Overview

Alcohol-related motor vehicle crashes kill someone every 31 minutes and nonfatal injure someone every two minutes (NHTSA 2005).

 What dose it mean to be driving under the influence of alcohol ?

• This is taken from  en.wikipedia.org this is a very good definition:

Statutes commonly provide for two separate and distinct criminal offenses. The first is the traditional "drunk driving" offense, consisting of driving under the influence of alcohol and/or drugs. Evidence to support this crime generally comes from the officer's observations (erratic driving, slurred speech, unsteady gait, etc.), performance on field sobriety tests, and a legal  presumption of intoxication from a blood alcohol test result over the legal limit. The second offense is the more recent so-called "per se" offense: rather than focusing on impairment the crime consists entirely of having a given blood alcohol content (BAC) at the time of driving, regardless of the individual's tolerance to alcohol. Both offenses may be charged, and the defendant may be convicted of both; if a blood alcohol test result was not obtained, only the traditional "DUI" offense will be charged.

BAC is most conveniently measured as a simple percent of alcohol in the blood by weight. It does not depend on any units of measurement. In Europe it is usually expressed as milligrams of alcohol per 100 milliliters of blood. However, 100 milliliters of blood weighs essentially the same as 100 milliliters of water, which weighs precisely 100 grams. Thus, for all practical purposes, this is the same as the simple dimensionless BAC measured as a percent. Since 2002 it has been illegal in all 50 US states to drive with a BAC that is 0.08% or higher.

Driving while consuming alcohol is generally illegal, though driving after drinking remains legal. In some jurisdictions it is also illegal for an open container of an alcoholic beverage to be in the passenger compartment of a motor vehicle or in some specific area of that compartment.

Occurrence and Consequences

• During 2004, 16,694 people in the U.S. died in alcohol-related motor vehicle crashes, representing 39% of all traffic-related deaths (NHTSA 2005).
   
• In 2004, about 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics (Department of Justice, 2004). That’s less than one percent of the 159 million self-reported episodes of alcohol–impaired driving among U.S. adults each year (Quinlan et al. 2005).
   
• Drugs other than alcohol (e.g., marijuana and cocaine) are involved in about 18% of motor vehicle driver deaths. These other drugs are generally used in combination with alcohol (Jones et al. 2003).
    
• More than two-thirds of child passengers ages 14 and younger who died in alcohol-related crashes during 1997–2002 were riding with the drinking driver; only 32% of them were properly restrained at the time of the crash (Shults 2004).

 
Cost

Each year, alcohol-related crashes in the United States cost about $51 billion (Blincoe 2002). 

 
Groups at Risk

• Male drivers involved in fatal motor vehicle crashes are almost twice as likely as female drivers to be intoxicated with a blood alcohol concentration (BAC) of 0.08% or greater (NHTSA 2004b). A BAC of 0.08% is equal to or greater than the legal limit in most states. 
   
• At all levels of blood alcohol concentration, the risk of being involved in a crash is greater for young people than for older people (Zador 2000). In 2003, 25% of drivers ages 15 to 20 who died in motor vehicle crashes had been drinking alcohol (NHTSA 2004c).  
   
• Young men ages 18 to 20 (under the legal drinking age) reported driving while impaired almost as frequently as men ages 21 to 34 (Liu 1997). 

• Among motorcycle drivers killed in fatal crashes, 30% have BACs of 0.08% or greater (Paulozzi 2004).

·       Nearly half of the alcohol-impaired motorcyclists killed each year are age 40 or older, and motorcyclists ages 40 to 44 years have the highest percentage of fatalities with BACs of 0.08% or greater (Paulozzi 2004).

• Of the 2,136 traffic fatalities among children ages 0 to 14 years in 2003, 21% involved alcohol (NHTSA 2004d).  

 Risk Factors

·      Nearly three quarters of those convicted of driving while impaired are either frequent heavy drinkers (alcohol abusers) or alcoholics (alcohol dependent) (Miller 1986).

• Among drivers involved in fatal crashes, those with BAC levels of 0.08% or higher were nine times more likely to have a prior conviction for driving while impaired (DWI) than were drivers who had not consumed alcohol (NHTSA 2004a).

CDC Activities

Actions to decrease alcohol-related fatal crashes involving young drivers have been effective
Over the past 20 years, alcohol-related fatal crash rates have decreased by 60 percent for drivers ages 16 to 17 years and 55 percent for drivers ages 18 to 20 years. However, this progress has stalled in the past few years. To further decrease alcohol-related fatal crashes among young drivers, communities need to implement and enforce strategies that are known to be effective, such as minimum legal drinking age laws and "zero tolerance" laws for drivers under 21 years of age. 

Elder RW, Shults RA. Trends in alcohol involvement in fatal motor vehicle crashes among young drivers – 1982-2001. MMWR 2002;51:1089–91.

Sobriety checkpoints reduce alcohol-related crashes
Fewer alcohol-related crashes occur when sobriety checkpoints are implemented, according to a CDC report published in the December 2002 issue of Traffic Injury Prevention. Sobriety checkpoints are traffic stops where law enforcement officers systematically select drivers to assess their level of alcohol impairment. The goal of these interventions is to deter alcohol-impaired driving by increasing drivers’ perceived risk of arrest. The conclusion that they are effective in reducing alcohol-related crashes is based on a systematic review of research about sobriety checkpoints. The review was conducted by a team of experts led by CDC scientists, under the oversight of the Task Force on Community Preventive Services—a 15-member, non-federal group of leaders in various health-related fields. (Visit www.thecommunityguide.org for more information.) The review combined the results of 23 scientifically-sound studies from around the world. Results indicated that sobriety checkpoints consistently reduced alcohol-related crashes, typically by about 20 percent. The results were similar regardless of how the checkpoints were conducted, for short-term “blitzes,” or when checkpoints were used continuously for several years. This suggests that the effectiveness of checkpoints does not diminish over time.

