REPORT TO THE LEGISLATURE OF THE STATE OF CALIFORNIA
SEPTEMBER 2002
EXECUTIVE SUMMARY
Motor vehicle crashes are the leading cause of death for Americans
aged 4 to 34. In the year 2000, a total of 41,821 people were killed in
traffic crashes in America, and 16,653 (or about 40%) of those fatalities
involved alcohol. After major reductions in driving-under-the-influence
(DUI) achieved during the 1980’s and early
1990’s, progress against DUI has slowed and stalled,
and the most recent (years 1999/2000) California data show the first
increase in DUI fatalities since 1987. The prevailing view of DUI in
America since the mid-1990’s has been that all of the
easy targets of opportunity had been identified and remediated, and that
additional reductions in DUI would only be gained incrementally, and in
small measure. The slowdown of progress against DUI in the late
1990’s, along with the recent negative reversal in DUI
trends, seemed to validate the perception that "all
had been done that could be done." In light of this present
review (conducted pursuant to Senate Bill 776, Torlakson, 2001) of
scientific literature on effective DUI countermeasures, however, this
prevailing perception can be seen as self defeating and unduly
pessimistic. Based on the scientific evidence, there are at least four
DUI legislative programs and initiatives that have the potential of
producing major reductions in the incidence of DUI, as large or larger
than the reductions seen in the 1980’s. These
countermeasures include:
- Pharmaceutical Treatment for Convicted DUI Offenders
Although drugs (particularly antabuse) have been used in the treatment
of alcoholism for decades with minor success, there are new
pharmaceutical treatments which are offering renewed hope for the
efficacy of this approach. One promising new drug is naltrexone, which
acts to reduce the opioid response to alcohol that causes alcoholics to
continue drinking to excess. Since the mid-1980’s,
studies at the University of Pennsylvania and Yale University have
established the effectiveness of naltrexone in reducing the craving and
consumption of alcohol. A major study of naltrexone and acamprosate drug
treatments, alone and in conjunction with psychosocial treatment, is
currently being conducted by the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) in 11 university research centers across the United
States. Based on the demonstrated success of naltrexone in these
university studies, the time is right to pilot test and scientifically
evaluate the impact of these new pharmaceutical treatments in the real
world applied setting of the DUI countermeasure system. The DUI system
provides an efficient means of identifying persons in need of treatment
for alcohol abuse via arrests for DUI, and the system structure and
service delivery components could be used to facilitate the trial of
pharmaceutical treatment for convicted DUI offenders, either at the
court, probation, or drinking driver treatment program level. As in
clinical trials, the most definitive and scientifically rigorous research
involves random assignment to treatment conditions; in this case,
convicted DUI offenders would be randomly assigned to existing DUI
sanctions and treatment, or to existing sanctions and treatment plus drug
treatment. The purpose of random assignment is to avoid bias between
groups which could compromise the evaluation of treatment effects, so
that the only systematic difference between treatment conditions is the
presence or absence of the additional drug treatment. Such a randomized
study of pharmaceutical treatment could corroborate the university
clinical trials and dramatically improve the effectiveness of treatment
for DUI offenders. The development of this pilot program would involve
the input of a wide variety of professionals from the medical and
judicial fields, as well as the cooperation of state and local agencies
involved in DUI control. - Alcoholic Beverage Control
Research has clearly shown that alcoholic beverage control policies
are associated with reduced consumption of alcohol and resultant
reductions in the multiple negative consequences associated with that
consumption, including alcohol-involved traffic crashes and fatalities.
The federal Prohibition laws of the 1920’s
demonstrated the positive societal benefits of reduced availability of
alcohol, yet ultimately proved untenable because of insufficient public
support. The majority of American adults consume alcohol, and perceive
positive benefits from this consumption, particularly in social settings.
Yet the vast majority (86%) of Americans also support increasing taxes on
alcohol in order to support drunk driving countermeasure programs.
