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- Road traffic crashes are one of the main causes of injury and death worldwide. Many such incidents involve alcohol-impaired drivers.
- Alcohol consumption impairs certain functions, such as visual acuity and reaction time, increasing the likelihood that accidents may occur.
- Efforts to address impaired driving include several measures that target drinking patterns, including setting of BAC limits and age-specific driving licenses.
- Effective strategies also include targeted interventions, such as education, awareness building, responsible hospitality, and other measures.
- For examples of interventions, see the online database Initiatives Reporting: Industry Actions to Reduce Harmful Drinking.
Driving requires a variety of skills that can change continually. A driver must maintain alertness and be able to react quickly to hazards, see clearly, and possess the ability to judge distance and speed. Certain drinking patterns can impair a number of the skills necessary for safely driving a motor vehicle and increase crash risk.
Impaired driving that involves alcohol consumption is sometimes referred to as “driving under the influence” (DUI), “driving while impaired” (DWI), “drunk driving,” or “drink-driving.” While the terminology may differ, there is broad agreement that alcohol-impaired driving is one of the leading causes of road traffic casualties. According to the WHO statistics, road traffic crashes—many of them involving impaired drivers—are one of the main causes of morbidity and mortality worldwide (Murray & Lopez, 1996).
Effects of drinking on driving
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Alcohol affects the central nervous system, impacting various behavioral and cognitive capabilities (see ANNEX 1: The Basics about Alcohol; see also Borkenstein et al., 1964; Grant, Millar, & Kenny, 2000; Parks et al., 2002). Drivers who have been drinking are more likely than sober drivers to be involved in crashes. Reaction times of an inebriated driver may be reduced by up to 10%–30%, vision may become blurred, and the judgment of distance, speed, and hazards is likely to be diminished (Davis, Quimby, Odero, Gururaj, & Hijar, 2003). Studies have also shown that crashes involving alcohol are more likely to be fatal or result in severe injuries (e.g., Moskowitz, Blomberg, Burns, Fiorentino, & Peck, 2002; Ramstedt, 2009; Zador, 1991; Zador, Krawchuk, & Voas, 2000). This appears to be due to evidence that impaired drivers are less likely to use seatbelts and more likely to exceed speed limits, significantly increasing their risk of severe crash-related injury (Allen et al., 2006; Department of the Environment Transport and the Regions, 1998).
Many countries have taken action to address impaired driving, making it both unacceptable to society and a criminal offense. An important first step in this process has been the establishment of a maximum permissible blood alcohol concentration (BAC) level (see MODULE 16: Blood Alcohol Concentration Limits; see also International Center for Alcohol Policies, 2002; Österberg & Karlsson, 2003; World Health Organization, 2004; a regularly updated table listing BAC limits worldwide is available in the Policy Issues: Drinking and Driving section of the ICAP website). The maximum permitted BAC level serves as the cornerstone for efforts to reduce and prevent alcohol-impaired driving by providing a baseline measurement for enforcement and prevention.
BAC limits are set by individual countries and span a range of values, reflecting historical evidence, perceived risk weighed against public convenience, and the cultural acceptability of restrictive BAC levels on an individual’s behavior (for discussion, see International Center for Alcohol Policies, 2002).
When evaluating how to address potential harm around drinking and driving, it is important to keep several factors in mind that have been shown to increase the likelihood of alcohol-involved crashes. These include—but are not limited to—elevated BAC, age, gender, and whether the individual is a “hard core” drinker.
- BAC: Even at a BAC of 0.2 mg/ml or lower, a driver’s ability to divide attention between two or more sources of visual information can be impaired (Moskowitz, Burns, & Williams, 1985; Ogden & Moskowitz, 2004). The risk of collision is found to increase at BAC levels of 0.5 mg/ml and drivers with a BAC of 0.9 mg/ml are more than 11 times likely to be involved in a fatal crash compared with drivers who have not consumed alcohol (Bloomberg et al., 2009; Zador, 1991; Zador et al., 2000).
- Age: Young drivers are at higher risk for involvement in traffic crashes, including alcohol-involved crashes, than older drivers. The reasons vary and include the limited driving experience of young drivers, a tendency to overestimate their driving skills, and a general penchant for risk-taking behavior, such as speeding (Hingson & Kenkel, 2004; Hingson, Heeren, & Winter, 1999; Hingson & Zha, 2009; Marczinski & Fillmore, 2009; Peck, Gebers, Voas, & Romano, 2008; Zador, 1991). Young drivers who drink are also more likely than older drivers to experiment with heavy and binge drinking (National Highway Traffic Safety Administration, 2004).
