What Can Be Done?
Some lessons from
past successes against DUI
Although the trend in driving under the influence (DUI) over the last 25 years has been substantially downward, no single strategy to combat DUI stands out as a proven, long-term success on its own. That is due in part to the lack of thorough, robust evaluations of programs. In light of the recent evidence suggesting a rise in DUI, researchers and policy-makers are looking at the whole host of anti-DUI programs in the 1980s and early 1990s, when the largest successes were recorded in terms of rising arrests and falling DUI-related deaths. (It is noteworthy that the under 20 age group, which received the most attention, also experienced the largest drop in DUI during that period of decline.)
The early findings suggest that long-term reductions in impaired driving crashes and fatalities can be achieved when enforcement and education efforts target environmental factors such as availability of alcohol, along with the specific behavior of driving after drinking. A program in Salinas, CA, is an example. It was a three-year effort that combined highly publicized sobriety checkpoints, training in responsible beverage service, and limits on the availability of alcohol at public events and retail outlets. An evaluation showed it to have a sustained effect in reducing traffic injuries and the incidence of impaired driving. More on the Salinas program.
"We have made tremendous gains in this country because we attacked it from all different perspectives—public education, law enforcement, having tougher laws, and more prosecution. If you want to make long-term change in reducing impaired driving, you need to raise awareness, enforce the laws, and have penalties,” said Pam Beer, a consultant on the NHTSA review.
Drinking and driving: a wide-ranging problem
Evidence also suggests that the target audience is much broader and that drinking drivers' drinking habits are not necessarily so different from most drinkers'. About two-thirds of drivers arrested or convicted of DUI are first-time offenders, according to the American Automobile Association Foundation for Traffic Safety. A significant portion of drivers involved in alcohol-related crashes do not appear to be habitual DUI offenders. This is a shift from earlier assumptions at the outset of the "war" against drunk driving 20 years ago.
"What we see is that impaired driving is an issue that affects everyone," said Ron Miller, Grant Coordinator for Mothers Against Drunk Driving (MADD) California. "In terms of what can be done about it, we have to look at a broad approach."
There does not appear to be a direct connection between levels of alcohol consumption in a society and the incidence of impaired driving. The historic downward trend in drinking and driving over the last 20 years in the U.S. took place even as alcohol consumption remained steady. Studies in Australia and Britain show similar trends. Despite very high per capita alcohol consumption in both countries, drunk driving has been reduced. "Efforts to get people to not drive after drinking have reduced crashes better than getting people not to drink," said NHTSA Regional Program Manager Paul Snodgrass.
"Don't drive drunk:" a major cultural shift
The most significant achievement in the area of DUI has been the change in cultural norms associated with drinking and driving, but exactly how this was achieved is not clear.
One of the most widely recognized forces in this transformation is the work of citizen advocacy organizations such as MADD, founded in 1980 by Candace Lightner after her daughter was killed in a drunk-driving crash. "MADD has done some amazing mind changing over the years," said Marilyn Sabin, Assistant Director of Operations for the California Office of Traffic Safety, alluding to its work with legislators to increase support for tougher laws, increased enforcement, prosecution, and punishment of DUI offenders.
"MADD brought the issue to people's attention," said Peter Roeper of the Pacific Institute for Research and Evaluation's Prevention Research Center in Berkeley, CA. "MADD is one of the most impressive intentional social change efforts that has existed. The norms have changed, and a lot of it is because people like MADD have made it a public concern."
MADD's success was part of a larger effort, however, "We would not have had the success we've had without organizations like MADD, but MADD in and of itself couldn't do it alone. Once they came on board, they needed the support of everyone else—you need penalties and consequences, or in other words, strong enforcement and good laws," Beer said.
Highly publicized enforcement efforts, such as blanket sobriety checkpoints, also seem to have had an effect. "Arrests don't touch that many people, but at a sobriety checkpoint, you've communicated to 1,000 people," Roeper said.
"Research shows that people respond more to the risk of being caught than the information about the [public health] risks of drinking and driving," Snodgrass said. "Preventing drunk driving is not all a police program, but it needs to come back to that," he said. "The general deterrence idea is important—people need to think they're going to get caught."
Merely increasing the amount of arrests or patrols won't have much effect unless the enforcement actions are publicized. "There was a study of two states that did checkpoints—one publicized the checkpoint, and one did not. There was a drop in crashes in the state that publicized, and not much change in the other state," Snodgrass said.
Similarly, tougher laws work best when they are visibly and consistently enforced. After California lowered the permissible blood alcohol concentration limit from 0.10% to 0.08% in 1990, the change was widely publicized, and enforcement was stepped up with highly visible campaigns. DUI crashes dropped 12%.
The value of publicity extends to education programs. The designated driver concept is one of the best-known legacies of the 80s and 90s anti-drinking and driving efforts. It was promoted on a number of fronts, including through the marketing arms of the nation's brewers and distillers. The use of the mass media to carry the message "was critical in promoting the designated driver idea," Roeper said. "It is basically a social program that tells people they should be safer, as opposed to just instilling the fear of getting arrested."
But when the public message is sent out too often, the audience and the media can become inured to the campaign. "If you have mobilizations too often, the media won't want to cover them—they're not news," Snodgrass said.
Communities can do things, too
"If I had advice for communities, it would be, get involved, form a task force," Snodgrass said. "The police can't do it themselves. Schools, public health people, grocery stores—they all need to be working together."
"Having community programs involved is nearly a requirement," said Roeper, adding that "MADD writ small" is very effective. "On the base, it's public energy that's going to rule the day."