Alcohol dropped off on a front porch in New Mexico because of the new state law permitting deliveries. (Photo by Austin Fisher / Source NM)
Lawrence Medina was 12 years old when he started to drink alcohol, and he drank heavily throughout his adolescence.
He didn’t keep track of how much he drank, he said, just that he did it everyday.
“When it came to drinking beer and liquor,” he said, “I drank to oblivion. You know what I mean? It was just: ‘I drink daily.’”
By the time he was 18, he was already abusing alcohol, Medina said, and by the time he was 22, he was in a rehab program for chronic alcoholism.
Now, he serves as the executive director of the Rio Grande Alcoholism Treatment Program (ATP) in Taos.
Medina said he’s concerned about the state’s move to relax restrictions on alcohol deliveries.
A spike in death rates
In 2016, the state’s alcohol-related death rate was nearly double the national rate. In just four years, New Mexico’s alcohol-related death rate rose another 34 percent, according to the LFC.
One in five deaths among working-age adults (20-64) in N.M. can be attributed to alcohol, according to the New Mexico Substance Use Epidemiology Profile.
Six of the 10 leading causes of death in New Mexico are at least partially due to the use of alcohol. Chronic liver disease, unintentional injuries and suicide are associated with alcohol use. Heart disease, malignant neoplasms (cancer) and cerebrovascular diseases are associated with both alcohol and tobacco use.
Alcohol-related death rates (per 100,000 people) in New Mexico:
—Source: Legislative Finance Committee report
“When I was actively living with alcoholism, it was very hard to stop,” he said. “And having easy access to it didn’t help the matter.”
New Mexico joined the rest of the nation in allowing for home delivery of alcohol from restaurants, liquor stores, grocery stores, breweries, wineries, distillers and third-party delivery drivers on Sept. 28, according to the New Mexico Alcoholic Beverage Control Board.
Pandemic lockdowns financially hobbled many restaurants and other alcohol outlets across the country, leading to a wave of state-level alcohol delivery laws. Forty-two other states had either temporary or permanent alcohol delivery rules in place by March.
Medina said he the new law that allows for alcohol to be delivered to people’s homes will increase the demand for treatment.
“The population of individuals living with addiction is going to be impacted by it, and we will see an increase of people needing treatment and possibly more deaths,” he said.
“As the alcohol industry consolidates and corporate interests align, the Alcohol and Tobacco Tax and Trade Bureau (TTB) serves as the critical defense to maintain proven regulations that protect children and communities,” Benjamin wrote.
The association suggested that the federal alcohol laws might supersede or overlap with some of the state’s laws, and the state deregulation efforts might be mitigated by the bureau.
Benjamin asked the federal government to oppose industry pressure to remove established federal regulations that protect the public’s health and safety.
The American Public Health Association letter does not go so far as to ask for intervention that will stamp out all state alcohol delivery provisions but warned that the deregulation of alcohol prevention policies — including legalizing deliveries — will have a negative impact on morbidity and mortality rates.
In a year that saw record profits for the alcohol industry, any reduction in health standards risks exacerbating trends in alcohol-use disorders and serious alcohol-related harms that worsened during the COVID-19 pandemic.
– Dr. Georges Benjamin, president of the American Public Health Association
David Jernigan, professor at the Boston University School of Public Health and the preeminent expert on alcohol-related illness-prevention strategies, said alcohol policy deregulation like the New Mexico law leads to more alcohol dependency and more related deaths.
“We’ve got an unseen, unrecognized epidemic happening alongside the pandemic,” he said. “And at the same time, we’re doing the things that decades of public health research have said are all the wrong things to do if you want to reduce and prevent alcohol problems.”
Alcohol-related deaths reached an all-time high in 2020 in New Mexico, according to a report presented to the state Legislative Finance Committee on Aug. 26. New Mexico also became the state with the highest rate of alcohol-related deaths in the nation.
Trips to the emergency room, poisonings and alcohol-related “diseases of despair” are also on the rise, Jernigan said.
