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• Ann Adv Automot Med
• v.55; 2011 Oct

Drunk Driving Among Novice Drivers, Possible Prevention with Additional Psychological Module in Driving School Curriculum

Road traffic collisions caused by drunk driving pose a significant public health problem all over the world. Therefore additional preventive activities against drunk driving should be worked out. The aim of the study was to assess drunk driving in novice drivers after a psychological intervention taking into account also impulsivity, law obedience, and alcohol-related measures. An intervention study was started with 1889 car driver’s license attempters during their driving school studies. Subjects were classified as intervention group (n=1083, mean age 23.1 (SD=7.4) years), control group (n=517, mean age 22.8 (SD=7.1) years) and “lost” group (n=289, mean age 23.0 (SD=6.9) years). “Lost” group subjects had been assigned into the intervention group, but they did not participate in the intervention. Subjects of the intervention group participated in a psychological intervention on the dangers of impulsive behavior in traffic. After a three year follow-up period it appeared that in the control group and in the lost group there was a significantly higher proportion of drunk drivers than in the intervention group, 3.3% (n=17), 3.5% (n=10) and 1.5% (n=10) (p=0.026), respectively. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving (p=0.015), and the impact of the intervention was persistent also in the case of higher scores in Mild social deviance. In subjects with higher scores in impulsivity measures and alcohol-related problems the impact of short psychological intervention was not sufficient for preventing drunk driving. It can be concluded that psychological intervention used during the driving school studies is an effective primary prevention activity against drunk driving. However, for drivers with high scores in impulsivity measures and alcohol-related problems, the short psychological intervention is not sufficient in reducing drunk driving behavior.

INTRODUCTION

Although drunk driving has been decreasing during the last decades [ Nochajski and Stasiewicz, 2006 ] road traffic collisions caused by drunk driving still represent a huge public health problem all over the world. Drinking behavior and drunk driving has been successfully decreased by social marketing campaigns, media advocacy campaigns, and increased drunk driving enforcement [ Voas et al., 1997 ; Clapp et al., 2005 ]. These are activities on the community level. On the personal level traffic safety baseline knowledge, skills crucial for preventing drunk driving should already be obtained in the family [ Jaccard and Turrisi, 1999 ; Buu et al. 2009 ] and at school [ Perry, 1984 ; Rothe, 1991 ]. However, the influence of obtained knowledge and skills on the behavior in traffic is not always persistent [ D’Amico and Fromme, 2002 ; Price et al., 2009 ]. The actual behavior in traffic depends on the situation and the environment, where a young driver is and what kind of decision he or she is making. In young ages, peers and friends play an important role. They may influence a young driver to drive or not to drive after alcohol use [ Turrisi et al., 1993 ; Poulin et al., 2007 ]. Young people are more prone to take risks, especially together with peers. A certain amount of risk-taking is a normal psychological attribute necessary for development [ McMahon et al., 2008 ], but young people should evaluate their own risks adequately to save the health and lives of themselves and others. In risk-taking behavior (the personality trait) impulsivity plays an important role. Impulsivity is a multidimensional construct and has several measures [ Evenden, 1999 ]. Several studies have shown that drunk driving as a risk-taking behavior is associated strongly with higher scores of maladaptive types of impulsivity like Thoughtlessness, Disinhibition, but also with higher scores of adaptive types of impulsivity like Excitement seeking [ Eensoo et al., 2004 ; Eensoo et al., 2005 ; Paaver et al., 2006 ] and Sensation seeking [ Zakletskaia et al., 2009 ]. Driving school curricula should deal with all risks in traffic. Novice car drivers have to be able to assess their risks in traffic adequately and make right decisions following traffic rules and driving a car without drinking alcoholic beverages.

The aim of our study was to assess drunk driving in novice drivers after a short psychological intervention taking into account also the subjects’ impulsivity, general law obedience and alcohol consumption measures.

Study sample

The intervention study was performed in the two biggest cities of Estonia, in Tartu and in Tallinn in 2007, and it was a part of the Estonian Psychobiological Study of Traffic Behavior (EPSTB). The main unit of sampling was a driving-school. In the preparation stage of the study (in 2006) there were 54 driving schools in the list. After contacting them, it appeared that 12 driving schools were no longer working and 17 refused (main reason was deficiency of time) or were not suitable (teaching only servicemen or in Russian language or for applying license of truck-drivers or motorcycle-riders) for the study. Twenty five driving schools were suitable and agreed to participate in the study. The study was carried out with the subjects learning in driving schools with the aim of obtaining a driver’s license. Every first and second group of license attempters attending the driving school during the recruitment period was included in the intervention group and the third into the control group. The psychological intervention study was carried out among 1889 car driver’s license attempters in total, which constitutes about 16% of the subjects having a provisional license in Tartu and Tallinn in 2007. The participants of the study gave their written consent. Of all the subjects invited to participate (n=1972), 95.8% agreed. Subjects were classified as the intervention group (n=1083, mean age 23.1 (SD=7.4) years), control group (n=517, mean age 22.8 (SD=7.1) years) and “lost” group (n=289, mean age 23.0 (SD=6.9) years). The “lost” group subjects had been assigned into the intervention group, but they did not participate in the intervention. The Ethics Committee at the University of Tartu approved this study.