Elder RW, Shults RA, Sleet DA, Nichols JL, Zaza S, Thompson RS. Effectiveness of sobriety checkpoints for reducing alcohol-involved crashes. Traffic Inj Prev 2002;3:266-74.

Stronger state DUI prevention activities may reduce alcohol-impaired driving
Strong state activities designed to prevent driving under the influence (DUI), including legislation, enforcement, and education, may reduce the incidence of drinking and driving, according to a study from the Centers for Disease Control and Prevention (CDC). For the study, which was published in the June 2002 issue of Injury Prevention, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) national telephone survey, and the Mothers Against Drunk Driving (MADD) Rating the States 2000 survey, that graded states on their DUI countermeasures from 1996-1999. Results showed that residents of states with a MADD grade of "D" were 60 percent more likely to report alcohol-impaired driving than were residents from states with a MADD grade of "A." MADD based the grades on 11 categories of prevention measures, including DUI legislation; political leadership; statistics and records availability; resources devoted to enforcing DUI laws; administrative penalties and criminal sanctions; regulatory control and alcohol availability; youth DUI legislation; prevention and education; and victim compensation and support.

The study also found that 4 percent of the residents who consume alcohol reported they had driven after having too much to drink at least once during the previous month. Men were nearly three times as likely as women to report alcohol-impaired driving, and single people were about 50 percent more likely to report alcohol-impaired driving than married people or those living with a partner.

Shults RA, Sleet DA, Elder RW, Ryan GW, Sehgal M. Association between state-level drinking and driving countermeasures and self-reported alcohol-impaired driving. Inj Prev 2002;8:106–10.

Research leads to bills that protect children from drinking drivers
CDC’s findings about the number of children killed in cars driven by drinking drivers has led legislators in several states to introduce bills to help protect them from drinking drivers. Such legislation creates special penalties under state child abuse laws for persons who transport children while driving drunk. Results from the study showed that nearly two-thirds of children killed in drinking driver-related crashes were riding with the impaired driver. Fewer than 20 percent of the children killed were properly restrained at the time of the crash, and restraint use decreased as the driver’s blood alcohol concentration increased.

Quinlan KP, Brewer RD, Sleet DA, Dellinger AM. Child passenger deaths and injuries involving drinking drivers. JAMA 2000:283(17):2249–52. 

Research identifies effective interventions against alcohol-impaired driving
CDC and the Task Force on Community Preventive Services—an independent, nonfederal panel of community health experts—published systematic reviews of the literature for five community-based interventions to reduce alcohol-impaired driving. The reviews revealed strong evidence of effectiveness for 0.08% blood alcohol concentration (BAC) laws, minimum legal drinking age laws, and sobriety checkpoints. They also found sufficient evidence of effectiveness for lower BAC laws specific to young or inexperienced drivers (zero tolerance laws) and intervention training programs for alcohol servers. A detailed description of the sobriety checkpoints systematic review was published in the December 2002 issue of Traffic Injury Prevention. The systematic review of the effectiveness of 0.08% BAC laws for drivers was helpful in establishing a 0.08% standard nationwide. The review revealed that state laws that lowered the illegal BAC for drivers from 0.10% to 0.08% reduced alcohol-related fatalities by a median of 7 percent, translating to 500 lives saved annually. With this evidence, the Task Force on Community Preventive Services strongly recommended that all states pass 0.08% BAC laws. In October 2000, the President signed the Fiscal Year 2001 transportation appropriations bill, requiring states to pass the 0.08% BAC law by October 2003 or risk losing federal highway construction funds. As of October 1, 2003, 45 states and the District of Columbia had enacted 0.08% BAC legislation.

In June 2001, Tommy G. Thompson, Secretary of the Department of Health and Human Services, awarded the Secretary’s Award for Distinguished Service to the systematic review team for their contribution to the field. The team is currently conducting systematic reviews of mass media campaigns, school-based education programs, and designated driver programs, which are scheduled for publication in 2004. 

The Guide to Community Preventive Services

Shults RA, Elder RW, Sleet DA, Nichols JL, Alao MA, Carande-Kulis VG, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving [published erratum appears in American Journal of Preventive Medicine 2002;23:72]. American Journal of Preventive Medicine 2001;21(4S):66–88.

Prevention Strategies

Effective measures to prevent injuries and deaths from impaired driving include: 

• Promptly suspending the driver's licenses of people who drive while intoxicated (DeJong 1998).
   
• Lowering the permissible levels of blood alcohol concentration (BAC) for adults to 0.08% in all states (Shults 2001). 
   
• Zero tolerance laws for drivers younger than 21 years old in all states (Shults 2001).
   
• Sobriety checkpoints (Shults 2001).
   
• Multi-faceted community-based approaches to alcohol control and DUI prevention (Holder 2000, DeJong 1998).
   
• Mandatory substance abuse assessment and treatment for driving-under-the-influence offenders (Wells-Parker, 1995).

Other suggested measures include:

• Reducing the legal limit for blood alcohol concentration (BAC) to 0.05% (Howat 1991; National Committee on Injury Prevention and Control 1989).
   
• Raising state and federal alcohol excise taxes (National Committee on Injury Prevention and Control 1989).
   
• Implementing compulsory blood alcohol testing when traffic crashes result in injury (National Committee on Injury Prevention and Control 1989).