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CRICOS No. 00213JProfessor Mary Sheehan AOICADTS, T2010, Oslo, August 24, 2010.Social Control of the Drinking DriverAcknowledgementsCARRS-Q team members:Professor Vic Siskind, StatisticianRebekah Chapman, NHMRC PhD ScholarDr Lisa Buckley, Postdoctoral FellowNicole 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

3CRICOS No. 00213JTerminologyTerminology - 1988Drinking-drivingDrunken drivingDrunk drivingDWI (driving while intoxicated)DUI (driving under the influence)Alcohol-impaired driving4CRICOS No. 00213J

Chapter 1: The Alcohol-Crash ProblemAlan C. DonelsonDeterrent-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

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Chapter 2: The Scandinavian ExperienceJohannes Andens 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.

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Chapter 3: Deterrence-based Policies in Britain, Canada and AustraliaH. Laurence Ross [the devils 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 halfIf 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).

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Chapter 4: Drinking-and-Driving Laws in the Federal Republic of Germany and the NetherlandsGunter KrojChanging 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 campaignsThe Dutch practice of random alcohol tests should be legalized in Germany.The Dutch practice of random alcohol tests should be legalized

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Chapter 5: The Control of Drinking-Driving in the United States: A Period in Transition?Joseph R. GusfieldCurrent period [70s-80s] 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 importantYoung people have status as a dangerous class in Americaand 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

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Chapter 6: The Legal Context in the United StatesMichael D. LaurenceTwo unique influences on drunken driving countermeasures:US Federal systemBill of RightsNational perception that drunken driving should be eradicated and the response reflects these two influencesIn 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

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

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

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Chapter 9: The Impact of Insurance and Civil Law Sanctions on Drunk DrivingJames B. JacobsTort and insurance law covers:Liability for property and personal injuries resulting from accidentsAwarding punitive damages to victimsExpanding the scope of liability to commercial alcohol dispensers and social hosts is unlikely to have much effectIf insurance companies perceive a demand for social host liability insurance they will attempt to market itLow impact other than on people protecting themselves financially against legal outcomes.Insurance measures will have low impact

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

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

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

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Chapter 13: Emerging Technologies for Controlling the Drunk DriverRobert B. VoasMany self testing devices are unreliable and appear to have limited acceptanceRecommend 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 evaluationAutomated 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.

17CRICOS No. 00213JKey policy initiativesAlcohol: 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

18Economics 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 warrantedShultz et al pg 81Person 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).

Comparison of countermeasuresFrom 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 belts129,297Airbags 4,305Motorcycle helmets 6,475Bicycle 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.

Countermeasures that work (NHTSA, 2007)Effectiveness:Demonstrated to be effective by several high-quality evaluations with consistent resultsDemonstrated to be effective in certain situationsLikely to be effective based on balance of evidence from high-quality evaluations or other sourcesEffectiveness still undetermined; different methods of implementing this countermeasure produced different resultsLimited or no high-quality evaluation evidence23CRICOS No. 00213JCountermeasures that work (NHTSA, 2007)CountermeasureEffectivenessUseCostTimeDeterrence: Laws ALR/ALSHighHighMedium Open containersHighLowShort High-BAC sanctionsMediumLowShort Alcohol-impaired driving law reviewLowMediumMedium BAC test refusal penaltiesUnknownLowShortDeterrence: Enforcement Sobriety checkpointsMediumHighShort Saturation patrolsHighMediumShort Preliminary Breath Test devices (PBTs)HighMediumShort Passive alcohol sensorsUnknownMediumShort Integrated enforcementUnknownLowShortDeterrence: Prosecution and Adjudication Division/plea agreement restrictionsMediumLowShort Court monitoringLowLowShort DWI courtsLowHighMedium SanctionsVariesVariesVaries24CRICOS No. 00213JCountermeasures that work (NHTSA, 2007)CountermeasureEffectivenessUseCostTimeDeterrence: DWI Offender Treatment, Monitoring and Control Alcohol problem assessment, treatmentHighVariesVaries Alcohol interlocksMediumMediumMedium Vehicle and license plate sanctionsMediumVariesMedium DWI Offender monitoringUnknownHighVaries Lower BAC limit for repeat offendersLowLowShortPrevention, Intervention, Communications and Outreach Alcohol screening and brief interventionsMediumMediumShort Mass-media campaignsHighHighMedium Responsible beverage serviceMediumMediumMedium Alternative transportationUnknownMediumShort Designated driversMediumLowShortUnderage Drinking and Alcohol-Related Driving Zero-tolerance enforcementUnknownMediumShort Age 21 enforcementVariesVariesVaries Youth programsHighVariesMedium School education programsUnknownLowLong25Personal drinking environmentInterventions should be targeted to the individual and their personal drinking environment

