A Qualitative Study of Drinking and Driving: Report on the Literature Review

Transcription

1 Road Safety Research Report No. 113 A Qualitative Study of Drinking and Driving: Report on the Literature Review Jean Hopkin, Wendy Sykes, Carola Groom and John Kelly Independent Social Research June 2010 Department for Transport: London

2 Although this report was commissioned by the Department for Transport (DfT), the findings and recommendations are those of the authors and do not necessarily represent the views of the DfT. While the DfT has made every effort to ensure the information in this document is accurate, DfT does not guarantee the accuracy, completeness or usefulness of that information; and it cannot accept liability for any loss or damages of any kind resulting from reliance on the information or guidance this document contains. Department for Transport Great Minster House 76 Marsham Street London SW1P 4DR Telephone Web site # Queen s Printer and Controller of Her Majesty s Stationery Office, 2010, except where otherwise stated Copyright in the typographical arrangement rests with the Crown. This publication, excluding logos, may be reproduced free of charge in any format or medium for noncommercial research, private study or for internal circulation within an organisation. This is subject to it being reproduced accurately and not used in a misleading context. The copyright source of the material must be acknowledged and the title of the publication specified. For any other use of this material, apply for a Click-Use Licence at To order further copies contact: DfT Publications Tel: Web: ISBN If you would like to be informed in advance of forthcoming Department for Transport priced publications, or would like to arrange a standing order, call Printed in Great Britain on paper containing at least 75% recycled fibre.

3 CONTENTS ACKNOWLEDGEMENTS 6 EXECUTIVE SUMMARY 7 1 INTRODUCTION The research Approach Scope of the review Overview of the material Terminology Outline of the report 14 2 BACKGROUND National statistics on drinking and driving Road accidents and casualties Convictions Attitudes and beliefs about drinking and driving Drinking patterns 20 3 PREVALENCE AND INCIDENCE OF DRINKING AND DRIVING Driving combined with drinking Reported over the limit driving after drinking Convicted driving over the limit Passengers 30 4 WHO DRIVES AFTER DRINKING? Socio-demographics and drinking behaviour Socio-demographics and drinking combined with driving Gender Age Social grade 37 3

4 4.2.4 Area Links with other driving offences Demographic profile Typologies and clusters Passengers 43 5 THE CIRCUMSTANCES UNDER WHICH PEOPLE DRIVE AFTER DRINKING Where? When? Who with? 47 6 ATTITUDES OF INDIVIDUALS WHO DRIVE AFTER DRINKING Why? motivations/reasons for driving after drinking Explanations Profile of drinking behaviour including planned and unplanned drinking Planning transport (or not) to avoid drink driving Changes in behaviour over time Perceptions of own driving with drinking behaviour The concept of drinking and driving Acceptability of drinking and driving Feelings of impairment (or not) when drinking and driving personal safe limits Actions to stay within the limit Perceptions of the legal limit Perceived risks Perceived causes of accidents Knowledge and understanding of laws and penalties Views on consequences 59 4

5 7 DRIVING UNDER THE INFLUENCE OF DRUGS Prevalence and incidence Who? Circumstances Passengers Attitudes and beliefs Drugs, alcohol and driving 65 8 IMPLICATIONS FOR THE QUALITATIVE RESEARCH Sample selection Interview coverage 67 9 REFERENCES 68 APPENDIX 1: Documents reviewed summary of scope and key points 71 5

6 ACKNOWLEDGEMENTS This research the qualitative study reported in a separate document (Sykes et al., 2010) and the literature review was carried out with the kind co-operation of 50 drivers who contributed their time to the project. Thanks are also due to various individuals and organisations whose input was important to the successful completion of the study. They include Liz Brooker at Lewisham Council, Andrew Clayton at RSN Associates, Helen Cooper at HAPAS Education and Training, Nick Docherty and others at Leo Burnett, Kirsty Favell at Hertfordshire County Council, Plus Four Market Research, Road Safety GB, TRL Library, Frances Underwood Secretarial Services, and Jenny Wynn at TTC. Policy and research colleagues at the Department for Transport whose input was highly valued by the research team include Andrew Burr, Fiona Seymour, Louise Taylor, and especially Rebecca Rhodes who managed the project from start to finish. 6

7 EXECUTIVE SUMMARY In the light of the need to reinvigorate road safety strategy and policy and drinkdrive campaigns, the Department for Transport commissioned a qualitative research project on drinking and driving to provide new insights. The project was designed to provide more in-depth understanding of the attitudes, behaviour and motivation of individuals who drive after drinking, whether or not they are knowingly over the prescribed limit. The research consisted of a literature review and a qualitative study: 1. The literature review was designed to inform the details of the qualitative research design, and to provide background and context for the findings of the qualitative study. 2. The qualitative study involved in-depth individual interviews that provided a confidential setting for detailed exploration of the patterns and circumstances of driving after drinking behaviour and the reasons why it occurs. Two reports summarise the project outcomes: this report covers the literature review, while the results of the qualitative study are reported in Sykes et al. (2010). The review analysed what is already known or understood about the characteristics, behaviour and attitudes of people who drink and drive (and drink drivers), and was used to generate a reasoned framework for the design of the qualitative research, including the composition of the sample, selection of sample members, and a topic guide. It focused on literature that is relevant to driving over the limit and driving after drinking generally, but included some studies on drug driving to identify parallels and overlaps, and also some key sources on drinking attitudes and behaviour in general. The review was confined to UK literature and most of the sources included were published or made available since Some 60 documents were identified, of which over 30 were summarised in the review. Terminology In this report, the term driving after drinking is used to refer to driving after drinking any quantity of alcohol, whether or not it is over the limit. Drink driving refers to driving over the legal limit for driving, although because much of the literature is based on self-report surveys, in practice this involves driving when perceived to be over the limit. Alcohol and road accidents Studies of alcohol impairment have demonstrated that driving skills are impaired at less than one eighth of the current legal limit. The accident statistics for Great 7

8 A Qualitative Study of Drinking and Driving: Report on the Literature Review Britain show that, in 2007, almost 6% of road casualties and 14% of road deaths occurred in accidents in which a driver had been drinking in excess of the legal limit for alcohol; 22% of drivers killed in road accidents are in excess of the legal alcohol limit; and 9% are well over twice the legal alcohol limit (Xu, 2009). Young drivers aged have the highest rate of drink-drive accidents per mile driven and the rate declines with age. In the last 10 years the rate of drink-drive accidents per mile has fallen in all age groups except Women are less likely than men to be involved in drink-drive accidents, and most convicted drink-drivers are men. Convicted drink-drivers are twice as likely to have a criminal record as others of the same age and gender. Alcohol and daily life Studies of drinking patterns and behaviour show that alcohol is an integral part of daily life in Britain a survey in 2008 found that 10% of adults drink almost every day and 27% on at least three days per week (Lader, 2009). Drinking in excess of the recommended daily maximum is relatively common and becoming more so: a 2007 survey found that 41% of men and 34% of women do so at least once a week (Robinson and Lader, 2009). Much alcohol is now drunk at home rather than in public places. Knowledge about measuring alcohol consumption is often inaccurate. Prevalence of driving after drinking Self-report surveys show that between one-fifth and two-fifths of drivers report driving within a few hours of drinking alcohol in the past 12 months. In there is some evidence of a decline between 2001 and 2007, but no recent information on trends elsewhere in the UK was identified. Most of those who drive after drinking alcohol report this to be a rare event: in, in 2007, 48% said once or twice during the year (Collins et al., 2008b). For a minority, driving after drinking is more common: in England, in 2002, 14% said once a month or more (Brasnett, 2004). Prevalence of drink driving Self-report surveys in in 2007 and 2001 found that 5% of drivers report driving at some time in the past 12 months when they thought they were over the legal limit for alcohol (Collins et al., 2008b; Anderson and Ingram, 2001). Most drink drivers report this to be rare: just over 70% said once or twice during the year in surveys in in 2007 and in England and Wales in 2002 (Collins et al., 2008b; Brasnett, 2004). In these two studies a few reported drink driving more frequently, for example 2% report driving over the limit fairly often in in 2007 and 18% once a month or more in England and Wales in One study in 2003 found that a small minority (1%) of heavy drinkers report that they drink drive nearly every day (Dalton et al., 2004). 8

