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Drinking-driving collisions are one of the largest sources of alcohol-involved
deaths and injuries. In the 20 - year period between 1977 and 1996, the
estimated numbers of deaths involving a drinking driver is in excess of
35,000 (Evans, 1990; Transport Canada, 2002). The problem is particularly
tragic among the young, but it is by no means restricted to them. Alcohol
is the leading contributor to deaths on our highways, and in recent years
it has been detected in about 40% of all drivers killed. The societal
impact of injuries is much larger than that of deaths. The number of people
seriously and often permanently injured is conservatively estimated to
be at least 10 times the number of people killed. Research indicates that
the more serious the collision, the more likely it is that alcohol is
involved. Impaired driving is one of the largest contributors to the social
and economic costs of alcohol abuse in Ontario and Canada (Single, Robson,
Xie and Rehm, 1996; Xie, Rehm, Single and Robson, 1996). It is clear that
there are unacceptable numbers of alcohol-related deaths and injuries
on our roads.
The collisions, injuries and deaths resulting from drunk driving can
be reduced by societal action. For example, over the past 20 years very
important reductions in the rates of death and injuries resulting from
impaired driving occurred. In 1981, 61% of all Ontario drivers killed
had alcohol in their system; by the early 90's this figure had declined
to around 40% (Wilson and Mann, 1990). These changes tell us that efforts
to reduce this problem can be successful on a scale that can mean the
avoidance of premature death and serious injury for thousands of people
each year.
Prevention of these injuries and deaths remains an important priority
for public health, the general public, and governments and there is substantial
research evidence to guide our efforts. It is possible to reduce alcohol
and traffic safety problems with a variety of measures. Research demonstrates
four key components that, if used properly, can reduce deaths and injuries
caused by drunk driving. It is also important to note that the principles
and programs described here also apply to operation of all motorized vehicles,
including boats and snowmobiles.
First, factors that influence the consumption of alcohol by individuals
and populations will also influence rates of driving after drinking and
resulting problems. Measures that determine the economic, legal and social
availability of alcohol will also influence drinking-driving rates. Thus,
for example, alcohol taxes play an important health role in reducing drunk-driving
fatalities. In general, any measure that will tend to increase alcohol
consumption or make alcohol more accessible will also tend to increase
rates of drinking-driving. Conversely, measures that tend to reduce alcohol
consumption will tend to decrease rates of drinking-driving (Edwards et
al, 1994; Mann and Anglin, 1990). For example, mandatory server training
programs have been demonstrated to reduce excessive drinking and associated
collisions (Gliksman, McKenzie, Single, Douglas, Brunet and Moffatt, 1993;
Holder and Wagenaar, 1994).
Second, the legal environment and enforcement practices will influence
drinking-driving by individuals and groups. Drinking-driving rates and
problems have been shown to be subject to substantial general deterrent
effects under appropriate circumstances. These general deterrent effects
can reduce collisions, deaths and injuries by large amounts, and may be
sustained over long periods of time under the proper circumstances (Homel,
1990; Mann, Macdonald, Stoduto, Shaikh and Bondy, 1998). Effective measures
here have included the introduction and lowering of legal limits and the
use of high-visibility, high-intensity enforcement campaign such as Ontario's
RIDE programme and Random Breath Testing in Australia. Additionally, several
sanctions have important specific deterrent effects, in that they appear
to reduce drunk driving and collisions in the individuals to whom they
are applied. License suspensions are very effective and inexpensive specific
deterrent measures, and vehicle impoundment also appears promising. Ignition
interlock devices, which are devices installed on the vehicles of convicted
offenders which require that persons starting and operating the vehicles
have a Blood Alcohol Content (BAC) of 0 or below some specified level,
appear to reduce recidivism for the period when they are installed on
the vehicle (Beck, Rauch, Baker and Williams, 1999). Imprisonment is costly
and has not been found to be effective in reducing recidivism and collisions
(Mann, Vingilis, Gavin, Adlaf and Anglin, 1991).
Third, rehabilitative and treatment measures are effective in improving
traffic safety when they are combined with other effective sanctions like
license suspensions. Convicted drinking drivers, as a group, are more
likely to demonstrate heavy or abusive drinking patterns that can be addressed
with rehabilitative or treatment measures (Macdonald and Mann, 1996).
In the past, it has been the practice to reduce or waive license suspensions
as an incentive for offenders to enter rehabilitation programs. This practice
fails to take optimum advantage of the collision-reducing potential of
combining rehabilitation with appropriate sanctions. Rehabilitative measures,
appropriately applied, reduce recidivism and collisions (Wells-Parker,
Bangert-Drowns, McMillen and Williams, 1996). Examples of Canadian programs
that are consistent with these principles include Ontario's Back on Track
program and Manitoba's Impaired Driver's Program.
Fourth, education and public awareness are important components of any
successful attack on drunk-driving injuries and fatalities. Education
and awareness involve informing the public about new legislative initiatives,
consequences of drunk driving, and how to avoid drunk driving. While the
specific effects of many educational activities can be difficult to assess,
the example of deterrence initiatives serves to underline their importance.
