WORLDWIDE DECLINE IN DRINKING AND DRIVING

Transcription

1 WORLDWIDE DECLINE IN DRINKING AND DRIVING

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3 Worldwide Trends in Drinking and Driving: Has the Progress Continued? B. M. Sweedler Safety and Policy Analysis International, Lafayette, California, USA. Keywords Drinking and Driving, worldwide trends Abstract This paper will summarize the trends in drinking and driving in a number of countries around the world and the nature of the trends. The countries include: Germany, France, The Netherlands, Canada and the United States. The trend appears to be following recent history. Nothing dramatic seems to be occurring. In some countries, such as the United States and The Netherlands there were increases. In France and Germany there were decreases. Introduction In the decade of the 1980s, there were impressive declines in drinking and driving in much of the industrialized world. The declines included about 50% in the U.K., 28 % in Canada and The Netherlands, 32% in Australia, 37% in Germany and 26% in the U.S. These declines did not continue in the early part of the 1990s. In some countries, there were actually increases. Toward the middle and latter part of the decade the increases stabilized and we again began to see some decreases. However, these decreases have been at a slower rate than the dramatic decreases in the 1980s. At the end of the decade, some countries began to again see small increases. The information and data in this paper comes from papers prepared by researchers from Canada, France, The Netherlands, Germany, and the United States for presentation at T2002, the 16 th International Conference on Alcohol, Drugs and Traffic Safety in Montréal, Québec, Canada in August For additional detail about each country, you are encouraged to review each of the referenced papers. This is the fifth occasion where experts from around the world met to continue discussions began in The reasons for the changes that occurred were discussed and were published in a special report (1). The results of the continued discussions in 1995, 1997 and 2000 were also published (2,3 and 4). Methods Crash and survey data was analyzed by researchers in the countries listed. Because of different methods used to collect, record and analyze this data in the participating countries, it is not possible to draw comparison between countries. However, the results in each country were compared to historical data in that country to develop trends in drinking and driving. The results of these analyses is summarized. Where it was possible, a number of the researchers also

4 discussed the reasons for what was occurring. The programs in place to combat drinking and driving and their effectiveness is reviewed, where applicable. Results Canada In 1981, 62% of the drivers killed in Canada had been drinking. By 1989, this figure had reached a low of 44%. This represents a 29% reduction in the magnitude of the alcohol-fatal crash problem. Importantly, from 1981 to 1989, the relative change in the number of fatally injured drinking drivers and the change in the percent of fatally injured drivers who had been drinking were similar 31% and 29% decreases, respectively. The downward trend was clearly interrupted in 1991 and 1992 when the percentage of fatally injured drinking drivers increased to 46% and 48%, respectively. But this increase occurred because the number of fatally injured non-drinking drivers declined but the number of fatally injured drinking drivers remained relatively stable. Since 1992, there has been an annual decline in the percentage of fatally injured drivers who tested positive for alcohol i.e., a decrease from 48% in 1992 to 34% in The level achieved in 1999 was the lowest point reached in the past three decades and this downward trend strongly suggests a resurgence of the declines in the magnitude of the alcohol-fatal crash problem characteristic of the 1980s. It is, however, important to note that the decline in the percent of fatally injured drinking drivers that began in 1993 was again a function of two things a decline in the actual number of drinking-driver fatalities, combined with an increase in the number of non-drinking driver fatalities. This divergence was particularly marked after 1996 and had a salutary effect on the percentage. Nonetheless, from 1992 to 1999, the absolute number of drinking drivers did decrease by 29%, an amount identical the decrease in the percentage of fatally injured drivers who tested positive for alcohol i.e., a 29% reduction. However, it is important to recognize that when progress is measured in terms of changes in the percent of fatally injured drivers who had been drinking, this index can produce spurious effects, if the number of non-drinking driver fatalities increased at the same time. If the number of nondrinking driver fatalities had remained unchanged during the latter part of the 1990s, or had decreased, the decline in the percentage of drinking driver fatalities would have been less. Apart from the caution this demands in reporting and interpreting such data, they reveal as well another important finding that has yet to be explored adequately. At issue is the divergence in trends between the number of fatally injured non-drinking drivers and drinking drivers. Why is the number of alcohol-related driver deaths declining while the number of non-alcohol related driver deaths is increasing? Several alternative explanations are discussed in the paper (5). France In France, alcohol tests are compulsory in cases of injury accidents or when an offence has been committed. Random tests are also conducted. The number of compulsory tests has been fairly static over the past 10 years at about 1,500,000 per year. However, the number of random tests has risen sharply. The number of random tests increased from about 2,881,000 in 1990 to about 7,925,000 in The number of tests in 2000 declined slightly. The positive rate (over the legal limit) for the random tests was 1.1% in 1990 and 1.3% in But the numbers since 1996 reflect the lowering of the legal limit from.08 to.05%. The positive rate for those tested after an offence declined slowly from 3.6% in 1990 to 2.9% in In 2000, that rate was 3.6%, but again reflects the lower limit. More importantly, the number of fatal and injury accidents has declined steadily from 1990 to The percentages of injury and fatal accidents involving