Diseases of despair are three classes of behavior-related medical conditions experienced by people who have a sense that their “long-term social and economic outlook is bleak,” according to the Washington Post. The three disease types are overdose, suicide and alcoholic liver disease.
ID checks and underage drinking
Accessing alcohol as a minor in New Mexico was relatively easy for Medina.
“Growing up in New Mexico, in a rural area, we had older friends buying us alcohol,” Medina said. “And, in some areas, you had bootleggers that we would access. And then, when I came to an age — and I got smarter — I got a fake ID.”
Profits off underage drinking
Alcohol beverage companies made an estimated $17.5 billion on underage drinking in the U.S. in 2016, according to 2021 research in the Journal of Studies on Alcohol and Drugs.
Those who begin drinking in their early teens are not only at “greater risk of developing alcohol dependence at some point in their lives, they are also at greater risk of developing dependence more quickly and at younger ages, and of developing chronic, relapsing dependence,” according to the National Institute on Alcohol Use and Alcoholism.
A key reason why alcohol deliveries have proven to be dangerous in other states is that ID checks are less easy to monitor and enforce at the point of delivery, Jernigan said.
Food delivery apps have facilitated a surge in alcohol sales to minors across the country, according to the Washington Post. Instances of drinks being left on doorsteps without any interaction, delivered in readily accessible cups with straw holes, and ordered independent of meals were commonplace.
Experts say that the delivery drivers failing to check a physical ID is common.
There is a lack of training on how to check and recognize IDs at the point of delivery and “all of their incentives are to make the delivery and move on to the next,” Jernigan said. Most delivery drivers who arrive and drop things off quickly can end up making more money per hour.
New Mexico’s new alcohol delivery law requires that every driver who is going to deliver alcohol take server training, said Andrew Vallejos, the director of the New Mexico Alcoholic Beverage Control division.
“Everyone who’s making a delivery — whether you work for the liquor store, or if you work for the brew pub, or if you’re using a third-party delivery system — every person who’s making the delivery has to be alcohol server-certified,” Vallejo said.
A server training program typically includes facts about regulations, not serving minors, the effects of alcohol, methods of detecting intoxicated patrons, intervention methods, a blood-alcohol content chart, a test for servers and, at the end, a course completion certification.
“They have to take a class on how to check for IDs, how to check for intoxication — sort of a jurisprudence class — and that every server has to take,” Vallejo said.
Still, he also said there is no specific training for delivery drivers.
“The delivery is just sort of like the same way a waitress would deliver on-premise, right?” he said. “If you’re doing a home delivery, you have to check an ID. If they don’t have an ID, you can’t sell it to them.”
Way to Serve and the New Mexico Restaurant Association’s ServSafe, online programs that provide training for servers in New Mexico, do not show any specialized server training options for alcohol delivery drivers on their websites.
Easier access for people with a chronic problem
Medina said alcohol delivery will increase access for those with chronic alcoholism.
There is nothing in the statute or the regulations that limit the number of deliveries to the same residence over a specified period of time.
“Accessibility that way for chronic alcoholics is very dangerous, because they don’t have to go anywhere now, and they could have their alcohol delivered,” he said. “And there’s no screening if that person is alcoholic or not. They’re putting profit above public safety or public health.”
Companies push back against limits for people who consume the most alcohol because it cuts into profits and a key consumer base, Jernigan agreed.
The industry is concentrated and in the hands of a small number of companies who make a lot of money, Jernigan said, “and they make that money off of all drinking,” he said. “But in particular, they make a lot of that money off of high-risk drinking.”
The heavy consumers are the ones who are literally drinking the most alcohol. So they're the ones who give the industry the most money.
– David Jernigan, professor at the Boston University School of Public Health
Vallejo said the state’s alcohol control division decided that they didn’t want to be too detailed about who to cut off and who to deliver to in the rule making including tracking the number of times a specific residence has purchased alcohol.
