Driving, Alcohol, and Drugs

Since the invention of the automobile, people have recognized that drinking alcohol could lead to traffic accidents. Injuries from motor vehicle accidents are now the leading cause of death for individuals ages 1 to 29, and alcohol is the single greatest cause of fatal vehicle crashes. In 2000 approximately 16,068 deaths in car accidents were linked to alcohol use and driving. In fact, more people are killed in automobile crashes involving alcohol than by firearms.

In 1968 the U.S. Department of Transportation made its first report to the U.S. Congress on traffic safety and alcohol. It revealed that more than 50 percent of fatal traffic collisions and 33 percent of serious injury traffic collisions were alcohol-related. By the late 1970s, citizen groups such as Mothers Against Drunk Driving, Students Against Driving Drunk (now calling itself Students Against Destructive Decisions), and Remove Intoxicated Drivers, had emerged to address the problem of drunk driving. These members—who included victims, their families, and concerned citizens—vigorously campaigned for new and tougher drunk-driving laws and punishments.

See Organizations of Interest at the back of Volume 1 for address, telephone, and URL.

In the 1980s, Congress encouraged states to adopt stricter laws regulating drinking and driving. It did this by refusing to grant states federal funds to build or repair highways unless the states raised the legal age for drinking to 21. Ultimately, every state raised its drinking age accordingly. The states also passed a flood of legislation, providing for more and better law enforcement and a greater range of criminal penalties—from losing one's license to mandatory education in safe driving to jail terms. Public tolerance of driving under the influence of alcohol decreased sharply.

All these developments led to a significant decline in traffic fatalities related to use of alcohol, from a high of 57 percent of all fatal crashes in 1982 to 38.3 percent in 1999. Unfortunately, 2000 saw a reversal of that trend: 16,653 people were killed in crashes involving alcohol, representing 40 percent of the 41,821 people killed in all traffic crashes that year. Alcohol remains the single largest factor in traffic fatalities and serious injuries. The National Highway Traffic Safety Administration estimates that three out of ten Americans will be involved in an alcohol-related crash sometime during their lives.

Driving Under the Influence

The terms "driving under the influence" (DUI), "driving while intoxicated" (DWI), and "driving while impaired" are legal terms. In some states, they are used interchangeably, and someone who is taken to court for any of these three offenses faces the same penalties and sentencing. In other states, they represent different blood alcohol levels, with DWI a more serious offense than DUI. People who are found to be DWI may get stiffer penalties and sentences than people who are found to be DUI. Furthermore, in some states young people under 21 who are arrested have stricter blood alcohol guidelines than do adults.

Some states also have a classification called "extreme DUI" for blood alcohol greater than 0.15 percent. In Arizona, for example, a jail sentence for extreme DUI tends to be ten times as long as a jail sentence for regular DUI or DWI. When a suspect is arrested for drunk driving, he or she must take a Breathalyzer test. The breath machine measures the amount of alcohol in the breath and converts it into a measure of the amount of alcohol in the blood. In most states, a blood alcohol concentration (BAC) of 0.10 percent or above is classified as driving under the influence. Some states have further reduced the legal limit to 0.08 percent, but the U.S. Congress rejected legislation in 1998 that would have required all states to lower the drunken driving arrest threshold to 0.08 percent. Most other industrial nations have already set their legal limit at 0.08 or lower. Not surprisingly, in most states where 0.08 BAC laws have been added to existing controls on impaired drivers, they have led to reductions in alcohol-related fatalities.

In October 2000, Congress passed the Transportation Appropriations Bill, which sets 0.08 BAC as the national standard for impaired driving. The legal limit for BAC is still set by the states, not the federal government. But states that do not adopt 0.08 BAC laws by 2004 would have 2 percent of certain highway construction funds withheld. The penalty increases to 8 percent by 2007. States adopting the standard by 2007 would be reimbursed for any lost funds.

There is a strong correlation between a BAC greater than 0.05 percent and risk of serious injury or death while operating a motor vehicle. The figure on page 223 helps you see this relationship. The x axis shows increasing amounts of blood alcohol content. The y-axis illustrates increasing risk of accident. As you follow the curved line

upward along the x-axis, you can see that at BACs greater than 80 milligrams/100 milliliters, relatively small increases in BAC will lead to an increasingly greater risks of accident.

