THE IMPACT OF STATE ALCOHOL EXCLUSION LAWS ON ALCOHOL-RELATED MORTALITY AND TREATMENT UTILIZATION

Abstract

Alcohol is one of the leading risk factors for preventable death and disability in the United States. It is a toxic substance that affects behavioral, physical, and cognitive functions of the body directly or indirectly. One of the federal and state efforts to intervene to reduce alcohol-related injuries and accidents includes the Alcohol Exclusion Law (AEL). Under AEL, insurance companies may refuse to pay healthcare providers for treating the injured while impaired by alcohol or any other drug that was not prescribed by a physician at the time of injury. My dissertation investigated the changes in alcohol-induced mortality and alcohol treatment utilization in the states that repealed AELs, compared with the changes for the same time in the states that did not repeal. I collected data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER), Treatment Episodes Data Set-Admissions (TEDS-A) from the Substance Abuse and Mental Health Services Administration, American Community Survey data from the U.S. Census Bureau, and the National Institute on Alcohol Abuse and Alcoholism. Combining these datasets, I conducted the panel data analysis using Two-Way Fixed Effects to examine the impact of AEL repeal. The first aim examined the impact of the repeal of AEL on alcohol-induced mortality rates, and the death rate decreased after the ban of AEL. The second aim evaluated the effect of the repeal of AEL on the admission rates to treatment facilities for those with alcohol problems, especially for racial/ethnic minority groups across different referral sources. The results suggest that the alcohol treatment admission rate among Hispanic individuals referred by criminal justice systems might have increased following the ban of AEL. Also, the repeal increased the alcohol admission rate among Hispanic individuals with individual referrals. The third aim examined the impact of the repeal on the treatment admission rates among males, females, and pregnant women. The evidence does not suggest that the repeal affected the alcohol admission rates of any of these subgroups. The findings provide policymakers with insights into how racial/ethnic minoritized populations were affected by the AELs, who are vulnerable to alcohol use.