Impaired Driving:Progress and Challenges

Brian JonahSenior Research ScientistTraffic Injury Research FoundationNational Conference of State LegislaturesAtlanta, GA May 14, 2009

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OverviewGlobal road safety situation

Impaired driving situation

Hard core impaired drivers

Impaired driving interventions

Drugs and driving

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Global Road Safety

1.2 million people killed annually on roads- 3,200 fatalities every day.About 50 million injured annually.Global cost of road collisions estimated to be $518 billion (1-2% of GNP).Road toll expected to decrease by 30% in high-income countries over next 20 years but increase by 80% in low and middle income countries due to increased motorization.

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Global Rank of Disease or Injury (2002) based on DALY’s*

20021. Ischaemic heart disease 2. Cerebrovascular disease 3. Lower respiratory infections 4. HIV/AIDS 5. Chronic pulmonary disease6. Perinatal conditions7. Diarrhoeal diseases8. Tuberculosis9. Trachea, bronchus,

lung cancers10. Road traffic injuries

*Disability adjusted life years lost

20301. Ischaemic heart disease2. Cerebrovascular disease3. HIV/AIDS4. Chronic obstructive pulmonary

disease5. Lower respiratory infections6. Diabetes mellitus7. Trachea, bronchus, lung cancers8. Road traffic injuries9. Tuberculosis10. Perinatal conditions

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Young people are prime victims in road collisions

Leading cause of death among 15-19 year olds.Second leading cause among 10-14 year olds and 20-24 year olds.Third leading cause among 5-9 year olds.Loss of our young people has major socio-economic impact

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Rank of Disease or Injury for Males in U.S.

Males1. Ischaemic heart disease2. Road traffic accidents3. Lung trachea or bronchial cancer4. HIV/AIDS5. Alcohol use6. Cerebrovascular disease7. Chronic obstructive pulmonary

disease8. Homicide and Violence9. Self-Inflicted Injuries10. Unipolar major depression

Females1. Ischaemic heart disease2. Unipolar major depression3. Cerebrovascular disease4. Chronic obstructive pulmonary

disease5. Lung trachea or bronchial cancer6. Breast cancer7. Osteoarthritis8. Dementia and other degenerative

and hereditary CNS disorders9. Diabetes mellitus10. Road traffic accidents

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Impaired DrivingSignificant progress was achieved in the late 1980s and early 1990s in reducing drunk driving.

Many jurisdictions implemented a range of programs and policies to address the problem.

Impaired driving continues to be a leading cause of death and injury in road crashes.

Hard core drunk drivers are an important part of the problem.

Young impaired drivers are at very high risk for death and injury.

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Number of Non-drinking and Drinking Fatally Injured Drivers and Pct. Positive Blood Alcohol Concentration (BAC) in US: 1990-2007

46 4543

4138 39 38 36 36 36 37 37 37 36 35 36 37 38

10

20

30

40

50

60

70

19

90

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

Year

Perc

en

t

0

3,000

6,000

9,000

12,000

15,000

18,000

Nu

mb

er

Pct Positive Non-Drinking Drinking

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Percent of Fatally Injured Drivers Positivefor Alcohol : US, 2007

62% 38%

13%0 BAC

+ BAC

80+ mg%

1-79 mg%

87%

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Percent of Fatally Injured Drivers Positivefor Alcohol : US, 2007

0 BAC

> 160 mg%

+ BAC

81-160 mg%

50-80 mg1-49 mg%

58% 42%55%

29%8%8%

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Percentage of All Drivers in Fatal Crashes Positive for Alcohol in US: 1990-2007

3331 30

28 27 26 2624 24 24

26 25 25 24 24 25 26 26

0

5

10

15

20

25

30

35

1990

1992

1994

1996

1998

2000

2002

2004

2006

Year

Perc

en

t

Pct Positive

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Percent of Fatally Injured Drivers With BACs Over 80 mg% by Age Group: U.S., 2007

0

10

20

30

40

50

60

<16 16-20 21-24 25-34 35-44 45-54 55-64 65-74 >74

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Percent of Drivers in Serious Injury Crashes that Involved Alcohol in Canada: 1995-2006

191819181920 202021 21 20 19

0

10

20

30

40

1996

1998

2000

2002

2004

2006

Pe

rce

nt

14

DrinkingDrinking

12%12%

88% not drinking

Alcohol among nighttime drivers

15

6.4

2.3 2.1

0.9

0

1

2

3

4

5

6

7

.02-.05 .051-.08 .081-.15 >.15

Percent

BACs of drivers in nighttime surveys

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Since the new millenniumProgress basically halted.

