Alcohol-impaired driving is a major contributor to morbidity and mortality. Alcohol is involved in a substantial proportion of traffic accidents worldwide.

• In the United States, around 500,000 people get injured and 17,000 killed each year in alcohol-related traffic incidences; around 40% of youth traffic fatalities are directly related to alcohol consumption.
• In South Africa, 31% of non-fatally injured drivers are intoxicated.
• In Colombia, 34% of driver fatalities and 23% of motorcycle fatalities are associated with alcohol.
• In Russia, intoxicated pedestrians are involved in nearly one-third of all traffic accidents.

Alcohol-impaired driving is a major contributor to the social costs of alcohol misuse. Estimates and methods of calculation differ, but impaired driving is a major contributor to high social costs in developed countries in the form of property damage, lost worker hours and performance, and loss of life.

• In the United States alone, an estimated USD 50 billion in economic losses is incurred each year.
• In many developing countries, lack of information and research leaves the damages difficult to calculate.

Legislation and enforcement measures vary internationally. Setting of maximum allowable blood alcohol concentration (BAC) limits for operating commercial and recreational vehicles has proven to be an effective prevention measure.  However, maximum BAC limits vary from country to country (see Policy Table: Blood Alcohol Concentration Limits Worldwide).

           
Although legislating maximum BAC limits can be an effective prevention measure, enforcement is often lacking, especially in developing countries.

Harm reduction measures have been successfully applied to drinking and driving. Combining legislation with the building of public awareness around alcohol-impaired driving has proven effective in reducing the incidence of alcohol-related traffic incidents, injuries, and deaths. Successful efforts include the following:

• public awareness campaigns – advertisements and messages by government, public health, and private sector organizations about the effects of alcohol on driving;
• designated driver campaigns and programs – initiatives that encourage designating a sober driver on drinking occasions;
• ride-share and free-taxi programs – programs that provide transportation for those who have been drinking, often sponsored by industry and local government;
• server training and responsible hospitality programs – training program for staff in retail and hospitality sectors to recognize and respond to impaired patrons.

However, these campaigns must be part of a comprehensive effort that also includes legal sanctions and effective enforcement, clearly demonstrating to the public the unacceptability of alcohol-impaired driving.

A key focus of many programs is the prevention of youth drinking and driving. Although legislation and enforcement have reduced alcohol-impaired driving in many countries over the years, the number of incidents involving young people has generally risen, partly due to the increase in the number of motor vehicles and volume of traffic. Youth drinking and driving involves a number of factors:

• youth drinking patterns, especially in connection to extreme or “binge” drinking;
• inexperience with alcohol and with driving;
• mixing of drinking with drugs;
• breaches of law around the legal drinking age limit and availability of alcohol to minors.

Addressing drinking and driving among young people may require specially designed measures and approaches.