Getting to Zero Alcohol-Impaired Driving Fatalities A Comprehensive Approach to a Persistent Problem (2018) / Chapter Skim
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The committee's recommendations include increasing alcohol excise taxes, lowering state per se laws for alcohol-impaired driving to 0.05% blood alcohol concentration (BAC) , preventing illegal alcohol sales to underage persons and to already-intoxicated adults, strengthening regulation of alcohol marketing, and implementing policies to reduce the physical availability of alcohol.
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The report also offers conclusions about what should be done to improve important existing interventions such as administrative license suspension/revocation laws; professional education for the judiciary, law enforcement, and health professionals; limits on diversion programs and plea agreements; and universal primary seatbelt laws. The committee suggests ways to ensure that these policies will have maximum impact -- for instance, that the National Conference of State Legislatures update and develop model legislation for the effective policies identified in this report to give states benchmarks for progress.
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This report presents these interventions and opportunities. To accelerate progress to reduce alcohol-impaired driving fatalities, the National Highway Traffic Safety Administration (NHTSA)
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Fell and Voas estimated that from 1982 to 2001 these actions saved more than 300,000 lives. Although much progress has been made as states passed and implemented policies, these heterogeneous policies lacked benchmarks and BOX S-2 Statement of Task for the Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities The National Highway Traffic Safety Administration requests that the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine convene a committee to examine • hich interventions (programs, systems, and policies)
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Reducing alcohol-impaired driving injuries and fatalities is difficult to separate from the broader public health rationale for reducing excessive alcohol consumption since drinking is the precursor for alcohol-impaired driving. In particular, while recognizing that many people enjoy alcohol responsibly, the committee believes that the evidence shows that placing some limits on the alcohol environment is warranted by the public health and safety benefits of decreasing alcoholrelated driving deaths.
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The Haddon Matrix paradigm provides an important organization to the many inputs to address alcohol-impaired driving crashes, and the committee's conceptual framework grows from that approach.
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With this in mind, the committee examined the available literature on alcohol-impaired driving interventions that target alcohol consumption, drinking to impairment, driving while impaired, and the postcrash and/or postarrest phase. The committee was not charged with undertaking a systematic review of the evidence, but rather to identify which interventions are most promising to prevent alcohol-impaired driving injuries and fatalities given the current state of knowledge and environment.
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, the Federal Motor Carrier Safety Administration, the Federal Highway Administration, and the National Safety Council launched the Road to Zero coalition in 2016 with the bold goal to end all traffic fatalities within 30 years. The Road to Zero is consistent with the goals of Vision Zero -- a philosophical approach to road safety that was crafted in the 1990s and adopted in Sweden in 1997.
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These partners include government agencies, car manufacturers, auto insurers, advocacy organizations, state and local public health agencies, technology companies, health care systems, clinicians, employers, alcohol retailers, wholesale distributors, alcohol producers, the hospitality industry, and law enforcement. Importantly, the public itself can also directly participate in preventing alcoholimpaired driving through participation in Vision Zero.
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.b Thus, in the United States, any crash involving one or more drivers with a BAC of 0.08% or higher is typically referred to by NHTSA as an alcohol-impaired driving crash, and fatalities stemming from those crashes are defined as alcohol-impaired driving crash fatalities. Of note, however, is that impairment begins below 0.08%, so this is an underestimate rela tive to all crash fatalities in which impairment from alcohol may have contributed.c Alcohol-related crash/fatality -- A crash or a fatality from a crash that involves one or more drivers of a motor vehicle with any alcohol in their system (i.e., a BAC greater than 0.00%)
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Conclusion 2-2: Policies to reduce binge drinking are also protective against alcohol-impaired driving, and the adoption of a comprehensive set of effective interventions and population-based strategies that take advantage of synergies across interventions would further help to reduce binge drinking and related harms. The lack of a comprehensive population-based strategy may partly explain why the proportion of crash fatalities that are alcohol related has not declined in the last decade and has begun to increase.
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policy for reducing binge drinking, and strong direct evidence shows that higher alcohol taxes reduce alcohol-impaired driving and motor vehicle crash fatalities. For example, there is research suggesting that a doubling of alcohol taxes would lead to an 11 percent reduction in traffic crash deaths.
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In addition, states could consider reducing or eliminating alcohol sales concurrent with driving, such as sales at drive-through retailers or gas stations, as a common sense measure. Policies to Reduce Illegal Sales of Alcohol and Strengthen Enforcement To reduce excessive alcohol consumption prior to driving, at the population level, there is a need for a comprehensive set of policies that
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Alcohol Advertising and Marketing Given that young people are at higher risk of alcohol-impaired driving, that the evidence is substantial that they are influenced by alcohol marketing, and that numerous studies have found the alcohol industry's self-regulation of its marketing ineffective and insufficient because the voluntary standards are permissive and vague, not consistently followed, and without penalties for violations, the committee recommends: Recommendation 3-4: Federal, state, and local governments should use their existing regulatory powers to strengthen and implement standards for permissible alcohol marketing content and placement across all media, establish consequences for violations, and promote and fund countermarketing campaigns. Mass Media Campaigns There is strong evidence based on findings from a variety of highquality systematic reviews, across numerous health behavior domains, that large-scale media campaigns can promote meaningful changes in 5 Underage persons are defined as individuals who are under 21 years old, the minimum legal age to purchase and possess alcohol in the United States.