5 drivers over the legal limit have also declined in that period. In 2000, in 5.5% of injury accidents and 16.2% of fatal accidents the driver was over the legal limit. This progress is attributable to the massive alcohol screening enforcement on the roads. Records show that more than one out of three drivers convicted of DWI with a BAC over.14% need medical care for an alcohol problem. The challenge for the future is to develop more effective interventions for alcohol impaired drivers. Analysis by age stresses the fact that it is important to recognize the road risk problem of the younger driver and the probable health risk problem of the older driver. Since alcohol has been classifies by experts as a hard drug, it is probably a priority to use traffic enforcement as a means of educating drivers about alcohol risks (6). Germany In the years after unification up to 1993 in Germany (East) the road accidents in general and especially alcohol related accidents worsened. But the figures from 1994 to 2000 show a stabilisation and improvement in the number of road accidents in Germany (East) especially with respect to related injuries and fatalities. Up to 2000 a favourable and continuous drop of alcohol related road accidents in all of Germany can be seen. Alcohol-related fatalities and percentage of total fatalities dropped from 1,828 (18.6%) in 1994 to 1,022 (13.6%) in The BAC limit was reduced from.08 to.05% in 1998, but because of the short time frame, its effects could not be assessed. Most drivers (up to 95 percent) remained below the legal BAC limit of 0.08 % and tend also to remain below the new legal BAC limit of 0.05 % as recent police records since 1998 demonstrate. The frequency distribution of the BAC level of involved car drivers influenced by alcohol indicates that the problem will not be solved only by lowering the legal BAC-limit. From this point of view, it is not only the problem of the low-level-driver, but also of driving alcoholics, especially within the age-group of 25 years and older. In view of the complicated structure of social control, a solution to the problem may be found by concentrating on primary prevention. A denser network of police controls would probably not increase the "yield" of undetected offenders much beyond the present level - according to surveys not higher than 2 percent. However, the establishment of breath tests gives the possibility of a less costly and more efficient policing of drink driving. In further years it has to be determined in which way a more efficient policing policy together with more severe sanctioning of drink driving (fine and suspension of licence for at least one month upwards 0.05 % BAC) could contribute to reduce alcohol-related accidents and thereby improve traffic safety (7). The Netherlands Between the mid-1980s and the early 1990s, DUI in the Netherlands decreased strongly: in weekend nights, the proportion of drivers with an illegal BAC (> 0.5 g/l) dropped from 12% in 1983 to 3.9% in This favourable development followed the introduction and extension of random breath testing, facilitated by the introduction of electronic screening devices and evidential breath testing. In recent years, however, DUI has not decreased any further, and even tended to increase. This may have been caused by an indecisive government policy towards drink-driving. After a reorganisation of the Dutch police forces in the first half of the 1990s, traffic law enforcement was given a lower priority than before. The introduction, in 1996, of a mandatory rehabilitation program for severe DUI-offenders was not accompanied by a large

6 scale publicity campaign. The introduction of a 0.2 g/l BAC limit for novice drivers, originally intended to become effective in 2001, was postponed by approx. 3 years. Furthermore, the formation of special traffic enforcement units in all 25 Dutch police regions, which started in 1999 and should have been completed in 2001, did not in the short term result in a higher enforcement level throughout the country. In weekend nights of 2000, 4.6% of Dutch motorists had an illegal BAC. Finally, results of a case-control study, conducted in 2000/2001, raised questions on the effectiveness of police enforcement and rehabilitation programmes in substantially reducing the number of hardcore drinking drivers and the resulting road trauma (8). United States For more than a decade, rates of alcohol-related crashes had declined in the United States. In 2000, however, 40 percent of all fatalities involved alcohol, up from the historic low of 38 percent in It was the first increase in alcohol-related deaths since In 2000, 16,653 fatalities were alcohol-related, compared to 15,976 in In 2001, the rate and number of alcohol-related fatalities remained essentially the same as in This was very discouraging news, especially in light of the bold new national goal that was established in 1995 to reduce alcohol-related traffic fatalities in America to no more than 11,000 by the year At that time, 125 recommendations were made to meet the ambitious goal. Despite all this activity, progress in achieving this national public health goal has been slow and for the past two years movement has been in the wrong direction. In addition, the prevalence of drinking drivers on the roadways on Friday and Saturday nights did not change much in the U.S. between 1986 and An update of a model used to analyze the effectiveness of various impaired driving laws in the U.S. projects that alcohol-related fatalities will still be at about 16,600 in 2005 if present trends continue. This slowness in progress is particularly discouraging because the tools to make significant progress are available. Many effective strategies are well known, but not implemented as widely or as vigorously as possible. Because of the significant progress that has been made in the past, complacency may have set in among policy makers. The level of public awareness and concern seems to have waned, with attention deflected to other issues. Several well established strategies exist that can significantly reduce impaired driving in the United States if they are implemented more broadly and more vigorously. Action should be taken at the national, state, and local level to ensure that we continue to make progress in reducing alcohol-related traffic crashes. These strategies include: administrative license revocation (ALR), lowering the illegal per se blood alcohol concentration (BAC) limit to.08 g/dl, graduated driver licensing, strengthened occupant protection laws, vehicle sanctions, sobriety checkpoints, enforcement of minimum drinking age and zero tolerance laws, improved public information and awareness, and alternatives to drinking and driving (9). Discussion As the new decade began, in The Netherlands, roadside surveys in 2000, showed an increase in drivers with an illegal BAC. In the United States, alcohol-related fatalities increased for the first time in 2000, since In 2001, the numbers were the same as On the other hand, in the Federal Republic of Germany, the share of accident-involved persons influenced by alcohol has continued to decrease from 1994 to In Canada, the downward trend continued. In France, the drinking and driving prevention system appears to have reduced the number of accidents attributed to alcohol. In a number of countries were progress has continued, the results can be

