Since the early 1980's, legislative initiatives, such as the minimum legal drinking age of 21, administrative license revocation, and lower legal blood alcohol concentration limits for youth and adults, have significantly decreased alcohol-related traffic fatalities. General deterrence legislation is aimed at dissuading the general public from driving after drinking, whereas specific deterrence laws seek to prevent people who have been convicted for driving under the influence from repeating their offense. Education, enforcement, and comprehensive community programs, combined with legislation, can substantially reduce alcohol-related traffic deaths. KEY WORDS: drinking and driving; deterrence of AODU (alcohol and other drug use); community based prevention; community based intervention; legislation; DWI laws; minimum drinking age laws; traffic accident; AODR (alcohol and other drug related) accident mortality; impaired driver; BAC; mandatory treatment; license revocation; imprisonment; probation; law enforcement; recidivism
Traffic crashes are the leading cause of death in the United States for persons ages 1 to 34 (Insurance Institute for Highway Safety 1995). In 1995, 41 percent of fatal traffic crashes involved a driver or pedestrian who had been drinking (National Highway Traffic Safety Administration [NHTSA] 1996b). This article reviews the nature and extent of the drinkingdriving problem in the United States, discusses major legal and community initiatives in the past 15 years to reduce the problem, and examines other potential interventions for further reducing injuries and fatalities from alcohol-impaired driving.
ALCOHOL AND IMPAIRMENT
Even at blood alcohol concentrations (BAC's) as low as 0.02 percent, alcohol affects driver performance by reducing reaction time and slowing the decisionmaking process. Epidemiological research comparing BAC's of drivers in single-vehicle fatal crashes with those of drivers stopped at random in nationwide surveys indicates that each 0.02-percent increase in BAC nearly doubles a driver's risk of being in a fatal crash (Zador 1991). The risk increases more rapidly with each drink for drivers under age 21, who have less experience in driving and who, as a group, more often take risks in traffic, such as speeding or failing to wear seatbelts. For all groups of drivers, fatal crash involvement per miles driven increases ninefold at BAC's of 0.05 to 0.09 percent (Zador 1991).
PROBLEMS POSED BY ALCOHOLIMPAIRED DRIVING
In 1995 there were 17,274 alcoholrelated traffic fatalities and approximately 300,000 persons injured in alcohol-related crashes (NHTSA 1996b). Young people, people previously convicted for driving under the influence (DUI), and males in general are disproportionately involved in alcohol-related traffic deaths. Approximately 3 in 5 Americans will be involved in an alcohol-related crash at some point in their lives (NHTSA and National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1996). In addition, alcohol-impaired driving often has an impact on innocent victims. In 1995, 39 percent of people killed in crashes involving drivers who had been drinking were persons other than the drinking driver.
Alcohol-related traffic crashes cost society $45 billion annually in hospital costs, rehabilitation expenses, and lost productivity (NHTSA 1995a). In 1995 more than 1.4 million people were arrested for driving while intoxicated, nearly 10 percent of all arrests made that year.
RECENT TRENDS IN ALCOHOLRELATED TRAFFIC DEATHS
The United States, like several other countries, has experienced marked declines in recent years in the number of fatal crashes involving alcohol. In 1982, when NHTSA began estimating the proportion of fatal crashes nationwide that involved alcohol, 25,165 fatal crashes (57.2 percent of all fatal crashes) involved a driver or pedestrian who had been drinking. In 1995 alcohol was involved in 17,274 crash fatalities, or 41. …