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Data from countries that have decreased their legal BAC to 0.05% suggest that this is an effective policy for reducing alcohol-impaired driving injuries and fatalities. The benefits of lowering BAC are on a continuum, but they are enhanced when introduced alongside high-visibility enforcement, sobriety checkpoints, and publicity.
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This means that the same laws and sanctions that currently apply to 0.08% per se laws could remain in place but enforceable at the 0.05% BAC limit. Effectiveness will also be enhanced by efforts to publicize 0.05% per se laws through mass media campaigns, by strong and sustained enforcement efforts, and through the implementation and enforcement of laws and policies to prevent illegal alcohol sales to underage or intoxicated persons (e.g., underage compliance checks with alcohol licensees and dram shop liability laws)
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is accurate and available for public use, auto insurers should provide policy discounts to stimulate the adoption of DADSS. Once the cost is on par with other existing automobile safety features and the technology is dem onstrated to be accurate and effective, the National Highway Traffic Safety Administration should make DADSS mandatory in all new vehicles.
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To ensure effective oversight for high-rate recidivists and/or high BAC offenders, the committee recommends: Recommendation 5-1: Every state should implement DWI courts, guided by the evidence-based standards set by the National Center for DWI Courts, and all DWI courts should include available consultation or referral for evaluation by an addiction-trained clinician. An arrest for DWI or admission to the hospital for an alcoholimpaired driving injury represents an opportunity to screen and treat individuals who engage in hazardous drinking.
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Evidence shows that a minimum monitoring period for interlock devices of 2 years is effective for a first offense, and 4 years is effective for a second offense. Other promising interventions in the postcrash or postarrest phase include limits on diversion programs and plea agreements; education of professionals in law enforcement to improve identification of alcoholimpaired individuals; training for prosecutors and for judges on what constitutes impairment and the proper protocols for screening for AUD; more widely and systematically used administrative license suspension or revocation laws; systems alcohol monitoring programs; and a coordinated and continuous learning trauma care system.
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Examples of improvements necessary for advancing the science include standardized data definitions, harmonization of reported data, and increased capacity for data linkages. Recommendation 6-2: To facilitate surveillance of alcohol impaired driving that is timely, ongoing, concise, and action able, the National Highway Traffic Safety Administration should convene a diverse group of stakeholders that includes academic researchers, law enforcement, city and state public health, transportation sector, and other federal agency repre sentation to create and maintain a metrics dashboard, and pub lish brief, visually appealing quarterly and annual national and state-by-state reports that analyze and interpret progress in reducing alcohol-impaired driving.
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The role of funding from NHTSA in getting MADD off the ground, and the lessons it has for the ability of well-aimed seed funding to "sprout" results, provides a successful example of funding community-level demonstration projects to identify innovative solutions and tactics. Based on extensive evidence and experience in the use of community coalitions both in the alcohol field and in other areas of public health, the committee recommends: Recommendation 7-3: The National Highway Traffic Safety Administration, other federal partners, and private funding sources free of conflicts of interest should support training, technical assistance, and demonstration projects in the imple mentation of effective strategies, including policy changes, for reducing alcohol-impaired driving.
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The Role of Alcohol Industry Alcohol companies have taken on an active role in traffic safety and alcohol-impaired driving. However, they generally promote ineffective or non-evidence-based policies, and generally oppose effective populationbased strategies to reduce binge drinking and impaired driving.
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. ACHIEVING ZERO DEATHS To achieve zero alcohol-impaired driving fatalities -- where every alcohol-impaired driving death could be thought of as a failure of the system -- a systematic, multipronged approach with clear roles and accountabilities across sectors (including public health, transportation, law enforcement, and clinical care)
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State and federal to 0.05% governments; law enforcement; news media/advertising (television, radio, print, social media) ; alcohol producers; hospitality and retail sectors; public/consumers; community coalitions Time frame: short term Conduct frequent, Stakeholders: *
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legal sector; * health care sector; state law enforcement, health and local public health professionals)
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NHTSA standardized, and Time frame: short term accessible data on alcohol-impaired driving with strategic dissemination to the public, and explore big data opportunities Convening of diverse Stakeholders: * NHTSA; academia/ stakeholders to create research; law enforcement; state and and maintain a metrics local public health; transportation dashboard for alcohol- sector; other federal agencies as impaired driving needed Time frame: short term Publish brief, visually Stakeholders: *
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Department of Transportation; DWI = driving while impaired; HHS = U.S. Department of Health and Human Services; IHS = Indian Health Service; NCSL = National Conference of State Legislators; NHTSA = National Highway Traffic Safety Administration; NIH = National Institutes of Health; SBIRT = screening, brief intervention, and referral to treatment; TTB = Alcohol and Tobacco Tax and Trade Bureau.
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