As noted above, deterrence initiatives have been demonstrated, under appropriate
conditions, to reduce significantly alcohol-related collisions. However,
for this effect to occur, public education is essential; without that
education, benefits are greatly reduced (Vingilis and Salutin, 1980).
Thus, education and public awareness initiatives are key components in
coordinated efforts to reduce drunk driving collisions, and are most effect
when they serve to draw the public' s attention to the risks and penalties
involved in drunk driving.
In addition to these four components that have been demonstrated to influence
significantly rates of drunk driving, two other components are generally
accepted by researchers as crucial for achieving the maximum effects of
countermeasure efforts. First, in order to be successful and to achieve
maximum benefits, drinking driving countermeasures should work together
and be mutually supportive. For example, the introduction of a new legal
initiative to prevent drunk driving may hold substantial promise for reducing
deaths and injuries. However, if it is not accompanied by any public education
measures, those effects will be reduced. Similarly, if a major effort
to reduce drinking driving problems occurs at the same time that the availability
of alcohol is substantially increased, for example by a marked reduction
in price, beneficial effects may be completely masked, and collisions
and injuries may be unaffected or even increase. Second, it is essential
to maintain a long-term commitment to reducing this problem. Previous
experience demonstrates that short-term efforts do not have long-term
benefits. Governments, educators, and the public must remain committed
over the long term for sustained reductions in collisions, injuries and
deaths to occur.
These principles identify specific effective measures and provide a general
context within which effective public policy to prevent drunk driving
can be created. With these principles in mind, current opportunities for
reducing deaths and injuries due to drunk driving can be considered. It
is also important to keep in mind that most initiatives to reduce the
harm caused by drunk driving involve a consideration of the balance between
public health and civil liberties concerns. Keeping this balance in mind,
the following recommendations are made with the goal of reducing the aggregate
or population levels of deaths and injuries caused by drunk driving. These
recommendations address three areas of current interest:
- lowering the legal limit in the Criminal Code of Canada to 50 mg%;
- mandatory server training programs; and
- ignition interlock devices for the vehicles of convicted drinking
drivers.
1) There has been recent interest in lowering the legal limit set in
the Criminal Code of Canada at which a drinking-driving offence occurs,
and groups such as Mothers Against Drunk Driving, the Canadian Medical
Association, the Addictions Foundation of Manitoba and the Ontario Community
Council on Impaired Driving have recommended a 50 mg% limit. The question
of what the legal limit should be is not an easy one to answer. However,
there is substantial research that is available on this issue that is
summarised in a recent report to Transport Canada (Mann et al, 1998).
Currently, legal limits in developed countries vary from low levels such
as 0 or 20 mg% (e.g., Sweden) to levels as high as 100 mg% (in some American
states). The Canadian limit was set initially at 80 mg% in 1969, in part
based on the experience in Great Britain where an 80 mg% limit was introduced
in 1967. Many countries have introduced or lowered the legal limit to
50 mg% including Australian states and many European states. The research
evidence clearly demonstrates that impaired driving behaviour and collision
risks are increased significantly at BACs of 50 mg%. As well, in the majority
of instances where legal limits have been reduced, including those instances
where they have been reduced to 50 mg%, significant reductions in aggregate
measures of driving fatalities have been observed. Based on experiences
in Australia and Sweden, it has been estimated that a 50 mg% legal limit
could have prevented between 185 and 555 deaths in 1996 alone (Mann et
al, 1998). he reductions observed when legal limits are lowered are due
to general deterrence, and are not restricted to drivers at lower BAC
levels (Mann et al, 1998 and 2001). The Centre for Addiction and Mental
Health therefore recommends that the legal limit for driving as defined
in the Criminal Code of Canada be reduced to 50 mg%. However, it is important
to note that additional factors can influence the success of this measure
in reducing alcohol-related deaths and injuries, including the availability
of resources to implement and enforce the reduced limit. These resource
issues need to be addressed in any process to revise the legal limit.
2) Server training programs were developed to assist those who serve
alcohol in identifying situations in which patrons may be served to intoxication,
and in taking action to prevent excessive alcohol consumption. Well-designed
programs have demonstrated their effectiveness in reaching those goals
(Gliksman et al, 1993; Sloan et al, 2000). One of the major consequences
of serving to intoxication is drunk driving, and server training programs
have demonstrated their ability to reduce the incidence of drunk driving,
or driving over the legal limit, among patrons of licensed establishments.
The implementation of mandatory server training programs, that is, programs
where every individual who serves alcohol is mandated to received high
quality server training, has been shown to reduce aggregate measures of
alcohol-related collisions (Holder and Wagenaar, 1994). Server training
programs which are not mandatory, or which do not involve high quality
instruction, have not been shown to influence aggregate collision rates.
Effective programs also involve training for owners and managers, as well
as for servers. Therefore, the Centre for Addiction and Mental Health
recommends that all individuals who serve alcohol be required to complete
successfully a programme of server training, taught by highly qualified
instructors and demonstrated by evaluation research to be effective.
