8

Conclusion

Despite years of progress in the United States, alcohol-impaired driving remains a major preventable public health and safety issue. Over the past 10 years progress has stalled, and for the past 2 years the number of alcohol-impaired fatalities has increased. Alcohol-impaired driving crashes cost the nation billions of dollars in terms of loss of life, injury and disability, lost productivity, and social and economic consequences, and it needs to become a priority issue across stakeholders and sectors. Changes in the social, economic, technological, and clinical arenas have opened up new opportunities to take action on this multifaceted problem. A renewed and comprehensive approach is needed to successfully reduce serious injuries and fatalities. Furthermore, a one-size-fits-all approach will not suffice, as U.S. states make up a patchwork of different existing policies, needs, and resources. Vision Zero, a philosophy that is grounded in the belief that no death caused by a motor vehicle crash is acceptable, provides a framework to engage novel stakeholders and a system with the goal of eliminating alcohol-impaired traffic fatalities. With this philosophy, each alcohol-impaired driver represents a system failure.

With this vision in mind, the committee examined the causes and consequences of alcohol-impaired driving and delineated the most promising and evidence-based solutions to employ. This report begins with an update on the burden of alcohol-impaired driving crashes (see Chapters 1 and 2) and delves into the complex factors that shape alcohol-impaired driving including the current alcohol and driving environments (see Chapter 2). Using the committee’s conceptual framework (see Figure 8-1) as a guiding schema, the report then discusses interventions (i.e., programs, policies,

and systems) to be used at the various phases of an alcohol-impaired driving crash: alcohol consumption and drinking to the point of impairment (see Chapter 3); driving while impaired (see Chapter 4); and postcrash and/or arrest (see Chapter 5). These interventions target multiple levels identified in the socioecological model (see Figure 1-6). The report then examines the current state of data and surveillance systems for alcohol-impaired driving and makes recommendations on how to improve the comprehensiveness and accessibility of data (see Chapter 6). Finally, the report explores the strategies and tools needed to generate action and discusses the roles of a few important stakeholders (see Chapter 7).

As illustrated in the committee’s conceptual framework, there are intervention opportunities across multiple sectors and disciplines. When interventions are implemented collectively, they can achieve the vision of zero alcohol-impaired driving fatalities. These cross-cutting relationships are visible in the synergies of the interventions that the committee

recommends throughout the report. For example, some of the drinking-oriented policies discussed in Chapter 3 that address illegal sales require public support and enhanced enforcement efforts to be most effective. Other strategies, including those related to taxation, outlet density, or hours of sale, do not depend on law enforcement and have population-level impact and therefore the potential for a large impact if prioritized. A systematic approach to addressing the alcohol environment would engage policy makers, alcoholic beverage control agencies, public health agencies, local law enforcement agencies, alcohol retailers, the legal community, and potentially other local institutions such as schools, health care systems, small businesses, local development agencies, and faith-based institutions.

Chapter 4 also illustrates the interdependent nature of interventions to reduce alcohol-impaired driving in the discussion of sobriety checkpoints. These enforcement activities are effective when the public is aware of them and the perceived risk of apprehension while driving impaired is significant. For example, the implementation of a lower blood alcohol concentration (BAC) limit set by state law will require publicity through media campaigns and visible enforcement to change norms. In addition, if the Driver Alcohol Detection System for Safety (DADSS) comes to market, it is unique in that it is a prevention technology that once in place will not require enforcement; however, it will require a successful media campaign to inform the public on what it is and why it is important. Furthermore, readily available data on high-risk areas and intersections or place-of-last-drink for driving while impaired (DWI) offenders would inform targeted enforcement interventions such as sobriety checkpoints.

Other recommendations would have an increased effect among specific populations when implemented in conjunction with each other. For example, for alcohol-impaired drivers with alcohol use disorder (AUD), a system such as DWI courts to engage high-rate recidivists or high BAC offenders could address the underlying causes of their behaviors. Moreover, if court-appointed practitioners use evidence-based evaluation and treatment practices, this would increase the likelihood that the individual will not repeat the offense. Importantly, many of the alcohol-impaired driving interventions in the report would also address drug-impaired driving, a growing public health and safety issue. For example, enhanced resources for law enforcement—trained to identify general impairment in drivers—to conduct frequent and publicized sobriety checkpoints and proper treatment of AUD would likely improve apprehension, deterrence, and treatment of individuals who drive under the influence of drugs. In summary, the synergies of the interventions discussed throughout the report need to be taken into account by policy and decision makers as they create a comprehensive plan for their state or locality. Implementing

these interventions in combination would also permit the development of improved evidence to inform the optimal mix of policies and interventions in the long term.

Rural areas are at particularly high risk, as interventions applicable in urban areas may be less practical in rural settings. A comprehensive approach that involves multiple sectors will be important to address the disproportionate number of fatalities in rural areas. For example, primary seat belt laws and enforcement, improved road design, improved emergency response, lower BAC limits set by state law, increased alcohol taxes, and use of ignition interlocks (and eventually DADSS), among other interventions, have the potential to be effective in rural areas when used together.

Applying a Vision Zero approach wherein every stakeholder has an opportunity and responsibility to take action and hold others accountable will help sustain comprehensive solutions for alcohol-impaired driving. Throughout the report, the roles of specific stakeholders are identified. For instance, Chapter 3 highlights the role of alcohol law enforcement agencies in monitoring and enforcing violations to reduce illegal sales to already-intoxicated adults and underage persons. Chapter 4 discusses the role of local departments of transportation in promoting the availability and affordability of alternative transportation options for individuals who drink alcohol. Chapter 7 outlines the role of the health sector, including public health, in providing care to individuals at risk for impaired driving, supplying data, and convening important stakeholders. Table 8-1 categorizes the interventions that are discussed in this report as evidence based or promising and identifies the important stakeholders and time frame for implementation.¹ Collectively, the committee’s conclusions and recommendations offer a blueprint for stakeholders across many sectors to take part in reducing alcohol-impaired driving fatalities.

This comprehensive multisector approach has the potential to renew progress and save lives from alcohol-impaired driving crashes.

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¹ Time frame (approximations of when these interventions could be in place): short term is 0–2 years, midterm is 3–10 years; long term is 10 years or more.

TABLE 8-1 Tools and Stakeholders to Accelerate Progress to Reduce Alcohol-Impaired Driving Fatalities

NOTES: Stakeholders marked with an asterisk are the primary actor(s) responsible for initiating action for the intervention. The rows shaded in gray are report conclusions and those in white are recommendations. The committee applied the Healthy People 2020 typology to inform the classification of evidence-based, promising, and emerging tools in this table. Time frame (approximations of when these interventions could be in place): short term is 0–2 years, midterm is 3–10 years; long term is 10 years or more. In some cases, the time horizon may be longer depending on the length of time it takes for a bill to be passed and signed into law. AUD = alcohol use disorder; CBT = cognitive behavioral therapy; DADSS = Driver Alcohol Detection System for Safety; DHS = U.S. Department of Homeland Security; DOJ = U.S. Department of Justice; DOT = U.S. Department of Transportation; DWI = driving while impaired; HHS = U.S. Department of Health and Human Services; IHS = Indian Health Service; NCSL = National Conference of State Legislators; NHTSA = National Highway Traffic Safety Administration; NIH = National Institutes of Health; SBIRT = screening, brief intervention, and referral to treatment; TTB = Alcohol and Tobacco Tax and Trade Bureau.

REFERENCE