North Carolina Alcohol Use and Related Harms Prevention

Jump to: Alcohol Environment | Alcohol Use | Alcohol-Related Harms | Access to Care | NC State Excessive Alcohol Advisory Committee | Additional Resources

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 and Related Harms 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

Jump to: Control of Alcohol Sales: State vs. Private | The 4 P's of Alcohol Access

The alcohol environment impacts alcohol use and related-health outcomes. It includes the physical availability of alcohol, price of alcohol, type of alcoholic beverage available, and exposure to alcohol marketing. Proven alcohol policies help to create community environments that can discourage excessive alcohol use and reduce harmful effects of alcohol. These policies focus on several factors that affect excessive drinking — state control of alcohol sales, and the 4 P's of Alcohol Access: Place, Price, Product, and Promotion.1 For more information on the alcohol policies, please see the Reducing Excessive Alcohol Use to Build Healthier North Carolina Communities Factsheet (PDF). 

Pie chart showing factors that affect alcohol use

Control of Alcohol Sales: State vs. Private 

State: State-controlled alcohol sales are when government organizations directly regulate the sale and distribution of alcohol.2 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.3 

Private: Evidence shows that privatizing alcohol sales by removing government control tends to increase 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.3 This can increase excessive alcohol use and its related harms like child maltreatment and neglect, violence, motor vehicle crashes, and chronic diseases.1 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.4

Two boxes: Left showing statistics about NC with state control, right showing statistics about SC with privatized control

The 4 P's of Alcohol Access 

The alcohol environment can be described using the 4 P’s of alcohol access: Place, Product, Price, and Promotion. The 4 P’s impact drinking behavior and related health outcomes.1

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The places where alcohol is sold can impact alcohol use. When alcohol is more available, people tend to drink more.5 There are two main types of businesses that sell alcohol, on-premises locations and off-premises locations.5

Two buildings: Left is on-premises, right is off-premises

Alcohol outlet density is used to measure the physical availability of alcohol. It measures the number and concentration 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 drink 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. For example, online sales and home food delivery apps increase alcohol access, which can be associated with excessive drinking.7 Alcohol social districts allow 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 use, however, evidence shows that when alcohol is more accessible, both alcohol use and its related harms increase.8

To learn more about alcohol social districts in NC, please see the NC Alcohol Social Districts Fact Sheet (PDF). 

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 pace 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 and be used to fund 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, low-cost, sweet, and high-alcohol-content beverages may appeal more to youth. Similarly, the packaging of the product may 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 use. Policies that limit alcohol beverage types that appeal to certain groups, such as youth, can reduce excessive alcohol use and its related harms.

The following strategies could help to address these concerns related to alcohol 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. The way these products are packaged can confuse people, leading them to accidentally pick up an alcoholic drink when they wanted a non-alcoholic drink. 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.
Two beverages: Left is non-alcoholic; Right is alcoholic
  • Avoid Sales of Dangerous New Intoxicating Beverage Products: Certain intoxicating beverages, such as alcoholic energy drinks or cannabis-infused drinks can increase the risk of related harms.11, 12
  • Consider Point of Sale Signage to Supplement Product Health Warning Labels: The Surgeon General recommends updating the warning label on alcoholic beverages to add information on the increased risk of cancer to help educate consumers.13 Additional signage at the point of sale or updated, expanded  product warning labels could also highlight the increased risk for injuries, chronic diseases, and other health outcomes associated with alcohol use.

Alcoholic beverages are marketed in many ways. Limiting alcohol advertising means having rules about brand signs, coupons, promotions, 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. Advertising limitations, like regulating the location and placement of a message, are proven strategies to decrease alcohol use.14

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 use and related harms.15 Maintaining or restricting 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 damage.16

Alcohol Use

Alcohol use can be broken down into different levels: moderate, binge, and heavy. 

Drinking levels defined by women and men: Moderate; Binge; Heavy

Excessive alcohol use includes binge drinking, heavy drinking, underage drinking, and consuming any alcohol while pregnant. Binge drinking is defined as 4 or more drinks on one occasion for women and 5 or more drinks on one occasion for men. Heavy drinking is defined as 8 or more drinks per week for women and 15 or more drinks per week for men.17

Excessive alcohol use is not the same as being dependent on alcohol or having alcohol use disorder. Nine out of ten people who excessively drink alcohol are not dependent on alcohol.18

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.17

Moderate alcohol use is consuming one drink or less in a day for women and two drinks or less in a day for men.19 Moderate drinking can reduce health risks compared to drinking excessively. However, even moderate drinking can increase the risk of injury, chronic disease, or death when compared to not drinking at all.17 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 use in NC, please see the NC Alcohol and Related Harms Data Dashboard.