3) The Province of Ontario has recently passed legislation which will
require convicted drinking drivers to complete an ignition interlock requirement
in the process of getting their license back after a period of suspension.
As noted, these devices appear to have the ability to reduce recidivism
during the period when they are installed on the vehicle of a convicted
offender (Beck et al, 1999) and thus the Centre for Addiction and Mental
Health supports their use as part of a period of restricted licensing.
However, there are at present several measures of proven effectiveness
that are applied to convicted offenders in Ontario, including license
suspensions and remedial requirements if they chose to obtain a license
following the period of suspension. It is important to remember that interlocks
cannot simply replace these programs of proven effectiveness. A key goal
in the process of introducing the ignition interlock requirement must
therefore be that the beneficial effects of license suspensions and remedial
requirements not be interfered with or reduced. Thus, the Centre for Addiction
and Mental Health recommends that the Province of Ontario introduce an
ignition interlock requirement for convicted offenders that complements,
and does not interfere with, existing measures of proven effectiveness.
Additionally, the reduction of the deaths and injuries resulting from
drunk driving requires personal and social action. Because both alcohol
and driving are imbedded within our society, it can be easy to combine
the two. Thus each of us must also look on preventing drunk driving as
a personal responsibility.
References
Beck, K.H., Rauch, W.J., Baker, E.A. and Williams, A.F. (1999). Effects
of ignition interlock licence restrictions on drivers with multiple alcohol
offenses: A randomized trial in Maryland. American Journal of Public Health,
89, 1696-1700.
Edwards, G., Anderson, P., Babor, T., Casswell, S., Ferrence, R., Giesbrecht,
N., Godfrey, C., Holder, H., Lemmens, P., Makela, K., Midanik, L., Norstrom,
T., Osterberg, E., Romelsjo, A., Room, R., Simpura, J. and Skog, O.-J.
(1994). Alcohol Policy and the Public Good. New York: Oxford University
Press.
Evans, L. (1990). The fraction of traffic fatalities attributable to
alcohol. Accident Analysis and Prevention, 22, 587-602.
Gliksman, L., McKenzie, D., Single, E., Douglas, R., Brunet, S. and Moffatt,
K. (1993). The role of alcohol providers in prevention: An evaluation
of a server intervention programme. Addiction, 88, 1195-1203.
Holder, H.O. and Wagenaar, A.C. (1994). Mandated server training and
reduced alcohol-involved traffic crashes: A time series analysis of the
Oregon experience. Accident Analysis and Prevention, 26, 89-97.
Homel, R. (1990) Random breath testing and random stopping programmes
in Australia. In Wilson, R.J. and Mann, R.E. (Eds.), Drinking and Driving:
Advances in Research and Prevention. New York: Guilford Press, pp. 159-202.
Macdonald, S. and Mann, R.E. (1996). Distinguishing causes and correlates
of drinking and driving. Contemporary Drug Problems, 23, 259-290.
Mann, R. E. and Anglin, L. (1990). Alcohol availability per capita consumption,
and the alcohol-crash problem. In: Wilson, R. J. and Mann, R.E. (Ed.)
Drinking and Driving: Advances in Research and Prevention, New York: Guilford,
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Mann, R.E., Macdonald, S., Stoduto, G., Shaikh, A. and Bondy, S. Assessing
the Potential Impact of Lowering the Legal Blood Alcohol Limit to 50 mg%
in Canada. Transport Canada Publication No. TR 13321 E. Transport Canada,
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Mann, R.E., Stoduto, G., Macdonald, S., Shaikh, A., Bondy, S. and Jonah,
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limits for driving: An international review. Accident Analysis and Prevention,
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Mann, R.E., Vingilis, E.R., Gavin, D., Adlaf, E. and Anglin, L. (1991).
Sentence severity and the drinking driver: Relationships with traffic
safety outcome. Accident Analysis and Prevention, 23, 483-491.
Single, E., Robson, L., Xie, X., & Rehm, J. (1996). The Costs of
Substance Abuse in Canada: Highlights of a Major Study of the Health,
Social and Economic Costs Associated with the Use of Alcohol, Tobacco
and Illicit Drugs . Ottawa: Canadian Centre on Substance Abuse.
Sloan, F.A., Stout, E.M., Whetten-Goldstein, K. and Liang, L. (2000).
Drinkers, Drivers and Bartenders: Balancing Private Choices and Public
Accountability. Chicago: University of Chicago Press.
Transport Canada. (2002). Collisions and casualties. http://www.tc.gc.ca/pol/en/ExcelSpreadsheets2/main.asp
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driving. Accident Analysis and Prevention, 12, 267-274.
Wells-Parker, E., Bangert-Drowns, R., McMillen, R., & Williams, M.
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drink-drive offenders. Addiction, 90, 907-926.
Wilson, R.J. and Mann, R.E. (1990). Introduction. In Wilson, R.J. and
Mann, R.E. (Eds.), Drinking and Driving: Advances in Research and Prevention.
New York: Guilford Press, pp. 1-7.
Xie, X., Rehm, J., Single, E., & Robson, L. (1996). The Economic
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Addiction Research Foundation.
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