CRICOS No. 00213J

Professor Mary Sheehan AOICADTS, T2010, Oslo, August 24, 2010.

Social Control of the Drinking Driver

Acknowledgements

• CARRS-Q team members:

– Professor Vic Siskind, Statistician

– Rebekah Chapman, NHMRC PhD Scholar

– Dr Lisa Buckley, Postdoctoral Fellow

– Nicole Allenden, Research Officer

CRICOS No. 00213J

OVERVIEW

• Terminology – 1988

• Chapter issues – 1988

• Key policy initiatives

• Chapter issues revisited – 2010

• Terminology -2010

• An ongoing challenge - A new Scandinavia?

• A tribute

CRICOS No. 00213J

Terminology

Terminology - 1988

Drinking-driving

Drunken driving

Drunk driving

DWI (driving while intoxicated)

DUI (driving under the influence)

Alcohol-impaired driving

CRICOS No. 00213J

Chapter 1: The Alcohol-Crash ProblemAlan C. Donelson

• Deterrent-based approaches are insufficient to produce change

• Focus has been on alcohol and the drunken driver but rarely on the social and cultural environment

• Need strategies in the “war against drunk drivers” not just tactics

• Need long-term comprehensive systems approaches

Need systems approach and strategies not just tactics

CRICOS No. 00213J

Chapter 2: The Scandinavian ExperienceJohannes Andenæs

• The feature of the Scandinavian system is the per se legislation

• Increasing movement to relying less on the strength of the sanction and more on increasing the likelihood of detection

• Our present drinking customs with their production of problem drinkers means we have to live with drunken driving as an important cause of traffic accidents

Successful Scandinavian policy based on the “per se” laws and increasing the likelihood of detection.

CRICOS No. 00213J

Chapter 3: Deterrence-based Policies in Britain, Canada and AustraliaH. Laurence Ross [the devil’s advocate]

• Focus on deterrence-based countermeasures leads to concentration on human factors and the deviant minority

• We fail to use institutional countermeasures (increasing taxes, restricting advertising, pressure on vehicle manufacturers).

• If drunk driving was eliminated the death rate might be reduced by a quarter, but if cars had operational airbags it may be reduced by half

• If it is easier to install airbags than to reduce drink driving a policy favouring the former should be used

- Challenge the priority of individual person solutions over institutional countermeasures- Personal change (reduced drunk driving) may be less effective than vehicular

modifications (airbags).

CRICOS No. 00213J

Chapter 4: Drinking-and-Driving Laws in the Federal Republic of Germany and the NetherlandsGunter Kroj

• Changing dominant attitudes and introducing new behavior modes of drink-driving control will be long and difficult.

• Control and actioning have to be integrated still more effectively into a broad range of educational measures and safety campaigns

• The Dutch practice of random alcohol tests should be legalized in Germany.

The Dutch practice of random alcohol tests should be legalized

CRICOS No. 00213J

Chapter 5: The Control of Drinking-Driving in the United States: A Period in Transition?Joseph R. Gusfield

• Current period [70’s-80’s] uniquely reflects a ‘new temperance’.

• The moral drama of drinking driving has been the most vital force at work [RID,MADD]

• Federal entry into traffic safety and alcohol policy is important

• Young people have status as a “dangerous class” in America…and are a relatively weak political group. A logical safety conclusion would extend the minimum drinking age to 25 and exclude all women from such legislation.

• A possible technological solution to DUI is at the inaugural trial stage for use with recidivists in several American cities. (interlocks)

- The moral drama (RID, MADD) is the most vital force for change- Young people being targeted

CRICOS No. 00213J

Chapter 6: The Legal Context in the United StatesMichael D. Laurence

• Two unique influences on drunken driving countermeasures: US Federal system Bill of Rights

• National perception that drunken driving should be eradicated and the response reflects these two influences

• In turn controlling drunken driving has had effects in turn on both the federal system of government and the protections guaranteed under the constitution.

Increase or maintain perception that drunken driving should be eradicated

CRICOS No. 00213J

Chapter 7: The Effects of Changes in Availability of Alcoholic Beverages Ragnar Hauge

• Strikes in State Wine and Spirits Monopoly and closing of liquor shops on Saturdays in Norway and Sweden showed no effect on drunken driving.

• Great increase in Norway and Denmark in post-war consumption of alcohol has not lead to comparable increases in drunken driving.

