A Guide for Reducing Alcohol-Related Collisions (2005)

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I-1 SECTION I Summary The Problem Alcohol-impaired driving is among the most common contributors to motor vehicle crashes in the United States. In 2003, 17,013 individuals were killed in a motor vehicle crash in which the driver or other participant had a positive blood alcohol concentration (BAC), and 15,630 of those were above 0.08 percent, which is the legal limit for drivers in all 50 states and the District of Columbia. The 17,013 alcohol-related fatalities represent 40 percent of the 42,643 motor vehicle fatalities that occurred in 2003. Alcohol-related crashes are estimated to cost the public more than $50 billion yearly. Although hundreds of millions of dollars have been spent during the past two decades on efforts to reduce alcohol-impaired driving, the problem has proved frustratingly resistant to change. There were marked declines in alcohol–related crash fatalities from the mid-1980s to the early 1990s; however, there has been little change since that time. Between 1994 and 2003, alcohol-related traffic fatalities have hovered between 16,500 and 17,500 a year (see Exhibit I-1). Although additional progress will be difficult, states can do much to further reduce the size of this problem. 0 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 27,500 2891 3891 4891 5891 6891 7891 8891 9891 0991 1991 2991 1 399 1 499 5991 6991 7991 8991 9991 0002 1002 2002 3002 EXHIBIT I-1 Number of Alcohol-Related Fatalities in the U.S., 1982–2003 Source: NHTSA, 2005

The two fundamental methods to reduce alcohol-related crashes are (1) to reduce excessive drinking through policies and programs to control alcohol sales and inform drinkers of the dangers of excessive drinking and (2) to deter driving while impaired by alcohol. Each method includes several distinct strategies directed at different target populations. The drinking while intoxicated (DWI) criminal justice system of laws, enforcement, prosecution, adjudication, sanctions, and offender monitoring is complex. All elements of this system must function well—both individually and cooperatively—to ensure that DWI offenders are (1) frequently detected, (2) routinely charged, (3) effectively prosecuted, (4) suitably punished when convicted, and (5) appropriately treated for alcohol abuse or dependency. If these enforcement efforts are to have a general deterrent effect on potential impaired drivers, as well as a specific deterrent effect on DWI offenders, the public needs to be regularly made aware of these activities. Strategies designed to prevent impaired driving before it occurs apply to the entire driving population. These are typically referred to as general deterrence strategies. These hold the greatest potential to substantially reduce impaired driving and alcohol-related crashes. Strategies that focus on punishing and rehabilitating individuals who have been arrested for DWI to discourage a repeat of the behavior are known as specific deterrence strategies. Individuals who have been arrested represent a relatively small proportion of the overall drinking-driving problem. To function well, all participating agencies in the DWI control system need readily available, up- to-date information about persons who have been arrested for impaired driving. In addition, these agencies need adequate resources. In view of the huge societal costs created by alcohol- related crashes and the demonstrated cost-efficiency of several countermeasures (NHTSA 2004a; http://www.nhtsa.dot.gov/people/injury/alcohol/impaired-drivingusa/US.pdf), additional resources applied to carefully selected programs are considered by many to be a wise investment of public resources. For further discussion on these issues, see Robertson et al., 2004 (http://www.trafficinjuryresearch.com/publications/pub_details.cfm?intPubID=196). Several specific attributes of the alcohol-related crash problem influence development and selection of prevention strategies. Foremost among these is that the criminal justice system through which impaired driving is largely addressed involves a set of complexly interrelated elements. These elements often don’t function well together; therefore, the system fails to achieve the objective of discouraging impaired driving. In addition, impaired drivers often have an alcohol dependency or abuse problem, which strategies need to address both directly and indirectly. Young drivers have long been recognized as a higher- risk segment of the driving population. The combination of young drivers and alcohol is hence particularly troublesome. When young people drive after drinking, they have a higher crash risk than more experienced drivers, and this fact merits special attention. Finally, one in eight alcohol-related fatalities involves an impaired pedestrian or bicyclist. Although some of the strategies described here may affect these individuals, the focus of this guide is on alcohol-impaired drivers. Objectives and Strategies Exhibit I-2 shows the objectives and strategies identified as the most promising approaches to reduce alcohol-related crashes. SECTION I—SUMMARY I-2