“We didn’t want to be so specific — like having too burdensome of a rule — whereby you’re trying to prescribe every action and to try to anticipate every scenario,” Vallejo said.
Though New Mexico is a little later than the rest of the country when it comes to adopting alcohol delivery rules, he said, it’s still a relatively new practice nationwide.
“There’s a little bit of history to it, But it’s a new enforcement paradigm for us,” he said. “So it’s just something that we’re going to have to get used to, and acclimatize ourselves to a little bit.”
The pandemic bill
The 2020 alcohol deliveries bill was bipartisan and co-sponsored by Rep. Antonio “Moe” Maestas (D- Albuquerque), Sen. Daniel A. Ivey-Soto (D-Albuquerque), Rep. Rod Montoya (R -Farmington), Rep. Joshua Hernandez (R-Rio Rancho) and Rep. Dayan Hochman-Vigil (D-Albuquerque).
The liquor lobby
Globally, alcohol is more than a $1.49 trillion industry.
Industry lobbying is present in state houses and on Capitol Hill in Washington, D.C., “much more so than public health ever has the resources to be,” Jernigan said.
Last year, the liquor lobby spent more money nationally than ever, pushing, in part, for the deregulation of alcohol.
Locally, the N.M. Restaurant Association, N.M. Brewers Guild, N.M. Distillers Guild, N.M. Wine Growers Association, the Wine Institute, and New Mexico Alliance of Alcohol Attorneys and Consultants all hired one or more lobbyists to appeal to New Mexico legislators in 2020, according to the NM Secretary of State lobby index.
On the public health side of the issue was the Santa Fe Recovery Center and a collection of smaller nonprofits, including Mothers Against Drunk Driving and the New Mexico Public Health Association, according to the New Mexico Secretary of State lobbyist index.
Rep. Montoya said he co-sponsored this bill because it was important for the economic viability of restaurants and other small businesses across the state.
“This was important to make sure that in any future disruption — as long as the workforce would be able to go in there and continue to cook — that they could also sell alcohol, which they are licensed to sell, through delivery,” Montoya said.
Montoya said that economic benefits to the restaurants and other alcohol outlets weren’t the only reason the bill was an important piece of legislation. There is also a public health advantage to keeping those who want to drink more alcohol off the road, he said.
“Say you’re watching a football game and some more people show up. The guy who’s hosting decides, ‘Hey, I’m going to go hop in my car, drive down to the liquor store and come back with more.’ This law allows him to call a liquor store, or order more food and have them deliver alcohol with it, and it keeps him off the road,” Montoya said.
In 2019, drinking and driving accounted for about 5.75 or 6% of the total alcohol-related deaths per 100,000 people, according to the National Highway Safety Administration.
Jernigan said that states across the nation have a history of forgetting that increasing access to alcohol results in more alcohol related deaths.
“We have a kind of societal amnesia about alcohol. It’s just that people literally forget,” Jernigan said. “And, there is a very large, very profitable industry that has an interest in helping people forget the negative consequences of alcohol use.”
Alcohol use disorder (AUD) is characterized by people being unable to stop or control alcohol use despite adverse social, occupational or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction and alcoholism. Considered a brain disorder, AUD can be mild, moderate, or severe. Lasting changes in the brain caused by alcohol perpetuate AUD and make individuals vulnerable to relapse, according to the National Institute of Alcohol Abuse and Alcoholism.
Part of the complexity behind the AUD epidemic in New Mexico and across the country is that moderate consumption is associated with positive social and health outcomes. According to one study, “social drinkers have more friends on whom they can depend for emotional and other support, and feel more engaged with, and trusting of, their local community.”
The issue, according to experts, is that the law does not take into account the differences between an occasional social alcohol purchaser and someone with an alcohol use disorder, according to Jernigan.
“This shouldn’t be a war on drugs,” Jernigan said. “This should be a public health approach to drugs. There are ways of regulating drugs that minimize the harm and can maximize the benefit.”
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