7 traced to the effectiveness of the prevention programs and the degree of attention placed on the issue. In those countries were progress has stopped or even reversed, the reasons can be traced to a lack of action, commitment or shifting priorities. References 1. Sweedler, BM (Ed). The Nature of and the Reasons for the Worldwide Decline in Drinking and Driving. Transportation Research Board Circular No. 422, Washington, DC, April Sweedler, BM. The Worldwide Decline in Drinking and Driving. In C.N. Kloeden and A.J. McLean (Eds). Alcohol, Drugs and Traffic Safety T 95, Adelaide, Australia, NHMRC Roas Accident Research Unit, University of Adelaide, pp , August Sweedler, BM. The Worldwide Decline in Drinking and Driving Where are we Now, In C. Mercier- Guyon (Ed). Alcohol, Drugs and Traffic Safety T 97, Annecy, France, CERMT, Centre d Etudes et de Recherches en Medecine du Trafic, pp Sweedler, BM. The worldwide decline in drinking and driving: has it continued. In Laurell (Ed) Alcohol, Drugs and Traffic Safety - T2000, Stockholm, Sweden, May Mayhew, DR., Beirness, DJ. and Simpson, HM. Are The Declines In Drinking Driving Fatalities In Canada Being Overestimated? Paper prepared for presentation at T2002, the 16 th International Conference on Alcohol, Drugs and Traffic Safety, Montréal, Québec, Canada, August Biecheler-Fretel, MB., Facy, F., Peytavin, JF. Drinking and Driving in France in : Changes in The Decade and New Perspectives, Paper prepared for presentation at T2002, the 16 th International Conference on Alcohol, Drugs and Traffic Safety, Montréal, Québec, Canada, August Kroj, G. and Lerner, M. Alcohol-related road accidents in the Federal Republic of Germany Status till Paper prepared for presentation at T2002, the 16 th International Conference on Alcohol, Drugs and Traffic Safety, Montréal, Québec, Canada, August Mathijssen, MPM. Indecisive Drink-Driving Policy Allows for Increase of DUI in the Netherlands, Paper prepared for presentation at T2002, the 16 th International Conference on Alcohol, Drugs and Traffic Safety, Montréal, Québec, Canada, August Stewart, K., Fell, J. Trends in Impaired Driving in the United States: Complacency or Backsliding? Paper prepared for presentation at T2002, the 16 th International Conference on Alcohol, Drugs and Traffic Safety, Montréal, Québec, Canada, August

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9 Alcohol Related Road Accidents in the Federal Republic of Germany Status till 2000 G. Kroj and M. Lerner Federal Highway Research Institute, Bergisch Gladbach, Germany Keywords Alcohol, accidents, traffic safety Abstract This article describes the development and actual status of alcohol related accidents in Germany and discusses the effectiveness of police controls, legislative and educational measures. Alcohol and road traffic in Germany Drink-drive limits In 1973, the critical BAC limit of 0.08 % was introduced as an offence which by statutory definition carries a fine ( 24a Road Traffic Act, StVG). After the unification of the Federal Republic of Germany and the German Democratic Republic from 1989 to 1993 there were two different legal BAC limits in the two former German states (West: 0.08 %; East: 0.00 %). In January 1993 in all parts of Germany the same BAC limit of 0.08 % became a legal requirement. In 1998 a second BAC-limit of 0.05 % was introduced, which indicated an offence without suspension of licence. The stricter limit was accompanied by a newly introduced limit for breath alcohol concentration of 0.25 mg/l. Instead of taking blood samples the police can carry out breath tests using special measuring instruments. This new and less costly testing procedure is admissible evidence in a court of law. Since April 2001 the limit of 0.05 % has replaced the limit of 0.08 % as an offence, which carries suspension of licence for at least one month. Alcohol related injury accidents - Data from the Federal Republic of Germany Alcohol related road traffic accidents are accidents in which at least one involved person has an alcohol concentration exceeding 0.03 %. In 1975 in West Germany 86 of injury-accident involved car drivers and 63 of pedestrians were influenced by alcohol. Since this time the figure decreased up to the year 2000 to 35 per involved car drivers and increased on the other hand up to the year 1993 to 73 per pedestrians (East: 84/West: 69). Since 1993 the figure of intoxicated injury accident involved pedestrians also decreased to 56 per pedestrians in Development till the unification of the two German states In the German Democratic Republic up to 1989 the trend of the development of alcohol related accidents was similarly favourable: compared with 1980, 14 % less alcohol related accidents with