• Violations are severely punished, permanent and relatively low BAC limits

• Acceptance of statutory provisions and high degree of acceptance that drunken driving is objectionable.

• Predict that countries where these factors don’t exist will be far more affected by the total alcohol consumption in the population.

The impact of total alcohol consumption is moderated by acceptance of statutory controls and acceptance that drunken driving is objectionable

CRICOS No. 00213J

Chapter 8: Deterrence of Alcohol-impaired Driving: An Effect in Search of a CauseJohn R. Snortum

• From 1981 to 1985, state legislatures passed 478 new laws amidst rising expectations about the prospects for controlling the alcohol-impaired driver (National Commission Against Drunk Driving 1985).

• Alcohol-impaired driving is highly resistant to social control and the majority of interventions have failed to demonstrate deterrent gains. Short term benefits have been demonstrated by license actions.

• Intensive law enforcement with media support can deliver non-trivial, short term benefits under optimal conditions.

• Random Breath testing in New South Wales appears to have broken “previous endurance records” for deterrence effectiveness.

- Only short term benefits from licence actions, intensive law enforcement with media support

- Random Breath Testing in New South Wales may have longer effect

CRICOS No. 00213J

Chapter 9: The Impact of Insurance and Civil Law Sanctions on Drunk DrivingJames B. Jacobs

• Tort and insurance law covers: Liability for property and personal injuries resulting from

accidents Awarding punitive damages to victims

• Expanding the scope of liability to commercial alcohol dispensers and social hosts is unlikely to have much effect

• If insurance companies perceive a demand for social host liability insurance they will attempt to market it

• Low impact other than on people protecting themselves financially against legal outcomes.

Insurance measures will have low impact

CRICOS No. 00213J

Chapter 10: Programs to Change Individual Behavior: Education and Rehabilitation in the Prevention of Drinking and DrivingRobert E. Mann, Evelyn R. Vingilis, and Kathryn Stewart

• Countermeasure approaches must understand the independent and interactive influences of both personal factors and environmental factors.

• The most effective way to combat a complex social problem like drinking and driving is to introduce a set of complementary person and environment based countermeasures

• Effective social control will make judicious use of both education and rehabilitation, and environment management countermeasures such as stricter laws, random breath testing, alcohol control, improved vehicle and road design.

Effective solutions should use complementary person based (education and rehabilitation) and environment based (RBT) countermeasures.

CRICOS No. 00213J

Chapter 11: The Economic Perspective on Controlling the Drunken DriverHarold L. Votey

• The challenge is not to conduct more tests of the deterrence or control hypothesis, but to improve techniques of benefit-cost assessment before one prescribes the best mix of sanctions

• Alternative sanctions need to be evaluated in a consistent framework in which one can be truly matched against another.

• Methodologies applied to accident modelling would make the calculation of marginal benefits and costs possible.

More benefit-cost research needs to be done on particular policies

CRICOS No. 00213J

Chapter 12: Drinking-Driving Intervention Strategies: A Person-Situation-Behavior FrameworkE. Scott Geller and Galen R. Lehman

• The environmental context within which drinking occurs has received much less attention than the individual drinker and driver as persons.

• Relatively minimal research into the effect of environmental variables (including Beer labels, Low alcohol beer, drinking at bars, Happy hours, size of drinking group, glasses vs. pitchers, servers).

• The role of person variables in excessive drinking and DUI complicates the development of broadly based intervention strategies to control drinking and driving.

Interventions should be targeted to the individual and their personal drinking environment

CRICOS No. 00213J

Chapter 13: Emerging Technologies for Controlling the Drunk DriverRobert B. Voas

• Many self testing devices are unreliable and appear to have limited acceptance

• Recommend in-vehicle testing as more robust

• An alcohol safety Ignition Interlock system must be seriously considered

• The passive sensor can be used by police as a screening tool

• Field sobriety tests have been found to be surprisingly effective (using .10 BAC)

• Field tests of the Electronystagmograph are beginning to measure impairment

• Evidential breath-testing devices have a high level of sophistication and accuracy.

• In- home monitoring being tested and needs evaluation

• Automated License checking and tagging vehicles and drivers should be tested.

- The development and testing of technologies for passive control, detection and monitoring is strongly supported

- Ignition Interlock Systems must be seriously considered.

CRICOS No. 00213J

Key policy initiatives

• Alcohol: No Ordinary Commodity: Research and Public Policy. 2010. Second edition, Oxford University Press.