Alcohol-Related Harms

Jump to: Short Term Risks | Long Term Risks | Economic Costs | Select Groups and Community-Centered Solutions

Alcohol use does not have health benefits, and it increases the risk of injury, chronic disease, and death when compared to not drinking at all.17 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 alcohol use or harms from long-term alcohol use. 

Short Term Risks

Drinking excessively on an occasion can lead to negative health outcomes, such as:

  • Drug Overdose: Alcohol in combination with other drugs can cause serious harm, including an increased risk of overdose or injury.25
  • Motor Vehicle Crashes: 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.

  • Suicide: Alcohol use has been linked to a higher risk of suicide. Alcohol can affect judgment and make it harder to think clearly. Alcohol is also sometimes used to cope with emotional pain, which may increase the risk of suicidal ideation.26

     

Long Term Risks

Drinking alcohol over time can cause significant health issues such as:

  • Cancer: Drinking any alcoholic beverage, in any amount, 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.
  • Liver Disease: 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.27

  • Hypertension: 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 increases the risk of stroke, heart disease, chronic kidney disease and death.28

     

Economic Cost

Alcohol does not just contribute to many negative health outcomes but also cost the state of North Carolina over $15 billion in 2023. Most of the expense comes from lost productivity due to early death, reduced work performance, missed work, and fetal alcohol syndrome. Other incurred costs include healthcare, criminal justice, and motor vehicle crashes.29

 

Select Groups and Community-Centered Solutions

Understanding alcohol-related harms among select groups can help develop or tailor 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.20,21,22,23

For example, alcohol-related harms disproportionately impact Black, Hispanic, and Indigenous communities because there are more alcohol-selling businesses in these areas compared to mostly white communities.24 Understanding these differences helps create more effective and 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.

Access to Care

Jump to: Screening | Treatment

The 4 P’s of alcohol access (place, price, product, promotion) and state control of alcohol sales are critical factors to address to reduce excessive alcohol use and its related harms. There are also opportunities to address excessive alcohol use through access to care and treatment.30

Screening

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.31 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.

 

Treatment

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.32  Multiple evidence-based behavioral interventions and FDA-approved medications exist to treat alcohol use disorder.33  Nine of out ten people who excessively drink do not meet the criteria for alcohol use disorder but still may benefit from professional help due to the risk of negative health, social, and interpersonal outcomes.18,34

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 treatment.35 In the U.S., about 1 in every 4 people seeking treatment for alcohol use disorder reported receiving treatment with medication.34 Learn more about NCDHHS resources for finding treatment for alcohol and other substance issues.

NC State Excessive Alcohol Advisory Committee 

North Carolina State Excessive Alcohol Advisory Committee (NC SEAAC) meetings focus on excessive alcohol use prevention priorities and feature presentations from subject matter experts. This group is composed of prevention, treatment, recovery, policy, advocacy, and research partners that are involved in alcohol-related work across the state. If you would like to join the group, please email substanceusedata@dhhs.nc.gov.

To see past presentations given at NC SEAAC, please see the North Carolina State Excessive Alcohol Advisory Committee (NC SEAAC) folder.

Additional Resources

NCDHHS Resources

Centers for Disease Control and Prevention

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Funding Disclaimer: This work is partially supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $166,667. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

Suggested citation:  NC Department of Health and Human Services Division of Public Health Injury & Violence Prevention Branch. “North Carolina Alcohol Prevention and Education | Division of Public Health.” North Carolina Alcohol Data. Accessed <access date>. https://www.dph.ncdhhs.gov/programs/chronic-disease-and-injury/injury-and-violence-prevention-branch/north-carolina-alcohol-use-and-related-harms-prevention

  1. Greisen, C., Grossman, E. R., Siegel, M., & Sager, M. (2019). Public health and the four P’s of marketing: Alcohol as a fundamental example. Journal of Law, Medicine &amp; Ethics, 47(S2), 51–54. https://doi.org/10.1177/1073110519857317
  2. National Alcohol Beverage Control Association. (2023, June). North Carolina. National Alcohol Beverage Control Association. https://www.nabca.org/sites/default/files/assets/files/NC_June2023.pdf
  3. William C. Kerr, Edwina Williams, Thomas K. Greenfield, Analysis of Price Changes in Washington Following the 2012 Liquor Privatization, Alcohol and Alcoholism, Volume 50, Issue 6, November/December 2015, Pages 654–660, https://doi.org/10.1093/alcalc/agv067
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