9 Who drives after drinking? Those who drink alcohol more frequently are more likely to report driving after drinking and drink driving in the past year. More men than women drive after drinking, and more men than women are drink drivers. The highest reported prevalence of driving after drinking in the past year is in the age group (Collins et al., 2008b; Anderson and Ingram, 2001). In contrast, the highest reported prevalence of drink driving in the past year is in the age group (in studies in in 2007 and 2001, and in England and Wales in 2002). One study in in 2007 found the highest number of driving after drinking incidents per driver in the past year to be among people over 60 (Collins et al., 2008b). Driving after drinking is more prevalent among social grade AB and lowest among social grade DE, while drink driving is lowest among social grade DE, but more similar across the other social grades. Circumstances of driving after drinking Surveys have found that driving occurs after drinking alcohol in a wide range of places, including clubs, pubs, restaurants, visiting family and friends. Collins et al. (2008b) found that these tend to be casual occasions rather than serious nights out because drivers tend to plan alternative transport for the more serious occasions. The drive after drinking alcohol tends to be on local, short journeys where the road is well known and drivers feel safe. Over half of driving after drinking occasions are in the evenings, but they also happen in daytime, late at night and on the morning after drinking. Drivers do not tend to recognise driving on the morning after as drink driving. Motivations of individuals who drive after drinking Drive after drinking journeys are mainly made when drivers perceive that they are within the legal limit of alcohol consumption for driving. They are made when drivers feel that they are safe to drive, using their own definitions of safe limits. Unexpected events and changes of plan are not common explanations for driving after drinking. However circumstances are used to explain some driving that is marginally over the legal limit. Habitual driving after drinking, and previous experience of driving after drinking without incident and without getting caught, also play a part in decisions to drive after drinking. Attitudes towards planned and unplanned drinking A qualitative study of men aged in social grades C1 and C2 who drive after drinking provided interesting insights (Davies McKerr, 2007). For planned events, arrangements to avoid driving after drinking are made and drink driving is seen as less forgivable. However, on unplanned and spontaneous occasions it is seen as more acceptable to let events take their course; drink driving was often described as 9

10 A Qualitative Study of Drinking and Driving: Report on the Literature Review something that happens to people rather than something they choose to do. These drivers do not accept responsibility for exceeding the limit on occasions when they do not intend to do so, and they expect credit for their good intentions. Planning transport to avoid drink driving In urban areas public transport and taxis are seen as a reason to avoid drink driving. However, some studies found resistance to using public transport, particularly in rural areas, and the cost of taxis can be a deterrent. Cars are used for convenience and when planning to drink within personal safe limits, in some instances with arrangements for a designated driver. Perceptions of own drinking and driving behaviour The terms drinking and driving and drink driving are associated with drinking an amount of alcohol which is significantly over the legal limit for driving. Driving after drinking an amount of alcohol which is significantly over the legal limit is seen as irresponsible. Drivers tend to have their own self-defined safe limits for drinking before driving, which may be well below the legal limit. However, the boundary between acceptable and dangerous behaviour is not fixed a couple of drinks more than this personal safe limit. Perceptions of laws and penalties Various surveys show that there is widespread uncertainty about how the legal limit for drinking alcohol before driving is defined. The likelihood of getting caught is perceived to be low and, as a result, the consequences of being caught are not of great concern to people who drink and drive. Some of the penalties for drink driving are little known, including the criminal record. Driving under the influence of drugs Self-report surveys indicate that drug driving is far more prevalent among those under 40 than among older people; surveys in in 2005 and in the late 1990s found that 3 6% of drivers under 40 reported driving under the influence of illicit drugs in the past year (Myant et al., 2006; Ingram et al., 2000). Drug-driving journeys are often for social reasons and over short distances. However, for problem drug users, all driving is under the influence of drugs. 10

11 Implications for the qualitative research The literature review produced wide-ranging insights into drink drivers and those who drive after drinking, where, when and how often. These provided a sound base for developing the qualitative research in the second phase of the project. The results of the literature review contributed to the design of the qualitative research, particularly in relation to the sample selection and the coverage of the interviews. 11

12 1 INTRODUCTION 1.1 The research In the light of the need to reinvigorate road safety strategy and policy and drinkdrive campaigns, the Department for Transport commissioned a qualitative research project on drinking and driving to provide new insights. In particular, the project was designed to provide more in-depth understanding of the attitudes, behaviour and motivation of individuals who drive after drinking, whether or not they are knowingly over the prescribed limit. There were two main strands to the research, including a review of research of direct relevance to the project and original qualitative research: 1. The literature review was designed to inform the details of the qualitative research design, and to provide background and context for the findings of the qualitative study. 2. The qualitative study involved in-depth individual interviews that provided a confidential setting for detailed exploration of the patterns and circumstances of driving after drinking behaviour and the reasons why it occurs. In particular, this part of the research was concerned with the perspectives of people who drive after drinking; how they construe and interpret the situations that surround and give rise to occasions when they drive after drinking; and how they classify and make sense of their own behaviour in this respect. Two reports of the project outcomes have been prepared: this report covers the literature review and the results of the in-depth interviews are reported in Sykes et al. (2010). 1.2 Approach The objectives of the literature review were to analyse what is already known or understood about the characteristics, behaviour and attitudes of people who drink and drive (and drink drivers), and to generate a reasoned framework for the design of the qualitative research, including the composition of the sample, selection of sample members, and a topic guide. The approach adopted was to identify literature held by the Department for Transport, and to carry out searches of the Transport Research Laboratory (TRL) library database and other relevant databases to which the library has links, key government websites and carefully worded internet searches. The reference lists in key documents identified in this way then led to other relevant documents. Contact was also made with road safety experts and practitioners to ascertain whether there were other sources of information that had so far been overlooked. 12

13 The documents identified were entered in a table which summarised the scope, types of information on characteristics, attitudes and behaviour, any limitations, and whether the study was concerned with drinking only or drinking and driving. This was used to select key documents for summarising in more detail. The more detailed summaries were made using a framework that was linked with the expected structure of the in-depth interviews. The information in the table and the more detailed summaries of key documents were then taken into account when designing the qualitative research. While the interviews were being conducted, the report of the literature review was prepared so that it would be possible to draw together the information from the interviews and the literature review at the reporting stage. 1.3 Scope of the review The scope of the review was designed to focus on literature that is relevant to driving over the limit and driving after drinking generally, to include some key sources on drug driving to identify parallels and overlaps, and to include some key sources on drinking attitudes and behaviour in general. To ensure that the review was relevant to the UK, it was confined to UK literature. No cut-off date was set for recent literature, but in practice most of the sources reviewed were published or made available since 2000, although a few key documents were older. The material in many of the older documents identified was, in the main, covered by more recent studies. 1.4 Overview of the material A total of 61 sources of information were identified as being potentially relevant. Of these, 33 are referred to in this review. Most of the 33 sources include information relevant to drinking and driving specifically, while seven have information on characteristics, attitudes or behaviour of drinkers or are concerned mainly with driving after using illegal drugs. The documents that were not used in the review were either discussions of policy issues or general information and statistics on drinking and driving that were either already covered in other sources included in the review, or in studies that were covered by subsequent wider ranging reports, or in research on drinking among specific groups; some of these other documents contributed background information and insights for planning the qualitative research phase of the project. 1.5 Terminology In this report, the term driving after drinking is used to refer to driving after drinking any quantity of alcohol, whether or not it is over the limit. Drink driving refers to driving over the legal limit, although, because much of the literature is based on self-report surveys, in practice this involves driving when perceived to be over the limit. 13

14 A Qualitative Study of Drinking and Driving: Report on the Literature Review 1.6 Outline of the report Section 2 sets the scene with background information on drinking and driving from national statistics, and discusses attitudes and beliefs about drinking and driving, drink driving, and drinking patterns. Section 3 then presents a range of quantified evidence on the prevalence and incidence of drinking and driving. Section 4 looks at who drives after drinking, including age distributions, gender and other demographic information, summaries of typologies and cluster analysis that have been identified, and information on passengers travelling with drivers who have been drinking. Section 5 summarises the evidence on the circumstances in which people drive after drinking: where drivers are going, when, and who they are travelling with. Section 6 examines the information on the attitudes of people who drive after drinking: their explanations, perceptions, knowledge, and views on the consequences. Section 7 provides a brief summary of the literature on driving under the influence of illegal drugs, prevalence, characteristics of drug drivers, circumstances, attitudes, and overlaps with alcohol and driving. Finally, Section 8 summarises the implications of the outcome of the review for the design of the qualitative research involving in-depth interviews with drink drivers and people who drive after drinking. The appendix to the report contains two tables which summarise the types of information and key points in the references identified: Table A1.1 covers those referred to in the main text of this review, and Table A1.2 covers those which are not referenced in the review. 14

15 2 BACKGROUND 2.1 National statistics on drinking and driving Box 2.1: Key findings In 2007, almost 6% of road casualties and 14% of road deaths occurred in accidents in which a driver has been drinking in excess of the legal limit for alcohol. Twenty-two per cent of drivers killed in road accidents are in excess of the legal alcohol limit and 9% are well over twice the legal alcohol limit. Young drivers are over-represented among road casualties who are over the legal limit for alcohol. Young drivers have the highest rate of drink-drive accidents per mile driven and the rate declines with age. In the last 10 years the rate of drink-drive accidents per mile has fallen in all age groups except Women are less likely than men to be involved in drink-drive accidents. Most convicted drink drivers are men. Convicted drink drivers are twice as likely to have a criminal record as others of the same age and gender Road accidents and casualties Key statistics on accidents and casualties involving drink drivers are summarised in Xu (2009). The numbers killed and seriously injured in drink-drive accidents have been declining steeply in the late 1980s and early 1990s, slowly during the 1990s, and more steadily since However, alcohol remains a significant factor in road accidents. In 2007, 6% of all road casualties happened when a driver had been drinking in excess of the legal limit for alcohol, and 14% of all those killed on the roads were in accidents involving a driver who was over the legal limit for alcohol. Provisional estimates 1 for 2008 show that, again, 6% of casualties were associated with drink driving, while 17% of those killed on the roads were in drink-drive accidents. Of the people driving cars and other motor vehicles (excluding motorcycle riders) who were killed in road accidents in 2007, 22% were over the 1 Estimates of the numbers killed in drink-drive accidents are provisional because they are based on coroners data which do not become available until some time after the data on the accidents themselves; 57% of records were available at the time when the 2008 statistics were compiled in this source. 15