Measures obtained in driving school

During the first meeting with the researchers at the driving schools the subjects filled in Impulsivity inventories Barratt Impulsivity Scale with 31 items by using the 4-point scale (1 = never or rarely, 4 = almost always, BIS-11) [ Barratt, 1994 ] and Adaptive and Maladaptive Impulsivity Scale with 24 items by using the 5-point scale (1 = very false, 5 = really true, scales of Fast decision-making, Thoughtlessness, Disinhibition and Excitement seeking) [ Eensoo et al., 2007 ]. The Social Motivation Scale, with 9 items by using the 3-point scale (1 = not really likely, 3 = very likely), was used to measure Mild social deviance [ West, 1993 ]. Alcohol-related problems were measured by the TWEAK questionnaire with 5 items relating to tolerance (T), worried (W), eye openers (E), amnesia (A), and cut down (K) (total score 0–7) [ Russell, 1994 ]. The subjects also filled in a questionnaire about their socio-economic status (gender, education, income).

Intervention

The psychological intervention (lasting for one and a half hours) on the topic of impulsive behavior in traffic was carried out by a psychologist among the intervention group during the next lesson. The methodology of the intervention was developed by the study-team. The intervention used active learning method [ Exley and Dennick, 2004 ] with lectures, teamwork and discussions. One starting point in the intervention was the basic position of cognitive-behavioral therapy, where the human behavior depends on the circumstances of how he or she thinks in these situations. Group activities and the lecture demonstrated how people can detect their own feelings and thoughts, monitor and modify their behavior in traffic and thereby control their behavior - established presumption to enhance self-regulation abilities of impulsive behavior in traffic. In the past, an intervention based on the cognitive-behavioral therapy was successfully implemented among aggressive drivers [ Deffenbacher et al., 2000 ]. The second starting point in the intervention consisted of the improvement of perception of personal risks: The lecture provided tips for self-monitoring one’s own tendencies of impulsivity, subjects were directed to acknowledge their potential personal risks, assess the likelihood of these risks, as well as to see the opportunities a person has to reduce his or her own risks in traffic. The lecture concentrated on the issue of impulsive behavior in traffic using the results from our own studies [ Eensoo et al., 2004 ; Eensoo et al., 2005 ; Paaver et al., 2006 ]. The effect of the treatment on subject’s perception of personal risks during driving school studies on reduced number of traffic accidents has been shown in Denmark [ Carstensten, 2002 ]. The causes of actual traffic accidents and possible psychological risk factors of the participants in traffic accidents were analyzed during as a teamwork. The aim of the group discussion was to demonstrate that in case of traffic collisions among other factors an important role is played by personal behavior. An earlier study has shown that the use of personal imagination about getting into traffic accidents has been successful in traffic safety interventions [ Falk and Montgomery, 2007 ].

Driving while impaired (DWI)

Data of three years penalties for drunk driving were obtained from the police database. According to the Estonian traffic law, 1.0 g of the driver’s blood may not constitute more than 0.20 mg of alcohol (0.2 per mil, 0.2‰). All drunk drivers were penalized once during the following period. For analyses subjects were divided as drunk drivers (drunk driving, yes=1) and controls (drunk driving, no=0).

Statistical analyses

Statistical analysis was performed using SAS (version 9.1). Nominal variables were described using frequency tables, and Pearson’s Chi-square test was used to compare different groups. The Kruskal-Wallis test was used to compare groups according to the variable with nonparametric distribution (age). For analyzing the occurrence of the event (police penalty for drunk driving) during the follow-up period Cox regression models were performed.

There were no significant differences between the study groups by age (Kruskal-Wallis test), median, 25%, and 75% quartiles respectively in the control group 20.3, 17.9, 25.6, in the intervention group 20.4, 17.9, 25.5, and in the “lost” group 20.8, 18.1, 24.9 years. Also there were no significant differences between study groups in gender, educational status, and income (see Table 1 in the appendix). Significant difference between study groups appeared in drunk driving (Chi-square test, p=0.026). During the follow-up period there were significantly higher proportions of drunk drivers in the control group and in the “lost” group than in the intervention group ( Table 1 ). All drunk drivers were males.