• Countermeasures that work: a highway safety countermeasure guide for state highway safety offices, NHTSA.

• Shults, RA, Elder, RW, Sleet, DA et al. (2001). Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Health 2001; 21(4s): 66-88.

• WHO (2004). Global Status Report: Alcohol Policy

Economics of Countermeasures

- Insurance measures will have low impact.

- More cost benefit research needs to be done on particular policies.

“Little economic evaluation information was available. Research is warranted”

Shultz et al pg 81

Person or Institutional change

- Challenge the priority of individual person solutions over institutional countermeasures.

- Personal change (reduced drunk driving) may be less effective than vehicular modifications (airbags).

- Challenge the priority of individual person solutions over institutional countermeasures.

- Personal change (reduced drunk driving) may be less effective than vehicular modifications (airbags).

Comparison of countermeasures

• From 1982 – 2001 in the U.S., 153,168 lives were saved by decreased drinking and driving. This is more than the combined numbers of lives saved by increased use of:– Seat belts 129,297– Airbags 4,305– Motorcycle helmets 6,475– Bicycle helmets 239

TOTAL 140,316Extracted from Hingson (2009)

Comprehensive system change

- Effective solutions should use complementary person based and environment based measures.

- Need systems approach and strategies not just tactics.

- Interventions should be targeted to the individual and the drinking environment.

- Effective solutions should use complementary person based and environment based measures.

- Need systems approach and strategies not just tactics.

- Interventions should be targeted to the individual and the drinking environment.

Countermeasures that work (NHTSA, 2007)

Effectiveness:Demonstrated to be effective by several high-quality evaluations with consistent results

Demonstrated to be effective in certain situations

Likely to be effective based on balance of evidence from high-quality evaluations or other sources

Effectiveness still undetermined; different methods of implementing this countermeasure produced different results

Limited or no high-quality evaluation evidence

CRICOS No. 00213J

Countermeasures that work (NHTSA, 2007)

Countermeasure Effectiveness Use Cost Time

Deterrence: Laws

ALR/ALS High High Medium

Open containers High Low Short

High-BAC sanctions Medium Low Short

Alcohol-impaired driving law review Low Medium Medium

BAC test refusal penalties Unknown Low Short

Deterrence: Enforcement

Sobriety checkpoints Medium High Short

Saturation patrols High Medium Short

Preliminary Breath Test devices (PBTs) High Medium Short

Passive alcohol sensors Unknown Medium Short

Integrated enforcement Unknown Low Short

Deterrence: Prosecution and Adjudication

Division/plea agreement restrictions Medium Low Short

Court monitoring Low Low Short

DWI courts Low High Medium

Sanctions Varies Varies Varies

CRICOS No. 00213J

Countermeasures that work (NHTSA, 2007)

Countermeasure Effectiveness Use Cost Time

Deterrence: DWI Offender Treatment, Monitoring and Control

Alcohol problem assessment, treatment High Varies Varies

Alcohol interlocks Medium Medium Medium

Vehicle and license plate sanctions Medium Varies Medium

DWI Offender monitoring Unknown High Varies

Lower BAC limit for repeat offenders Low Low Short

Prevention, Intervention, Communications and Outreach

Alcohol screening and brief interventions Medium Medium Short

Mass-media campaigns High High Medium

Responsible beverage service Medium Medium Medium

Alternative transportation Unknown Medium Short

Designated drivers Medium Low Short

Underage Drinking and Alcohol-Related Driving

Zero-tolerance enforcement Unknown Medium Short

Age 21 enforcement Varies Varies Varies

Youth programs High Varies Medium

School education programs Unknown Low Long

Personal drinking environment

Interventions should be targeted to the individual and their personal drinking

environment

Countermeasure Effectiveness Use Cost Time

Open containers High Low Short

“Open-container laws prohibit the possession of any open alcoholic beverage container and the consumption of any alcoholic beverage by motor vehicle drivers or passengers”