16 A Qualitative Study of Drinking and Driving: Report on the Literature Review legal blood alcohol limit (80 mg/100 ml), 15% were over 150 mg/100 ml and 9% were over 200 mg/100 ml. Drinking alcohol at below the legal limit is also associated with some road deaths: in 2007, 7% of drivers killed had blood alcohol levels between 9 and 50 mg/100 ml, and another 2% had blood alcohol levels between 50 and 80 mg/100 ml. The provisional estimate of the proportion of people killed while driving cars and other motor vehicles (excluding motorcycle riders) who were over the legal blood alcohol limit in 2008 was highest among those aged 30 39, of whom 39% were over the limit, and lowest among those over 40, of whom 15% were over the limit. A larger proportion of young drivers aged who were killed were over the legal limit (23%) and 33% of drivers aged who were killed were over the limit. In 2007, drivers aged who were killed had the lowest proportion with no alcohol present and the highest proportion with over twice the legal alcohol limit (over 16%). The proportion of drivers killed with over twice the legal limit for alcohol in their blood was around 9 13% for drivers in their 30s, 40s and 50s. Young drivers are over-represented among all road casualties who are over the legal limit for alcohol while driving (whether killed, or with serious or slight injuries). Estimates for 2007 indicate that drivers aged represented 40% of car-driver casualties who were over the legal limit (compared with 20% of those under the limit); 57% of car-driver casualties over the limit were aged (compared with 69% of those under the limit), while 4% of car-driver casualties over the limit were aged 60 or over (compared with 11% of those under the limit). While the overall trend in killed and seriously injured drink-drive casualties has been downwards, it has recently levelled off among young drivers aged In 2007 young drivers had more drink-drive accidents per driver and per mile driven than other drivers, and drivers over 60 had the least (Figure 2.1). Compared with 10 years earlier, the rates in each age group were lower, apart from in the age group. The statistics also provide information on gender and regional variations. Women drivers are much less likely than men to be involved in drink-drive accidents. The estimated rate of drink-drive casualties per 100,000 population in 2007 was highest in Wales, the West Midlands and the North West (over 27 per 100,000 population), and lowest in London where there were less than 7 per 100,000 population. In between these extremes, the rates in the East Midlands, South West and South East were between 26 and 27 per 100,000; in the East and the North East between 18 and 26; and between 7 and 18 in. 16

17 Figure 2.1: Drink-drive accident rate by age group, per driver and distance driven (source: Xu, 2009, based on STATS19 and NTS) The statistics on accidents and casualties show that, while there has been a decline in accidents and casualties associated with alcohol, for young drivers aged it has levelled off. Drinking over the legal alcohol limit still accounts for a large proportion of deaths among drivers in their 30s and in their 20s, with drink-drive accidents per mile driven being highest among year-olds and decreasing steadily with age; it is likely that the high rate among this youngest group of drivers reflects their higher level of involvement in road accidents of all types. Most drink drivers involved in accidents are men, and the drink-drive casualty rate per head of population varies considerably between different regions of the country. The statistics also show that it is not just a case of misjudging the amount of alcohol consumed before driving: some drivers are drinking more than twice the legal limit for alcohol Convictions Home Office statistics on convictions for drink driving show that convicted drink drivers are predominantly men; the most recent statistics identified showed that a third are aged and almost half are aged 35 and over (Figure 2.2). Analysis of those who had committed serious traffic offences compared with mainstream criminal offences in the Home Office Offenders Index for March 1996 shows that 40% of convicted drink drivers had previous convictions (not necessarily for drink driving) compared with 70% of those convicted of mainstream offences (Rose, 2000). Of those with previous convictions, drink drivers had a lower incidence of offending: the average number of previous offences was seven compared with 15 for mainstream offenders and their last court appearance was, on average, eight years previously, compared with an average of 2.5 years for 17

18 A Qualitative Study of Drinking and Driving: Report on the Literature Review Figure 2.2: Age and gender of convicted drink drivers, 2004 (source: Cunliffe and Shepherd, 2007) mainstream offenders. However, drink drivers were estimated to be twice as likely to have a criminal record as a member of the general population of the same age and gender (based on data for people aged 21 32). Analysis of repeat offences showed some evidence of specialising in serious traffic offences, but the most common type of reconviction among traffic offenders was for a mainstream offence. Thus, while drink drivers may be perceived by some as being otherwise law-abiding citizens who, on one occasion, made a mistake or were overtaken by circumstances, a substantial minority of those convicted have already been convicted of previous offences, some for traffic offences and some for other criminal offences. 2.2 Attitudes and beliefs about drinking and driving Box 2.2: Key findings Many people who drink alcohol but do not drive afterwards think that driving after drinking is wrong, and many think it is too risky. There is widespread uncertainty about how the legal limit for drinking alcohol before driving is defined and measured. Many drivers develop their own safe limit. Studies of alcohol impairment show that driving skills are impaired at less than an eighth of the current legal limit. The views of people who drink alcohol but do not drink and drive may shed some light on how to influence those who do drink and drive. One survey found that of those who had drunk alcohol in the last year but who reported that they had never driven within a few hours of drinking alcohol, half thought that it is not right to be 18

19 allowed to drink any alcohol before driving, 39% thought that driving after drinking would be too much of a risk, 33% said that they would not feel safe after drinking alcohol, and 27% said that they would be worried that they might be over the limit without realising it (Collins et al., 2008b). Misconceptions and misunderstandings about the definition of the legal limit for driving after drinking alcohol abound. One study carried out group discussions and in-depth interviews with drivers and found that the uncertainty about how the legal limit for driving is defined and measured was due to confusion about the number of drinks legally allowed and how this related to units of alcohol and milligrams (Collins et al., 2008b). Drivers thought that the factors affecting alcohol absorption, such as having a meal and an individual s size and weight, also made it difficult to estimate alcohol consumption, but there was also mention that this confusion led to drivers giving themselves greater leeway when drinking alcohol. Many drivers develop a definition of their own safe limit on the basis of a combination of perceptions of the legal limit, their own feeling of impairment and previous experience of driving after drinking. (This is discussed in more detail in Section 4.) However, the research shows that these perceived safe limits are not as safe as people assume. Data on blood alcohol concentrations of accident-involved drivers show that any amount of alcohol can increase the risk of a crash. A summary of the evidence on alcohol impairment and the implications for driving demonstrates that the first effect of alcohol on the brain is to close down mental activity, while some of the skills most critical to driving, namely the ability to observe, interpret and process information from the eyes and other senses, are impaired at the lowest level of alcohol consumption that can be measured reliably (Lyle Baillie International, 2005). This report shows that consuming alcohol at less than an eighth of the legal limit results in the impairment of basic driving skills and divided attention ability. The impairment of sensible decision-making at low levels of alcohol consumption affects the ability to assess competence to drive and means that there is a perception that it is safe to drive although some impairment is already occurring. As the amount of alcohol consumed increases, there is a progressive increase in the extent of impairment, as more and more mental functions fail to operate correctly, producing a more complex set of impairments. Other information on the effect of alcohol on driving skills states that alcohol can slow down reaction time by up to 30%, reduce peripheral vision and the ability to see distant objects, cause blurred and double vision, and reduce night vision by up to 25% (Institute of Alcohol Studies, 2009), although this source does specify the amount of alcohol that typically causes these degrees of impairment. 19

20 A Qualitative Study of Drinking and Driving: Report on the Literature Review 2.3 Drinking patterns Box 2.3: Key findings Alcohol is an integral part of daily life in Britain 10% of adults drink almost every day and 27% on at least three days per week. Drinking in excess of the recommended daily maximum is relatively common and becoming more so: 41% of men and 34% of women do so at least once a week. The prevalence of heavy drinking among women has been increasing. There is some evidence of a recent decrease in alcohol consumption among year-olds. Much alcohol is now drunk at home. Knowledge about measuring alcohol consumption is often inaccurate. Drinking alcohol is seen as an integral part of the way of life for many people in all parts of the UK (see, for example, Smith and Foxcroft, 2009). A study in in 2007 found that 67% of adults agree that drinking is a major part of the Scottish way of life, while at the same time the amount of alcohol consumed was also something to be ashamed of for many (48%) people (Ormston and Webster, 2008). Similar findings for other countries in the UK have not been identified, so the extent to which this view is held elsewhere is not known. Another survey in, in 2001, found that there is a perceived difficulty with going out and remaining sober which arises from the central role of alcohol in social life in drinking alcohol is seen as an integral part of a good night out and those who are not participating in this feel excluded (Anderson and Ingram, 2001). Other factors identified as having an influence included social pressures, the size and appearance of the glasses in which low alcohol and non-alcoholic drinks are served cause a difficulty for men, while respondents also reported that there is little financial incentive to avoid alcoholic drinks. A national survey of adults drinking behaviour in Great Britain in 2008 as part of an omnibus survey found that 27% of people reported drinking alcohol on at least three days a week in the last year, 28% once or twice a week, 14% once or twice a month, 15% between once a week and once a year, while 16% reported that they had not had an alcoholic drink at all in the last year (Lader, 2009). For 10% of this sample, alcohol was such an integral part of their lives that they reported drinking almost every day; this proportion was highest among older people: 22% of men and 14% of women over the age of 65 reported drinking almost every day compared, for example, with 5% of men and 4% of women aged In this study, average weekly alcohol consumption was estimated at 12.7 units (18 units for men and

