Illegal alcohol sales to obviously intoxicated patrons at licensed establishments

BACKGROUND: Early studies assessing propensity of alcohol sales to underage youth found that, before intervention, likelihood of licensed alcohol establishments selling alcohol to underage youth was 50% or higher across many communities. Community-wide interventions successfully lowered underage alcohol sales rates in several communities. Across studies assessing propensity for alcohol sales to obviously intoxicated patrons, sales rate estimates ranged from 58% to 85% for on-premise establishments (e.g., bars). No previous studies have assessed likelihood of alcohol sales to obviously intoxicated patrons in off-premise establishments (e.g., liquor stores). One goal of this study was to assess propensity for illegal alcohol sales to obviously intoxicated patrons at on- and off-premise establishments. Another goal was to assess whether server and/or establishment characteristics were related to the likelihood of illegal sales. Results may inform future interventions to reduce illegal alcohol sales at licensed alcohol establishments. METHODS: Trained actors attempted to purchase alcohol while acting out signs of obvious intoxication at a census of on- and off-premise alcohol establishments (n = 372) in 11 communities. The outcome variable was whether an establishment sold alcohol to a buyer. Independent variables included age and gender of server/clerk, type of establishment, area, exterior maintenance, type of license, and time of purchase attempt. Bivariate and multivariate analyses were conducted. RESULTS: Seventy-nine percent of the establishments sold alcohol to a buyer (83% and 76% at off- and on-premise establishments, respectively). Servers/clerks who appeared younger than age 31 and off-premise establishments were significantly more likely than older appearing servers and on-premise establishments to sell alcohol to buyers. CONCLUSIONS: The likelihood of alcohol sales to obviously intoxicated patrons in licensed alcohol establishments is very high. Interventions to reduce illegal alcohol sales to intoxicated patrons are needed.     

A randomized trial to evaluate a management training program to prevent illegal alcohol sales

AIMS: To evaluate effects of a training program for owners/managers of alcohol establishments-Alcohol Risk Management (ARM)-on: (i) propensity to sell alcohol to obviously intoxicated patrons; and (ii) changing establishment-level policies/practices. DESIGN: We assigned alcohol establishments randomly to intervention (full-ARM) and delayed-intervention/control (ARM Express) conditions. SETTING: One large metropolitan area in Midwestern United States. PARTICIPANTS: Owners and managers at 231 on-premise alcohol establishments (i.e. bars, restaurants). INTERVENTION: Training programs consisted of one-to-one sessions with the owner/manager at each establishment. The goal of training was to help owners/managers to select and implement alcohol control policies in their establishments. The full-ARM training consisted of four one-to-one sessions and the ARM Express was a single session. MEASUREMENTS: We measured intervention effects through baseline and follow-up pseudo-intoxicated alcohol purchase attempts (i.e. feigning intoxication while attempting to purchase alcohol) and telephone surveys of owners/managers at alcohol establishments. FINDINGS: Sales rates to pseudo-intoxicated patrons reduced 23% (relative to delayed-intervention/control condition) at the first follow-up purchase attempt (P = 0.06) but returned to baseline levels 3 months later. On average, establishments selected 13 of 18 recommended policies, but in multivariate models we observed no significant differences at follow-up in reported policies/practices across establishments. CONCLUSIONS: Reliance on manager training to promote responsible establishment alcohol policies is not sufficient to prevent illegal alcohol sales to obviously intoxicated patrons and to reduce alcohol-related problems.     