CountermeasureEffectivenessUseCostTime Open containersHighLowShortOpen-container laws prohibit the possession of any open alcoholic beverage container and the consumption of any alcoholic beverage by motor vehicle drivers or passengersAlcohol Interlocks- 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 offendersCanadaMandatory in some jurisdictions and linked with rehabilitation programsEurope Used and tested in a large number of countriesSweden Mandatory for post conviction, used in vehicle fleets and being investigated as standard for all vehiclesAustralia Mandatory for recidivists in 4 states CRICOS No. 00213JCountermeasureEffectivenessUseCostTime Alcohol InterlocksMediumMediumMediumNovice DriversYoung people being targeted

AustraliaMajority of statesUSAMajority of states EuropeA number of countries

CountermeasureEffectivenessUseCostTime Graduated Driver LicensingHighMediumLongGraduated Driver LicensingMinimum drinking age 18yrs USA since 1987 Zero tolerance for novice drivers - Australia and widely established in Europe BUTOnly 19 of 139 countries with BAC limits have lower limits for novice driversDrinking AgeCountermeasureEffectivenessUseCostTime Zero-tolerance enforcementUnknownMediumShort Age 21 enforcementVariesVariesVaries Youth programsHighVariesMediumDrink driving should be eradicatedThe 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) Factors most often leading to road crashes: drink driving, 1993 - 2009Source: Wave Survey 2009Community perceptions Australia

%Australia - last 6 months, 1993 2009European countries last 3 years, 2003Source: Wave Survey 2009Exposure to RBT

%NE: 37SE: 41UK: 9CRICOS No. 00213J2004 Global Status Report: Alcohol Policy

36CRICOS No. 00213J2004 Global Status Report: Alcohol PolicyBAC level and RBTCountryMaximum BAC levelUse of RBTNorway0.2OFTENThe Netherlands0.5OFTENJapan0.3SOMETIMESNew Zealand0.8SOMETIMESAustralia0.5OFTENUSA - California0.8SOMETIMES

37CRICOS No. 00213JTerminology 2010 TerminologyDrink drivingDrunken drivingDWIBAC limits.10.08.05.03.0238The ongoing challengeThe impact of total alcohol consumption is moderated by acceptance of statutory controls and acceptance that drunken driving is objectionable

CRICOS No. 00213JAlcohol 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)40CRICOS No. 00213J

MV mortality rates by relative alcohol price rankingMV Mortality Rates (WHO, 2002)Price ranking with respect to GDP (WHO, 2004)(alcohol most commonly consumed)Sp.USFr.Port.It.Au.DKGe.Cz.Can.NRSwzSwe.Nor.Ire.Fin.Ice.UKAust.NZ41CRICOS No. 00213J

MV mortality rates by relative alcohol price rankingMV Mortality Rates (WHO, 2002)Price ranking with respect to GDP (WHO, 2004)(alcohol most commonly consumed)Sp.USFr.Port.It.Au.DKGe.Cz.Can.NRSwzSwe.Nor.Ire.Fin.Ice.UKAust.NZ42A 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 Teacher44Chart1645055575454545252445048524851

Series 1

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Seen RBT activity (Australia)Been tested (Australia)

Sheet1Column1Seen RBT activity (Australia)Been tested (Australia)Series 31993612021995621721996672031997702551998702619997026200071262001702520027427200375302004782920057632200674282008752720097528To resize chart data range, drag lower right corner of range.

Chart19.88.29.18.87.813.78.57.29.611.86.96.27.21414.35.85.66.4158.312.5

Jap.Y-Values

Sheet1X-ValuesY-Valuesaustria49.8canada108.2czech rep99.1denmark78.8finland217.8france313.7germany88.5iceland237.2ireland209.6italy1111.8japan86.9nethland36.2norway147.2potugal814spain114.3sweden135.8switzland95.6UK266.4USA215australia168.3NZ2212.5

Chart19.88.29.18.87.813.78.57.29.611.86.96.27.21414.35.85.66.4158.312.5

Jap.Y-Values

Sheet1X-ValuesY-Valuesaustria49.8canada108.2czech rep99.1denmark78.8finland217.8france313.7germany88.5iceland237.2ireland209.6italy1111.8japan86.9nethland36.2norway147.2potugal814spain114.3sweden135.8switzland95.6UK266.4USA215australia168.3NZ2212.5