21 for women); 28% of men and 17% of women reported drinking amounts which are above the level which is regarded in government guidance as sensible (i.e. over 21 units per week for men and over 14 units for women), 58% of men and 66% of women reported drinking amounts within these sensible levels, while 14% of men and 17% of women reported that they were non-drinkers. The General Household Survey collects information on alcohol consumption in the previous week,which is regarded as more accurate than the consumption recorded in the omnibus survey. The 2007 survey found that 72% of men and 57% of women had had an alcoholic drink on at least one day during the previous week (Robinson and Lader, 2009). Over a fifth of men (22%) and over a tenth of women (12%) had drunk alcohol on at least five of the previous seven days, while 13% of men and 7% of women reported drinking alcohol every day during the previous week. A substantial minority of people in the General Household Survey (41% of men and 34% of women) reported drinking in excess of the recommended daily maximum (four units for men and three units for women) on at least one day in the previous week. On their heaviest drinking day in that week, 31% of men and 23% of women had drunk at this recommended maximum level, and 24% of men and 15% of women had drunk to the extent that they were likely to have been intoxicated (i.e. more than eight units in the day for men and more than four units for women). A recent examination of drinking trends in the UK over the past years based on a synthesis of large, regular cross-national surveys found an increase in average weekly consumption of alcohol since 1992 in Great Britain and an overall increase in drinking over the recommended weekly limits for men and women (Smith and Foxcroft, 2009). Key trends in drinking among adults were identified: an increase in drinking among women has reduced the gap between men and women in the prevalence of heavy drinking; among middle- and older-age groups alcohol consumption is lower than among younger people, but has increased steadily as a result of a combination of factors; also, three of the surveys indicated a possible recent decrease in drinking among year-olds (since about 2000). The omnibus survey found that much of the drinking in Great Britain now takes place in the home. Of those who had drunk alcohol in the previous week, the most recent or heaviest drinking day involved drinking at home for 45% of men and 60% of women, and 9% of men and 11% of women had been drinking in another person s home. Just over a third (35%) of men and 17% of women had been drinking in a pub or bar, 9% of men and 9% of women had been drinking in a restaurant, and 8% of men and 7% of women had been drinking in a club (Lader, 2009). Relevant to the issue of drinking and driving is people s knowledge and behaviour related to measuring alcohol consumption. Most of the respondents in the omnibus survey in Great Britain had heard of measuring alcohol consumption in units, and almost all heavy drinkers had heard of this (Lader, 2009). However, there was a 21

22 A Qualitative Study of Drinking and Driving: Report on the Literature Review significant minority who were not aware of the number of units represented by standard measures of the types of drink which they usually consumed: a third of frequent beer drinkers and a quarter of frequent wine drinkers, for example, did not have accurate information on the amount which constitutes a unit of these drinks. Of those who had heard of units, 16% said that they kept a check on the number of units they drank (although some of these checks were not likely to be accurate). Research on some specific groups of drinkers provides further insights into drinking patterns which have a bearing on driving after drinking. A study of harmful drinkers 2 shows that, for these people, alcohol has become a seamless and integrated part of everyday life; they defend their level of drinking and encourage others to join them. Over a long period of years their tolerance to alcohol has increased and they do not consciously register much of their consumption as drinking (2CV, 2008). A study of young binge drinkers found that, while some young people planned their big nights out, many had experienced occasions when a social drink had turned unexpectedly into a drunken evening ; most of these attributed this to difficulties with both judging limits and slowing down once they had started drinking (Engineer et al., 2003). Among these young binge drinkers, drinking was often associated with asserting their personal freedom and independence and wishing to escape, which encouraged some to behave less responsibly than usual or to be less likely to consider the consequences of their actions. Peer-group norms were identified as influencing drinking patterns and behaviour while drunk, encouraging extreme behaviour and a belief that drunkenness is acceptable. The influence of drunkenness on mood and behaviour was also shown to be strong, making them overconfident, more likely to act on impulse and to think less about the consequences of their actions. The general picture presented is thus of a pervasive drinking culture with a large proportion of people drinking alcohol, many of them frequently, often without accurate knowledge about how to measure consumption. The possible recent decrease in drinking among year-olds since 2000 offers, on the face of it, some hope for a reduction in drink driving, however this is the age group where the number of killed and seriously injured drink-drive casualties has not fallen recently, despite the overall downward trend. 2 For men, 50 or more units per week or 8 units per day; for women 35 or more units per week or 6 units per day. 22

23 3 PREVALENCE AND INCIDENCE OF DRINKING AND DRIVING 3.1 Driving combined with drinking Box 3.1: Key findings Self-report surveys show evidence of lifetime prevalence of driving after drinking and prevalence and incidence in the previous year. Surveys show that between one-fifth and two-fifths of drivers report driving within a few hours of drinking alcohol in the past 12 months. In there is some evidence of a decline between 2001 and 2007 (but no recent information on trends was identified for other parts of the UK). For most of those who drive after drinking alcohol, it is reported to be a rare event: 48% said once or twice during the year. For a minority, driving after drinking is more common: 14% said once a month or more. Surveys have been used to assess the prevalence of drinking and driving in two ways: self-report surveys and roadside surveys in which drivers are stopped and asked to take part in a breath test. The most recent roadside surveys identified were carried out in 1998 and Police officers in 11 police forces in Great Britain surveyed drivers on Thursday, Friday and Saturday nights between 10 pm and 2 am. Around 1% of the 10,000 drivers in October 1998 and 0.7% of around 10,000 drivers in April 1999 were found to be over the legal limit for alcohol (Jackson, 2008); the figures for 1999 were considered to reflect an underestimate rather than a reduction in drink driving between the two surveys. In 1990, roadside surveys at over 400 sites in 10 areas during peak drinking hours (Thursday, Friday and Saturday nights between 7 pm and 2 am) reported in Maycock (1997) found that 15% of all drivers at these times had been drinking an amount of alcohol (13% of men and 7% of women). This may be higher than current levels: there is some evidence from self-report surveys that the prevalence of driving after drinking has decreased in recent years and the drink-driving casualty statistics have also shown a reduction since then, as Section 2 showed. The results of the self-report surveys are summarised in Table 3.1. Two studies in have looked at the lifetime prevalence of drink driving among current 23

24 A Qualitative Study of Drinking and Driving: Report on the Literature Review drivers; in 2001, 55% of drivers who had driven in the past year reported that they had ever driven within a few hours of drinking alcohol (Anderson and Ingram, 2001) and this had fallen to 43% by 2007 (Collins et al., 2008b). This second study examined whether the difference could have been due to variations in levels of reporting or other factors; on the basis of the evidence on respondents opinions reported in the two studies, the authors concluded that prevalence and incidence of drink driving had probably decreased between 2001 and A survey in Northern Ireland in 2008 offers a different perspective, with 30% of motorists who drink alcohol saying that they would never drink and drive, and 21% saying that they would normally drive after one drink (Department of the Environment Northern Ireland, 2008). Reported prevalence of driving within a few hours of drinking alcohol during the previous 12 months has been measured in separate surveys in and in England and Wales. In the Scottish surveys, 25% of drivers reported they had driven within a few hours of drinking alcohol in the past 12 months in 2007 (Collins et al., 2008b), compared with 37% in 2001 (Anderson and Ingram, 2001). Another Table 3.1: Prevalence of driving combined with drinking Prevalence Sample Year and place Source 43% reported ever driving within a few hours of drinking alcohol Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b 55% reported ever driving within a few hours of having something alcoholic to drink Drivers aged 17+ who had driven in last year (n = 1,004) 2001, Anderson and Ingram, % reported they had driven within a few hours of drinking alcohol in past 12 months Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b 44% reported driving after drinking alcohol in past 12 months Drivers who had driven in last year (n = 1,083) 2002, England and Wales Brasnett, % reported they had driven within a few hours of having something alcoholic to drink in past 12 months Drivers aged 17+ who had driven in last year (n = 1,004) 2001, Anderson and Ingram, % reported driving on roads in a built-up area after drinking some amount of alcohol in past 12 months 16% reported driving on rural roads after drinking some amount of alcohol in past 12 months Drivers aged 17+ who had driven on a rural road in past year (n = 991) 2007, Collins et al., 2008a 30% of motorists who drink alcohol said they would never drink and drive 21% of motorists who drink alcohol said they would normally drive after one drink 3% of motorists who drink alcohol would normally drive after two drinks Drivers interviewed in Northern Ireland Omnibus Survey (799 motorists of whom 545 drank alcohol) 2008, Northern Ireland Department of the Environment Northern Ireland,