Evaluating alcohol access and the alcohol environment in neighborhood areas

BACKGROUND: This paper examines neighborhood, outlet, and server characteristics related to successful purchases of alcohol by intoxicated patrons and underage drinkers at alcohol establishments. It is hypothesized that outlets in commercial areas near to other premises, with poor exterior maintenance, much advertising, and inexperienced youthful servers will be more likely to sell alcohol to intoxicated and underage patrons. METHODS: Data were collected using pseudo-intoxicated patron and apparent minor surveys of randomly selected alcohol establishments in a metropolitan area of northern California. Data collection operations included independent surveillance of these drinking places to establish neighborhood and premise characteristics and pseudo-intoxicated patron and apparent minor stings to assess rates of these forms of illegal alcohol sales. Male actors feigning intoxication and female of-age youth identified as appearing to be 20 years or younger attempted to purchase alcohol at on- and off-premise establishments, respectively. Rates of sales (off-premise) and service (on-premise) were the primary outcomes. RESULTS: Apparent minors purchased alcohol in 39% of attempts (95% CI, 34-45%) while pseudo-intoxicated patrons were served alcohol in 58% of attempts (95% CI, 50-67%). Sales to apparent minors were significantly related to percentage of Hispanic residents and areas with greater population density. Sales to pseudo-intoxicated patrons were more frequent when the server was male and appeared to be under the age of 30. These sales were also more frequent in Hispanic neighborhoods with high population density and high numbers of on-premise outlets but were less frequent in African American neighborhoods. CONCLUSION: The findings suggest that underage and intoxicated patron sales differ by areas. Both forms of illegal sales of alcohol are more likely in highly populated areas of communities. The findings also suggest that server characteristics are strongly related to sales to intoxicated patrons, suggesting some leverage for responsible beverage service programs in these environments.     

Likelihood of illegal alcohol sales at professional sport stadiums

Background: Several studies have assessed the propensity for illegal alcohol sales at licensed alcohol establishments and community festivals, but no previous studies examined the propensity for these sales at professional sport stadiums. In this study, we assessed the likelihood of alcohol sales to both underage youth and obviously intoxicated patrons at professional sports stadiums across the United States, and assessed the factors related to likelihood of both types of alcohol sales. Methods: We conducted pseudo‐underage (i.e., persons age 21 or older who appear under 21) and pseudo‐intoxicated (i.e., persons feigning intoxication) alcohol purchase attempts at stadiums that house professional hockey, basketball, baseball, and football teams. We conducted the purchase attempts at 16 sport stadiums located in 5 states. We measured 2 outcome variables: pseudo‐underage sale (yes, no) and pseudo‐intoxicated sale (yes, no), and 3 types of independent variables: (1) seller characteristics, (2) purchase attempt characteristics, and (3) event characteristics. Following univariate and bivariate analyses, we a separate series of logistic generalized mixed regression models for each outcome variable. Results: The overall sales rates to the pseudo‐underage and pseudo‐intoxicated buyers were 18% and 74%, respectively. In the multivariate logistic analyses, we found that the odds of a sale to a pseudo‐underage buyer in the stands was 2.9 as large as the odds of a sale at the concession booths (30% vs. 13%; p = 0.01). The odds of a sale to an obviously intoxicated buyer in the stands was 2.9 as large as the odds of a sale at the concession booths (89% vs. 73%; p = 0.02). Conclusions: Similar to studies assessing illegal alcohol sales at licensed alcohol establishments and community festivals, findings from this study shows the need for interventions specifically focused on illegal alcohol sales at professional sporting events.     

Alcohol Price and Intoxication in College Bars

Background:  Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we assessed patron's cost per gram of ethanol consumed at on-premise drinking establishments and its association with intoxication upon leaving an establishment.
Methods:  On 4 consecutive nights during April 2008, data were collected from 804 patrons exiting 7 on-premise establishments in a bar district located adjacent to a large university campus in the southeastern United States. Anonymous interview and survey data were collected as well as breath alcohol concentration (BrAC) readings. We calculated each patron's expenditures per unit of ethanol consumed based on self-reported information regarding the type, size, number, and cost of consumed drinks.
Results:  A multivariable model revealed that a 10-cent increase in cost per gram of ethanol at on-premise establishments was associated with a 30% reduction in the risk of exiting an establishment intoxicated (i.e., BrAC ≥ 0.08 g/210 l).
Conclusions:  The results are consistent with economic theory and population-level research regarding the price elasticity of alcoholic beverages, which show that increases in alcohol prices are accompanied by less alcohol consumption. These findings suggest that stricter regulation of the drink discounting practices of on-premise drinking establishments would be an effective strategy for reducing the intoxication levels of exiting patrons.     