SECTION I—SUMMARY Explanation of Objectives and Strategies This guide discusses four objectives with successively restricted target populations: • Reduce excessive drinking and underage drinking. • Deter driving after drinking through effective DWI law enforcement. • Improve the system for prosecuting, imposing sanctions against, and treating DWI offenders. • Control the most recalcitrant offenders. I-3 EXHIBIT I-2 Objectives and Strategies to Reduce Alcohol-Related Collisions Objectives Strategies 5.1 A—Reduce Excessive 5.1 A1—Increase the State Excise Tax on Beer (T) Drinking and Underage Drinking 5.1 A2—Require Responsible Beverage Service Policies for Alcohol Servers and Retailers (P) 5.1 A3—Conduct Well-Publicized Compliance Checks of Alcohol Retailers to Reduce Sales to Underage Persons (T) 5.1 A4—Employ Screening and Brief Interventions in Health Care Settings (T) 5.1 B—Enforce DWI Laws 5.1 B1—Conduct Regular Well-Publicized DWI Checkpoints (P) 5.1 B2—Enhance DWI Detection Through Special DWI Patrols and Related Traffic Enforcement (T) 5.1 B3—Publicize and Enforce Zero Tolerance Laws for Drivers Under Age 21 (P) 5.1 C—Prosecute, Impose 5.1 C1—Suspend Driver’s License Administratively Upon Arrest (P) Sanctions on, and Treat DWI Offenders 5.1 C2—Establish Stronger Penalties for BAC Test Refusal Than for Test Failure (T) 5.1 C3—Eliminate Diversion Programs and Plea Bargains to Non-Alcohol Offenses (T) 5.1 C4—Screen All Convicted DWI Offenders for Alcohol Problems and Require Treatment When Appropriate (P) 5.1 D—Control High-BAC and 5.1 D1—Seize Vehicles or Vehicle License Plates Administratively Upon Repeat Offenders Arrest (P) 5.1 D2—Require Ignition Interlocks as a Condition for License Reinstatement (P) 5.1 D3—Monitor All Convicted DWI Offenders Closely (P) 5.1 D4—Incarcerate Offenders (P) Note: (P) indicates that a strategy is proven effective. (T) indicates that a strategy has been tried extensively but is not yet proven effective. Further explanation of (T) and (P) appears in Section V.