25 Scottish survey in 2007, focusing on people who had driven on rural roads in the past 12 months, found smaller proportions of drivers reporting driving after drinking: 20% of drivers reported driving on built-up roads after drinking any amount of alcohol and 16% on rural roads (Collins et al., 2008a). The difference between the two surveys may reflect differences in focus; the sole purpose of the former two Scottish surveys was to examine drinking and driving, and they went to considerable lengths to reduce under-reporting, while this latter survey was not focused specifically on drinking and driving and may, by comparison, have underreported drinking and driving. In a survey in England and Wales in 2002, 44% of drivers reported driving after drinking some amount of alcohol in the past 12 months (Brasnett, 2004). It is not clear whether these differences between survey results represent real differences between areas or years, or reflect other differences such as rates of reporting, but they suggest that between about one-fifth and two-fifths of drivers have driven after drinking during a recent year and that a rather larger proportion of drivers have driven after drinking alcohol on at least one occasion in the past. There is some indication of a possible decrease in between 2001 and The surveys in and in England and Wales found that most people who report driving after drinking alcohol present this as an occasional or rare event, as Table 3.2 shows. However, for a small minority it is a relatively frequent occurrence: once a month or more often during the previous year for 14% of those surveyed in England and Wales in 2002 (Brasnett, 2004), and in, in 2007, 6.3 times in the last year per driver who had driven after drinking (Collins et al., 2008b). The higher levels of reported frequency and incidence of driving after drinking in the 2001 survey in compared with the 2007 survey indicate that these may have declined between the two surveys. Table 3.2: Incidence of drinking combined with driving Frequency and incidence Sample Year and place Source Frequency of ever driving after drinking alcohol:* 48% once or twice; 42% occasionally; 9% fairly often; and 1% very often Drivers who had driven in last year who had ever driven after drinking alcohol (n = 446) 2007, Collins et al., 2008b Frequency of ever driving after drinking alcohol: 43% just once or twice; 46% occasionally; 9% fairly often; and 2% very often Of those who had ever driven after having something alcoholic to drink (n = 552) 2001, Anderson and Ingram, 2001 (continued) 25

26 A Qualitative Study of Drinking and Driving: Report on the Literature Review Table 3.2: (continued) Frequency and incidence Sample Year and place Source 14% drive after drinking under the limit once a month or more in past year Drivers who had driven in last year (n = 1,083) 2002, England and Wales Brasnett, incidents per 100 drivers of driving after alcohol reported in past 12 months Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b Average 3.6 times per driver in past 12 months Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b Average 6.3 times per driver in past 12 months Drivers who had driven after drinking alcohol in last year (n =,254) 2007, Collins et al., 2008b 229 incidents per 100 drivers in past 12 months Drivers who had driven in last year (n = 1,004) 2001, Anderson and Ingram, 2001 * Calculated from Figure 4.6 in Collins et al. 2008b 3.2 Reported over the limit driving after drinking Box 3.2: Key findings Self-report surveys show evidence on lifetime prevalence of driving after drinking over the limit, and prevalence and incidence in the previous year. Surveys show that 5% of drivers report driving when they thought they were over the legal limit for alcohol in the past 12 months. Most drink drivers report this to be a rare event: 72 73% said once or twice during the year. A few report drink driving more frequently, for example 2% report driving over the limit fairly often and 18% once a month or more (studies in and Great Britain). A small minority of heavy drinkers report that they drink drive nearly every day. A minority of people have travelled as passengers with drink drivers (13%). A majority of people say they would not travel in a car with a driver who has had one drink. The 1990 roadside surveys during peak drinking hours (Thursday, Friday and Saturday nights between 7 pm and 2 am) reported in Maycock (1997) found that 1% of all drivers at these times had been drinking over the legal limit for alcohol (between 0.5% and 1.6% in different areas). As in the case of driving after drinking 26

27 any alcohol, this may be higher than current levels because there is some evidence from self-report surveys that the prevalence of driving after drinking over the limit has decreased in recent years. Self-report surveys can only reflect respondents perceptions of whether they have driven while over the legal limit for alcohol. Table 3.3 shows that the proportion of drivers reporting that they had ever driven when they might have been over the legal limit varied between about 20% to just 1 2% in different studies. The highest figures were from the two Scottish drinking and driving surveys in which 18% and 22% of drivers reported ever driving over the limit (Collins et al., 2008b; Anderson and Ingram, 2001). A survey in Great Britain found that 13% reported having driven when they were unsure whether they were over the limit (the time span for this response is not clear), and 5% reported driving when they thought they were over the limit (Angle et al., 2008). The lowest figures were from rural road drivers in ; just 1% reported driving on rural roads in the past year and 2% on urban roads when they thought they might have been over the limit (Collins et al., 2008a). In addition to possible differences between areas and time periods, the differences in question wording and in the approach to reducing under-reporting may explain some of the variation in these responses. In the Scottish surveys, while the reported prevalence of driving after drinking during the past year appeared to decrease between 2001 and 2007, the reported prevalence of driving in the last year when the driver suspected that they might have been over the legal limit did not decrease, but remained at 5% in each survey; the authors noted that a change in this small proportion would have been more difficult to detect in a survey of this size (Collins et al., 2008b). Table 3.3: Prevalence of over the limit driving after drinking Prevalence Sample Year and place Source 18% reported ever driving when they suspected they might have been over the limit for drink driving Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b 22% reported they had ever driven when they suspected they might have been over the limit for drink driving Drivers who had driven in last year (n = 1,004) 2001, Anderson and Ingram, % reported driving when they thought they were over the legal limit (time period not specified) 13% reported driving when they were unsure if they were over the legal limit (time horizon not specified) Drivers aged 18+ (n = 1,227) 2008, Great Britain Angle et al., % reported driving when they suspected they might have been over the limit for drink driving in past 12 months Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b (continued) 27

28 A Qualitative Study of Drinking and Driving: Report on the Literature Review Table 3.3: (continued) Prevalence Sample Year and place Source 5% reported driving when they suspected they might have been over the limit for drink driving in past 12 months Drivers who had driven in last year (n = 1,004) 2001, Anderson and Ingram, % reported driving when they thought they were over the limit in past 12 months Drivers who had driven in last year (n = 1,083) 2002, England and Wales Brasnett, % reported driving on roads in a built-up area in past 12 months when they thought they might be over the limit 1% reported driving on rural roads in past 12 months when they thought they might be over the limit Drivers aged 17+ who had driven on a rural road in past 12 months (self-completion part of main survey, n = 991) 2007, Collins et al., 2008a 21% reported ever driving when they thought they were over the drink-drive limit 5% had done so in the previous year Drivers aged (n = 1,031) 2005, Myant et al., % reported that in the past year they had driven a car while intoxicated or after consuming two or more units of alcohol over the previous hour Untreated heavy drinkers (n = 307) 2003, Birmingham Dalton et al., % of men and 5% of women had driven after drinking at least five units of alcohol on one or more occasions in the previous 12 months Drivers aged who sometimes drove a car or van in leisure time and who drank at least occasionally away from home (n = 1,700) 1986, England and Wales Riley, 1991 A survey of heavy drinkers in Birmingham in 2003 identified, as would be expected, rather higher levels of reported drink driving: 27% (defined more precisely as having driven a car while intoxicated or after consuming two or more units of alcohol over the previous hour) (Dalton et al., 2004). A much earlier survey identified self-reported drinking potentially well in excess of the legal limit: in 1986, 22% of men and 5% of women reported driving after drinking at least five units of alcohol at least once during the recent year (Riley, 1991), although the study does not report whether the time period for consumption and the time elapsed before driving were specified to drivers answering this question. Most people who admit to driving when they suspect they may be over the legal alcohol limit report this as a rare event (Table 3.4). Surveys in England and Wales in 2002 (Brasnett, 2004) and in in 2007 (Collins et al., 2008b) found that 73% and 72% respectively reported one or two occasions in the past year. However, for some it is a common occurrence: in, in 2007, 2% said they drove when they might be over the limit fairly often, and in England and Wales, in 2002, 18% said once a month or more. In the survey of untreated heavy drinkers in 28

29 Table 3.4: Reported incidence of over the limit driving Frequency and incidence Sample Year and place Source 11 incidents per 100 drivers of driving when suspected of being over the limit in past 12 months Drivers who had driven in last year (n = 1,034) 2007, Collins et al., 2008b 19 incidents per 100 drivers of driving when suspected of being over the limit in past 12 months Drivers who had driven in last year (n = 1,004) 2001, Anderson and Ingram, 2001 Frequency of driving when suspected to be over the limit in past 12 months: 73% once or twice; 25% occasionally; and 2% fairly often Drivers who had ever driven when they suspected they might be over the limit (n =,186) 2007, Collins et al., 2008b Average two times per driver in year Drivers who had driven when they suspected they might be over the limit in past year (n =,52) 2007, Collins et al., 2008b Average four times per driver in year Drivers who had driven when they suspected they might be over the limit in past year (n=,50) 2001, Anderson and Ingram, 2001 Frequency of driving while over the limit in past year: 72%, 1 2 times in year; 9% every few months; and 18% once a month or more Drivers who admitted to driving over the limit in the past year (n = 130) 2002, England and Wales Brasnett, 2004 Number of occasions in past year when driven while intoxicated or after consuming two or more units of alcohol over the previous hour: 16% on 1 10 occasions; 6% on occasions; 4% on occasions; and 1% on more than 300 occasions Untreated heavy drinkers (n = 307) 2003, Birmingham Dalton et al., % men and 2.5% women had driven after drinking at least five units of alcohol on one or more occasions in previous week Drivers aged who sometimes drove a car or van in leisure time and who drank at least occasionally away from home (n = 1,700) 1986, England and Wales Riley, 1991 Birmingham (Dalton et al., 2004), 4% reported driving within an hour of consuming two or more units between 50 and 300 times in a year, and 1% reported that they did this more than 300 times in a year, the implication being that this is a daily event for a minority of heavy drinkers. There is some evidence of a reduction in the overall frequency of driving after drinking over the legal limit for alcohol. The number of incidents reported in the past year per 100 drivers fell from 19 to 11 between the 2001 and 2007 surveys in 29