Additional economic policies that also impact the price of alcohol
include price controls and limits on rebates, discounts, or other
economic inducements. Other alcoholic beverage control measures include
marketing control policies and regulations on the manufacture,
distribution, advertising, and sale of alcohol. - Reduce crashes associated with on-premise drinking
Research has shown that roughly half of all alcohol-related crashes
involve drinking at an on-premise establishment, while only a quarter of
all alcohol is consumed onpremise. These facts clearly identify
on-premise drinking as a major target of opportunity for reducing drunk
driving. Several DUI countermeasures address this problem, including
designated driver programs, server intervention programs, alcoholic
beverage control laws and server liability. Research has shown that
server intervention programs can be effective in reducing the proportion
of patrons who leave an establishment above illegal per se levels, and
one study identified a reduction in alcohol crash measures associated
with server intervention. California’s Department of
Alcoholic Beverage Control (ABC) has an active server intervention
program which is offered free of charge to licensed establishments on
request. The voluntary 4-hour program has trained over 150,000 servers
since the program was initiated in 1995. Although the current program has
been successful, mandatory server intervention training as part of the
ongoing ABC licensing process might have wider impact. California has not
had an effective server liability law ever since the dram shop law was
repealed in 1978. The Centers for Disease Control (CDC) review of server
intervention programs and liability laws recommended that server
liability laws are likely more effective than server intervention
programs. In California, the gap between the current virtually
nonexistent server liability statutes and the repealed dram shop laws
from 1978 is sufficiently large to provide a wide
"middle ground" for server liability
statutes which responsibly address the overrepresentation of on-premise
drinking among alcohol related crashes, while responding to the concerns
of the industry (including insurance costs). - Increase DUI prevention and general deterrence efforts,
particularly those targeting youth
If an ounce of prevention is worth a pound of cure," and
there is evidence that this concept applies to alcohol abuse and impaired
driving, then a shift in priorities from punishment to prevention might
be in order for our overall societal response to alcohol-impaired
driving. Recent research evidence that the age of onset of drinking is a
primary predictor of adult alcohol abuse points to the need to target
prevention efforts at youth. Research also suggests that prevention
efforts and public information and education (PI&E) campaigns would
benefit from a professional marketing approach similar to that used by
commercial interests to promote alcohol consumption. One key to any
successful PI&E campaign is to have a viable concept to
"sell," one which will make sense to and
be embraced by the target population. One such campaign in the area of
DUI prevention is the designated driver program, which has survived the
initial media blitz and become entrenched in the public consciousness as
one practical method of avoiding alcohol-impaired driving. One of the
more effective prevention efforts, which is often not seen as such, is
sobriety checkpoints. The ultimate function of a sobriety checkpoint is
not to catch drunk drivers (although DUI offenders are apprehended and
arrested), but as a general deterrent to the larger public of potential
impaired drivers, discouraging or
"preventing" them from driving impaired in
the first place.
WHAT WORKS?
Based on a review of the existing scientific literature, the following
countermeasures have proven significantly effective in reducing
alcohol-impaired driving:
- Effective Driver-Based Countermeasures
- Minimum drinking age laws
- Per se BAC laws
- Administrative per se license action laws
- "Zero-tolerance" laws for youth
- Other licensing actions, including restriction and probation
- Alcohol treatment
- Server intervention programs
- House arrest in lieu of jail
- Lower per se BAC for repeat offenders
- Sobriety checkpoints
- Public information and education
- Effective Vehicle-Based Countermeasures
- Vehicle impoundment or immobilization
- Ignition interlock
- Other Countermeasures Impacting Alcohol-Impaired Driving
- Seat belts
- Graduated driver licensing
- Alcoholic beverage control
WHAT DOESN’T WORK?
The following countermeasures, which have long formed the basis of
punishment for convicted DUI offenders, have not proven effective in
reducing impaired driving:
- Jail or community service
- Fines
WHAT MIGHT WORK?
The following countermeasures may prove effective in reducing
alcohol-impaired driving:
- Preliminary Breath Test (PBT) BAC testing of all crash-involved
drivers - Designated driver and safe rides programs
Alternative treatment modalities, including pharmaceutical treatment
Most of the scientifically proven effective countermeasures listed above
have been implemented, if not initiated, in California. It is important
that the integrity of these countermeasures is maintained, and that new
DUI legislation and programs do not diminish or work at cross-purposes to
laws and programs that are effective, including the minimum drinking age
law, "illegal per se" BAC level,
administrative per se license actions,
"zero-tolerance" for youthful offenders,
postconviction license suspension and revocation, and drinking driver
program treatment. Caution should be used in expanding underutilized DUI
programs with promise, including server intervention programs, house
arrest in lieu of jail, sobriety checkpoints, PI&E campaigns, vehicle
impoundment and interlock, in order that these programs can be maximally
effective and target the appropriate population of offenders. At the same
time, California should focus on and fully explore those legislative and
program areas that provide the greatest opportunity for having the
largest impact in reducing the incidence of alcohol-impaired driving.
This involves a fundamental shift in focus from punishment to
prevention.
RECOMMENDATIONS FOR CONSIDERATION
In addition to the four major initiatives identified earlier, based on
the review of scientific evidence regarding existing DUI countermeasures,
the following DUI legislation and programs also provide opportunities for
reducing the incidence of DUI:
- Lower illegal per se BAC levels for target groups
- Mandatory license suspension for all convicted DUI offenders
- Mandatory vehicle impoundment for persons arrested for a repeat DUI
offense - Increased use of house arrest in lieu of jail.
In addition, the following initiative offers the potential to improve
the identification and prosecution of DUI offenders:
- Permissive hospital BAC testing
CONCLUSION
California has long been recognized as a leader in traffic safety, and
many of the demonstrably effective DUI countermeasures have already been
enacted and implemented in this state, including the minimum drinking age
law, the 0.08% "illegal per se" BAC level,
administrative per se license action, "zero
tolerance" for youthful offenders, drinking driver treatment
programs, ignition interlock, and vehicle impoundment. While California
has enacted most of the known effective DUI countermeasures, there are
countermeasures implemented in other states which might be of benefit to
California, such as a lower per se BAC level for repeat offenders. There
are also effective countermeasures which are not implemented as widely as
they might be, including house arrest in lieu of jail, sobriety
checkpoints, and server intervention programs. Most importantly, there
are four major initiatives which offer the potential for large-scale
reductions in alcohol-impaired driving, including new pharmaceutical
treatments (naltrexone), increased alcoholic beverage control, reducing
the contribution of on-premise drinking to the DUI problem, as well as
prevention efforts focused on youth. There continues to be strong public
support for anti-DUI efforts, including the raising of alcohol taxes,
provided the funds are used against drunk driving.
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