For additional analysis only intervention and control groups were included. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving (p=0.015). Analyzing possible interactions between psychological intervention and measures obtained in driving school, several models were built ( Table 2 ).

Hazard ratios for drunk driving (drunk drivers vs controls) depending on not participating in the intervention (Control group=1 and Intervention group=0) and other risk factors

The models showed that adjusting by BIS-11 (Model 1) or Mild social deviance (Model 6) the effect of the intervention remained statistically significant. Drunk drivers (drunk driving=yes) were more likely no-participants in the intervention and had higher scores in BIS-11 or Mild social deviance than controls (drunk driving=no). It is known that impulsivity decreases with age. After adjusting the impact of intervention on drunk driving both by BIS-11 and age, significant impact of intervention on drunk driving disappeared. So it appeared that in the case of higher scores in impulsivity measures (BIS-11, Fast decision-making, Thoughtlessness, Disinhibition, Excitement seeking, Models 1–5) and TWEAK (Model 7) the impact of psychological intervention is not sufficient for preventing drunk driving.

The study sampling was carried out on the basis of the list of driving schools. It was surprising that one fifth of the driving schools had finished their business during the one-year preparation stage of the study. The reasons might be different, for example working in the conditions of developing market economy is quite difficult for new and small driving schools. Also the activity license for working is needed and it should be applied for regularly. According to the regulations curricula for driving schools has been established. It comprises lessons and practice about safe traffic behavior and communication with other vehicle occupants and pedestrians. Additionally, the applied psychological intervention gave new scientific-based knowledge about impulsive behavior in traffic, possibilities for self-monitoring and enhanced self-regulation abilities through the lecture, teamwork and discussions.

In Estonia a Graduated Driver Licensing (GDL) system exists for new car drivers. Subjects with a provisional license are not allowed to exceed speeds over 90 km/h when driving a car. The provisional license period is two years. Before getting full driving-license novice drivers have to participate in additional lessons and practice on topics of eco-driving and skidding-driving. Subjects who want to participate in driving school studies are required a minimum age – 6 months before turning 16. Novice drivers younger than 18 years old can drive only under supervision of an adult person with a full driver’s license.

Subjects of our study were divided into intervention group and control groups using a systematic sampling method. Although before the study the aim of the study was explained and all participants gave their written consent, out of the 1372 subjects assigned into the intervention group, 21.1% did not participate in the intervention. These subjects were assigned into the “lost” group. As the study groups were not significantly different in respect to main socioeconomic characteristics - age, gender, education and income - it is possible to investigate the impact of the intervention. Although study groups seemed to be similar, there might be some measures that are more distinctive for the “lost” group. At the same time not participating in the intervention might be occasional, for example not participating due to illness. It might also raise a hypothesis that the intervention group has higher consciousness than the “lost” group, while participation in the learning process needs purposefulness. It has been shown that success in the learning process is associated with higher consciousness [ Kaufman et al., 2008 ]. In our study consciousness was not measured. Although the control group and the “lost” group were not significantly different in respect to drunk driving, we analyzed them separately due to the unknown factor in the “lost” group.

In this work only data from police records on drunk driving were used. In one earlier study with male car drivers we have analyzed both police-referred driving while impaired by alcohol (DWI) and self-reported driving after drinking (DAD) [ Eensoo et al., 2005 ]. We found that in the control group 38% of the men reported DAD (Control II) and in the DWI group 22% subjects denied DAD (DWI I). Analyzing the formed groups separately it appeared that the differences were the most distinct between Control I group (controls who denied DAD) and DWI II group (DWI subjects who reported DAD). The best predictor of drunk driving was the measure of alcohol-related problems. Platelet monoamine oxidase (pl-MAO) activity is a peripheral marker of serotonergic activity in the central nervous system [ Fahlke et al., 2002 ]. Pl-MAO activity is lower in alcohol dependent subjects [ von Knorring and Oreland, 1996 ]. We have shown that the DWI I and DWI II groups’ mean pl-MAO activities were both significantly lower compared to Control I and Control II groups [ Eensoo et al., 2005 ]. This result showed that police referred drunk driving separately quite well and drunk drivers with alcohol-related problems.

During the follow-up period in our study only men got fines for drunk driving. It is not surprising, because it is known that men take risks more often than women [ Cestac et al., 2011 ; ]. It has been shown that the proportion of fatal accidents with positive blood alcohol concentration is significantly higher in male drivers than in female drivers [ Tsai et al., 2008 ], but the percentage of young female drunk drivers in fatal accidents showed a greater increase than that of young male drunk drivers at the age of 19–24 years [ Tsai et al., 2010 ]. Women’s socialization decreases differences between female and male adolescents [ Brown and Tappan, 2008 ]. Also in drinking patterns the differences between female and male adolescents have decreased [ Wilsnack and Vogeltanz, 2000 ]. Therefore activities preventing risk-taking and drunk driving should nevertheless be carried out for both genders.