30 A Qualitative Study of Drinking and Driving: Report on the Literature Review (Collins et al., 2008b). These two surveys also indicate a reduction in frequency among drivers who drive when they suspect they may be over the limit, from an average of four times per person per year in 2001 to two times in The proportion of people who reported driving in the previous week after consuming at least five units of alcohol in a 1986 survey (10% of men and 2.5% of women who drive and drink away from home) (Riley, 1991) also implies a greater frequency of driving over the limit at that time than in the more recent surveys. 3.3 Convicted driving over the limit Little evidence was found on the prevalence or frequency of drink driving among those convicted of drink driving over the legal limit. Studies of re-offending based on national statistics focus on re-offending in general (rather than repeating the same offences), and surveys of participants in Drink Drive Rehabilitation schemes provide limited information on the incidence of drink driving among convicted drink-drivers. Information on the High Risk Offenders scheme indicates that about a quarter of High Risk Offenders 3 are people who have re-offended following an earlier conviction, amounting to around 10,000 people per year in 2005 and 2006 out of a total of around 40,000 High Risk Offenders in these years (Department for Transport, 2008). A study of a small sample (183) of convicted drink-drivers taking part in a trial of alcohol interlock devices found that 82% were first-time offenders, 11% had been convicted in the previous 10 years, and 6% had a prior conviction more than 10 years ago (Beirness et al., 2008). The records on use of the alcohol interlock provide an indication of the incidence of potential drink-drive behaviour. Two-thirds of participants had less than three occasions per month when their breath sample exceeded 20 mg/100 ml when they attempted to start their vehicle, a quarter averaged between 3 and 10 occasions per month, and one person averaged 47 (1.5 per day). In addition, there were attempts to circumvent the interlock, but their frequency is not documented so it is not clear how many more potential drink-drive trips these represent. 3.4 Passengers Evidence in the literature on the prevalence and incidence of travelling as a passenger with a driver who has been drinking alcohol is limited and is summarised in Table 3.5. In 2002, a study in England and Wales found that 13% of people interviewed had been a passenger with a driver whom they believed to be over the legal limit in the previous year (Brasnett, 2004), while a 2008 study in Great Britain found that 13% had travelled with a driver who may have been under the influence 3 Drink drivers are classified as High Risk Offenders if they are either convicted at, or above, two and a half times the prescribed limit for alcohol, or are re-offenders, or have failed to provide a specimen. 30

31 Table 3.5: Travelling as a passenger with a driver who has been drinking alcohol Incidence/frequency/intentions Sample Year and place Source 13% had been a passenger of a driver who they believed to be over the legal limit at least once in past year 79% had been a passenger once or twice in past 12 months Drivers who had driven in last year and non-drivers (n = 1,648) Passengers of a driver who they believed to be over the legal limit in past year (n = 214) 2002, England and Wales 2002, England and Wales Brasnett, 2004 Brasnett, % would not travel in a car in which the driver has had one drink 64% would not travel in a car in which the driver has had two drinks 85% would not travel in a car in which the driver has had three or more drinks People interviewed (drivers and non-drivers) in Northern Ireland Omnibus Survey (n = 1,183) 2008, Northern Ireland Department of the Environment Northern Ireland, % had refused to travel with a driver who was possibly under the influence of alcohol or drugs 13% had travelled with a driver who was possibly under the influence of alcohol or drugs This behaviour did not differ between drivers and non-drivers People aged 15+ (n = 2,009) 2008, Great Britain Angle et al., 2008 of alcohol or drugs (the time period was not specified) and 17% reported that they had refused to travel with a driver who may have been under the influence of alcohol or drugs (Angle et al., 2008). In the case of the study in England and Wales, travelling as the passenger of a driver who may have been over the limit was relatively infrequent: 79% of them had done so once or twice in the last year. Data on behavioural intentions from a survey in Northern Ireland indicated a low level of willingness to travel with drivers who had been drinking alcohol: 61% said they would not travel in a car with a driver who had consumed one drink, a slightly larger proportion said they would refuse to travel with a driver who had had two drinks (64%), and most said they would refuse if the driver had had three or more drinks (85%) (Department of the Environment Northern Ireland, 2008). 31

32 4 WHO DRIVES AFTER DRINKING? Box 4.1: Key findings More frequent drinkers are more likely to report driving after drinking and drink driving in the past year. More men than women drive after drinking, and more men than women are drink drivers. The highest reported prevalence of driving after drinking in the past year is in the age group. The highest reported prevalence of drink driving in the past year is in the age group and it declines with age. One study found the highest number of driving after drinking incidents per driver in the over 60 age group. Driving after drinking is more prevalent among social grade AB and lowest among social grade DE. Drink driving is lowest among social grade DE, but more similar in other groups. 4.1 Socio-demographics and drinking behaviour The evidence on driving after drinking shows that there is a link between frequency of drinking and incidence of driving after drinking. A survey in England and Wales, in 2002, found that those who drink alcohol more often are more likely to have driven after drinking any amount of alcohol in the past year (Brasnett, 2004). A larger proportion (53%) of those who thought they might have driven while over the limit in the past year drank alcohol on three or more days in a week compared with 32% of all respondents (drivers and non-drivers). Another study quoted by the author (Johnson et al., 1998) found that frequency of drinking was more strongly associated with driving after drinking than the level of drinking. The 2007 Scottish study (Collins et al., 2008b) showed greater prevalence of reported driving after drinking and driving while over the limit among drivers who had drunk 15 or more units of alcohol in the past week compared with those who had drunk none (Table 4.1). 32

33 Table 4.1: Recent alcohol consumption and reported driving after drinking (source: Collins et al., 2008b) Reported driving after drinking in in 2007 Alcohol consumption in last seven days Never driven within a few hours of drinking alcohol Had not driven after drinking alcohol in last 12 months Had never driven while over the limit None (%) or more units (%) One study provides evidence of high levels of alcohol consumption among convicted drink-drivers who continue to drink alcohol. Most of those in a sample of 183 convicted drink-drivers who had attended a Drink-Drive Rehabilitation course in two areas of England in 2004 had been drink driving for many years, often without knowing that they were over the limit (Beirness et al., 2008). Of those who had consumed at least one drink in the past seven days, the average alcohol consumption was 32 units per week with a range between 2 and 200 per week; 79% of males and 55% of females had exceeded the sensible drinking guidelines; and three-quarters had drinking levels that are considered by health professionals to represent hazardous 4 or harmful 5 drinking. 4.2 Socio-demographics and drinking combined with driving Gender Several surveys show that a larger proportion of men report ever driving after drinking than women (Table 4.2), and the proportion reporting driving after drinking in the past year is also higher among men than women (e.g. 28% of men and 21% of women in in 2007 Collins et al., 2008b). The difference between men and women in the proportion reporting driving when they suspected they might be over the legal limit is higher (e.g. 7% of men and 3% of women in, in 2007, reported driving when they suspected they might be over the legal drink-drive limit in the past 12 months Collins et al. (2008b)). This survey also found that the reported frequency of driving after drinking was higher among men than women. Some of the measures of prevalence and incidence of drinking combined with driving reported appear to indicate lower reported prevalence and incidence among men in recent surveys than in earlier surveys, but a smaller or no reduction among women. For example, in, comparing results in 2007 with 2001, prevalence fell less among women than men except among the over 60s; the authors concluded that this may indicate that women are becoming more likely to drive after drinking, but that the lower starting point for women means that any reduction is likely to be smaller (Collins et al., 2008b) units per week for men; units per week for women units per week or 8 units per day for men; 35+ units per week or 6 units per day for women. 33

34 A Qualitative Study of Drinking and Driving: Report on the Literature Review Table 4.2: Gender differences in prevalence and incidence of driving after drinking Prevalence, incidence and frequency Sample Year and place Source 49% of men and 37% of women reported ever driving within a few hours of drinking alcohol Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b 64% of men and 44% of women reported ever driving within a few hours of drinking alcohol Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, % of men and 32% of women said they never drink and drive Drivers who drink alcohol (n = 545) 2008, Northern Ireland Department of the Environment Northern Ireland, % of men and 11% of women reported ever driving when they suspected they might be over the legal drink-drive limit Drivers who had driven in the last year (n=1,034) 2007, Collins et al., 2008b 32% of men and 11% of women reported ever driving when they suspected they might be over the legal drink-drive limit Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, % of men and 21% of women reported driving within a few hours of drinking alcohol in past 12 months Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b 43% of men and 30% of women reported driving within a few hours of drinking alcohol in past 12 months Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, % of men and 31% of women reported driving after drinking alcohol in past 12 months Drivers aged 16 and over who had driven in the last year (n = 1,083) 2002, England and Wales Brasnett, 2004 Incidence of driving after drinking alcohol in past 12 months: 192 per 100 male drivers; and 114 per 100 female drivers Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b Incidence of driving after drinking alcohol in past 12 months: 314 per 100 male drivers; and 126 per 100 female drivers Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, % of men and 3% of women reported driving when they suspected they might be over the legal drink-drive limit in past 12 months Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b 8% of men and 3% of women reported driving when they suspected they might be over the legal drink-drive limit in past 12 months Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, % of men and 6% of women reported driving when they suspected they might be over the legal drink-drive limit in past year Drivers aged 16 and over who had driven in the last year (n = 1,083) 2002, England and Wales Brasnett,

