Alcohol abuse costs Massachusetts at least $5.6 billion annually, while causing thousands of deaths and illnesses, according to a new analysis from Boston University researchers.
Yet revenues from alcohol-specific taxes fall far short of repaying those costs, the report concludes. And the state has failed to take basic steps, such as raising the excise tax on liquor or prohibiting advertising that targets minors, that would reduce alcohol’s heavy toll and improve health, the researchers say.
“If you don’t take into account all of alcohol’s effect across the board, it’s hard to get a picture of how much impact it is having,” said David Jernigan, a professor of health law, policy, and management at BU’s School of Public Health and lead researcher of the report.
Jernigan’s analysis draws on state and federal data, as well as dozens of published studies covering more than a decade. A number of studies have noted a steep increase in drinking nationally since the pandemic, but Jernigan’s analysis noted severe impacts of excessive drinking in Massachusetts predate the pandemic.
“Alcohol’s role in death and disability in the Bay State has risen by 13.8% since 2009 — faster than lung cancer, diabetes, hypertension, dietary risks, and tobacco use,” his report concludes.
While opioid-related deaths have captured a lot of attention in recent years in Massachusetts, alcohol has quietly killed more people. Alcohol causes on average 2,760 deaths per year in Massachusetts, or 1 in 20 deaths, with the largest consequences being poisonings, alcohol liver disease, alcohol-attributable cancers, and cirrhosis, the report finds.
By comparison, opioid overdoses caused 2,290 deaths in the state in 2021.
Jernigan moved back to Massachusetts in 2018 after decades of working in other states and said he was shocked to discover that a state known as a medical mecca was lacking a central repository of information about the many impacts in the state of excessive and underage drinking.
“The debates about alcohol in Massachusetts are all about alcohol as a business and about economic development, and yet there’s little conversation as to the very large safety and health problems with it,” he said.
His report notes the state’s alcohol excise taxes, which are levied at retailers but generally passed through to the consumer, have lost 72 percent of their value over time since 1980, when they were last raised. They are now less than a nickel per drink.
Jernigan said raising the alcohol excise tax would lead to lower consumption and fewer drunken driving incidents, a conclusion echoed by a number of national reports, including a 2018 analysis by the National Academy of Sciences.
Representative Kay Khan, a psychiatric nurse who has been a state legislator for 28 years, said she has repeatedly filed proposals to raise the alcohol excise tax because of significant health impacts linked to excessive drinking, particularly among those with serious mental illness.
The proposals have gone nowhere.
“I feel like I have been a lone wolf out there,” said Khan, a Newton Democrat. “No one really wants to talk about alcohol and the money we spend as a result of abuse of alcohol.”
The report notes that Massachusetts levies a sales tax on most consumer products, but not on alcoholic beverages. The Legislature in 2009 moved to add the sales tax to alcohol sold in liquor stores, with the proceeds to go to a fund dedicated to substance use prevention and treatment. However, opponents of the tax took it to voters in 2010 in the form of a ballot initiative. By a margin of 52 percent to 48 percent, the measure succeeded and the tax was repealed.
“I get the feeling that legislators feel the people spoke and they don’t want to touch it again,” Khan said.
Still, she said she plans to file a bill, once again, in the new year to try to raise the excise taxes.
But Rob Mellion, executive director of the Massachusetts Package Stores Association, a trade group representing local liquor stores, said raising excise taxes on alcohol will not dampen excessive drinking. He said it will merely drive people over the border to New Hampshire, which doesn’t tax alcohol sales and sells wine and distilled spirits in state-run stores.
“Raising excise taxes is a simplistic response,” he said. “All you are going to do by raising the excise tax in Massachusetts is push more people to bootleg alcohol from New Hampshire into Massachusetts.”
Mellion said the state should instead spend more money on “educating the next generation about healthy living.” He did not say where that funding should come from.
In Massachusetts, there is no shortage of places selling alcohol. The new report notes that the state has roughly five times as many licenses to sell alcohol as Pennsylvania or New Jersey, which have substantially larger populations.
“In 2011, the state had a total of 20,754 active alcohol licenses, permits, and certificates; by 2019, this number had grown to 33,667, a 63% increase in the total number of active alcohol licenses, permits, and certificates over less than a ten-year period,” the report notes, citing data gleaned from the state’s Alcoholic Beverages Control Commission.
Another area in which Massachusetts leaders could take action to lessen problem drinking, the report notes, is in advertising. While there has been significant attention paid to youth smoking and regulating tobacco ads targeted to younger people in the state, much less attention has been focused on ads that appeal to younger drinkers.
The authority for regulating alcohol marketing in the United States mostly lies at the federal level, but the report notes Massachusetts could, for instance, prohibit outdoor alcohol advertising in locations where children are likely to be present, or prohibit alcohol advertising that targets minors.
“Among youth, it’s the most commonly used substance,” said Elizabeth Parsons, coordinator of the Massachusetts Alcohol Policy Coalition, a statewide group of public health professionals, parents, and community leaders who work to reduce drinking-related harms in young people and adults.
Alcohol ads on the MBTA were banned in 2012, with officials citing the exposure to youth as the main reason. But in 2017, with revenues running low, the transit system partially reversed itself and allowed alcohol ads back with restrictions on where they could run: not in rail stations where more than 10 percent of weekday passengers use student passes.
By contrast, MBTA policy prohibits any advertising of tobacco or tobacco-related products, electronic cigarettes, or vaping devices, as well as cannabis accessories or products.
Parsons said young people are especially swayed by advertising.
“The more alcohol ads kids see, the more likely they are to drink,” she said.
“It’s a social justice issue,” Parsons added. “The kids in Boston are exposed to more alcohol advertising simply because of where they live than the kids in the suburbs, so they are more at risk of underage drinking and harms because of that exposure.”
An earlier version of this story misspelled the name of Representative Kay Khan. The Globe regrets this error.