Most alcohol-related traffic collisions occur because the driver's attention, visual abilities, and perception are all impaired. These are considered information-processing errors. The second most frequent cause of alcohol-related collisions are errors in judgment, such as believing the car is traveling more slowly than it really is. Driving also requires divided-attention tasks, which means that the driver must monitor and respond to more than one source of information at the same time. For instance, drivers need to pay attention to where the car is headed as well as what cars nearby are doing. Divided attention occurs in drivers with BAC levels as low as 0.02 percent. It is interesting to note that an adult male who drinks two twelve-ounce beers or two other standard drinks on an empty stomach will have a BAC of about 0.04 percent an hour later. Drivers under the influence of alcohol frequently fail to detect threats or dangers on the road around them.

Many studies have shown that any amount of alcohol in the system impairs a person's abilities. It is important to note that a person can have enough alcohol in the system to impair driving abilities even without showing any signs of being drunk, such as having slurred speech or appearing unsteady. He or she may not seem drunk but could still have a BAC high enough to increase the chances of having an accident. Recent studies have shown that impairment occurs at very low alcohol levels. Some researchers suggest that impairment begins as soon as alcohol is actually detectable in the bloodstream.

The Extent of the Problem

More than 1.4 million people are arrested each year for drunk driving. An unknown number of violators never get caught. Those most likely to be caught are usually the most dangerous of the drunk drivers: those who drive far above the speed limit, weave in and out of traffic, and cross into lanes of traffic going in the opposite direction. The toll in terms of personal and property damage caused by drunk drivers is staggering. Drunk drivers themselves, often in single-car collisions, account for a large number of motorists who are killed. Each year thousands of pedestrians and other motorists are also killed by drunk drivers, and tens of thousands are badly injured.

The Offender

Ninety percent of those arrested for drunk driving are white males. The highest percentage of this group are in their 20s. People who drive drunk are likely to be heavy drinkers and alcohol abusers, although light and moderate drinkers may also drive drunk on occasion, perhaps following a binge. The consensus of studies based on screening tests of drunk drivers is that about 50 percent arrested for this offense are alcohol abusers, about 35 percent are social drinkers, and the remainder fall in between.

The Crime of Drunk Driving

In most states, a first drunk-driving offense is a misdemeanor , and a second offense within a specified time period (up to ten years in some states) is a felony . In a few states, a first offense is treated as a traffic violation, a second offense a misdemeanor, and a third offense a felony. Punishments vary from state to state. The usual range of punishments includes loss of a driver's license for up to one year, fines of $500 to $1,000, and incarceration (or jail time) for up to thirty days. In the late 1980s, several states passed laws mandating at least forty-eight hours of incarceration for a first DWI offense and a longer time for a second or subsequent offense. Another penalty that is increasingly used is the automatic and immediate forfeiture of the driver's license at the police station when the suspect fails or refuses to take the breath test.

In many states, all drunk-driving offenders are routinely screened for alcoholism and alcohol abuse. Surveys such as the Michigan Alcoholism Screening Test (MAST) or the Mortimer-Filkins Questionnaire, the Driver Risk Inventory, the Substance Abuse Life Circumstance Evaluation, the Alcohol Use Inventory, or the Lovelace Comprehensive Screening Instrument are lists of questions about a person's drinking and/or drug habits. The person giving the test then uses these answers to create a score that helps identify which people have a chronic problem with drinking and driving, and who may be struggling with actual alcoholism. Drunk drivers found to be alcoholics or drug abusers may be assigned to treatment programs rather than be prosecuted. A judge can also direct the offender to participate in treatment as a condition of probation or in order to obtain a provisional or regular driver's license. In some states, the largest share of people entering drug treatment programs do so as the result of a court order.

Several million people have attended drinking-driver schools since the mid-1970s. Classes cover such subjects as the deterioration of driving skills at different BAC levels, the ineffectiveness of coffee or cold showers to "sober up," and criminal penalties for drunk driving. People taking these classes are also required to complete the MAST to determine whether they are alcohol abusers.

