Getting to Zero

Alcohol-Impaired
Driving Fatalities

There is strong, direct evidence that increasing alcohol prices and taxes reduces binge drinking and deaths from drinking and driving. Yet alcohol taxes have eroded over time in inflation-adjusted terms at both federal and state levels.

Alcohol taxes should be raised significantly enough that they have a meaningful impact on price and thus on reducing alcohol-related crash fatalities. In 2017, federal alcohol taxes were decreased by 16%.

Research suggests that doubling alcohol taxes would lead to an 11 percent reduction in traffic crash deaths.

Currently, alcohol taxes average about 11 cents per standard drink, and the costs attributable to alcohol-related harms amount to approximately $2 per standard drink.

Policies to address physical availability of alcohol, such as reducing hours and days of sale or limiting the number of alcohol sales points in an area, are tied to reducing excessive drinking and related harms.

Beyond the laws currently in place, policies that minimize the illegal sale of alcohol to people under age 21 and already-intoxicated people help reduce excessive drinking before driving.

Opportunities include:

• strong penalties for violating existing laws;
• dram shop liability laws without caps (permitting legal action against commercial establishments that sell alcohol illegally);
• high-quality, mandatory responsible beverage service training;
• strong social host laws (assigning liability for providing alcohol to someone under age 21 or an obviously intoxicated adult if damages or injuries occur as a result); and
• collection of place-of-last-drink data.

Young people are at higher risk of alcohol-impaired driving, and they are influenced by alcohol marketing. Studies have found the alcohol industry’s self-regulation of its marketing to be ineffective and insufficient.

Most states set the blood alcohol concentration (BAC) limit at 0.08%. Yet a person’s ability to drive a car begins to deteriorate at BAC levels well below 0.05%, increasing a driver’s risk of being in a crash. Data from other countries that have decreased their BAC levels to 0.05% suggest that this is an effective policy intervention.

A change to this law would have the greatest potential impact on those at the highest risk of alcohol-impaired traffic fatalities. The benefits are optimized when accompanied by high-visibility enforcement, sobriety checkpoints, and publicity.

Alcohol-impaired drivers are less likely to use seatbelts than non-impaired drivers.

Given the low rates of seat belt use and high rates of crashes in rural areas, universal adoption of primary seat belt laws for all occupants and child restraints, combined with enhanced enforcement, could reduce alcohol-related crash injuries and fatalities particularly in these high risk areas.

Having an ignition interlock device—breath alcohol analyzers connected to the ignition system of a vehicle—installed in a car reduces repeat offenses and risk of crashes.

States that have passed all-offender ignition interlock laws have seen reductions in deaths from drinking and driving. A minimum monitoring period of two years is effective for a first offense; four years for a second offense.

Administrative license suspension and revocation (ALS/ALR) laws are swift and certain: The consequences immediately follow the offending behavior, rather than following a conviction. Penalties include having a license suspended or revoked for refusing or failing a BAC test.

These laws have effects on the general public and drivers with prior DWI offenses, and they can reduce crashes and convictions from drinking and driving.

There is considerable variation in how alcohol-impaired driving laws and policies are implemented across states. Given the lack of progress over the last decade in reducing fatalities, a more uniform approach and best practices are needed.

Model legislation would allow states to adopt or update effective policies or laws based on the best available evidence. Such legislation could also inform stakeholder groups such as community coalitions, which often lack the technical expertise to develop such legislation.

The effectiveness of alcohol-related policies is hampered if sufficient alcohol law enforcement activities are not in place. A systematic approach could include:

• increased resources;
• data collection and sharing;
• multisector collaboration; and
• publicity.

Sobriety checkpoints aim to identify and arrest alcohol-impaired drivers—and they increase the perceived risk of arrest for driving while impaired.

Publicized sobriety checkpoint programs have been shown to reduce alcohol-impaired driving fatalities in both urban and rural areas.

There is a need for systematic and continuing training for the various professionals involved in:

• detecting
• prosecuting
• adjudicating
• monitoring
• assessing
• and treating

DWI offenders.

DWI courts combine comprehensive monitoring and substance abuse treatment to hold DWI offenders accountable for their actions and change their behavior by treating the underlying causes of impaired driving.

DWI courts can provide effective oversight for high-rate recidivists and high BAC offenders. Traditional court processes and sanctions are generally not effective in influencing the behavior of offenders with multiple DWIs.

When the record of an alcohol-impaired driving offense is erased or reduced through participating in a diversion program—usually an education or treatment program—or through plea agreements, the severity of consequences is reduced and it is more difficult to identify those who reoffend.

There is a need for research on restrictions to these programs as approaches to decrease DWI recidivism.

Systems alcohol monitoring programs have been shown to be effective in reducing alcohol use and recidivism among high-risk offenders, particularly in rural areas.

There is a need for systematic and continuing training for the various professionals involved in:

• detecting
• prosecuting
• adjudicating
• monitoring
• assessing
• and treating

DWI offenders.