10 injuries were counted in 1989 and 25 % less fatalities in alcohol related accidents, whereas the number of injury accidents not involving alcohol even rose by 3 % in that time. The number of fatalities also decreased by 8 %, which was clearly lower than in alcohol related accidents [1]. In the period from 1975 to 1990 in the Federal Republic of Germany (West) alcohol related injuries and fatalities in road traffic accidents decreased continuously: The alcohol related injury accidents decreased significantly (-32 %). On the contrary the non alcohol related injury accidents increased between 1975 and 1990 (+6 %). The alcohol related casualties also decreased dramatically in this period (-37 %), meanwhile the non alcohol related casualties rose (+2.5 %). The alcohol related fatalities in road accidents decreased from 1975 to 1990 by 57 %, whereas the non alcohol related fatalities in road accidents accounted only for -44 %. Three years before unification (1986 to 1989), the share of alcohol related injury accidents in the German Democratic Republic was approximately the same as in Federal Republic of Germany (10 %). The share of alcohol related fatalities in road accidents was also similar (FRG 18 %; GDR 17 %). But after the unification the road accidents increased dramatically in the former GDR. Especially the alcohol related injury accidents as well as the alcohol related casualties increased substantially from 1990 to 1993, while in Western Germany these figures continued to decrease. Since 1994 in the western part as well as in the eastern part of Germany all figures of alcohol related injury accidents have decreased. Although, the share of alcohol related accidents in the eastern federal states is higher, the figures of western and eastern countries become more and more equal. Alcohol related injury accidents in Germany since 1994 In the period from 1994 to 2000 all injury accidents decreased slightly (-2.5 %) while there was a continuous decrease concerning alcohol related injury accidents (-31 %). Especially the alcohol related fatalities (-44 %) as well as fatalities in general (-24 %) decreased substantially till accidents involving alcohol occurred in the year That means a reduction of nearly one third compared to These accidents accounted for casualties, of them died. Both the share of alcohol related accidents and casualties have decreased since 1994: The share of alcohol related injury accidents decreased from 1994 to 2000 from 10.2 to 7.2 % [see table 1]. The share of alcohol related casualties decreased from 1994 to 2000 from 10.3 to 7.6 % [see table 2] while the share of alcohol related fatalities decreased even from 18.6 to 13.6 % [see table 3]. The share of accident-involved persons influenced by alcohol decreased between 1994 and 2000 from 5.3 to 3.7 %

11 Table 1: Time series of injury accidents in total and alcohol related injury accidents in the period from in Germany Injury accidents in total Alcohol related injury accidents Share of alcohol related injury accidents % 9.5 % 9.2 % 8.6 % 7.6 % 7.2 % 7.2 % Table 2: Time series of casualties in road accidents in total and alcohol related casualties in the period from in Germany Casualties in road accidents Alcohol related Casualties Share of alcohol related casualties % 9.8 % 9.4 % 8.8 % 7.6 % 7.2 % 7.2 % Table 3: Time series of fatalities in road accidents in total and alcohol related fatalities in the period from in Germany Fatalities in road accidents Alcohol related fatalities Share of alcohol related fatalities % 18.2 % 16.8 % 16.9 % 14.3 % 14.3 % 13.6 % Most of the persons involved influenced by alcohol were car drivers (63 %). Only a minority of them were women (11 %) whereas compared with 1994 (8 %) the share of female impaired car drivers rose slightly. The problem of alcohol-impaired driving clearly shows age- and sexspecific features. Most of the male drivers involved are aged between 21 and 25 whereas the share of female drink-drivers involved raises continuously till the age of

12 The temporal distribution of alcohol related accidents shows the connection of alcohol impaired driving and leisure time. Nearly half (49 %) of alcohol impaired involved car drivers in 2000 had an accident at weekend (Saturday and Sunday), more than a quarter (27 %) in the nights of Friday and Saturday between 8 PM and 4 AM. With regard to the frequency distribution of the BAC level of involved car drivers, it must be taken into account that driving with lower BAC-level occurs more often than with higher levels. On the other hand the risk of an accident rises with the BAC-level. In combination of both factors the frequency distribution shows a peak between 0.14 and 0.17 % BAC. The mean BAC figure was - depending on the age - between 0.12 % (18-21 and above 75 years) and 0.19 % (40-50 years). Despite the mostly positive development of the alcohol related accident statistics the results of alcohol related accidents are more serious than the results of accidents in general. The severity of drink-drive accidents is - expressed as fatalities per injury accidents nearly twice as high as that of accidents in general. From 46.5 in 1994 this figure decreased to 37.3 in Discussion Until 2000 a favourable and continuous drop of alcohol related road accidents in Germany can be seen. In the years after unification till 1993 in Germany (East) the road accident development in general and especially concerning alcohol related accidents worsened. But the figures from 1994 to 2000 show a stabilisation and improvement of the road accident development in Germany (East) especially with respect to related injuries and fatalities. Because of the short period of analysis one could not assess clearly the effects of the lower legal BAC-limit in 1998 and 2001 on the alcohol related accident statistics. But the frequency distribution of the BAC level of involved car drivers influenced by alcohol indicates that the problem is not to be solved only by lowering the legal BAC-limit. From this point of view, it is not only the problem of low-level-driver, but also of driving alcoholics, especially within the age-group of 25 years and older. Outlook In view of the complicated structure of social control, a solution to the problem may be found by concentrating on primary prevention. Most drivers (up to 95 percent) remained below the legal BAC limit of 0.08 % [2] [3] and tend also to remain below the new legal BAC limit of 0.05 % as recent police records since 1998 demonstrate. A denser network of police controls would probably not increase the "yield" of undetected offenders much beyond the present level - according to surveys not higher than 2 percent [4]. However, the establishment of breath tests gives the possibility of a less costly and more efficiently policing of drink driving. In further years it has to be examined in which way a more efficient policing together with a more severe sanctioning of drink driving (fine and suspension of licence for at least one month upwards 0.05 % BAC) could contribute to reduce alcohol related accidents and so to improve traffic safety. Present efforts in the Federal Republic of Germany towards a more systematic integration of driver improvement programs into the existing legal and administrative framework seem to