The study groups did not differ significantly in respect to education and income. About 10% of the subjects had university education. According to the distribution of the income we can say that about 10% of the subjects had a higher income and after deduction of the taxes it was over 15 000 EEK (958.7 EUR) per month. The minimum wage in Estonia in 2007 was 230.08 EUR [ Eurostat ], it is income with taxes. Minimum wage without taxes was somewhat less than 3000 EEK (191,7 EUR). About one third of the subjects had an income lower than 3000 EEK. Such people may be students or young people with low income and may have studied at the driving school supported by their parents or friends. Driving a car means additional costs. We do not know how many of the subjects actually drove a car during the following period. It might be one limitation of our study. But supposing that at the beginning of the study the study groups were not significantly different in respect to their socio-economic background, it could be similar during the following period and also for car driving.

The survival analysis revealed that the subjects in the intervention group were less likely drunk drivers than the subjects in the control group. The result is quite unique, as the intervention was brief and a persistent result is evident after almost three years. In other school-based short interventions preventing drunk driving there is insufficient evidence to determine the effectiveness of these interventions on drunk driving outcomes, at the same time they have been effective in reducing sharing the car with drunk drivers among students [ Elder et al., 2005 ]. The effectiveness of this brief intervention might also be explained by the following circumstances: in driving school students have similar learning objectives, they are all applying for a driver’s license, they all have been interested in knowledge necessary for driving and for passing the driver’s license exam, and probably most of them are highly motivated to become good drivers. Therefore such an intervention would be more suitable to be carried out in a driving school than in a regular school.

According to the theory of planned behavior, an individual’s intention to perform behavior could be predicted by the individual’s attitudes toward the behavior, by their subjective norms (the individual’s perception of social pressures to perform a behavior), and by perceived behavioral control (the individual’s perception of control over the behavior) [ Ajzen, 1991 ]. Marcil et al. (2001) showed that young males’ intention to drink and drive is predicted by their attitudes, their perceived behavioral control, and to a lesser degree, by subjective norms. The authors highlighted that drunk driving prevention work should aim at reducing this perception to a more realistic level. During our psychological intervention it was explored and discussed why drivers take higher risks and have driven drunk, and how it would be possible to strengthen self-control over one’s decision not to drink and drive. It could also be possible that the subjects of the intervention group may after drinking have perceived lower control over their own driving ability due to obtained knowledge from the intervention and have not driven drunk so often as controls.

Our study was carried out at the time of the national traffic safety program. Topics of traffic safety, including drunk driving, were highlighted in the media. Every year a traffic safety campaign against drunk driving is organized around the midsummer day celebration. Therefore the general attitude against drunk driving might be negative in the population. Nevertheless among groups where risk-taking behavior is more prevalent the situation might be different. Our study revealed that in the case of higher scores in Fast decision-making, Thoughtlessness, Disinhibition, Excitement seeking and also adjusting by age in the case of higher scores in BIS-11 short psychological intervention was not sufficient for preventing drunk driving.

In novice drivers both Fast decision-making and Excitement seeking that describe the adaptive side of impulsivity and only Thoughtlessness, one measure that describes the maladaptive side of impulsivity have significantly been associated with drunk-driving. In our earlier study with male car drivers (mean age of drunk drivers 33±11 years and in controls 36±12 years) it appeared that drunk driving was associated with Disinhibition and Thoughtlessness, which both describe the maladaptive side of impulsivity [ Eensoo et al., 2004 ; Paaver et al., 2006 ], and have been characterized as an inability to plan and think through one’s actions, thus leading to negative consequences [ Dickman, 1990 ]. In earlier studies it has been found that in younger subjects Sensation seeking (18-years college students) [ Zakletskaia et al., 2009 ] and Excitement seeking (drunk-drivers recorded in the police records who have been reported driving drunk sometimes or often per year, mean age 28 years) [ Eensoo et al., 2005 ] have significantly been associated with drunk-driving.

Our results show that subjects with higher scores in impulsivity need an additional intervention for preventing drunk driving. It is known that personality traits including also impulsivity measures are normally distributed in population, therefore this psychological intervention might be more effective in subjects with low or mean level of impulsivity rather than in subjects with high impulsivity. On average, certain types of impulsive behavior decrease with age, but generally impulsivity is a persistent personality tendency [ Evenden, 1999 ].