Deterring the Drinking Driver

Deterrence based on the threat of arrest, conviction, and punishment remains the chief strategy in the attack on drunk driving. State and local governments have established dozens of strike forces and passed hundreds of laws aiming to raise the costs to the offender of driving while intoxicated.

The number of traffic fatalities fell steadily from 1982 until 1992; since then the number has remained around 41,000 deaths per year. Fatalities related to drunk driving have clearly fallen steadily since 1982, when more than 25,000 deaths were due to alcohol-related accidents (57.3 percent), to 1999 (15,976 deaths, or 38.3 percent of all traffic fatalities). This trend appears to be slowing, however, since the percent of alcohol-related traffic fatalities actually rose slightly in 2000. There may be reasons for this other than deterrence, including general reductions in alcohol consumption and abuse, and more responsible public attitudes toward sober driving. However, the effect of deterrence, even if small, cannot be ruled out as a factor in the decline.

Other Strategies to Fight Drunk Driving

In addition to deterrence, states and localities have implemented many other anti-drunk-driving strategies. Since all these strategies are being used simultaneously, it is impossible to credit any reductions to one strategy over another.

"Vehicular homicide" is a term used to describe a situation in which one person kills another; the weapon in this instance is the vehicle driven by the killer. Even though the driver may not have intended to kill someone, if he or she drives while under the influence of drugs and/or alcohol, the driver can be charged with vehicular homicide. All but three states have vehicle-specific homicide statutes that allow impaired drivers to be tried on homicide charges. Two states (North Carolina and Kentucky) have even allowed cases of drivers charged with vehicular homicide to be tried as capital murder cases, meaning that the driver faced the death penalty.

Some courts have required a convicted drunk driver to pay punitive damages to victims in an accident. In this case, a jury determines an amount of money the convicted drunk driver must pay the accident victim to make up for his or her loss. Some states permit the drunk driver's automobile insurance to cover the costs of punitive damages. In this case the punishment has no deterrent effect, as the money does not come out of the driver's own pocket.

In some states, legislatures and courts have declared that businesses that sell alcohol can be held liable for causing drunk-driving injuries. Called Dramshop Laws, these regulations vary from state to state. In most cases they make sellers of alcohol to underage or intoxicated persons liable for any injuries they cause to themselves or others. A few state courts have even made social hosts, such as a person who gives a party where alcohol is served, liable for the alcohol-related traffic injuries caused by their guests.

An essential strategy for controlling drunk drivers is taking away their licenses to drive. Several studies have shown that drunk drivers who lose their driver's licenses are less likely to have a recurrence than drunk drivers who are fined, sent to jail, or assigned to mandatory treatment programs. Nevertheless, many people continue to drive even after their licenses are suspended (temporarily taken away) or revoked (taken away permanently). This should not be a surprise given how vital automobiles are to most people's economic and social lives. Several states also have laws that authorize taking away a person's vehicle, but these sanctions are rarely used, perhaps because automobiles are among our most valued, expensive pieces of private property.

"Opportunity blocking" refers to anticrime strategies that change the environment to reduce the opportunities of committing particular offenses. The best opportunity-blocking strategy for drunk driving involves fixing the defendant's vehicle so that it cannot be started until he or she blows alcohol-free breath into a tube affixed to the vehicle. Such equipment is now available, and several jurisdictions have begun experimental programs. Other opportunity-blocking strategies include setting the drinking age at 21 and new laws and regulations on bars, taverns, and stores that sell alcoholic beverages.

Many educational programs are designed to stop drunk driving. These include public-service announcements on radio and television and educational materials for primary and secondary schools. The effects of such programs are very difficult to evaluate. However, communities that are aware of the problem of alcoholism are more likely to offer effective rehabilitation strategies and other treatment services to drunk drivers.

Driving and Drugs

The role of alcohol in traffic and other injuries is well documented, but determining the effects of other drugs, both legal and illegal, on driving is more difficult. This is true for three reasons: (1) Few drivers who are not involved in crashes volunteer to provide blood samples so their drug levels can be compared with drug levels in blood samples obtained from collision victims; (2) It is very difficult to determine how drug levels in the blood are related to the drug's actions in the brain, and it is those actions in the brain that cause impaired behavior; and (3) It can be difficult to determine how the interactions of various combinations of drugs, with or without alcohol, may contribute to impairment.

