is linked with an increased risk of several types of cancer. For more information visit the CDC Alcohol and Cancer page.
Drinking too much alcohol over time can reduce the liver’s ability to regenerate new cells. This can result in permanent damage to the liver, decreasing its ability to filter toxins from the blood, aid with digestion, regulate blood sugar, and fight infections and disease.24
Drinking too much alcohol can raise your blood pressure to unhealthy levels. Repeated binge drinking can lead to long-term increases in blood pressure. High blood pressure can increase the risk of stroke, heart disease, and chronic kidney disease.25
Cost of Excessive Alcohol Use
Alcohol does not just contribute to many negative health outcomes but also costs the state of North Carolina over $9.5 billion each year. Most of the expense comes from lost productivity due to things like early death, reduced work performance, missing work, and fetal alcohol syndrome. Other costs include healthcare, criminal justice, and motor vehicle crashes.26
Access to Care
The 4 P’s of alcohol access (place, price, product, promotion) and state control of alcohol sales are the most effective ways to reduce excessive alcohol use and its related harms. There are also opportunities to address excessive alcohol consumption through access to care and treatment.27
Healthcare providers can routinely use alcohol screening, brief intervention and referral to specialized treatment for those who need it. In addition, electronic screening and brief intervention (e-SBI) can be used in healthcare or non-healthcare settings (e.g., workplaces, universities) to electronically screen adults for excessive drinking and provide a brief intervention on the risks and consequences of excessive drinking for those who screen positive. Widely accessible, validated, and user-friendly screening measures can help increase access to care and treatment.28 The CDC offers a free, confidential website where adults can check their alcohol use and get personalized feedback. The website is also available in Spanish.
Alcohol use disorder is a treatable, chronic disease in which someone continues to drink alcohol despite it causing substantial personal, social, work, or health problems.29 Multiple evidence-based behavioral interventions and FDA-approved medications exist to treat alcohol use disorder.30 9 out of 10 people who excessively drink do not meet the criteria for alcohol use disorder but still may benefit from professional help due to risk of bad health outcomes.16, 31
Data on treatment rates for North Carolina residents with alcohol use disorder are currently unavailable. Prior estimates suggest that roughly 8 in every 100 people in the U.S. with alcohol use disorder in the past year sought treatment32 In the U.S., about 1 in every 4 people seeking treatment for alcohol use disorder reported receiving treatment with medication.31 NC DHHS provides resources for finding treatment for alcohol and other substance issues here.
Maternal and Infant Health Indicators
Birth Characteristics/Risk Factors
- Birth Demographics
- Low Birthweight
- Preterm Births*
- Smoking Prior to Pregnancy*
- Smoking During Pregnancy
- Pre-Pregnancy Overweight or Obese
- First Trimester Prenatal Care*
- Gestational Diabetes
- Maternal Hypertension
- Cesarean Section Deliveries
- Breastfed at Delivery Discharge*
- Short Birth Interval <6 months
- Short Birth Interval <18 months*
Fertility, Teen Births, and Infant Death Rates
More Indicators
*This is a Perinatal Health Equity Collective (PHEC) Indicator.