Preventing youth access to alcohol: outcomes from a multi-community time-series trial*

AIMS/INTERVENTION: The Complying with the Minimum Drinking Age project (CMDA) is a community trial designed to test effects of two interventions designed to reduce alcohol sales to minors: (1) training for management of retail alcohol establishments and (2) enforcement checks of alcohol establishments. DESIGN: CMDA is a multi-community time-series quasi-experimental trial with a nested cohort design. SETTING/PARTICIPANTS: CMDA was implemented in 20 cities in four geographic areas in the US Midwest. MEASUREMENTS: The core outcome, propensity for alcohol sales to minors, was directly tested with research staff who attempted to purchase alcohol without showing age identification using a standardized protocol in 602 on-premise and 340 off-premise alcohol establishments. Data were collected every other week in all communities over 4 years. Mixed-model regression and Box-Jenkins time-series analyses were used to assess short- and long-term establishment-specific and general community-level effects of the two interventions. FINDINGS: Effects of the training intervention were mixed. Specific deterrent effects were observed for enforcement checks, with an immediate 17% reduction in likelihood of sales to minors. These effects decayed entirely within 3 months in off-premise establishments and to an 8.2% reduction in on-premise establishments. CONCLUSIONS: Enforcement checks prevent alcohol sales to minors. At the intensity levels tested, enforcement primarily affected specific establishments checked, with limited diffusion to the whole community. Finally, most of the enforcement effect decayed within 3 months, suggesting that a regular schedule of enforcement is necessary to maintain deterrence.     

Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales,Australia

Aims To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales. Design Telephone‐based cross‐sectional survey. Setting New South Wales, Australia. Participants A total of 1090 people aged 18–39 years old. Findings Seventy‐five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol‐related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51–58%) of both males and females who had consumed at acute‐risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51–61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15–23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7–15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48–61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the ‘non‐intoxicated’ patrons reporting that they had seen licensed premises staff intervene in some way with other ‘intoxicated’ patrons. Conclusions While the majority of 18–39‐year‐olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.     

Over-serving patrons in licensed premises in Stockholm

Aims. To study the frequency of alcohol service to intoxicated patrons in licensed premises. Design. Actors were hired to simulate severe intoxication. Following a review of videotaped portrayals of drunken behaviour by the actors, an expert panel of bartenders and restaurant managers determined which scene was least consistent with responsible beverage service. The actors then enacted this scene in the licensed premises, while monitored by project staff. Setting. Ninety-two licensed premises in Stockholm city were visited by the actors. Findings. The actors were served alcohol at 95% of the licensed premises. Conclusion. The results show that existing serving policies at licensed premises in Stockholm are very permissive regarding the degree of intoxication among patrons.     

Identifying drunkenness in the night-time economy

BACKGROUND: Prohibiting the sale of alcohol to intoxicated patrons by licensees and their staff requires definitions of drunkenness. AIMS: To assess the relationship between blood alcohol concentration (BAC) and indicators used in field sobriety tests putatively associated with intoxication. DESIGN, PARTICIPANTS, SETTING, MATERIAL AND METHODS: A random sample of 314 female and 579 male city centre drinkers. Surveyors scored respondents' and non-respondents' gait, eyes and speech for signs of drunkenness as well as their drunkenness on a 10-point Likert scale. Breath analysis was used to determine respondents' BAC. FINDINGS: Combinations of slurred speech, staggering gait and glazed eyes significantly predicted levels of BAC with a staggering gait indicating highest levels of intoxication. CONCLUSIONS: Subjective ratings of drunkenness by trained observers corresponded with BAC. Transition BACs denoting observable behaviour change associated with intoxication have been identified. Observations of gait, combined with assessment of slurred speech should be the basis of estimates of drunkenness.     

Alcohol sales to underage adolescents: an unobtrusive observational field study and evaluation of a police intervention