- Gender: In most countries, men are more likely to be involved in alcohol-related crashes than women (Burns & Fiorentino, 2000; Karoll & Memmott, 2001; Roads and Traffic Authority of New South Wales, 2000; Zador et al., 2000), but the number of women who drink and drive is increasing (e.g., Tsai, Anderson, & Vaca, 2010).
- Reoccurrence: When it comes to drunk driving, repeat offenders with prior DUI convictions are a significant traffic safety problem. They are more likely than others to be involved in fatal crashes where alcohol impairment is involved (Beerman, Smith, & Hall, 1988; Impinen et al., 2009; Perrine, 1990; The Century Council, 2004).
Implications for policy and prevention
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Countermeasures aimed at drinking and driving are intended to change the behavior of people who might drive while intoxicated and also to sustain the behavior of those who seldom or never drive if over the local BAC limit. Countermeasures generally cover four areas: public education, policies, enforcement, and sanctions. The approaches adopted by countries worldwide vary greatly and reflect relevant target groups, culture, government commitment, and experience with the issue of drunk driving.
Increasing awareness among drivers about the dangers of impaired driving, as well as ensuring that they are informed about existing laws, the risk of being detected, and the consequences of this behavior are widely agreed to be important elements of any approach toward reducing alcohol-related crashes (Davis et al., 2003; Shults et al., 2009). Public education programs include school education for children and youth, professional education in driver training, training for servers in premises licensed to sell alcohol, designated driver campaigns, and publicity campaigns targeting specific groups (see MODULE 1: Alcohol Education and MODULE 4: Responsible Hospitality). A variety of information campaigns focusing on impaired driving has been successfully implemented in many countries by government agencies, bodies sponsored by the beverage alcohol industry, and advocacy groups. Many of these campaigns have been developed and executed as partnership efforts by the different entities.
How individual countries address drinking and driving through legislation varies worldwide (International Center for Alcohol Policies, 2002; Österberg & Karlsson, 2003; WHO, 2004). In order to be effective, a country’s legislation should be appropriate and workable, taking into account local circumstances (Davis et al., 2003). Several aspects of legislation are relevant to alcohol-impaired driving (Fell et al., 2009; International Center for Alcohol Policies, 2002; Stewart, 2000):
- The setting of a maximum BAC is generally regarded as an important milestone in impaired driving legislation.
- Lower BAC levels are often established for drivers of commercial vehicles.
- In some countries (e.g., Australia, Spain, and the United States), lower BAC levels are set for younger or novice drivers.
- Other related legislation is targeted at access to alcohol, ranging from minimum purchasing age, licensing, taxation, and regulating points of sale (e.g., the density of establishments or sales along motorways).
Research indicates that combinations of these various measures have been effective in reducing the proportion of fatal crashes involving drunk driving (Anderson, Chilson, & Fuhr, 2009; Voas, Blackman, Tippetts, & Marques, 2002).
Laws also exist in numerous countries on detecting impaired drivers. These include granting power to the police forces to conduct random breath tests on drivers, even if they are not specifically suspected of impairment. Drivers who do not comply can be pressured to submit to the test or can face severe penalties.
As with any policy measure that relies on legislation, effectiveness of laws against drunk driving can only be ensured through enforcement by local authorities and police. It is generally agreed that any enforcement activity should be high profile and target specific groups and individuals (Davis et al., 2003). The actual intention of enforcement activities should not be to apprehend as many offenders as possible, but rather to create the perception that those who break the law will be caught and punished. The approach and commitment to enforcing impaired driving laws vary greatly around the world.
Methods shown to be effective in enforcing impaired driving laws include breath testing (particularly, random—as opposed to selective—breath testing), sobriety check points, coordinated enforcement efforts, and impaired driving task forces (Brady et al., 2009; Erke, Goldenbeld, & Vaa, 2009; Moynham et al., 2000; Peek-Asa, 1999; Stewart & Sweedler, 1997). Providing proper equipment and training to police for these tasks is of vital importance.