Alcohol Interlocks

- The development and testing of technologies for passive control, detection and monitoring is strongly

supported

- Ignition Interlock Systems must be seriously considered

- The development and testing of technologies for passive control, detection and monitoring is strongly

supported

- Ignition Interlock Systems must be seriously considered

USA Used in majority of states in

varying ways and types of offenders

Canada Mandatory in some jurisdictions and linked

with rehabilitation programs

Europe Used and tested in a large

number of countries

Sweden Mandatory for post conviction, used in vehicle fleets and being investigated as

standard for all vehicles

Australia Mandatory for recidivists in 4 states

CRICOS No. 00213J

Countermeasure Effectiveness Use Cost Time

Alcohol Interlocks Medium Medium Medium

Novice Drivers

Young people being targetedYoung people being targeted

Australia Majority of states

USAMajority of states

Europe A number of countries

Countermeasure Effectiveness Use Cost Time

Graduated Driver Licensing High Medium Long

Graduated Driver Licensing

• Minimum drinking age 18yrs – USA since 1987

• Zero tolerance for novice drivers - Australia and widely established in Europe

BUT• Only 19 of 139 countries with BAC limits have

lower limits for novice drivers

Drinking Age

Countermeasure Effectiveness Use Cost Time

Zero-tolerance enforcement Unknown Medium Short

Age 21 enforcement Varies Varies Varies

Youth programs High Varies Medium

Drink driving “should be eradicated”

• The moral drama (MADD and RID) is the most vital force for change.

• Increase or maintain perception that drunken driving should be eradicated.

• Successful Scandinavian policy based on the “per se” laws and increasing the likelihood of detection.

• Random alcohol tests should be legalized following the Dutch practice.

• Random Breath Testing in New South Wales may have longer effect.

• The moral drama (MADD and RID) is the most vital force for change.

• Increase or maintain perception that drunken driving should be eradicated.

• Successful Scandinavian policy based on the “per se” laws and increasing the likelihood of detection.

• Random alcohol tests should be legalized following the Dutch practice.

• Random Breath Testing in New South Wales may have longer effect.

Percentage of fatally injured motorists with a BAC of .05 or more in Australia (1981-2006)

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 20060

5

10

15

20

25

30

35

40

45

50

4442

40

3739

40

3735

34 3432

2829

2830

2928

2627

2425

28 2826

29 29

Factors most often leading to road crashes: drink driving, 1993 - 2009

Source: Wave Survey 2009

Community perceptions – Australia

%

Australia - last 6 months, 1993 – 2009European countries – last 3 years, 2003

Source: Wave Survey 2009

Exposure to RBT

%NE: 37SE: 41

UK: 9

CRICOS No. 00213J

2004 Global Status Report: Alcohol Policy

CRICOS No. 00213J

2004 Global Status Report: Alcohol PolicyBAC level and RBT

Country Maximum BAC level Use of RBT

Norway 0.2 OFTEN

The Netherlands 0.5 OFTEN

Japan 0.3 SOMETIMES

New Zealand 0.8 SOMETIMES

Australia 0.5 OFTEN

USA - California 0.8 SOMETIMES

CRICOS No. 00213J

Terminology – 2010

Terminology

Drink driving

Drunken driving

DWI

BAC limits

.10

.08

.05

.03

.02

The ongoing challenge

The impact of total alcohol consumption is moderated by acceptance of statutory controls

and acceptance that drunken driving is objectionable

CRICOS No. 00213J

Alcohol in Fatal Crashes (WHO reports – 93 countries)

• In 29% of countries, 30% or more of fatal crashes involved alcohol

• WHO recommends 0.05% legal BAC

• Only half of countries with legal BAC limits have a BAC of 0.05% or lower

Extracted from Hingson (2009)

CRICOS No. 00213J

MV mortality rates by relative alcohol price ranking

MV Mortality

Rates (WHO, 2002)

Price ranking with respect to GDP (WHO, 2004)(alcohol most commonly consumed)

Sp.

US

Fr.Port.

It.

Au.

DKGe.

Cz.

Can.

NRSwz Swe.

Nor.

Ire.

Fin.Ice.

UK

Aust.

NZ

CRICOS No. 00213J

MV mortality rates by relative alcohol price ranking

MV Mortality

Rates (WHO, 2002)

Price ranking with respect to GDP (WHO, 2004)(alcohol most commonly consumed)

Sp.US

Fr.Port.

It.

Au.

DKGe.

Cz.

Can.

NRSwz Swe.

Nor.

Ire.

Fin.Ice.

UK

Aust.

NZ

A new Scandinavia – Japan?

In June 2002:

• BAC went from 0.05% to 0.03%

• Fines went from US$425 to US$4250

• Bartenders and passengers culpable in addition to arrested drivers.

CRICOS No. 00213J

For Johannes AndenaesScholar and Teacher