Nearly all countries regulate distilled spirits differently from beer and wine. However, the scientific basis for this differential treatment has not been clearly established. This review covers beverage-specific relationships with alcohol-related mortality causes at the population level in the United States and includes a new analysis of motor-vehicle-accident mortality. Spirits were found to be more strongly related to, or the only beverage type with a significant positive association with, cirrhosis, IHD, and head and neck cancer mortality. Spirits sales, along with beer, were also implicated in motor-vehicle-accident mortality and homicide. While all three beverage types were found to be associated with suicide mortality, only spirits had a significant unlagged association. These associations were found under policy arrangements where spirits were discouraged with relatively higher taxes, lower availability, and more restricted marketing opportunities. This suggests that the differential policy treatment found in the United States and most other countries is justified on the basis of differential-harm relationships.
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