When impaired drivers are identified by the enforcing authorities, sanctions are needed. These sanctions serve the dual purpose of appropriately punishing offenders for breaking the law and preventing reoccurrence of the offense. Traditional sanctions, widely applied around the world, include driving license suspension, fines, jail time, and community service (International Center for Alcohol Policies, 2002; Rehn, Room, & Edwards, 2001). Other forms of sanctions may consist of counseling, rehabilitation programs, driver education, and the use of measures implemented on vehicles, such as impoundment and alcohol interlock devices. In some countries, differential sanctions are applied to impaired drivers depending on their age. Young people are generally held to less stringent standards than adults (National Highway Traffic Safety Administration & National Institute on Alcohol Abuse and Alcoholism, 1999).
International research has shown that reoccurring or recidivist impaired drivers may be less receptive to traditional sanctions and require tailored and more intense rehabilitation, in part because many of them are alcohol abusers and therefore need a broader approach (Hedlund, 1995; Hingson, Heeren, & Winter, 1998; Roads and Traffic Authority of New South Wales, 2000; Simpson, Beirness, Robertson, Mayhew, & Hedlund, 2004; Simpson, Mayhew, & Beirness, 1996; The Century Council, 2004).
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Although alcohol-impaired driving appears to be a single issue, it is in fact a complex problem that includes various dimensions such as alcohol abuse, underage drinking, and other social concerns. Solutions need to be equally complex and wide-ranging, demanding a comprehensive, creative, and flexible approach. It is important to view alcohol-impaired driving within the broader context of public health implications of alcohol abuse. As a result, solutions must take into account drinking patterns and groups particularly at risk.
Countermeasures vary widely from country to country, but generally aim to persuade people not to drink and drive. Initiatives can be separated into four broad groups: public education, policies, enforcement, and sanctions. Measures chosen and applied in a given country must enjoy the support of both government and the public. Without government commitment, measures aiming to prevent impaired driving can have little long-term or sustainable positive effect. Efforts to reduce the occurrence of impaired driving can be most effective and sustainable when stakeholders from various sectors and disciplines work together.
As the problem of drinking and driving affects society at large, it needs cooperation from a variety of sectors and disciplines to solve it. Government efforts through legislation, education, and enforcement can be pooled with efforts by the beverage alcohol industry, community-based organizations, and academic institutions to address the problem. The experience of numerous countries shows that collaboration among a variety of stakeholders can result in a larger and more sustainable reduction of impaired driving incidents.
POLICY OPTIONS: Drinking and Driving
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In developing policies and approaches, consideration of a number of key elements is required. While some elements may be necessary at a minimum and under most conditions, others may not be appropriate in all cases, or may be difficult to implement. The list below offers a menu of areas that need to be addressed, based on effective approaches that have been implemented elsewhere. Specific examples are provided in the Examples of Targeted Interventions section of the ICAP Blue Book.
Laws and regulations for setting the parameters around drinking and driving. For example:
- Blood alcohol concentration (BAC) limits for setting the legal threshold for “driving under the influence.” BAC limits range from 0.0 mg/ml to 0.8 mg/ml, with 0.5 mg/ml the standard in most countries.
- A lower threshold for drivers below the drinking age, where the drinking age is higher than the age for driving.
- The option of setting lower BAC thresholds for operators of commercial vehicles.
Enforcement of policies may include:
- Breath and blood tests to monitor compliance with BAC limits.
- Random road blocks and testing.
- Appropriate sanctions for those over the BAC limit. Special sanctions and criminal penalties may be applied to repeat offenders, those grossly over the limit, or for injury and fatalities.
- Interlock devices requiring breath tests for repeat offenders.
Availability of trauma and emergency care for injured as a result of impaired driving.
- Screening for alcohol abuse may be included, along with brief intervention and counseling sessions.
Education to raise public awareness around BAC limits, penalties, and responsible drinking and driving may be appropriate through media campaigns, school programs, and other venues.
- Interactive BAC calculators may be offered in serving establishments; driving simulators may be made available where possible and appropriate.
- Responsibility messages included in commercial communications.
- Increased visibility of campaigns and messages around holidays and events.
Prevention measures against alcohol-impaired driving include targeted interventions, such as:
- Designated driver programs may be effective and can be encouraged through serving establishments.
- Responsible hospitality measures include training staff to assess impairment, attempting to prevent impaired driving, and offering alternative transportation.
- Access to alternative modes of transportation around events.
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