35 4.2.2 Age Several studies have found that the prevalence of reported ever driving after drinking is higher among those aged than among younger or older drivers, and some have also found this to be the case for over-the-limit driving (Table 4.3). However, in three studies, the proportion reporting driving in the past 12 months when they suspected they might be over the limit was highest among young people and declined with increasing age (Collins et al., 2008b; Anderson and Ingram, 2001; Brasnett, 2004). In the 2007 Scottish survey, the number of incidents reported was measured and, while prevalence is lowest among older people, they were found to report more incidents per 100 drivers during the last year than younger drivers, indicating that over 60s who drive after drinking do so more frequently than drivers under the age of 60 (Collins et al., 2008b). Comparison of the two Scottish studies showed a decline in prevalence in each age group between 2001 and 2007, which was considered to be due either to a possible effect of campaigns, making people less willing to mention driving after drinking, or because responses to the question on ever drinking and driving related to more recent rather than historical behaviour (Collins et al., 2008b). The 2007 Scottish study found that, while in the age groups over 30 the proportion reporting driving after drinking alcohol in the past 12 months was higher for men than women, this was not the case in the youngest (17 29) age group (Collins et al., 2008b). An earlier study in England and Wales in 2001 had found higher prevalence of driving after drinking among men than women in all age groups (Brasnett, 2004). Table 4.3: Age differences in prevalence and incidence of driving after drinking Prevalence and incidence Sample Year and place Source Per cent who reported ever driving within a few hours of drinking alcohol: 33% aged 17 29; 49% aged 30 44; 49% aged 45 59; and 40% aged 60+ Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b Per cent who reported ever driving within a few hours of drinking alcohol: 43% aged 17 29; 60% aged 30 44; 61% aged 45 59; and 48% aged 60+ Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, 2001 Per cent who reported that they never drink and drive: 29% aged 25 34; 26% aged 35 49; and 33% aged (under 25 and over 65 samples small) Drivers who drink alcohol (n = 545) 2008, Northern Ireland Department of the Environment Northern Ireland, 2008 (continued) 35

36 A Qualitative Study of Drinking and Driving: Report on the Literature Review Table 4.3: (continued) Prevalence and incidence Sample Year and place Source Per cent who reported ever driving when they suspected they might be over the legal drink-drive limit: 14% aged 17 29; 15% aged 30 44; 25% aged 45 59; and 14% aged 60+ Highest prevalence of ever drink driving is among males aged (33%) Per cent who reported ever driving when they suspected they might be over the legal drink-drive limit: 15% aged 17 29; 24% aged 30 44; 29% aged 45 59; and 17% aged 60+ Drivers who had driven in the last year (n = 1,034) Drivers aged 17+ who had driven in the last year (n = 1,004) 2007, 2001, Collins et al., 2008b Anderson and Ingram, 2001 Per cent who reported driving within a few hours of drinking alcohol in past 12 months: 21% aged 17 29; 29% aged 30 44; 26% aged 45 59; and 20% aged 60+ Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b Per cent who reported driving within a few hours of drinking alcohol in past 12 months: 34% aged 17 29; 41% aged 30 44; 40% aged 45 59; and 28% aged 60+ Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, 2001 Per cent who reported driving after drinking alcohol (whether under or over the limit) in past 12 months: 54% of men and 30% of women aged 16 29; 59% of men and 33% of women aged 30 59; and 47% of men and 23% of women aged 60+ Drivers aged 16 and over who had driven in the last year (n = 1,083) 2002, England and Wales Brasnett, 2004 Incidence of driving after drinking alcohol in past 12 months: 106 per 100 drivers aged 17 29; 149 per 100 drivers aged 30 44; 157 per 100 drivers aged 45 59; and 177 per 100 drivers aged 60+ Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b Incidence of driving after drinking alcohol in past 12 months: 126 per 100 drivers aged 17 29; 242 per 100 drivers aged 30 44; 256 per 100 drivers aged 45 59; and 154 per 100 drivers aged 60+ Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, 2001 Per cent who reported driving when they suspected they might be over the legal drink-drive limit in past 12 months: 9% aged 17 29; 6% aged 30 44; 5% aged 45 59; and 2% aged 60+ Drivers who had driven in the last year (n = 1,034) 2007, Collins et al., 2008b (continued) 36

37 Table 4.3: (continued) Prevalence and incidence Sample Year and place Source Per cent who reported driving when they suspected they might be over the legal drink-drive limit in past 12 months: 9% aged 17 29; 7% aged 30 44; 3% aged 45 59; and 2% aged 60+ Drivers aged 17+ who had driven in the last year (n = 1,004) 2001, Anderson and Ingram, 2001 Per cent who reported driving when they suspected they might be over the legal drink-drive limit in past year: 26% of men and 6% of women aged 16 29; 17% of men and 7% of women aged 30 59; and 10% of men and 2% of women aged 60+ Drivers aged 16 and over who had driven in the last year (n = 1,083) 2002, England and Wales Brasnett, Social grade The survey in in 2007 was the only one identified which analysed variations in prevalence and incidence of driving after drinking according to social grade. Reported prevalence was highest in social grade AB and lowest among those in social group DE, except in the case of driving over the limit in the past 12 months, where the sample was small (53) and no real difference was apparent. The reported incidence of driving after drinking alcohol in the past 12 months was about three times as high in the AB social group as in the DE social group (Table 4.4). Table 4.4: Differences with social grade in driving after drinking in in 2007 (source: Collins et al., 2008b) Prevalence and incidence AB C1 C2 DE Per cent who reported ever driving within a few hours of drinking alcohol Per cent who reported ever driving when they suspected they might be over the legal drink-drive limit Per cent who reported driving within a few hours of drinking alcohol in past 12 months Incidence of driving after drinking alcohol in past 12 months per 100 drivers 58% 22% 40% 255/100 44% 17% 25% 146/100 40% 20% 21% 130/100 29% 12% 12% 86/ Area Two surveys in in 2007 investigated differences in driving after drinking between people living in urban and rural areas. The proportion who reported ever driving after drinking, ever driving when they suspected they might be over the legal limit and driving within a few hours of drinking alcohol in the past 12 months differed by just 1 3 percentage points in the survey focusing on driving after 37

38 A Qualitative Study of Drinking and Driving: Report on the Literature Review drinking, but the incidence of driving after drinking was higher in urban areas 163 per 100 drivers compared with 139 per 100 in rural areas (Collins et al., 2008b). The other survey focused on people who had driven on rural roads in the past year, and found slightly greater differences in prevalence of driving after drinking in the past year on urban roads (20%) compared with rural roads (16%); the incidence of driving when they thought they might be over the legal limit was also higher on urban roads than rural roads, albeit at low levels (2% on urban roads and 1% on rural roads (Collins et al., 2008a)) Links with other driving offences One of the surveys in in 2007 identified an association between driving after drinking and other driving offences (Collins et al., 2008b). Those who reported that they had ever driven after drinking were more likely to report having penalty points on their licence than others (61% compared with 50%). There was also an association with being breathalysed of those who had ever been breathalysed, 61% reported that at some time they had driven within a few hours of drinking alcohol, compared with 47% of those who had never been breathalysed. 4.3 Demographic profile The survey in in 2007 provides information on the demographic profile of those who reported driving after drinking alcohol in the past year (Collins et al., 2008b). The results can be compared with the profile of drivers stopped in earlier (1990) roadside surveys which identified the profile of drivers who had been drinking and a survey of people arrested for drink driving in (Boreham et al., 2006). The evidence on demographic profiles is summarised in Table 4.5. In the survey in, males were over-represented (57% of those who had driven within a few hours of drinking alcohol in the last year were male compared with 51% of all drivers in the sample). The 1990 roadside surveys found higher proportions of males: 74% of those who had been drinking alcohol were men (summarised in Maycock, 1997). The age distribution of drivers reporting that they had driven after drinking in the past year was generally similar to that of all drivers in the sample (10% were 17 29, 37% were aged 30 44, 28% were and 24% were aged 60+), but over 60s were slightly under-represented and those aged were slightly overrepresented. Those in social grade AB comprise 36% of the sample, C1 comprised 33%, C2 made up 20%, and 10% were DE. Compared with drivers in the sample as a whole, the AB group was over-represented (only 22% of all drivers were in this group) and group DE was under-represented (21% of drivers in the sample). 38