Aims. The aims of this study were to assess the ease with which adolescents in the United Kingdom are able to buy alcohol, to obtain information concerning vendors' perceptions of alcohol sales to adolescents, and to evaluate a police intervention intended to reduce underage alcohol sales. Design, setting, subjects. An unobtrusive naturalistic field study was conducted in two urban locations. Pairs of 13‐ and 16‐year‐old boys and girls were trained to attempt the purchase of different types of alcohol (alcopops, beer, cider, wine, spirits) from four different types of retail outlets (corner shops, off‐licence, public houses and supermarkets), under the supervision of a researcher and typically a parent. The assessment was repeated, with the omission of the 13‐year‐old boys, following a police intervention in one of the performance sites, consisting of warning letters and visits to vendors, and the issue of a small number of police cautions. A total of 62 underage confederates in all attempted 470 test purchases in phase 1 and 348 in phase 2. Between the two waves of test purchases a sample ( n= 95) of the same vendors was surveyed by telephone. Findings. In phase 1, sales resulted from 88.1% of purchase attempts by 16‐year‐old girls, 77% of attempts by 16‐year‐old boys, 41.6% of 13‐year‐old girls and 4.1% of 13‐year‐old boys. These figures were generally comparable across locations, alcohol types and outlet types. Refusals were more likely when another vendor was present. Eighty per cent of sales to 16‐year‐olds and 65% of sales to 13‐year‐old girls were made without challenge. 'Prove‐It' ID cards were requested in fewer than 12% of purchase attempts in both age groups. Overall, there was no evidence that the police intervention reduced sales of alcohol to 16‐year‐olds. There was a hint that the intervention may have caused a very short‐lasting decrease in sales to 13‐year‐old girls, but this was contained within an overall increase in sales to this group. Alcohol vendors reported that they rarely encountered underage customers or refused sale though 90% of vendors said that if they became suspicious, they would request ID. Only two vendors believed that they were likely to suffer adverse consequences if they sold alcohol to minors. Conclusions. These data suggest that 16‐year‐olds, and girls as young as 13, have little difficulty in purchasing alcohol, and that there is little difference between different types of outlets in their willingness to sell alcohol to minors. Vendors perceive little risk in selling alcohol to adolescents. The fact that the police intervention failed to decrease sales suggests that vendors do not change their behaviour in response to the threat of legal action.     

Old enough for a beer? Compliance with minimum legal age for alcohol purchases in monopoly and other off‐premise outlets in Finland and Norway

AIM: To assess whether government monopoly outlets comply better with minimum legal age for purchase of alcohol compared to other off-premise outlets for alcohol sales. METHODS: Under-age-appearing 18-year-olds attempted to purchase alcohol in off-premise outlets applying identical procedures in Finland (n = 290) and Norway (n = 170). Outcomes were measured as whether or not the buyers were asked to present an identity (ID) card and whether or not they succeeded in purchasing alcohol. RESULTS The buyers were asked to present an ID card in slightly more than half the attempts, and they succeeded in purchasing alcohol in 48% of the cases. The buyers were more likely to be requested to present an ID card and less likely to succeed in purchasing alcohol in monopoly outlets compared to other types of outlets, and also when other outcome predictors, such as age and gender of salesperson and crowdedness in the outlet, were taken into account. CONCLUSION: Monopoly outlets may facilitate compliance with minimum legal age for purchase of alcohol.     

The ability of young people to purchase alcohol without age identification in northeastern Minnesota, USA

The purpose of this study was to determine the rate at which young people can purchase alcohol without age identification in off-premises businesses, and the factors which influence the rate of purchase. All retail outlets licensed to sell distilled spirits and/or full strength beer and wine in 28 northern Minnesota communities were visited on different occasions by three 21-year-old female buyers who appeared to be aged 19 or younger. These youthful buyers were able to purchase beer without age identification in 47% of the 336 purchase attempts. Almost four-fifths of the businesses sold beer to these buyers at least once in three attempts. These results provide clear evidence that many commercial off-sale businesses in the US supply alcohol to youthful buyers, and that practices vary significantly by community and by business. These results support the need for greater attention to availability as a factor in teenage drinking patterns.     

Alcohol outlet policies and practices concerning sales to underage people

Little is known about the relationship between alcohol outlet policies and practices in the United States and the likelihood that outlets will sell alcoholic beverages to persons under the legal drinking age. This study assessed the prevalence of such outlet-level policies and practices, and analyzed the relationships between outlet variables and outlets' actual propensity to sell alcoholic beverages to youth. The sample consisted of all outlets licensed for off-premise and a 40% random sample of outlets licensed for on-premise sale of alcoholic beverages in 15 small to medium-sized communities in Minnesota and Wisconsin (USA). Data on outlet characteristics, policies and practices were collected by a telephone survey of the owner or manager of each outlet. In addition, alcohol purchase attempts were conducted at each outlet by youthful-appearing study confederates. Generally, policies and practices that may reduce the likelihood of sales to youth were reported by a minority of outlets. Purchase success was found to be associated with a number of outlet characteristics, policies and practices. The implications of these findings for policy and future research are discussed.     