The strategies within each objective were identified using a two-step process. Potentially useful approaches were first identified through an extensive review of the research literature on programs and policies to reduce alcohol-impaired driving. The most promising strategies were then selected and clarified in consultation with an expert panel composed of experienced researchers and state officials with responsibility for DWI programs. A large number of strategies to reduce alcohol-related crashes have been tried. Many have not been evaluated, and others have shown no benefits when evaluated. The strategies presented here are considered to be the most effective based on results from well-designed evaluation studies and the opinions of top experts in the field. Although these strategies often require state-level action, several of these strategies can also be adapted and productively used in individual communities. Some widely used or commonly advocated approaches are not included because there is no evidence that they reduce alcohol-related collisions and no compelling reason to believe that they could. Given that resources to address behavioral factors that contribute to traffic crashes are severely limited, consideration should be given to directing resources toward implementation, expansion, or enhancement of strategies discussed here and away from approaches not covered by this guide. States where all or most of the included strategies already are in place may wish to consider whether these strategies could be implemented more effectively or more widely throughout the state before turning to other, unproven strategies. To select which strategies will most likely produce the greatest benefit in a given jurisdiction, an important first step is to conduct a careful assessment of the nature of the jurisdiction’s drinking-driving problem and how the DWI countermeasure system is currently functioning. This assessment requires a multidisciplinary team. States frequently use a task force that represents all the key elements of this system. Without such an approach, a fragmented and incomplete understanding of the problem is likely and progress will be difficult. The system for dealing with alcohol-impaired driving may be the most complex and involve the greatest number of disciplines and state agencies of any traffic safety issue. For further discussion of the process for implementing strategies, see Section VI. Reduce Excessive Drinking and Underage Drinking Excessive drinking often leads to alcohol-impaired driving. Drinking habits can be changed. The decreases in alcohol-related crashes during the past two decades have partly resulted from such changes. States can use the strategies within this objective to reduce excessive drinking and subsequent impaired driving. Increase the State Excise Tax on Beer. Studies over the past 20 years repeatedly show that higher beer prices are associated with less drinking and fewer motor vehicle crashes. This holds true for heavier drinkers as well as more typical drinkers. The relationship is somewhat stronger among underage drinkers. States influence beer prices through excise taxes. In most states, the value of this tax has been substantially eroded by inflation since the current rate was established. Require Responsible Beverage Service Policies for Alcohol Servers and Retailers. Prohibiting marketing tactics that encourage excessive consumption and reducing the sale of alcohol to persons who are already impaired can reduce excessive drinking and impairment. Although SECTION I—SUMMARY I-4

SECTION I—SUMMARY alcohol advertising is largely a national-level matter, state alcoholic beverage control laws can address many problematic sales tactics, as well as some kinds of advertising. In addition, laws allowing injured parties to recover damages from licensed establishments (so-called dram shop laws) can encourage alcohol retailers to adopt responsible beverage service policies. Conduct Well-Publicized Compliance Checks of Alcohol Retailers to Reduce Sales to Underage Persons. Responsible beverage service policies generally are effective only when they are adequately enforced. One effective tactic is well-publicized compliance checks, in which underage persons working with law enforcement attempt to purchase alcohol. Employ Screening and Brief Interventions in Health Care Settings. Many persons arrested for DWI have some level of problem controlling their drinking. Alcohol screening to identify individuals with alcohol problems—followed when appropriate by brief, single-session interventions by health care professionals to encourage changes in drinking behavior—has proved to be effective for persons who are not seriously dependent on alcohol. Those who are dependent often require treatment. Enforce DWI Laws DWI law enforcement is critical in controlling impaired driving. The enforcement strategies identified here have been demonstrated to be more effective than other enforcement activities. The goal of all enforcement strategies is to deter persons from driving while impaired by alcohol, not just to arrest and punish impaired drivers. Conduct Regular Well-Publicized DWI Checkpoints. At a DWI checkpoint, law enforcement officers stop cars to determine whether drivers are impaired by alcohol. Regular well- publicized checkpoints may be the single most effective strategy for deterring impaired driving. Highly visible and well-publicized checkpoints help convince the public that impaired drivers are likely to be arrested and punished. Enhance DWI Detection Through Special DWI Patrols and Related Traffic Enforcement. Checkpoints operate only at specific times and locations. By highlighting DWI in all traffic enforcement activities, officers continually reinforce the message that impaired drivers will be stopped and arrested. Checking for alcohol impairment among persons stopped for speeding or seatbelt violations is particularly important since drinking drivers often speed and fail to buckle up. Publicize and Enforce Zero Tolerance Laws for Drivers under Age 21. All states prohibit persons under 21 from driving after drinking any detectable amount of alcohol, although for technical reasons this is sometimes reflected by a legal BAC limit of 0.01 or 0.02 rather than zero. In many jurisdictions, these laws are not well understood and are not enforced. In several states, provisions of the law create unnecessary barriers to enforcement. Removing any such barriers, actively enforcing the law, and publicizing both the law and the enforcement activities can discourage driving after drinking by underage persons. Prosecute, Impose Sanctions on, and Treat DWI Offenders DWI laws and enforcement are empty threats without effective prosecution, adjudication, and punishment for offenders. The consequences should be swift, certain, and appropriately severe. Swiftness and certainty are more important than severity. The strategies within this I-5

