Oregon is a drinker’s paradise. The state boasts more craft distilleries than Kentucky and is second only to California in the number of wineries. Some call Portland, Oregon, “beervana” for its bevy of breweries.

But Oregon also has among the highest prevalence of problem drinking in the country. Last year, 2,153 residents died of causes attributed to alcohol, according to the Oregon Health Authority — more than twice the number of people killed by methamphetamines, heroin and fentanyl combined.

Sonja Grove, a retiree in Portland whose adult son drank himself to death in April 2020, feels the toll is overlooked compared with those of other drugs. “Alcoholism has sort of taken a back seat.”

In 2021, confronted by these conflicting trends, as the pandemic raged on, Oregon lawmakers made it easier to drink. They permanently legalized the sale of to-go cocktails, which the Distilled Spirits Council of the United States called a “lifeline,” and increased the number of cases that wineries could ship directly to consumers.

Reginald Richardson, director of the state’s Alcohol and Drug Policy Commission, described the policies as incongruent. “We obviously want to create an environment that’s pro-business, that helps the state to develop, but we’ve got this other thing,” he said.

That disconnect is typical: Before COVID-19 lockdowns, no state permitted bars or restaurants to deliver liquor to customers at home, according to a trade association. Now, 28 have relaxed the rules.

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In contrast, policies that experts consider most effective at curbing excessive drinking have been ignored. For example, even as alcohol-related deaths soared to record highs in the past few years, alcohol taxes have fallen to the lowest rates in a generation.

The Economics of Alcohol

Americans drank more during the pandemic, but national data on the change have only recently become available. Alcohol tax revenues collected by the U.S. Treasury Department rose by 8% in the fiscal year that ended Sept. 30, 2021, compared with the previous year, and remain well above pre-pandemic levels.

Deaths caused by drinking also rose during the pandemic, spiking 25% in 2020 over the previous year. But the deaths — which have topped 140,000 nationwide — have been rising for decades in every state. Few places have seen a greater uptick than Oregon, where the rate of alcohol-induced deaths grew 2.5 times from 1999 to 2020, after adjusting for the state’s changing age distribution.

Grove’s only son, Jonathon, had begun drinking excessively in college, she said, but managed to work as a pharmacy tech for years at Oregon Health Sciences University despite his worsening addiction. Cheap beer and white wine were his weaknesses. “He always thought that he wasn’t drinking hard alcohol, so he wasn’t really an alcoholic,” Grove said. He died in a cheap hotel, surrounded by empty cans and containers.

Various studies in recent years have suggested that even moderate drinking poses a health risk, including to the heart. The Centers for Disease Control and Prevention recommends that men consume no more than two drinks a day and women no more than one.

Dr. Eric Roth, chief of emergency medicine at Kaiser Permanente’s two hospitals in the Portland area, estimated that 10% to 30% of his patients had illnesses or injuries at least partly linked to drinking. “It’s always been a big problem,” he said, “and it’s getting to be an increasingly big problem.”

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To address substance abuse, Oregon has emphasized education and treatment to address substance use. A ballot measure passed in 2020 that decriminalized possession of small amounts of all drugs also diverted hundreds of millions of tax dollars from marijuana to recovery services, including for alcohol. This summer, Oregon sponsored a campaign to “Rethink the Drink.”

Dr. Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria, labeled educational campaigns a “fig leaf” and said that treatment, while helpful, was akin to parking an ambulance beneath a cliff rather than fencing the precipice to prevent people from falling. Measures to prevent excessive drinking are less costly and more effective, he said. “If you want to talk prevention, you’ve got to talk policies.”

The U.S. Community Preventive Services Task Force, an independent group of experts, has endorsed measures to deter excess drinking, including raising the price of alcohol. And alcohol has never been more affordable: As a share of average household income, a can of Budweiser in 2010 cost one-fifth of what it did in 1950 after adjusting for inflation, one study calculated, and the cheapest available liquor cost one-fifteenth the price.

One way that governments can influence the price of alcohol is by taxing its producers or sellers, which pass the cost on to consumers. This is comparable to taxes on tobacco, which scores of studies show to be a powerful tool for reducing smoking. A large body of evidence shows that higher alcohol taxes are associated with less excessive drinking and lower rates of disease and injury deaths. After Illinois and Maryland raised alcohol taxes, the states reported reductions in binge drinking and car crashes involving intoxication.

Alex Wagenaar, a professor emeritus at the University of Florida College of Medicine, said studies across diverse places and populations were consistent. “There’s just no question that the tax rate affects how much people drink, and the effect then ripples through to a really wide range of alcohol-related problems,” he said.

But Oregon, which has no sales tax, has long curried favor with the wine and beer industries by keeping alcohol taxes low — less than 3 cents per glass of wine and not even a penny per a 12-ounce beer. For years, sporadic efforts to raise rates have sputtered.