Levels of drunkenness of customers leaving licensed premises in Perth, Western Australia: a comparison of high and low ';risk' premises

A measure of the risk of licensed premises having customers involved in road traffic accidents and drink-driving offences was utilised in order to identify seven ‘High Risk’ and eight ‘Low Risk’ premises in metropolitan Penh, Western Australia. This measure, or ‘Risk Ratio’, was defined as the ratio of incidents of alcohol-related harm to an estimate of on-premises alcohol sales for a particular establishment. A study was conducted to test the hypothesis that a High Risk status would be associated with greater levels of customer intoxication. Interviews concerning drinking behaaviour and breathalyser readings were collected from 74.2% of 414 customers exiting from the chosen premises between 8 p.m. and midnight on Friday and Saturday nights. High Risk premises had three times more customers whose readings were in excess of 0.15 mg/ml (p < 0.01). The proportion of customers with BAL's above 0.15 correlated strongly with the premises' Risk Ratio(r = 0.63, p < 0.01). There were also significantly more patrons from High than from Low Risk establishments who were rated as appearing moderately or severely intoxicated but refused to be interviewed or breath-tested. It is argued that these results support the need for strategies which aim to reduce very high levels of intoxication on licensed premises in order to reduce alcohol-related accidents, injuries and offences.     

Artificial sweeteners, caffeine, and alcohol intoxication in bar patrons

Background: Previous laboratory research on alcohol absorption has found that substitution of artificially sweetened alcohol mixers for sucrose‐based mixers has a marked effect on the rate of gastric emptying, resulting in elevated blood alcohol concentrations. Studies conducted in natural drinking settings, such as bars, have indicated that caffeine ingestion while drinking is associated with higher levels of intoxication. To our knowledge, research has not examined the effects of alcohol mixers that contain both an artificial sweetener and caffeine, that is, diet cola. Therefore, we assessed the event‐specific association between diet cola consumption and alcohol intoxication in bar patrons. We sought to determine whether putative increases in blood alcohol, produced by accelerated gastric emptying following diet cola consumption, as identified in the laboratory, also appear in a natural setting associated with impaired driving. Methods: We conducted a secondary analysis of data from 2 nighttime field studies that collected anonymous information from 413 randomly selected bar patrons in 2008 and 2010. Data sets were merged and recoded to distinguish between energy drink, regular cola, diet cola, and noncaffeinated alcohol mixers. Results: Caffeinated alcohol mixers were consumed by 33.9% of the patrons. Cola‐caffeinated mixed drinks were much more popular than those mixed with energy drinks. A large majority of regular cola‐caffeinated mixed drink consumers were men (75%), whereas diet cola‐caffeinated mixed drink consumers were more likely to be women (57%). After adjusting for the number of drinks consumed and other potential confounders, number of diet cola mixed drinks had a significant association with patron intoxication (β = 0.233, p < 0.0001). Number of drinks mixed with regular (sucrose‐sweetened) cola and energy drinks did not have significant associations with intoxication (p > 0.05). Conclusions: Caffeine’s effect on intoxication may be most pronounced when mixers are artificially sweetened, that is, lack sucrose which slows the rate of gastric emptying of alcohol. Risks associated with on‐premise drinking may be reduced by greater attention given to types of mixers, particularly diet colas.     

Heart rate response to alcohol and intoxicated aggressive behavior

BACKGROUND: This study examined the elevated heart rate (HR) response to alcohol intoxication, thought to reflect an increased sensitivity to alcohol-induced reward, as a potential factor in the increased likelihood of alcohol-induced aggression. METHODS: Three groups, intoxicated high (n=37) and low (n=37) HR responders and sober controls (n=73), participated in a laboratory measure of physical aggression, the Taylor Aggression Paradigm. RESULTS: Results revealed that intoxicated high HR responders were more aggressive than the intoxicated low HR responders and sober controls. CONCLUSIONS: These findings are interpreted within a hypothetical model relating increased alcohol-induced aggression to a dysregulation in the motivational system responding to rewards.     