Same pattern holds for all the reliable indicators we have.

Declines were due to socially responsible individuals who drink less and drink and drive less.

Despite progress, the problem persists at unacceptable levels.

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Who is the problem ?

NHTSA (2001) survey data NHTSA (2001) survey data shows that shows that problem drinkers account for 27% of all drivers but account for 46% of the drinking and driving trips.

These drivers are the hard core impaired drivers.

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Profile of the Hard Core

They often drink and drive -- this is frequent and routine behavior for them.

They usually have consumed large amounts of alcohol -- this is extremely dangerous for them and others.

Many of them are alcohol dependent.

They usually have a history of prior DWI convictions

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High BACs predominate

In most jurisdictions, the average BAC is .17:» among fatally injured drivers» among injured drivers» among arrested drivers

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Few, but dangerous

Although high BAC drivers account for less than 1% of the nighttime drivers on the roads, they are responsible for as many as 60% of the serious collisions.

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Hard core repeatrepeat offender

Repeat offender -- operationally defined in terms of prior convictions.

Using this definition, the best official statistics suggest that about 30-40% of impaired convictions involve a repeat offender.

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Even this is an underestimate because of low probability of:» Getting detected and arrested

(Odds are anywhere from 1 in 200 to 1 in 2,000).

» Getting convicted (Many cases are plea-bargained or result in acquittal at trial).

Hard core repeatrepeat offender

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Summary

The hard core should be our The hard core should be our priority for drinkingpriority for drinking--driving driving countermeasures.countermeasures.

But by no means should this But by no means should this exclude our focus on exclude our focus on ““social social drinkersdrinkers”” or young drivers.or young drivers.

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.08 legal limitSobriety checkpointsAdministrative license revocationVehicle impoundmentAssessment/treatment of offendersAlcohol ignition interlocks

Solutions to Drinking & Driving

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Sanctions and programs are not enough

The drunk-driving system is replete with loopholes and inconsistencies that compromise its efficiency and effectiveness.There are problems at all levels -- in enforcement, prosecution, sanctioning and supervision that allow savvy DWI offenders in particular to “slip through the cracks”.Offenders are not consistently subject to programs that we know are effective.

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Fixing the system

The system needs to be streamlined, integrated, and loopholes eliminated.

In partnership with 14 major criminal justice agencies in the U.S., TIRF has identified where the problems are, and how to fix them to improve the efficiency and effectiveness of the system.

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Working Group on DWI System Improvements

The goal of the annual meeting in 2008 was to identify priority recommendations to address drunk driving among offenders and reduce alcohol-related deaths and injuries.

10 priority recommendationswere developed focusing on: » research » programs and interventions» the justice system

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Research recommendationsImprove the quality and quantity of data and data collection process to support research initiatives and decision-making.

Discover answers to key questions:» Pathways to DWI offending;» Effective strategies for dealing with DWI

offenders;» Targeted interventions for specific types of DWI

offenders;» Gender-specific strategies;» Financially viable strategies for rural areas;» Effective strategies for poly-substance abuse

offenders.

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Program recommendationsExpand DWI programs that work and discontinue those that do not.Establish effective practices and principles for the implementation and delivery of impaired driving strategies. Enhance training and education for practitioners regarding effective impaired driving strategies.Increase funding to support agency personnel.

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System recommendations

Make DWI a priority across the justice system.Enhance measures of system effectiveness.Improve communication and cooperation across all levels of the system.Make screening and treatment available at all phases of the system.