It is possible to develop self-regulation abilities and learn to control impulsive tendencies. For drivers with higher impulsivity it might be useful to develop a prevention program focusing on coping strategies [ Kulick and Rosenberg, 2000 ]. For example according to the adapted Marlatt’s cognitive-behavioral model an individual may obtain coping skills to avoid a high-risk situation (e.g. walking to the drinking location). Coping results in increased self-efficacy (belief in one’s ability to resist driving after drinking) and decreased likelihood of driving after drinking in the future [ Kulick and Rosenberg, 2000 ].

Our intervention has a significant effect on drunk driving in the case of higher scores in Mild social deviance, but not in the case of higher scores in TWEAK. Additional interventions and rehabilitation programs for drunk driving offenders should pay attention also to the alcohol problems. It has been shown that drunk driving offenders and especially relapsed drunk driving offenders are a very heterogeneous group. For example relapsed drunk driving offenders are more likely to have been involved in collisions, they have more traffic violations and crimes other than drunk driving, heavier drinking patterns, prior treatment for alcohol or other drug problems, they are less likely to have college education, more likely to be unemployed, and have lower household incomes than the first-time drunk driving offenders [ Nichajski and Stasiewicz, 2006 ].

After the three-year follow-up period it was evident that in the control group and in the “lost” group there was a significantly higher proportion of drunk drivers than in the intervention group. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving. Compared to the intervention group the control group had a higher risk for drunk driving also in the case of higher scores in Mild social deviance or alcohol-related problems. In the case of higher scores in impulsivity measures the impact of short psychological intervention is not sufficient for preventing drunk driving. On the basis of these results we can conclude that a brief psychological intervention focusing on the topic of impulsive behavior in traffic is suitable to be carried out in driving schools as a primary prevention activity against drunk driving.

Acknowledgments

This research was supported by the Estonian Road Administration, and the Estonian Ministry of Education and Research (no. 0180027 and 0180060).

Basic characteristics of the study groups

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Prevention of Alcohol Abuse pp 441–468 Cite as

Prevention of Drunk Driving

• Felix Klajner 4 ,
• Linda C. Sobell 4 &
• Mark B. Sobell 4  

108 Accesses

3 Citations

Casualties resulting from drunk driving extract an enormous toll from society. At least 30%, and up to 50%, of highway fatalities are related to excessive drinking (Cimburra, Warren, Bennett, Lucas, & Simpson, 1981; Filkins, Clark, Rosenblatt, Carlson, Kerlan, & Manson, 1970; Perrine, Waller, & Harris, 1971; Transport Canada, 1975; Waller, King, Nielson, & Turkel, 1970; Zylman, 1974), as are 9% to 13% of nonfatal traffic injuries and 5% of property-damage crashes (Borkenstein, Crowther, Shumate, Ziel, & Zylmand, 1964; Farris, Malone, & Lilliefors, 1976). The relatively low proportion of nonfatal and property-damage accidents should not obscure the fact that the actual number of such accidents is staggering. In the United States in 1975 there were an estimated 765,000 property-damage and 120,000 personal-injury accidents involving drivers with blood alcohol concentrations (BACs) of at least 100 mg ethanol/100 ml blood volume (.10%), as compared to 15,200 fatal crashes (Jones & Joscelyn, 1978). Jones and Joscelyn (1978) estimated that if these alcohol-related collisions could have been prevented, a cost savings of approximately 6.5 billion dollars would have resulted. When the composite costs of drunk driving to both individuals and society are considered (e.g., loss of income and property, medical care, legal proceedings, insurance, productivity, disfigurement, trauma, and death), there can be little argument that prevention of drunk driving should be a priority for legal and social planners. Yet, the prevention of drunk driving has persistently defied the efforts of highway safety planners, researchers, and clinicians alike, despite a sizeable expenditure of resources.

• Blood Alcohol Concentration
• Traffic Safety
• Recidivism Rate
• Drunk Driving
• Legal Sanction

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Klajner, F., Sobell, L.C., Sobell, M.B. (1984). Prevention of Drunk Driving. In: Miller, P.M., Nirenberg, T.D. (eds) Prevention of Alcohol Abuse. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2657-1_21

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What Works: Strategies to Reduce or Prevent Alcohol-Impaired Driving

The strategies in this section are effective for reducing alcohol-impaired driving. *  They are recommended by The Guide to Community Preventive Services, the National Highway Traffic Safety Administration, or the National Academies of Sciences, Engineering, and Medicine. Different strategies might require different resources for implementation or have different levels of impact. This information can help decision makers and community partners see gaps and identify the most effective strategies to reduce alcohol-impaired driving.