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Max Williams, who as a state legislator between 1999 and 2003 pressed unsuccessfully for an increase, noted that wine taxes have not changed since 1983 nor have beer taxes since 1977. “I was a seventh grader at Cascade Junior High the last time that happened,” he said.

Furthermore, leaving tax rates unchanged has the practical effect of reducing them. As in much of the country, Oregon sets alcohol taxes by the volume of the beverage rather than as a percentage of its price, so when inflation pushes up prices, it effectively erodes the tax rate. Over the past 45 years, Oregon’s beer tax has lost 80% of its value.

Both her parents drank heavily and died young, LaRue said, adding that it made her an impassioned supporter of mental health services. She noted that her mother consumed cheap whiskey, not craft IPAs. “If a person has a drinking problem,” she said, “they’re going to find a way.”

A Movement by the Afflicted

Last year, Oregon Recovers, a nonprofit advocacy organization, renewed the push for a tax increase. Its executive director, Mike Marshall, an electoral strategist who has worked on campaigns for marriage equality and a race for governor, is 14 years sober.

In contrast with Alcoholics Anonymous, which has a foundational tradition of avoiding politics, Oregon Recovers has proved an effective if polarizing force.

The group approached state Rep. Tawna Sanchez to sponsor the bill. Sanchez, who is Shoshone-Bannock and one of the few Native American members of the legislature, is open about her own struggle with drinking and said she was motivated in part to address addiction in her community.

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“The beer and wine industries have fought tooth and nail — and have won thus far — to keep their taxes from going up,” she said. “And I don’t think that’s fair to everyone else.”

Marshall said the proposed increase — $0.21 on a 12-ounce beer and $0.40 on a glass of wine — was proportionate to Oregon’s alcohol problems, and the state’s Health Authority supported the bill. But the alcohol industry branded it as extreme, labeling it “a 2,700% increase” from the state’s rates.

The bill never made it out of its first legislative committee. The Oregon Beverage Political Action Committee, which opposed the bill, has given more than $500,000 in campaign contributions to local politicians since 2020. Danelle Romain, its treasurer, said the measure’s demise was a bellwether for public support of such policies.

“I don’t think Oregonians think alcohol is evil,” she said. “I just don’t think that message resonates.”

Politics vs. Public Health

Views about alcohol policies do not necessarily cleave along familiar partisan lines. Williams was a Republican when he pushed for a tax increase, although he has since given up his party affiliation. “This is one of those issues that I think is way less politicized by party and more politicized by ideology,” he said.

Since 2013, Democrats have held Oregon’s governor’s office and majorities in both legislative chambers. But the state’s prominent progressives do not connect the lax regulatory environment with alcohol’s widening harms. Last year, Sen. Ron Wyden, D-Ore., a supporter of better mental health care, led successful efforts to permanently lower federal alcohol taxes. An industry group named him a “Beer Champion” of the year.

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Some experts say that the Biden administration has also favored alcohol producers over consumers. In February, the Treasury Department released a report on the market for beer, wine and spirits that mainly advanced recommendations for “boosting opportunity for small businesses.”

David Jernigan, a professor at Boston University School of Public Health and an expert on alcohol, said the report “entirely ignored” public health in its push to reduce regulatory barriers and to foster more competition in alcohol production. “That’s all well and good for dish soap,” he said. “It has really different consequences for alcohol.”

Major philanthropies have not invested significantly in initiatives aimed at reducing alcohol-related health risks, and advocates are scarce. The U.S. Alcohol Policy Alliance is one of the only nonprofits focused on reducing alcohol-related harms nationwide, and it is tiny. According to Nicole Holt, its chair, it has an annual budget of less than $50,000 and a single paid staff member. In the wake of the pandemic, the torrent of state laws deregulating alcohol sales occurred faster than the group could respond. “We have been on our heels,” she said.

Efforts to raise alcohol taxes are rare. Since 2020, public health advocates in Hawaii have promoted a bill to increase rates there, but the measure did not gain traction this year. In New Mexico, where an attempt to raise alcohol taxes in 2017 failed, the issue has resurfaced.

In Oregon, Marshall was not dissuaded by the long odds. “I am a gay man with a wedding band on my finger,” he said. “My life experience tells me it absolutely can happen.” Grove remains one of the group’s volunteers, although she took time off to undergo breast cancer treatment. “The chemo knocked me down, but you know, after you go through the death of a child, nothing can be as horrible as that,” she said.

Sanchez, who now heads a legislative committee overseeing state budget policy, said she was not cowed either. Last year’s bill started a conversation that she feels compelled to pursue, especially because of her experience in recovery.

“Should we continue to be anonymous about this?” she asked. “Should we continue to keep it all quiet? I think we need to start talking about it.”