13 provide a more promising route to traffic safety in the medium term than do demands for radical changes in sanctions [2] [5] [6] [7]. Driver improvement programs can already be considered as making an important and unique contribution to road safety in the Federal Republic of Germany, but they cannot be seen as a substitute for legal sanctions and measures. References 1. Kretschmer-Bäumel E. Drinking and Driving in Germany: Behavioural Patterns and Influencing Factors-- a temporal and cross-cultural comparison. J Proceedings "Alcohol, Drugs and Traffic Safety-T'92", Vol. II, Verlag TÜV Rheinland, Köln, 1993, Stephan E. Wirksamkeit der Nachschulungskurse bei erstmals alkoholauffälligen Kraftfahrern. Forschungsberichte der BASt, Bereich Unfallforschung, H 170, Bergisch Gladbach, Krüger HP. Das Unfallrisiko unter Alkohol, Gustav Fischer Verlag, Stuttgart, Jena, New York, Kerner HJ. Gesetzgebung, polizeiliche Überwachung und Strafgerichtsbarkeit in der Bundesrepublik Deutschland. Forschungsberichte der BASt, Bereich Unfallforschung, H. 115, Bergisch Gladbach, Winkler W, Jakobshagen W, Nickel WR. Wirksamkeit von Kursen für wiederholt alkoholauffällige Kraftfahrer. Forschungsberichte der BASt, H 224, Bergisch Gladbach, Kroj G. Rehabilitation of drunken drivers in the Federal Republic of Germany. J Proceedings "Alcohol, Drugs and Traffic Safety - T'92", Vol. I, Verlag TÜV Rheinland, Köln, 1993, Kroj G (ed.). Psychologisches Gutachten Kraftfahreignung. Deutscher Psychologen Verlag, Bonn, Statistisches Bundesamt. Alkoholunfälle im Straßenverkehr. Auszug aus Fachserie 8, Reihe 7 "Verkehrsunfälle", Wiesbaden, Ausgabe 1993 und Statistisches Bundesamt. Fachserie 8. Reihe 7 Verkehrsunfälle 2000, Wiesbaden,

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15 Are The Declines In Drinking Driving Fatalities In Canada Being Overestimated? D.R. Mayhew, H.M. Simpson and D.J. Beirness Traffic Injury Research Foundation 171 Nepean St. Suite 200 Ottawa, ON Canada K2P 0B4 Keywords Trends, drinking-driving, alcohol-impaired driving, driver fatalities, alcohol-fatal crash problem, driver characteristics Abstract Previous research has shown that the magnitude of the alcohol-fatal crash problem in Canada declined between 1992 and 1997, when it reached the lowest point in the past three decades. This paper examines trends in the alcohol-fatal crash problem to determine if reductions in the magnitude of the problem have continued. The analyses revealed continued progress from 1997 to 1999 as the percentage of fatally injured drivers who were positive for alcohol, as well as the number of drinking driver fatalities dropped even further. By contrast, the number of nondrinking driver fatalities actually increased over this period. The implications of these findings for estimating changes in the magnitude of the alcohol-fatal crash problem are discussed. Introduction In Canada during the 1980s, consistent and significant declines were reported in the alcohol-fatal crash problem (1, 2, 3). However, these declines halted rather abruptly and significantly for two years in 1991 and 1992, when increases were recorded (4). The following year, the downward trend re-emerged with decreases occurring each year. As a result, by 1997, the magnitude of the alcohol-fatal crash problem reached the lowest point recorded in the previous three decades (5). This paper examines more recent trends to determine if reductions in the magnitude of the problem have continued. In so doing, it seeks to identify reasons for both the historical and recent trends, some of which are related to how the problem itself is measured. In this context, a measure that is a widely accepted in many countries as a valid and reliable measure of changes in the magnitude of the alcohol-crash problem (6, 7, 8, 9) is the annual percentage of fatally injured drivers who test positive for alcohol. Measuring the magnitude of the problem in this way can, however, create interpretive difficulties because the index is sensitive to annual changes in both the numbers of drinking and nondrinking driver fatalities. For example, if both the number of non-drinking driver fatalities and the number of drinking driver fatalities decreased at the same rate each year, the percent of fatally

16 injured drivers who were positive for alcohol would not change. On the one hand, this could be interpreted as no improvement in the drinking-driving problem, since the percent of fatalities that were alcohol-related did not decline; on the other hand, such results could be interpreted in a positive light, since the absolute number of alcohol-related fatalities did decline each year. Accordingly, this paper also considers the extent to which changes in the percent of fatally injured drivers testing positive for alcohol, faithfully reflect changes in the magnitude of the problem. Data Sources Since 1973, the Traffic Injury Research Foundation (TIRF) has collected and maintained a database containing the results of tests for the presence and amount of alcohol performed on fatally injured drivers in seven provinces -- British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, and Prince Edward Island. In 1987, the Fatality Database was expanded to include all ten provinces and two territories. Rates of testing for alcohol vary somewhat among jurisdictions but, on average each year, about 80% of drivers of highway vehicles who died within six hours of the crash are tested for the presence of alcohol. Information on the presence of alcohol in fatally injured drivers is used in this paper as an index of the alcohol fatal-crash problem in Canada. Consistent with previous papers on this issue, trends in the problem are examined using an indicator derived from the fatality database i.e., the percentage of fatally injured drivers who tested positive for alcohol. To understand the basis for the changes in this indicator, annual changes in the number of non-drinking driver fatalities and the number of drinking driver fatalities are also examined. Results The numbers of fatally injured drivers who tested negative (non-drinking) for alcohol and the number who tested positive (drinking), as well as the percent of tested driver fatalities with positive BACs are shown in Figures 1, 2, and 3 for the 1970s, 1980s, and 1990s, respectively. During the 1970s, the percentage of fatally injured drinking drivers remained relatively stable ranging from 58% to 60% (see Figure 1). This trend occurred because the number of fatally injured non-drinking drivers mirrored annual changes in the number of fatally injured drinking drivers i.e., their numbers rose and fell together. Importantly, however, from 1973 to 1979, even though the percentage of drinking driver fatalities remained basically unchanged, the absolute number of drinking driver fatalities actually decreased by 11%. Figure 1 Numbers of Non-Drinking and Drinking Fatally Injured Drivers and Percent with Positive BACs: Canada*, Percent Pct Positive Non-Drinking Drinking Number * Seven provinces Year