Lower Blood Alcohol Concentration (BAC) Limits

Alcohol-impaired driving laws make it illegal to drive with a BAC at or above a specified level (0.05 grams per deciliter [g/dL] or 0.08 g/dL, depending on the state). Globally, most high-income countries have BAC laws set at 0.05 g/dL or lower, 1,2  and these laws are effective for reducing crashes involving alcohol-impaired drivers and deaths from these crashes. These laws serve as a general deterrent and reduce alcohol-impaired driving even among drivers who are at highest risk of impaired driving. Utah implemented a 0.05 g/dL BAC law in 2018. This law was associated with an 18% reduction in the crash death rate per mile driven in the first year after it went into effect. The new law was also associated with lower alcohol involvement in crashes. 3

Other Laws and Policies That Can Reduce Access to Alcohol and Alcohol-Impaired Driving

Zero tolerance laws make it illegal for people under age 21 to drive with any measurable amount of alcohol in their systems. These laws and laws that maintain the minimum legal drinking age at 21 are in place in all 50 states and D.C. They have saved tens of thousands of lives. Maintaining these laws is critical.

Policies that make alcohol less accessible, available, and affordable are effective for reducing drinking to impairment and can also help to prevent alcohol-impaired driving. Some examples include increasing taxes on alcohol and regulating alcohol outlet density to reduce the number of retailers that can sell alcohol in a particular location.

Publicized Sobriety Checkpoints

Publicized sobriety checkpoints allow law enforcement officers to briefly stop vehicles at specific, highly visible locations to check drivers for impairment. Officers may stop all or a certain portion of drivers. Sobriety checkpoints should be well publicized, such as through mass media campaigns, and conducted regularly for greatest impact.

High-Visibility Saturation Patrols

High-visibility saturation patrols consist of a large number of law enforcement officers patrolling a specific area, usually at times and locations where crashes involving alcohol-impaired drivers are more common. These patrols should be well publicized and conducted regularly just like sobriety checkpoints.

Ignition Interlocks

Ignition interlocks for all people convicted of alcohol-impaired driving, including first-time offenders, can be installed in vehicles to measure alcohol on a drivers’ breath. Interlocks keep vehicles from starting if drivers have a BAC above a certain level, usually 0.02 g/dL. Interlocks are highly effective at preventing repeat offenses while installed. Incorporating alcohol use disorder assessment and treatment into interlock programs shows promise in reducing repeat offenses even after interlocks are removed. 4

Alcohol Use Disorder Assessment and Treatment Programs

People who have alcohol use disorder (AUD) can benefit from long-term, tailored, and specialized treatment programs. Ideally people would receive treatment for AUD before committing an alcohol-impaired driving offense. However, when people are arrested for alcohol-impaired driving, this can serve as an opportunity to assess drinking habits and refer them for brief interventions (described below) or specialized treatment. Treatment for people with AUD who are convicted of alcohol-impaired driving is most effective when combined with other strategies (such as ignition interlocks) and when offenders are closely monitored. Treatment should not replace other strategies or remove alcohol-impaired driving sanctions from a person’s record. Assessment and treatment are critical to the success of driving while impaired (DWI) courts, which are specialized courts focused on changing the behavior of people who are convicted of alcohol-impaired driving.

Alcohol Screening and Brief Interventions 5,6

Alcohol screening and brief interventions typically focus on identifying people who drink alcohol excessively  but do not have AUD. Ideally people would be identified before committing an alcohol-impaired driving offense. However, an alcohol-impaired driving arrest can be used as an opportunity to screen people for excessive alcohol use. Brief interventions involve assessing readiness, motivators, and barriers to behavior change. These interventions can be delivered in person or electronically (such as on computers or cell phone apps) in many settings, such as hospitals, doctor’s offices, and universities.

Multi-Component Interventions

Multi-component interventions combine several programs or policies to reduce alcohol-impaired driving. The key to these comprehensive efforts is community mobilization, in which coalitions or task forces help design and implement interventions.

School-Based Instructional Programs

School-based instructional programs are beneficial for teaching teens not to ride with alcohol-impaired drivers.

* Unless otherwise noted by a numbered reference, the content for this page comes exclusively from the following sources:

• The Community Preventive Services Task Force (CPSTF) Findings for Motor Vehicle Injury
• National Highway Traffic Safety Administration (NHTSA). Countermeasures That Work: A Highway Safety Countermeasures Guide for State Highway Safety Offices, Tenth Edition, 2020
• National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities. Getting to Zero Alcohol-Impaired Driving Fatalities: A Comprehensive Approach to a Persistent Problem . Negussie Y, Geller A, Teutsch SM, editors. Washington, DC: National Academies Press (US) ; 2018.
• Dellinger AM, Yellman MA. Chapter 170: Road Safety and Injury Prevention . Maxcy-Rosenau-Last Public Health & Preventive Medicine , 16e . Boulton ML, Wallace RB, editors. McGraw Hill ; 2022.

Working together, we can keep alcohol-impaired drivers off the road.  Fact sheets are available for each state and the District of Columbia. They include national and state data on alcohol-impaired driving and crash deaths involving alcohol-impaired drivers, as well as an overview of proven strategies for reducing and preventing alcohol-impaired driving.

