Drinking and Driving
License loss is effective for both alcohol-related and non-alcohol-related accidents, but its impact on drinking and driving can be enhanced if combined with alcohol treatment. While treatment without license suspension is generally ineffective, suspension plus education, psychotherapy counseling, or follow-up contact probation (preferably in combination) produce an additional 7 to 9 percent reduction in recidivism and accidents (Wells-Parker et al.). Ignition interlock devices, which prevent a vehicle being started until the driver passes a breath test, have been shown to be very effective for many high-risk offenders. However, the effects tend to be limited to the period of the court order unless combined with treatment within a case management framework to deal with the underlying problems.
The problem with all countermeasures focused on apprehended offenders is that most serious alcohol-related crashes involve drivers with no prior drinking and driving convictions. Hard-core drivers who drink comprise about 1 percent of drivers on the road, but more than a quarter of drivers killed. Many of these drivers have a history of violence and serious antisocial behavior including crime, with alcohol abuse simply one facet of their deviant careers. It is likely that for this group a radically different approach is needed, involving early childhood interventions (Farrington).
Most accidents do not involve hard-core offenders, and there is therefore a continuing need for countermeasures directed at the general population. Promising measures include promotion of responsible beverage service for bar staff and managers of on-premise alcohol outlets combined with deterrence of drinking and driving through local enforcement; reduction in retail availability of alcohol to minors; and reductions in the number and density of alcohol outlets to limit general access to alcohol. Any measure that reduces per capita alcohol consumption, such as increases in price through taxation, will reduce alcohol-related accidents.
Reducing dependence on driving has similar promise. Successful measures include designated driver programs (someone in a group stays sober so that that person can drive home), safe rides programs, and increasing the age of driver licensing or restricting licenses to daytime use for young drivers. Promoting public transport would certainly be effective if it were ever evaluated for its impact on drinking and driving. Contrary to expectations, there is no evidence that driver education for young people reduces crash involvement. Indeed, the evidence suggests the reverse: by encouraging young people to gain their license at an earlier age, such training increases exposure to risk, and hence accidents.
Finally, making the vehicle and roadside environment more forgiving of the errors of drinking drivers will reduce deaths and injuries. Frangible poles that minimize damage to vehicles; improved response times and skills of emergency medical teams; more use of seatbelts and airbags; and brighter reflective road signs (so impaired drivers notice them) are but a few examples of effective environmental interventions.