Traffic crashes are the cause of more fatal and debilitating traumatic injuries than any other modern activity in the United States, and today few are blind to the fact that alcohol-impaired drivers pose a significant risk to themselves and others. The deaths and injuries that drunk driving causes are frequently inflicted upon innocent victims; as there is no justification for drunk driving, these are particularly pointless and tragic occurrences. But broad recognition of the problems drunk drivers cause has not led to an easy crafting of effective strategies to combat them; indeed, the path remains contentious. Even fundamental issues, such as defining the term drunk driving, spark sometimes-heated battles among researchers, activists, industry, and the government. Nonetheless, great strides have occurred in preventing deaths from drunk driving. Of concern, though, is the apparent recent stall in the decline in drunk driving and the identification of tools for further prevention success.
Drunk driving is the act of driving after being impaired by alcohol, placing the driver at a higher risk of crashing than normal, given the same driving conditions. This is a more general term than a legal definition, which requires impairment to be identifiable by an enforcement officer, or a per se definition of driving under the influence (DUI) based on a specific blood alcohol concentration (BAC). States vary in their definitions of DUI and driving while impaired (DWI). Further, the U.S. National Highway Traffic Safety Administration (NHTSA) uses the term alcohol related to mean a crash that occurs where at least one driver, pedestrian, or pedalcyclist has a BAC greater than or equal to .01 (g/dL). To avoid confusion, statistics in this entry include the terms and definitions of the statistic’s source.
The NHTSA compiles alcohol-related traffic fatalities within a database, the Fatality Analysis Reporting System (FARS), formerly known as the Fatal Accident Reporting System. FARS is a valuable resource for understanding the prevalence of drunk driving within the United States. Each state reports to this system its fatal road crashes, along with important details about the drivers, other vehicle occupants, the vehicles, and the crash itself. Included within the driver data set are the results of any alcohol level testing. The NHTSA uses an imputing scheme to replace missing data from states’ reports.
According to the NHTSA analysis, in 2005, 16,885 fatalities stemmed from alcohol-related crashes. Most of these crashes (85.3 percent) involved drivers whose BAC was .08 (g/dL) or greater. In fact, more than half of the crashes (57.6 percent) involved a driver with a BAC of .15 (g/dL) or greater. Relative to their risk of being in any fatal crash, males and those between ages 20 and 39 are at a disproportionate risk of being in an alcohol-related fatal crash. Motorcyclists are also disproportionately involved in alcohol-related crashes.
Alcohol is usually absorbed quickly through the stomach and intestines and thus enters the bloodstream within 20 minutes of consumption. Food in the stomach acts to slow this absorption. The concentration of alcohol within the blood is usually measured in the proportion of grams of alcohol per deciliter of blood (g/dL). This fraction is often referred to as blood alcohol concentration (BAC). A number of formulas can estimate the resulting BAC from the consumption of varying amounts of alcohol. The actual attained BAC that results from consumption is a function of the drinker’s physiology (including weight and sex), the quantity of alcohol consumed, and the time over which the consumption occurred. Time plays two roles: latency of absorption and time that it takes for removal of the alcohol by the liver.
In 2000, the U.S. Congress mandated that states adopt a legal limit of BAC 0.08 g/dL. Since then, all states have adopted this standard, many lowering it from their previous limit of BAC 0.10 g/dL. Also, mandatory “zero tolerance” laws now make it illegal for drivers under age 21 to have virtually any BAC at all.
The amount of impairment alcohol causes is directly related to the BAC, though people differ with respect to the concentration needed to observe particular impairments. The effects of low BAC levels (below .04 g/dL) are difficult to observe without baseline performance assessments. Generally, these impairments involve attentive and cognitive functions. Such impairments, while mild, may account for some of the increased risk of crashes such BAC levels appear to produce, as driving is a behavior that requires the ability to divide one’s attention among a number of important tasks.
At moderate BACs (.05 to .08 g/dL), cognitive impairments become more pronounced, affecting not only attention but judgment. Some drinkers experience gross motor impairment at this level too. Above a BAC of .08 g/dL, gross motor coordination problems are usually observable. Perceptual impairments may also be present as attentiveness impairments become severe. Judgment becomes impaired as cognitive effort becomes too great to consider multiple alternative choices within the decision process.