17 During the 1980s, the trend was decidedly different (see Figure 2). The percentage of fatally injured drivers who were drinking increased slightly in 1980 and again in 1981 and then declined to the end of the decade. In 1981, 62% of the drivers killed in Canada had been drinking. By 1989, this figure had reached a low of 44%. This represents a 29% reduction in the magnitude of the alcohol-fatal crash problem. The downward trend in the 1980s occurred not only because the actual number of fatally injured drinking drivers declined but also because the number of non-drinking drivers increased. The divergence in these trends was underscored in 1987, the last year in which the majority of fatally injured drivers had been drinking. Importantly, from 1981 to 1989, the relative change in the number of fatally injured drinking drivers and the change in the percent of fatally injured drivers who had been drinking were similar 31% and 29% decreases, respectively. Figure 2 Numbers of Non-Drinking and Drinking Fatally Injured Drivers and Percent with Positive BACs: Canada*, Percent Pct Positive Non-Drinking Drinking Year * Seven provinces Number As shown in Figure 3, the downward trend was clearly interrupted in 1991 and 1992 when the percentage of fatally injured drinking drivers increased to 46% and 48%, respectively. But this increase occurred because the number of fatally injured non-drinking drivers declined but the number of fatally injured drinking drivers remained relatively stable. Since 1992, there has been an annual decline in the percentage of fatally injured drivers who tested positive for alcohol i.e., a decrease from 48% in 1992 to 34% in The level achieved in 1999 was the lowest point reached in the past three decades and this downward trend strongly suggests a resurgence of the declines in the magnitude of the alcohol-fatal crash problem characteristic of the 1980s. In fact, both the decades of the 1980s and 1990s witnessed an initial increase in the magnitude of the problem followed by a consistent and comparable drop reductions of about 30% in both of these decades. It is, however, important to note that the decline in the percent of fatally injured drinking drivers that began in 1993 was again a function of two things a decline in the actual number of drinking-driver fatalities, combined with an increase in the number of non-drinking driver fatalities. This divergence was particularly marked after 1996 and had a salutary effect on the percentage. Nonetheless, from 1992 to 1999, the absolute number of drinking drivers did

18 decrease by 29%, an amount identical the decrease in the percentage of fatally injured drivers who tested positive for alcohol i.e., a 29% reduction. Figure 3 Numbers of Non-Drinking and Drinking Fatally Injured Drivers and Percent with Positive BACs: Canada*, Percent Pct Positive Non-Drinking Drinking Year * Seven provinces Number Discussion The above findings demonstrate that the magnitude of the alcohol-fatal crash problem in Canada declined in the 1980s and again in the 1990s. In fact, both the percentage and number of drinking driver fatalities decreased at a comparable rate in the 1980s as well as the 1990s about a 30% reduction for both measures in each of these decades. However, it is important to recognize that when progress is measured in terms of changes in the percent of fatally injured drivers who had been drinking, this index can produce spurious effects, if the number of non-drinking driver fatalities increased at the same time. If the number of non-drinking driver fatalities had remained unchanged during the latter part of the 1990s, or had decreased, the decline in the percentage of drinking driver fatalities would have been less. Apart from the caution this demands in reporting and interpreting such data, they reveal as well another important finding that has yet to be explored adequately. At issue is the divergence in trends between the number of fatally injured non-drinking drivers and drinking drivers. Why is the number of alcohol-related driver deaths declining while the number of non-alcohol related driver deaths is increasing? Several alternative explanations are possible. One hypothesis is that the prevailing trend in the 90s was actually for an increase in driver deaths. However, drinking-driving initiatives may have exerted a powerful countervailing influence on factors that were leading to an increase in the number of fatally injured drivers. The myriad of safety measures targeting drinking drivers in the 1980s and 1990s resisted these prevailing influences and the alcohol-fatal crash problem decreased rather than increased. If so, the declines in drinking driver fatalities, as measured by the percentage of fatally injured drivers who tested positive for alcohol, is actually not at all spurious or an overestimate of the magnitude of the reductions. In fact, it would be an appropriate index of the downward trend because it takes into account the increase that would have occurred in the absence of the effective initiatives i.e., the number of drinking driver fatalities would have increased at the same rate as did the number of non-drinking driver fatalities