Breath-testing and transdermal alcohol monitoring devices are increasingly being marketed to consumers. For this reason, there is a need for peer-reviewed, objective evidence to verify their accuracy—including research into unintended consequences—before widespread adoption.

Although personal breath-testing devices have existed since the 1980s, little is known about who uses them, how accurate they are, and how they affect public health.

DADSS, or Driver Alcohol Detection System for Safety, is a passive alcohol detection system built into vehicles that can stop a vehicle from starting if the driver is detected of having a BAC over the limit set by state law.

DADSS has gained strong public support and endorsement from various sectors and has the potential to reduce alcohol-related traffic fatalities once the cost is on par with other vehicle safety features and the technology is accurate.

Once this is achieved, auto insurers should provide policy discounts to stimulate adoption of DADSS, and NHTSA should make the technology mandatory in all vehicles.

Having an ignition interlock device—breath alcohol analyzers connected to the ignition system of a vehicle—installed in a car reduces repeat offenses and risk of crashes.

States that have passed all-offender ignition interlock laws have seen reductions in deaths from drinking and driving. A minimum monitoring period of two years is effective for a first offense; four years for a second offense.

A DWI arrest or hospital admission for an alcohol-impaired driving injury is an opportunity to screen and treat people who engage in hazardous drinking and driving.

An offender should be evaluated by an addiction-trained clinician and if appropriate, offered treatment with relapse-prevention medication and cognitive behavioral therapy.

Integrating response and care services and linking data are key components in reducing alcohol-impaired driving fatalities, particularly in rural and tribal areas.

Yet the United States lacks a coordinated and continuous learning trauma care system.

There is a need for systematic and continuing training for the various professionals involved in:

• detecting
• prosecuting
• adjudicating
• monitoring
• assessing
• and treating

DWI offenders.

Young people are at higher risk of alcohol-impaired driving, and they are highly influenced by alcohol marketing. Studies have found the alcohol industry’s self-regulation of its marketing to be ineffective and insufficient.

In fact, alcohol brands most likely to be consumed by young people are more likely than any other brands to advertise in magazines with high youth readerships.

When well-funded and informed by rigorous formative research and behavior change theories, media campaigns are an important component of alcohol-impaired driving interventions, such as sobriety checkpoints and new BAC laws.

Media campaigns paired with increased enforcement work and are cost-effective interventions to reduce alcohol-impaired driving and related crash fatalities.

Providing access to convenient, affordable, and safe alternative transportation options for people who drink alcohol appears to hold promise to reduce alcohol-impaired driving.

Municipalities should permit transportation network company ridesharing, enhance public transportation options (especially during nighttime and weekend hours), and boost or incentivize transportation alternatives in rural areas.

Having a comprehensive understanding of alcohol-impaired driving is vital to create specific and targeted interventions. This includes knowing more about rates of occurrence, traffic crashes, injuries, fatalities, arrests, and convictions, as well as why people drive impaired. For example, collecting information about the last place a person had a drink before an alcohol-impaired driving arrest or crash would shine a light on problem establishments or high-risk drinking locations.

A user-friendly metrics dashboard should integrate analyzed and linked data from the many different stakeholders that play a role in reducing alcohol-impaired driving fatalities. This would allow those groups to continue timely and actionable alcohol-impaired driving surveillance.

The Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), whose members are representatives from 15 federal agencies, is an example of a multi-stakeholder group that has successfully formulated action plans and strategies. ICCPUD continues to be active in efforts to reduce and prevent underage drinking, producing mandated annual reports to Congress and generating other initiatives involving all member federal agencies.

There is a need to identify data elements and sources required to monitor changes in rates of alcohol-impaired driving risk factors, arrests, crashes, and fatalities, as well as to inform quarterly metrics and reports to communicate findings in a visually appealing way about these changes and interventions to policymakers, the public, and other stakeholders.

Well-aimed seed funding at the community level has the potential to produce effective and innovative solutions, as in the success of Mothers Against Drunk Driving (MADD) with some support from the National Highway Traffic Safety Administration.

To ensure a comprehensive approach, input and collaboration from multiple sectors is needed. Specifically, coordination and cooperation across federal agencies will be an important element in making the best use of limited resources. A federal interagency coordinating committee could include:

• U.S. Department of Health and Human Services—Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Indian Health Service, National Institutes of Health;
• Alcohol and Tobacco Tax and Trade Bureau;
• U.S. Department of Transportation—National Highway Traffic Safety Administration, Federal Highway Administration;
• U.S. Department of Homeland Security (emergency services sector);
• U.S. Department of Justice;
• U.S. Department of Defense; and
• U.S. Department of Veterans Affairs.

The HealthyPeople 2020 baseline and target objectives for alcohol-related deaths per 100 million vehicle miles traveled were 0.39 and 0.38, respectively. Based on the stagnation in progress to reduce alcohol-impaired driving fatalities, and the growing movement towards zero deaths in the traffic safety community, a more ambitious target is needed.