The relationship between alcohol availability and drink-driving policies and admissions to substance use disorder treatment during pregnancy.

Objective: Pregnancy-specific alcohol policies are widely adopted yet have limited effectiveness and established risks. It is unknown whether general population alcohol policies are effective during pregnancy. This study investigated associations between general population policies and alcohol treatment admission rates for pregnant people specifically.

Method: Data are from the Treatment Episodes Data Set: Admissions and state-level policy data for 1992-2019 (n=1,331 state-years). The primary outcome was treatment admissions where alcohol was the primary substance, and the secondary outcome included admissions where alcohol was any substance. There were five policy predictors: 1) Government spirits monopoly, 2) Ban on Sunday sales, 3) Grocery store sales, 4) Gas station sales, and 5) Blood alcohol concentration (BAC) laws. Covariates included poverty, unemployment, per capita cigarette consumption, state and year fixed effects, and state-specific time trends.

Results: In models with alcohol as the primary substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer and spirits) had lower treatment admission rates [IRR=0.88, 95% CI: 0.78-0.99, p=0.028]. States with BAC laws at 0.10% (vs. no law) had higher treatment admission rates [IRR=1.24, 95% CI: 1.08-1.43, p=0.003]. When alcohol was any substance, prohibiting spirits sales in grocery stores (vs. allowing heavy beer and spirits) was again associated with lower treatment admission rates [IRR=0.89, 95% CI: 0.80-0.98, p=0.021], but there was no association for BAC laws.

Conclusions: Restrictions on grocery store spirits sales and BAC laws were associated with lower and higher alcohol treatment admission rates among pregnant people, respectively, suggesting general population alcohol policies are relevant for pregnant people's treatment utilization.