19 Alternatively, drinking-driving initiatives may have fostered a climate in which driving after drinking has become socially unacceptable. Drivers who would have previously driven after drinking refrained from doing so, but they crashed anyway. If this were the case, one would have to conclude that in such crashes alcohol was not a primary causal factor; rather, other factors, such as driving inexperience, overconfidence, poor skills, aggressive driving, and fatigue played a principal role in the increased number of non-drinking driver fatalities. This speaks to the fact that the presence of alcohol in a collision is not synonymous with alcohol being a cause in the collision. If this hypothesis were supported, it would suggest that although drinking-driving initiatives may have contributed to reductions in alcohol-related fatal crashes, they have not positively influenced the overall road crash problem. It is also possible that drinking-driving initiatives have played a negligible role in determining the divergent trends that have emerged in the past two decades. Perhaps powerful secular forces have exerted the major influence on these trends. Demographic changes, economic conditions, shifts in attitudes about health and alcohol, and a myriad of other factors largely define the context in which drinking and driving and road crashes takes place and, consequently, could be the driving force behind the divergent trends in the alcohol-and non-alcohol-fatal crash problems. Such explanations are speculative and provocative. But they underscore the need to reconsider the meaning of changes in indicators of the magnitude of the alcohol-crash problem, and perhaps more importantly, the need for research to understand why the number of alcohol-related fatal crashes has declined but the number of non-alcohol-related crashes has increased. Conclusion The meaning and continued value of indicators typically used to examine trends in the magnitude of the alcohol-fatal crash problem need to be examined. Apparent reductions in the problem as measured by declines in the percentage of fatally injured drinking drivers can result simply from increases in the number of non-drinking fatally injured drivers and this has been happening in recent years. Even so, it is important to underscore that during the 1980s and 1990s both the percentage and number of drinking driver fatalities declined at about the same rate in Canada. The implication of these divergent trends for understanding the impact of drinking-driving countermeasures, however, remains unclear. This is especially the case if powerful secular forces and not safety measures have exerted the major influence on these trends. Basically, the explanation for these trends remains open to speculation. The factors responsible for them have not been adequately documented. Further research beyond the descriptive level is needed to understand what precipitated the changes in the magnitude of the problem observed in the 1980s and 1990s. Acknowledgement The Fatality Database is funded by the Canadian Council of Motor Transport Administrators (CCMTA) and Transport Canada

20 References 1. Beirness DJ, Simpson HM, Mayhew DR, Wilson RJ. Canadian trends in drinking driver fatalities. In H. Utzelman, G. Berghaus and G. Kroj (Eds) Alcohol Drugs and Traffic Safety. Cologne: Verlag TUV Rheinland, 1993, pp Simpson HM, Beirness DJ, Mayhew DR. Decline in drinking and driving crashes, fatalities and injuries in Canada. In B. Sweedler (Ed.) The Nature of and Reasons for the Worldwide Decline in Drinking & Driving. Proceedings of a Workshop of the TRB Committee on Alcohol, Other Drugs and Transportation. Washington: (DC) 1994, TRB Circular No Simpson HM, Mayhew DR, Beirness DJ. The decline in drinking-driving fatalities in Canada: A decade of progress comes to an end? In C.N. Kloeden and A.J. McLean (Eds) Alcohol Drugs and Traffic Safety T 95, Adelaide, Australia: NHMRC Road Accident Research Unit, University of Adelaide, Volume I, 1995, pp Simpson HM, Mayhew DR, Beirness, DJ. The decline in drinking-driving fatalities in Canada: Progress re-emerges? In C. Mercier-Guyon (Ed) Alcohol, Drugs and Traffic Safety T 97, Annecy, France: Centre d Études et de Recherches en Médecine du Trafic, Volume 3, 1997, pp Mayhew DR, Beirness, DJ, and Simpson, HM. Trends in drinking-driving fatalities in Canada Progress continues. In: Alcohol, Drugs and Traffic Safety T 2000, Stockholm, Sweden, May Sweedler, B.M. (ed) The Nature of and the Reasons for the Worldwide Decline in Drinking and Driving. Transportation Research Board Circular No. 422, Washington, D.C. April Sweedler, B.M. The worldwide decline in drinking and driving. In C.N. Kloeden and A.J. McLean (Eds) Alcohol Drugs and Traffic Safety T 95, Adelaide, Australia: NHMRC Road Accident Research Unit, University of Adelaide, Volume I, 1995, pp Sweedler, B.M. The worldwide decline in drinking and driving Where are we now. In C. Mercier-Guyon (Ed) Alcohol, Drugs and Traffic Safety T 97, Annecy, France: Centre d Études et de Recherches en Médecine du Trafic, Volume 3, 1997, pp Sweedler, B.M. The worldwide decline in drinking and driving : Has it continued. In: Alcohol, Drugs and Traffic Safety T 2000, Stockholm, Sweden, May