An innovative research protocol, known as the Grand Rapids Study, estimated the increased risk associated with various BAC levels. Breath alcohol tests were conducted on drivers who matched accident-involved drivers on environmental exposure to road conditions. Thus the researchers were able to control for a variety of external factors related to the crashes and estimate the role of alcohol. Their data showed that as measured BACs rose above .04 g/dL, a clear increase in accident involvement risk emerged and rose exponentially. Looking at accident causation, by BAC .10 g/dL the relative probability of causing an accident was estimated at more than 5 times greater than having a BAC 0.0 g/dL. By BAC .16 g/dL, the probability increases by a multiple of 35. The stark results of this seminal study have been credited for spurring the adoption of laws regarding BAC levels in the United States.
Recognition of the Problem
Concerns about drunk driving date back to the introduction of the automobile. Early 20th-century temperance movement literature mentions drunk driving as a justification for avoiding alcohol. One 1917 temperance publication lauded the American Automobile
Association’s contest board policy of prohibiting the use of alcohol among “drivers, mechanicians [sic] and officials of races.” It laments, however, that alcohol was still sold to spectators, indicating that the American Automobile Association’s policy reflected a driving-related safety concern and not a general affinity for the temperance cause. At the end of Prohibition, temperance movements again raised the issue of drunk driving concurrently with other social ills associated with alcohol. The Kansas United Dry Forces produced poster stamps with messages like “Death rides the highway” and “Alcohol belongs in the radiator” in 1939. An early anti-drunk driving poster commissioned by the WPA Federal Arts Project in 1937 depicted a skull, whiskey bottle, and gas pump with the caption reading “DON’T MIX ‘EM.”
Although early research pointed out the inherent hazards of drunk driving and government-funded anti-drunk driving programs had been around for decades, there was little advocacy for a collective approach to the problem. That changed with the founding of Mothers Against Drunk Driving (MADD) in 1980. Candy Lightner, whose daughter Cari was killed by a drunk driver, launched the organization after encountering mostly indifference from state officials about the issue. That indifference launched a quickly growing sense of outrage spurred by MADD, as it rapidly became a national organization. Lightner’s effective use of television news events is credited for bringing the staggering statistics of the true impact of drunk driving into the social consciousness and changing the perception of the nature of drunk driving.
The Drunk Driver
Drunk driving cuts across all racial, ethnic, age, and socioeconomic categories. It is a crime that a substantial proportion of the U.S. population commits at least occasionally. However, certain risk patterns remain fairly consistent. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), female drivers 21 and over are less likely than their male counterparts to report having driven under the influence within the past year (11.4 percent vs. 22.0 percent respectively; SAMHSA). The prevalence generally declines with age, though reporting of ages within most studies tends to group ages into broad categories, making it difficult to be certain that the decline is linear. Both the National Survey on Drug Use and
Health (NSDUH) and the FARS data show declines with age, though the NSDUH data on self-reported DUI (SAMHSA) appear to show a steeper slope than the FARS crash data (NHTSA). Native American drivers and non-Hispanic white drivers report the highest rates of driving under the influence (SAMHSA).
Though most incidents of drunk driving do not end in either a crash or an arrest, when they do, it is often a wake-up call for the driver to modify his or her behavior. However, a substantial proportion of DUI arrests are for drivers who have already been arrested at least once before. This recurrence of arrests indicates that drunk driving behavior has a persistence that some drivers find difficult to break. In fact, over half of one sample of interviewed DUI offenders admitted to driving under the influence again during the penalty phase of their DUI convictions.
- Kelly, Erin, Shane Darke, and Joanne Ross. 2004. “A Review of Drug Use and Driving: Epidemiology, Impairment, Risk Factors and Risk Perception.” Drug and Alcohol Review 23:319-44.
- Moskowitz, Herbert. 1973. “Laboratory Studies of the Effects of Alcohol on Some Variables Related to Driving.” Journal of Safety Research 5:185-99.
- Ross, H. Laurence. 1982. Deterring the Drinking Driver: Legal Policy and Social Control. Lexington, MA: Lexington Books.
- Williams, Allan F. 2006. “Alcohol-Impaired Driving and Its Consequences in the United States: The Past 25 Years.” Journal of Safety Research 37:123-38.
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