inte Alcohol Impaired Driving
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Getting to Zero

Alcohol-Impaired
Driving Fatalities

A Comprehensive Approach

to a Persistent Problem

Alcohol-impaired driving is the deadliest and costliest danger on U.S. roads today. While the causes of this problem are complex, the resulting deaths are preventable. A report of the National Academies of Sciences, Engineering, and Medicine identifies many evidence-based and promising policies, programs, and systems changes to accelerate national progress in reducing deaths from alcohol-impaired driving.

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Key Facts

  • 29 people in the U.S. die each day in an alcohol-impaired driving crash, or one person every 49 minutes.

  • The plateauing fatality rates indicate the progress has stagnated and even reversed.

  • In 2016, 10,497 people died in alcohol-impaired driving crashes, accounting for 28 percent of traffic deaths.

  • 40 percent of people killed in alcohol-impaired driving incidents were not the drinking driver.

  • The economic cost—including medical costs, lost productivity, legal expenses, and property damages—of alcohol-impaired driving crashes was $121.5 billion in 2010.

  • More people die from drinking and driving each year than from other public health and safety hazards, such as certain cancers, HIV/AIDS, and drownings.

    Intervention Opportunities

    Changes in the social, economic, technological, and clinical arenas have opened up new opportunities to take action on alcohol-impaired driving. The report embraces a vision in which no alcohol-impaired driving deaths are acceptable—Vision Zero. To reach this ambitious goal, a renewed, comprehensive, multisector approach is needed to successfully reduce serious injuries and fatalities. The report’s recommendations, taken together, have the potential to reinvigorate commitment and accelerate progress to eliminate deaths from alcohol-impaired driving.

    • Policy Opportunities

      Enacting effective policies has historically been the impetus for reductions in alcohol-impaired driving fatalities. Implementing evidence-based policy interventions at the federal, state, and local levels—such as increasing alcohol taxes, lowering the BAC set by state law to 0.05, and all-offender ignition interlock laws—can resume progress on alcohol-impaired driving.

      • Increase alcohol taxes

        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.

        State alcohol taxes declined in inflation-adjusted terms from 1991 to 2015 for beer, wine, and spirits.

      • Implement policies to address the availability of alcohol

        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.

        The more alcohol sales points in an area, the more alcohol-impaired driving and alcohol-related crashes, including among underage people.

      • Implement and enforce policies to reduce illegal sales of alcohol

        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.
      • Regulate alcohol marketing

        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.

        In 2000, distillers spent $4.3 million on television advertising. By 2016, this amount had grown to $227.6 million.

      • Lower BAC laws to 0.05%

        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.

        Adopting 0.05% blood alcohol concentration per se laws nationally could save more than 1,500 lives each year.

        A person's driving abilities begin to deteriorate at blood alcohol concentration levels well below 0.05 percent.

        See also...
        • Communications and Marketing Opportunities
        • Use media campaigns in conjunction with enforcement policy interventions
      • Adopt universal primary seatbelt laws

        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.

        Since 1975, approximately 345,000 lives have been saved because of the use of seat belts.

      • Enact all-offender ignition interlock laws and extended monitoring periods

        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.

        When 18 states required ignition interlocks for all offenders, 915 lives were saved over 6 years.

        See also...
        • Communications and Marketing Opportunities
        • Use media campaigns in conjunction with enforcement policy interventions
      • Improve administrative license suspension/revocation laws

        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.

      • Develop model legislation from NCSL

        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.

    • Enforcement Opportunities

      Enforcement is a crucial determinant of the effectiveness of many alcohol-related policies and laws. This could include enforcement of policies to reduce the illegal sale of alcohol to people under age 21 or already-intoxicated adults and traffic safety enforcement activities such as sobriety checkpoints. Enforcement efforts require sufficient resources, training for personnel, and accurate and comprehensive data to inform these activities.

    • Legal System Opportunities

      For alcohol-impaired driving, the legal system is essential to apprehend, adjudicate, monitor, and treat DWI offenders. There are a number of opportunities to leverage the strengths and resources of the current legal system and adopt new, promising approaches while also improving specific aspects such as systematic and continuous training for professionals.

    • Technological Opportunities

      Technological advances mean new opportunities to intervene on alcohol-impaired driving fatalities. While additional research is still needed in some areas, there are a number of promising solutions, including ignition interlocks and a new passive, in-vehicle alcohol detection system.

      • Investigate consumer-marketed personal breath-testing devices

        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.

      • Explore future use of DADSS

        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.

        About 7,000 lives could have been saved in 2015 if DADSS set at a BAC limit of 0.08% had been in every vehicle.

      • Enact all-offender ignition interlock laws and extended monitoring periods

        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.

        When 18 states required ignition interlocks for all offenders, 915 lives were saved over 6 years.

    • Clinical Opportunities

      Clinical care can help reduce alcohol-impaired driving injuries and fatalities as well as identifying and treating people who engage in hazardous drinking. As part of a comprehensive approach to reducing alcohol-impaired driving, it is important to engage clinicians and the health care sector in training and system changes to reduce the burden of injuries and deaths due to alcohol-impaired driving.

    • Communications & 
Marketing Opportunities

      Solutions to address the social and cultural environment that shapes alcohol-impaired driving behaviors are essential to the success of other interventions. For example, well-designed media campaigns can enhance the effectiveness of policy interventions or enforcement activities by raising awareness, increasing perceived risk, and shifting norms.

      • Regulate alcohol marketing

        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.

      • Use media campaigns in conjunction with enforcement policy interventions

        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.

        See also...
        • Enforcement Opportunities
    • Transportation Opportunities

      Transportation-oriented solutions are needed to increase the availability of safe, convenient, and affordable alternatives to driving while impaired.

      • Increase availability of transportation alternatives

        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.

    • Data Opportunities

      Having a better understanding about many different facets of alcohol-impaired driving requires solutions to address data gaps, resolve methodological issues, and integrate and share data where possible.

    • Opportunities to Generate Action

      To initiate and sustain action that will bolster progress to reduce alcohol-impaired driving fatalities, a strategic and comprehensive effort needs to be put forth nationwide. Such an effort requires the support for and creation of innovative projects, multisector collaboration, and benchmarks to guide the progress of states.

      • Fund and support community-level demonstration projects

        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.

      • Create interagency coordinating committee on alcohol-impaired driving

        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.
      • Update HealthyPeople 2030 objectives for alcohol-impaired driving fatalities

        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.