21 Indecisive Drink-Driving Policy Allows for Increase of DUI in the Netherlands M.P.M. Mathijssen SWOV Institute for Road Safety Research, Leidschendam, The Netherlands. Keywords Alcohol, drugs, policy, risk Abstract Between the mid-1980s and the early 1990s, DUI in the Netherlands decreased strongly: in weekend nights, the proportion of drivers with an illegal BAC (> 0.5 g/l) dropped from 12% in 1983 to 3.9% in This favourable development followed the introduction and extension of random breath testing, facilitated by the introduction of electronic screening devices and evidential breath testing. In recent years, however, DUI has not decreased any further, and even tended to increase. This may have been caused by an indecisive government policy towards drink-driving. After a reorganisation of the Dutch police forces in the first half of the 1990s, traffic law enforcement was given a lower priority than before. The introduction, in 1996, of a mandatory rehabilitation program for severe DUI-offenders was not accompanied by a large-scale publicity campaign. The introduction of a 0.2 g/l BAC limit for novice drivers, originally intended to become effective in 2001, was postponed by approx. 3 years. Furthermore, the formation of special traffic enforcement units in all 25 Dutch police regions, which started in 1999 and should have been completed in 2001, did not in the short term result in a higher enforcement level throughout the country. In weekend nights of 2000, 4.6% of Dutch motorists had an illegal BAC. Finally, results of a case-control study, conducted in 2000/2001, raised questions on the effectiveness of police enforment and rehabilitation programmes in substantially reducing the number of hardcore drinking drivers and the resulting road trauma. Introduction Between 1970 and 1999, SWOV carried out periodic roadside surveys into the alcohol consumption of Dutch motorists during autumn weekend nights (10 pm-4 am). Since 2000, the surveys are being conducted by the Transport Research Centre (AVV) of the Ministry of Transport. The objective of these surveys is to obtain an insight into the patterns of drink-driving and into the effects of countermeasures

22 In 2000/2001, SWOV, in collaboration with Utrecht University, conducted a case-control study to determine the relative injury risk of psychoactive substance use by motorists. Until then, only rough estimates of the DUI road toll could be made, based on incomplete official statistics. Methods Roadside surveys Since 1991, roadside surveys have been conducted on a yearly basis. In each of the twelve Dutch provinces a varying number of survey areas is selected, dependent on population size of the province. The sample of survey areas is geographically spread over the province and stratified by degree of urbanisation. In each survey area, a police team, instructed and accompanied by a researcher, is performing RBT-activities at four to six consecutive locations, situated along main roads inside built-up area. The frequent change of location is intended to minimize the predictability of the combined survey and enforcement activities with respect to time and place. Motorists are taken at random from moving traffic and breath-tested by means of a Dräger Alcotest 7410 Plus screening device. Since random breath testing by the police is legally admitted in the Netherlands, non-response is virtually non-existent. Police survey teams are equally distributed over Friday and Saturday nights, and random breath testing is performed between 10 pm and 4 am. Each test result, as well as sex and age of the motorist, is entered on a registration form with preprinted date, time and location. In the end, provincial samples are put together, forming one nationwide sample. Since the distribution of observations over the various provinces is not equal to the distribution of the population (as an indicator of traffic volume), the BAC-distribution of the sample is weighted for provincial population size. The sample size has grown from about 3,000 tested motorists in the 1970s to nearly 25,000 in recent years. Data analysis is performed with the log-linear Weighted Poisson Model (1,2). In 1997 and 1998, a random sub-sample of 893 motorists was also urine-tested for a number of licit and illicit drugs, i.e.: (meth)amphetamines, cannabis, cocaine, opiates, methadone, benzodiazepines, barbiturates, and tricyclic antidepressants (3). In addition to the roadside survey, accident data is analyzed, and police co-ordinators of the police teams are interviewed on developments in enforcement levels and tactics. Furthermore, data on publicity campaigns, rehabilitation programmes, medical examinations, and accident data is collected and analyzed. Case-control study From May 2000 until August 2001, a prospective case-control study was conducted in the town of Tilburg and surroundings, covering a population of approximately 350,000 inhabitants in the south of the Netherlands. Cases consisted of seriously injured motorists who were admitted to the emergency department of the Tilburg St. Elisabeth Hospital. Controls consisted of motorists who were taken at random from moving traffic in the Tilburg police district, which covers the catchment area of the St. Elisabeth Hospital

23 Body fluids (urine or blood) of both cases and controls were tested for the presence of alcohol and the above-mentioned licit and illicit drugs. The relative risk of psychoactive substances was determined by comparing their prevalence in cases with their prevalence in controls. Odds ratios were computed by relating subjects who had been tested positive for a substance or a combination of various substances, to subjects who had been tested negative for all substances. A 5% probability level (p < 0.05) was used for significance. Results Development of drink-driving Between 1970 and 2000, the proportion of drivers with a BAC >0.5 g/l dropped from 15% to 4.5%. Significant reductions of drink-driving in weekend nights could be observed after police enforcement was intensified and/or the perceived risk of apprehension was enhanced (4): - Immediately after the introduction of the legal BAC-limit of 0.5 g/l, in 1974, the proportion of motorists with an illegal BAC dropped sharply, due to a perceived high risk of apprehension. Although this initial effect diminished quickly, a significant and stable 25% reduction of drink-driving could be observed until the mid-1980s. - From 1985 on, drink-driving again decreased rapidly,coinciding with expanding possibilities for random breath testing (RBT) by the police. RBT was facilitated by the introduction of electronic screening devices and the subsequent introduction of evidential breath testing. The share of motorists with an illegal BAC dropped to 3.9% in A temporarily strong reduction of the enforcement level after a reorganization of Dutch police forces, which came into effect in 1992, resulted in an increase of drink-driving. In weekend nights of 1994, 4.9% of motorists had an illegal BAC. Since then, the pre-reorganization enforcement level was more or less restored, and the proportion of illegal BACs stabilized at about 4.5% between 1995 and 2000 (see Figure 1). Figure 1: Development of the proportion of motorists with an illegal BAC, in the Netherlands, in weekend nights, in the period Drink-driving in the Netherlands in weekend nights, %