Minimum drinking age laws
Minimum legal drinking age (MLDA) laws specify the legal age when an individual can purchase alcoholic beverages. In the U.S., the age in all states is currently 21 years1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced impaired driving
Reduced alcohol-related crashes
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced underage drinking
Reduced emergency room visits
Reduced hospital utilization
Reduced suicide
Reduced arrests
What does the research say about effectiveness?
There is strong evidence that current minimum legal drinking age (MLDA) laws reduce alcohol-impaired driving and alcohol-related crashes2, 3, 4, 5 as well as associated injuries among 18- to 20-year-old drivers4. Dedicated efforts to prevent alcohol sales to minors, especially compliance checks on retail alcohol outlets, increase effectiveness of the laws5.
The implementation of a nationwide MLDA of age 21 has led to significant decreases in alcohol-related fatal traffic crashes3, 4, 6. The National Highway Traffic Safety Administration estimates that MLDA saved about 500 lives annually from 2013 to 20177. Current MLDA laws appear to decrease alcohol consumption among young people2, 5. Historical increases in minimum legal drinking age are associated with a reduction in binge drinking among youth at age 18 and increases in binge drinking for male youth ages 18-228. The age 21 MLDA has been associated with reductions in emergency department visits and hospital admissions among those under age 219, and reductions in suicide2, 10 and arrests among youth6, 11.
Compared to age 21 MLDA laws, exposure to permissive MLDA laws (e.g., allowing alcohol purchase for those age 20 and under) during adolescence was associated with an increased likelihood of alcohol-related chronic disease mortality across a lifespan12, but not associated with drug use or dependence into adulthood13. The effects of MLDA changes on teen fertility and alcohol consumption appear to vary by race and socio-economic status in women ages 15-2314.
How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples
Although 21 is the minimum legal drinking age in all states, many states have exceptions to this law (e.g., on private premises, with parental consent, for religious purposes, etc.). As of June 2021, 20 states had no exceptions to the minimum legal drinking age for consumption of alcohol15. The California Evidence-Based Clearinghouse for Child Welfare offers a toolkit, “Communities Mobilizing for Change on Alcohol” that supports reducing rates of underage drinking through changes in the policies and practices of communities16.
Implementation Resources
APIS - Alcohol Policy Information System (APIS). Welcome to the Alcohol Policy Information System.
CMCA - California Evidence-Based Clearinghouse for Child Welfare. Communities Mobilizing for Change on Alcohol (CMCA).
UW WAPP - University of Wisconsin-Madison Law School. Wisconsin Alcohol Policy Project (WAPP): Preventing underage drinking.
Footnotes
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1 CDC-MLDA - Centers for Disease Control and Prevention (CDC). Alcohol and public health: Age 21 minimum legal drinking age (MLDA).
2 DeJong 2014 - DeJong W, Blanchette J. Case closed: Research evidence on the positive public health impact of the age 21 minimum legal drinking age. Journal of Studies on Alcohol and Drugs, Supplement. 2014;(s17):108-115.
3 Fell 2016 - Fell JC, Scherer M, Thomas S, Voas RB. Assessing the impact of twenty underage drinking laws. Journal of Studies on Alcohol and Drugs. 2016;77(2):249-260.
4 CG-Motor vehicle injury - The Guide to Community Preventive Services (The Community Guide). Motor vehicle injury prevention.
5 Wagenaar 2002 - Wagenaar AC, Toomey TL. Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol. 2002;(Suppl 14):206-25.
6 IOM-Underage drinking 2004 - Institute of Medicine (IOM), National Research Council (NRC), Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Board on Children, Youth, and Families (BCYF). Reducing underage drinking: A collective responsibility. (Bonnie RJ, O’Connell ME, eds.). Washington, D.C.: National Academies Press; 2004.
7 NHTSA-MLDA 2019 - National Center for Statistics and Analysis, National Highway Traffic Safety Administration (NHTSA). Lives saved in 2017 by restraint use and minimum-drinking-age laws. Washington, D.C.: National Highway Traffic Safety Administration, U.S. Department of Transportation (U.S. DOT); 2019.
8 Jager 2015 - Jager J, Keyes KM, Schulenberg JE. Historical variation in young adult binge drinking trajectories and its link to historical variation in social roles and minimum legal drinking age. Developmental Psychology. 2015;51(7):962-974.
9 Carpenter 2017 - Carpenter C, Dobkin C. The minimum legal drinking age and morbidity in the United States. Review of Economics and Statistics. 2017;99(1):95-104.
10 Xuan 2016 - Xuan Z, Naimi TS, Kaplan MS, et al. Alcohol policies and suicide: A review of the literature. Alcoholism: Clinical and Experimental Research. 2016;40(10):2043-2055.
11 Carpenter 2015 - Carpenter C, Dobkin C. The minimum legal drinking age and crime. Review of Economics and Statistics. 2015;97(2):521-524.
12 Plunk 2016 - Plunk AD, Krauss MJ, Syed-Mohammed H, et al. The impact of the minimum legal drinking age on alcohol-related chronic disease mortality. Alcoholism: Clinical and Experimental Research. 2016;40(8):1761-1768.
13 Krauss 2015 - Krauss MJ, Cavazos-Rehg PA, Agrawal A, Bierut LJ, Grucza RA. Long-term effects of minimum legal drinking age laws on marijuana and other illicit drug use in adulthood. Drug and Alcohol Dependence. 2015;149:173-179.
14 Cintina 2015 - Cintina I. The effect of minimum drinking age laws on pregnancy, fertility, and alcohol consumption. Review of Economics of the Household. 2015;13(4):1003-1022.
15 APIS - Alcohol Policy Information System (APIS). Welcome to the Alcohol Policy Information System.
16 CMCA - California Evidence-Based Clearinghouse for Child Welfare. Communities Mobilizing for Change on Alcohol (CMCA).
Related What Works for Health Strategies
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