• Impaired Driving: Get the Facts
• Data and Resources for States and Tribes
• Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS)*

*CDC offers an interactive calculator to help state decision makers prioritize and select from a suite of 14 effective motor vehicle injury prevention interventions. MV PICCS is designed to calculate the expected number of injuries prevented and lives saved at the state level and the costs of implementation, while considering available resources.

• World Health Organization. Global status report on road safety 2018 . Geneva, Switzerland: World Health Organization; 2018.
• Yellman MA, Sauber-Schatz EK. Motor Vehicle Crash Deaths — United States and 28 Other High-Income Countries, 2015 and 2019 . MMWR Morb Mortal Wkly Rep . 2022;71:837–843. doi:10.15585/mmwr.mm7126a1
• Thomas FD, Blomberg R, Darrah J, Graham L, Southcott T, Dennert R, Taylor E, Treffers R, Tippetts S, McKnight S, Berning A. Evaluation of Utah’s .05 BAC per se law (Report No. DOT HS 813 233) . Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA); February 2022.
• Voas RB, Tippetts AS, Bergen G, Grosz M, Marques P. Mandating treatment based on interlock performance: evidence for effectiveness . Alcohol Clin Exp Res . 2016;40(9):1953–1960. doi:10.1111/acer.13149
• Tansil KA, Esser MB, Sandhu P, Reynolds JA, Elder RW, Williamson RS, Chattopadhyay SK, Bohm MK, Brewer RD, McKnight-Eily LR, Hungerford DW, Toomey TL, Hingson RW, Fielding JE; Community Preventive Services Task Force. Alcohol Electronic Screening and Brief Intervention: A Community Guide Systematic Review . Am J Prev Med . 2016;51(5):801–811. doi:10.1016/j.amepre.2016.04.013
• U.S. Preventive Services Task Force. Final Recommendation Statement – Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions . U.S. Preventive Services Task Force; November 2018.

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We know what it takes to end drunk driving, fight drugged driving and educate the next generation of drivers. But we still need help to reach the day that no one experiences a broken heart due to impaired driving.

Answering the call for help is at the heart of Mothers Against Drunk Driving’s mission. Whether you have questions about services, or need support after a crash, MADD cares about you and we want to help. If you or someone you know has experienced injury or was killed or experienced another kind of impact, you are not alone, MADD is here for you.

Get Involved

Behind every drunk and drugged driving statistic is a person whose life was full of family and friends, love and life, joy and laughter. Mothers Against Drunk Driving has several ways you can help create a future of No More Victims ® .

At Mothers Against Drunk Driving, we’re focused on one goal: ending impaired driving for good. Since our founding, we've served as a lifeline for thousands of victims and survivors, and drunk driving fatalities have been cut in half — but we refuse to stop there. Together, we can end this 100% preventable crime.

Solving the Problem

Drunk Driving Impacts Everyone

Drunk driving does not discriminate..

It takes sons, spouses, mothers, daughters, fathers, grandparents and grandchildren.

If it hasn't impacted you or someone you love, it still could .

Drunk driving is the #1 cause of death on our roadways.

The numbers don't lie. The destructive force of drunk and drugged driving must end.

until the next drunk driving injury

people have been injured in a drunk driving crash since you woke up

How Can We Stop This Tragedy?

Wearing a seatbelt, using public transport & rideshare apps, and taking personal responsibility for the safe roadways are all crucial steps.

Law enforcement and technology are also key parts of the solution. And through court monitoring, MADD identifies inconsistencies in how drunk driving cases are handled.

But the crashes, injuries, and deaths of our loved ones won’t stop unless we act together

It starts with YOU.

Court Monitoring

Law enforcement.

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Drunken driving is a persistent problem. But there may be a technological solution.

Asking people not to drink and drive has only gotten us so far.

Drunken driving control efforts have sputtered out in recent years with more than 11,000 preventable deaths now occurring annually. Over the past four decades, public health officials have largely focused on changing behaviors — asking people to not drink and drive. But now, there are new auto technologies that can prevent them from doing so.

As part of President Biden’s infrastructure law, Congress decided that some version of these devices needs to be installed in new American cars beginning in 2026. But first, the National Highway Traffic Safety Administration (NHTSA) must examine all available technologies and then select the most effective one. This development is an important opportunity to readdress a pressing public health crisis. Quite simply, the new innovations can surmount the cultural and libertarian barriers that have thwarted past efforts to end drunken driving fatalities.

For decades, drunken driving control was seen as a law enforcement issue . As cars multiplied on American roads in the early 20th century, cities and states began passing laws making it illegal to drink and drive. But they were not enforced aggressively, neither during Prohibition (1919-1933), when alcohol was less available, or after, when there was a backlash against anti-alcohol sentiments.