Liquid Courage: Alcohol Fosters Risky Sexual Decision-Making in Individuals with Sexual Fears

The interaction of sexual fear and acute alcohol intoxication on the likelihood of risky sexual behavior was explored. Participants (Ps; N = 115) completed a measure of sexual fears and were randomly assigned to no-, low-, or high-dose alcohol conditions. Ps then read an eroticized vignette, where they were the protagonist, and rated their likelihood of sex with a new partner when no condom was available. Controlling for gender and social desirability, compared to sober Ps, highly intoxicated Ps indicated that they were more likely to engage in risky sexual behaviors. Sexual fear was modestly negatively related to risky sex likelihood among sober or mildly intoxicated Ps but strongly positively related to risky sex likelihood among highly intoxicated Ps. Findings underscore the notion that alcohol affects different types of individuals differently and indicate that alcohol may foster sexual risk-taking, in part, by attenuating or counteracting fear or anxiety.     

A Comparative Analysis of Alcohol in Fatal and Nonfatal Bicycling Injuries

Bicycling is the leading cause of recreational injury, resulting in more than half a million emergency department visits and about 900 deaths each year in the United States. Previous research on bicycling injury was conducted predominantly in children and focused on the effectiveness of safety helmets. Few studies have examined the role of alcohol in bicycling injuries. This study examined the magnitude of and factors related to alcohol involvement in fatal and nonfatal bicycling injuries, and tested the hypothesis that alcohol intoxication is associated with significantly increased likelihood of fatality given a serious bicycling injury. Medical examiner data on all fatally injured bicyclists aged 10 years or older from 1987 to 1994 in Maryland (fatal cases, n= 63) were compared with trauma registry data on all injured bicyclists who were treated at a regional trauma center during the same time period (nonfatal cases, n= 253) on variables related to blood alcohol concentrations (BACs), demographic characteristics, and injury circumstances. The fatal cases were more likely than the nonfatal cases to have positive BACs (30% vs. 16%, p < 0.01). and to be legally intoxicated (is., BACs ≥ 0.10%) (22% vs. 13%, p < 0.01). For both fatal and nonfatal cases, intoxication was more prevalent among victims who were male, aged 20 to 39 years, or who were injured at nighttime (7:00 PM to 6:59 AM). Bicyclists who died at the scene were four times as likely as those who died at hospitals to be legally intoxicated (35% vs. 9%, p < 0.02). Given a serious bicycling injury, intoxication was associated with significantly increased likelihood of fatality, with an adjusted odds ratio of 2.8 (95% confidence interval, 1.3 to 6.3). This increased likelihood of fatality was probably due in part to the fact that the rate of helmet use at the time of injury among the intoxicated was much lower than among the sober (vs. 31%, p < 0.05). Results indicate that alcohol plays an important role in fatal and serious bicycling injuries. Preventing intoxicated biking should be incorporated into helmet campaigns and other bicycle safety programs.     

Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving

Intoxication in and around licensed premises continues to be common, despite widespread training in the responsible service of alcohol and laws prohibiting service to intoxicated individuals. However, research suggests that training and the existence of laws are unlikely to have an impact on intoxication without enforcement, and evidence from a number of countries indicates that laws prohibiting service to intoxicated individuals are rarely enforced. Enforcement is currently hampered by the lack of a standardized validated measure for defining intoxication clearly, a systematic approach to enforcement and the political will to address intoxication. We argue that adoption of key principles from successful interventions to prevent driving while intoxicated could be used to develop a model of consistent and sustainable enforcement. These principles include: applying validated and widely accepted criteria for defining when a person is ‘intoxicated’; adopting a structure of enforceable consequences for violations; implementing procedures of unbiased enforcement; using publicity to ensure that there is a perceived high risk of being caught and punished; and developing the political will to support ongoing enforcement. Research can play a critical role in this process by: developing and validating criteria for defining intoxication based on observable behaviour; documenting the harms arising from intoxication, including risk curves associated with different levels of intoxication; estimating the policing, medical and social costs from intoxicated bar patrons; and conducting studies of the cost‐effectiveness of different interventions to reduce intoxication.