objective will help states increase the swiftness and certainty of DWI offender punishment. In addition, because many drinking drivers have an uncontrolled problem with drinking, it is important to identify those individuals and to ensure that they complete treatment for the problem before they are allowed to regain unrestricted driving privileges. Suspend Driver’s License Administratively Upon Arrest. A critical feature of laws that are widely heeded is the perception that punishment for a violation is likely and will occur quickly. However, DWI laws often result in substantial delays and frequently allow individuals to escape punishment altogether despite their guilt. To provide quick and certain consequences, most states also administratively suspend the driver’s license of a person arrested for DWI. The effectiveness of administrative license suspension in reducing impaired driving is well documented. Establish Stronger Penalties for BAC Test Refusal Than for Test Failure. As part of the driving privilege, implied consent laws require individuals to provide a breath or blood test upon the request of an officer who has reason to believe a driver has been drinking. In states where the penalty for test refusal is less than the penalty for a DWI conviction, many drivers refuse the test. Without a BAC test result, achieving a DWI conviction often is more difficult. Eliminate Diversion Programs and Plea Bargains to Non-Alcohol Offenses. To reduce demands on overloaded prosecutors and judges, DWI charges are often dropped in exchange for guilty pleas to lesser charges. In other instances, drivers who complete an alcohol education or community service program have their DWI conviction removed from their record (in so called “diversion” programs). Both practices undermine the integrity of DWI countermeasure systems by allowing individuals to escape appropriate punishment and preventing states from identifying and treating multiple offenders more seriously. Screen All Convicted DWI Offenders for Alcohol Problems and Require Treatment When Appropriate. Many persons arrested for DWI have driven while impaired many times and have some problem controlling their drinking. These individuals often need professional treatment. The DWI arrest provides an opportunity to determine if alcohol treatment is needed. When it is, the court’s control over convicted offenders can provide the incentive these individuals need to complete the full treatment requirements. Control High-BAC and Repeat Offenders Some individuals drive repeatedly while impaired by alcohol in spite of the threat of being arrested and punished. Many of them have been convicted of DWI more than once; many have a very high BAC at their first arrest. The strategies within this objective provide methods to control their drinking and driving behavior. Seize Vehicles or Vehicle License Plates Administratively Upon Arrest. Many persons whose driver’s license has been suspended or revoked continue to drive. The next step to stop their driving is to apply measures to their vehicles by taking the license plate or by immobilizing or impounding the vehicle. These procedures are generally quite effective when applied, but courts rarely use them. They are more effective when applied administratively by the motor vehicle licensing agency. Require Ignition Interlocks as a Condition for License Reinstatement. An alcohol interlock prevents a vehicle from being started if the driver has been drinking. Interlocks allow DWI SECTION I—SUMMARY I-6

SECTION I—SUMMARY offenders to resume driving after a period of license suspension or revocation but prevent the offender from driving after drinking. Interlock effectiveness is well documented. Monitor All Convicted DWI Offenders Closely. Many convicted DWI offenders fail to comply with conditions of their sentences such as alcohol treatment requirements and prohibitions on driving. This failure to comply with sentences is particularly common when offenders are not monitored closely. Methods to monitor offenders closely include intensive supervision probation, home confinement with electronic monitoring, specialized DWI/drug courts, and dedicated detention facilities. Incarcerate Offenders. Although this strategy is far too costly to be used widely, incarcerating recalcitrant offenders, as a matter of last resort, will prevent these individuals from driving while impaired. More importantly, the ultimate threat of incarceration can serve as the key to encouraging individuals to comply with a variety of less restrictive mandates to stop driving while impaired. I-7