One study was designed to get around the first problem. Researchers studied only drivers who had been in crashes. They divided the drivers into two groups—those who were responsible for the crash and those who were not—and studied blood samples from each. The drivers who caused crashes had higher levels of prescription drugs, such as antidepressants and tranquilizers, or over-the-counter drugs, such as antihistamines or cold medicines, in their blood than the other drivers.

Other researchers examined the presence of drugs in blood specimens from 1,882 fatally injured drivers. Drugs, both illicit and prescription, were found in 18 percent of the fatalities. Marijuana was found in 6.7 percent, cocaine in 5.3 percent, tranquilizers in 2.9 percent, and amphetamines in 1.9 percent of these fatally injured drivers. Crash-responsibility rates increased significantly as the number of drugs in the driver increased. Many drug users used several drugs simultaneously, and these drivers had the highest collision rates.

Marijuana. The most frequently used illegal drug in the United States since the mid-twentieth century is marijuana. It is also the drug most often used by drivers. More studies have been performed to understand its effects on drivers than on any other drug. Many of these studies, both those conducted on the road and with driving simulators, indicate that marijuana impairs coordination, tracking (the ability of the eyes to follow movement), perception, and vigilance. A 1999 study, however, concluded that there was no evidence that marijuana alone increased either fatal or serious injury crashes. The evidence was inconclusive as to whether marijuana in combination with alcohol caused more fatalities and serious injuries than did alcohol alone.

Prescription Drugs. Numerous experiments have been performed to evaluate the effects of prescription drugs on vision, attention, vigilance, and the performance of psychomotor skills such as tracking. When a prescription drug is shown to produce side effects, this finding has important implications for the use of drugs while driving.

A wide variety of studies have shown that many prescription tranquilizers, especially benzodiazepines such as Valium, impair attention and tracking. However, more recently introduced tranquilizers such as buspirone (tradename Buspar) showed little evidence of impairment.

Another class of psychoactive drugs, antidepressants, have long been known to impair performance on a variety of skills. This is especially true of amitriptyline (tradename Elavil). However, recently introduced types of antidepressants, such as Prozac and other selective serotonin reuptake inhibitors, such as Zoloft, Paxil, and Effexor, do not produce the same degree of impairment.

Scientists have shown that narcotic painkillers, such as codeine and Demerol, derived from opium (opiates) lead to decreased alertness in laboratory animals. However, some reports state that chronic use of narcotics produces tolerance to some of these side effects. This may explain why scientists have not found differences in crash rates between narcotic users and nonusers. Heroin addicts are often given methadone-maintenance treatment but this drug, a synthesized narcotic, does not usually lead to impairment.

Antihistamines. Some antihistamine drugs (such as Benadryl) show evidence of impairing skills performance in laboratory studies. Many people who have taken certain antihistamines report that their performance becomes impaired and that they are drowsy. Recent pharmacological improvements have produced antihistamine drugs, such as loratadine (Claritin), that provide the benefits of antihistamine actions but, because they have difficulty crossing the blood-brain barrier, produce little impairment.

Stimulants. While there has been concern over increased use of stimulants, such as amphetamines and cocaine, by motor vehicle drivers, there is little experimental evidence that these drugs impair driving skills. In fact, most studies of these stimulants, as well as of caffeine, indicate that they improve skills performance. However, tolerance develops with chronic (long-term) use of stimulants, and the user must increase the dosage to get the desired effect. Thus, the dose levels examined in the laboratory may not be as high as those found among drivers. Also, an initial phase in which the user feels stimulated is followed by a phase in which depressant effects occur, including increased drowsiness and lack of alertness. Further study of stimulant drugs in relation to driving is needed, both for one-time use and chronic use.

see also Accidents and Injuries from Alcohol; Accidents and Injuries from Drugs; Addiction: Concepts and Definitions; Breathalyzer; Costs of Substance Abuse and Dependence, Economic; Drinking Age; Mothers Against Drunk Driving (MADD); Prevention; Students Against Destructive Decisions (SADD).