The tolerance for drunken driving at mid-century — an era in which manufacturers of alcoholic beverages routinely celebrated heavy drinking and even called beer “liquid bread” — was remarkable. Although many states had laws that let police arrest drivers with blood alcohol levels between 0.05 and 0.15 percent, the de facto level was 0.15 percent, almost twice as high as our current legal limit of 0.08 percent. That meant that severely impaired drivers often went unprosecuted, even when they injured or killed someone.

The situation worsened in the 1950s when suburbanization and the new interstate highway system led to even more drivers. While no one explicitly condoned drunken driving, having several drinks and getting behind the wheel became commonplace for men in their 20s and 30s, who were most likely to drive drunk.

Finally, in the 1960s, a physician and epidemiologist named William Haddon began to scrutinize the carnage caused by drunk drivers. His scientific approach included careful research demonstrating that high blood alcohol levels were associated with more and often fatal crashes. Haddon’s efforts culminated in a 1968 federal report estimating that roughly 25,000 Americans died annually from drunken driving.

For Haddon, this was a public health emergency. But with the cultural worship of drinking and driving, it was hard to get people to pay attention. It took the efforts of a journalist in Upstate New York and a grieving mother in California a decade later to rouse the public and legislators.

Together, these women told hundreds of stories of lives lost needlessly due to drunk drivers. The journalist, Doris Aiken, founded Remove Intoxicated Drivers in 1978 after learning about the deaths of two local teenagers killed by a driver with a 0.19 percent blood alcohol level who was still clutching a beer. RID broadly publicized the damage caused by drunken driving and pushed for stiffer penalties, especially locally.

Two years later, Candy Lightner’s 13-year-old daughter, Cari Lightner, was killed by a man with four prior driving while intoxicated arrests, the latest of which had been only two days earlier. Lightner founded Mothers Against Drunk Drivers — later Mothers Against Drunk Driving — in part because a police officer had told her: “Lady, you’ll be lucky if he sees any time in jail at all, much less prison. That’s the way the system works.”

MADD in particular would spearhead an enormous surge of interest in drunken driving. Lightner, both tenacious and telegenic, worked relentlessly to obtain stricter laws across the country. Drunken driving, The Washington Post announced on its front page in 1981, was “a national outrage.” Always front and center were “innocent victims,” pedestrians or other drivers either killed or maimed by drunk drivers. Within five years of its founding, MADD had 300 chapters and 600,000 volunteers.

Perhaps MADD’s greatest success occurred in 1984 when it got President Ronald Reagan to sign the Minimum Legal Drinking Age Law raising the legal drinking age to 21.

In the meantime, state legislatures stepped up, passing over 700 new laws by 1985. And by 2004, all 50 states had lowered the legal blood alcohol level to 0.08 percent. These efforts coincided with messaging campaigns by MADD, as well as by state and federal agencies. Propelled by catchphrases such as “Friends don’t let friends drive drunk,” the concept of the designated driver — someone who stayed sober and drove intoxicated friends home safely — became a fixture of high school health classes and public service announcements.

Despite these accomplishments, barriers emerged. The beverage and restaurant industries, afraid that regulations would deter social drinking, opposed many initiatives, especially any further lowering of the legal blood alcohol level. Libertarian critics termed MADD and its allies “neoprohibitionists,” opposed not only to drunken driving, but to the consumption of any alcohol.

And other worthy public health campaigns, such as the prevention of texting and driving, overshadowed the persistent problem of drunken driving. As a result, drunken driving deaths, which had fallen to roughly 10,000 annually by 2009, stagnated there until 2020, when they rose to more than 11,000. Which is why there is now such a unique opportunity to reverse course and address a social problem that has been, to some degree, unsolvable.

The new technologies, broadly known as passive alcohol detection systems, work in one of two ways. Some of the devices detect illegal blood alcohol levels at or above 0.08 percent, preventing the car from starting, while others monitor the driver and/or the driver’s behavior to determine whether that person exhibits signs of impairment.

There will undoubtedly be criticisms: that these systems infringe on civil liberties, the technologies are unreliable and data collected by cars can be used against drivers. The congressional mandate to NHTSA should take all of these concerns into account.

Regardless of which technology is chosen, the potential impact of the new detection system requirement, which was passed thanks to the efforts of anti-drunken driving activists and has the support of the alcohol and insurance industries, is staggering. It will force drivers to act responsibly, potentially eliminating most drunken driving deaths and preventing countless injuries.

As the coronavirus pandemic has reminded us, there are limits to moral persuasion, even when lives are at stake. But this time, technology can help force people to do the right thing — since they will not always do it on their own.