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Blue Ribbon Panel to Develop Driver Alcohol Detection System for Safety (DADSS)

Created in 2007, Panel includes representatives from NHTSA, other governments, vehicle manufacturers, parts manufacturers, researchers, MADD.Objective is a device that can measure alcohol in the body in reliable and transparent manner.Also, want to increase use of current alcohol interlocks by convicted DWIsConsidering various technologies such as tissue or distant spectroscopy, transdermal.Not likely to have technology for 5-10 years

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Summary

Drinking and driving should be a priority traffic safety issue.Emphasis should be on hard coreEfforts are needed on many fronts with different groups of offenders.Efforts are needed to make the system more effective and efficient.More effort on technology to deter impaired driving

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Drugs and Driving

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Do drugs impair driving skillsDo drugs impair driving skills

Yes. Experimental studies show a wide Yes. Experimental studies show a wide range of drugs impair critical skills and range of drugs impair critical skills and abilities (e.g., response times, abilities (e.g., response times, concentration). concentration). Some have a potent impact particularly Some have a potent impact particularly those with a sedative/hypnotic effect s those with a sedative/hypnotic effect s (e.g., valium). (e.g., valium). Some have a moderate effect (e.g., Some have a moderate effect (e.g., cannabis) and others are less impairing cannabis) and others are less impairing (e.g., stimulants).(e.g., stimulants).

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Do drugs impair driving skillsDo drugs impair driving skills

Epidemiological (real world) studies are Epidemiological (real world) studies are weak and vague. weak and vague.

The evidence that cannabis is related to The evidence that cannabis is related to crash risk is mixed. crash risk is mixed. »» Some studies report that the crash risk is Some studies report that the crash risk is

actually lower than the average driver, actually lower than the average driver, »» Others report crash risk is 1.5Others report crash risk is 1.5--2.5 times 2.5 times

greater.greater.

Studies of Studies of benzodiazapinesbenzodiazapines show the crash show the crash risk is 1.6risk is 1.6--5.0 times greater.5.0 times greater.

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Survey by Canadian Centre on Substance AbuseSurvey by Canadian Centre on Substance Abuse»» Roadside survey conducted 9:00pmRoadside survey conducted 9:00pm--3:00am 3:00am

WedWed--Sat in 3 British Columbia cities June Sat in 3 British Columbia cities June 20082008

»» 1200 drivers provided oral fluid for lab testing 1200 drivers provided oral fluid for lab testing »» 10% +10% +veve for drugs and 8% +for drugs and 8% +veve for alcoholfor alcohol»» CannabisCannabis-- 4.6%; Cocaine4.6%; Cocaine-- 4.6%4.6%»» Alcohol use more common for 19Alcohol use more common for 19--24 year olds24 year olds»» Drug use was very similar for 16Drug use was very similar for 16--54 year olds54 year olds

NHTSA 2007 report roadside survey which tested NHTSA 2007 report roadside survey which tested for alcohol and drugs coming out soon.for alcohol and drugs coming out soon.

Do people use them and Do people use them and drive?drive?

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Are drugged drivers involved Are drugged drivers involved in crashes?in crashes?

Yes. Overall incidence of drugs among drivers Yes. Overall incidence of drugs among drivers killed or injured in road crashes is in the 14killed or injured in road crashes is in the 14--17% range.17% range.Most commonly detected substance is Most commonly detected substance is cannabis (about 10cannabis (about 10--11% of cases); next are 11% of cases); next are benzodiazepines found in about 5benzodiazepines found in about 5--9% of 9% of cases.cases.Testing of fatally injured drivers is low.Testing of fatally injured drivers is low.Drugs frequently detected in blood in Drugs frequently detected in blood in combination with alcohol (up to 75%).combination with alcohol (up to 75%).Therefore, evidence of the contribution of illicit Therefore, evidence of the contribution of illicit drugs to crashes is inconsistent and drugs to crashes is inconsistent and inconclusive.inconclusive.

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SummarySummary

Many drugs impair skills and abilities Many drugs impair skills and abilities deemed important for the safe operation deemed important for the safe operation of a vehicle.of a vehicle.Many of these drugs are used by people Many of these drugs are used by people when they drive.when they drive.Many of these drugs are found in drivers Many of these drugs are found in drivers involved in collisions.involved in collisions.The risks of these drugs (contributory The risks of these drugs (contributory effects) are not well established. effects) are not well established. On balance, the evidence shows that the On balance, the evidence shows that the problem is by no means trivial even problem is by no means trivial even though still not well understood.though still not well understood.

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Staying informed

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