39 In line with the finding that there were no differences between urban and rural areas in the prevalence of driving after drinking, the distribution of people in the Scottish survey in 2007 who reported driving within a few hours of drinking alcohol in the past year was the same as in the sample as a whole: 63% lived in an urban area and 38% in a rural area. The survey in provided indicative information only on the demographic profile of those who reported driving when they suspected they might be over the legal drink-drive limit in the past 12 months because the sample size was small (53). Of these 53, 7 out of 10 were men; 1 in 5 were aged 17 29; 4 in 10 were aged 30 44; 1 out of 4 were aged 45 59; and 1 in 10 were aged 60+. Between a quarter and a third were in each of the social grades AB, C1 and C2, while just an eighth were in social grade DE. Two-thirds of them were living in urban areas. Earlier roadside surveys and surveys of drink-driving offenders in a range of areas found quite different results. Of those stopped in the 1990 roadside survey, a higher proportion of those driving over the limit were men: 89%. The social grade distribution was also different, with far fewer professional, managerial and other non-manual grades and more in the skilled and unskilled manual grades C2 and DE, resulting in an over-representation of skilled manual and manual groups compared with the population. A survey of people prosecuted for drink driving between 1990 and 1992 found that 92% were male and that, while just 6% were in social grade AB, 18% were C1, 30% were C2 and 42% were in group DE. A survey of convicted drink-drivers who had been referred to rehabilitation between 2000 and 2002 found that 89% were male, 43% were aged 16 29, 27% were 30 39, 23% were and 6% were aged 55 or over (Smith et al., 2004). A survey of over 7,500 people aged 17 and over who had been arrested on suspicion of any offence in a 12-month period in provides the age distribution of some 570 people who had been arrested on suspicion of drink driving. Nearly half (45%) were aged 35 and over, 28% were aged and 27% were aged (Boreham et al., 2006). It is not clear whether these differences between surveys reflect changes over time or between and other areas of Great Britain, or differences in the nature of the samples. All surveys confirm the preponderance of men in samples of people who drive after drinking and who drink drive, but the evidence on age and social grade distributions of these groups is conflicting. 39

40 A Qualitative Study of Drinking and Driving: Report on the Literature Review Table 4.5: Demographic profile of drinking drivers Demographic characteristics Sample Year and place Source 57% male, 43% female Males over-represented (51% of all drivers in sample were male): 10% aged 17 29; 37% aged 30 44; 28% aged 45 59; and 24% aged 60+ Similar to age distribution of drivers except that over 60s slightly under-represented, slightly over-represented Social grade: 36% AB; 33% C1; 20% C2; and 10% DE ABs over-represented (22% of drivers in sample) DEs under-represented (21% of drivers in sample) 62% live in an urban area, 38% in rural (same as distribution of drivers in sample) Drivers who had driven after drinking alcohol in last year (n = 254) 2007, Collins et al., 2008b 7/10 male;* 1/5 aged 17 29; 4/10 aged 30 44; 1 4 aged 45 59; 1/10 aged 60+; to 1/3 in social grades AB, C1 and C2; 1 4 1/8 in DE; and 2/3 live in urban areas Drivers who reported driving when they suspected they might be over the legal drink-drive limit in past 12 months (n = 53) 2007, Collins et al., 2008b 74% of those who had been drinking alcohol were men Drivers who had been stopped in roadside survey (n = 13,316) , 10 areas Maycock, % of those who had been driving over the limit were men Over-representation of skilled manual and manual groups compared with the population: 13% in AB; 26% in C1; 40% in C2; and 20% in DE Drivers who had been stopped in roadside surveys who were over the limit (n = 129) , 10 areas Maycock, % male Over-representation of skilled manual and manual groups compared with the population: 6% in AB; 18% in C1; 30% in C2; and 42% in DE Prosecuted for drink driving (n = 7,063) , 3 police force areas Maycock, 1997 (continued) 40

41 Table 4.5: (continued) Demographic characteristics Sample Year and place Source 89% male, 11% female 43% aged 16 29; 27% aged 30 39; 23% aged 40 54; and 6% aged 55 + Convicted drink drivers referred for rehabilitation (n = 87,650) , Great Britain Smith et al., % aged 17 24; 28% aged 25 34; and 45% aged 35+ People aged 17+ who had been arrested on suspicion of drink driving (n = 572) , England and Wales Boreham et al., 2006 * Results are quoted in fractions because the sample size is small. 4.4 Typologies and clusters The survey in in 2007 looked at attitude clusters associated with aspects of disapproval, fear of consequences, and myths and excuses, and identified six groups of respondents, but found that those who admitted to driving over the limit did not fit within specific attitude clusters, implying that they did not have similar attitudes (Collins et al., 2008b). Attitudes were not linked to demographic characteristics either. The study concluded that drink driving is often linked to situational factors and postulated that one reason may be that the sample of people who admitted to driving over the limit was too small for clusters of people with similar attitudes to be apparent. The survey in in 2001 (Anderson and Ingram, 2001) identified the following clusters associated with situational factors and behaviour, rather than demographics and attitudes: The chronic drink-driver these are caught repeatedly and lose their licence for years at a time, some with a prison sentence. They have serious alcohol problems and are unable to recognise the problem with alcohol itself or drink driving. The lads night out a culture of excessive alcohol consumption and resistance to staying sober or having soft drinks, more likely to take risks and less likely to check behaviour by criticising drink drivers. The quiet back-road driver a common justification for drink driving is that the journey is short and at a time when the roads are quiet so there are unlikely to be police and there are fewer hazards (for example, from other vehicles or complex junctions). The one-off many respondents referred to a particular occasion when they had driven while they suspected that they might be over the legal limit. This 41

42 A Qualitative Study of Drinking and Driving: Report on the Literature Review often followed an unexpected event: a change of plan, an impromptu social gathering, or an emergency when they had either not expected to drink or not expected to drive. Three pints on an empty stomach these are people who regularly drink an amount which might mean that they are over the legal limit. Other factors such as how much they have eaten or the length of time between the last drink and driving can be enough to take them over the legal limit. The golf club dinner an evening of drinking in significant quantity during a meal is a typical risk for older people, often in the belief that, while probably over the limit, their driving was not impaired so the chances of anything happening were slight. The truly drunk driver these have drunk so much that they no longer know what they are doing, are unlikely to be influenced by any inhibiting factors, and may be influenced by other irrational justifications; these tend to be young people, particularly men. Next day driving a common occurrence, and even if they are aware that it is possible still to be over the limit the following morning, people are reluctant to face up to it. This is affected by the elapsed time, the need to fulfil work or domestic responsibilities, and the fact of having slept, showered and eaten breakfast since their last drink. A much earlier study came to different conclusions about the role of situational factors and it is possible that there has been a change in factors associated with drink driving in the intervening years. Reporting on a 1986 national survey of drivers aged in England and Wales who drink away from home on some occasions, Riley (1991) found that drink driving was closely associated with five types of factors (in descending order of importance). In this case the factors were linked more with attitudes and beliefs than with situational factors, as follows: 1. Whether drivers regarded drinking and driving as an important aspect of their social lives. 2. Drivers beliefs about how drinking increased their chances of being stopped by the police and drivers concerns about the legal consequences of conviction. 3. Drivers beliefs about the dangers of drinking before driving. 4. Drivers beliefs about the likelihood that family or friends would disapprove of their drinking and driving. 5. The effects of alcohol on mood and behaviour which they have experienced. Cluster analysis of data from a survey of men in a large metropolitan area who had been convicted of drink driving in 1992 focused on behavioural and demographic characteristics and attitudes (Clayton, no date). Situational factors comprised one of 42

43 the components of these clusters, but attitudes were also a component in this case. The clusters identified were as follows: Persisters 23% of the sample, aged 25 to 44, typically drinking beer (81%) or strong beer (16%) in a pub or at home before offending. Many were unemployed C2DE men with previous convictions for drink driving and other crimes. Refuters 19% of the sample, aged 25 to 54, typically drinking beer (80%) or strong beer (13%) in pubs before offending. Largely C2DEs who denied that drink driving is wrong and felt that the chances of being stopped were remote. Generally, they believed that they were good drivers who were unaffected by drinking. Devastated Professionals 19% of the sample, aged 25 to 44, of whom 72% drank beer, 16% wine and 16% spirits, in either a pub or at home before offending. Predominantly middle-aged ABs or C1s who were shocked at being treated as criminals. They felt that they were capable of driving after drinking. Young Irresponsible 17% of the sample, aged 25 to 35, who typically drank strong beer at home or at friends homes before offending. C1s and C2s with a carefree attitude to life, easily influenced in a group, and inexperienced drivers. They generally knew that their driving was impaired, but took the risk. One-Offs 7% of the sample, aged 35 to 54, C1 and C2DEs who typically drank beer at a friend s or relative s home before offending. Often unusual circumstances, such as a celebration, argument or depression, led to the offence being committed. These people were severely affected by their conviction and claimed to be reformed as a result. To summarise, four studies were identified which looked at clusters or typologies of drinking after driving or drink driving. Of the two recent studies since 2000 (Collins et al., 2008b; Anderson and Ingram, 2001), one found that driving after drinking is often linked to situational factors rather than attitudes, and the other developed a typology based primarily on situational factors. One of the earlier studies (in 1992) of convicted drink-drivers identified a typology based on a combination of situational factors, behaviour, demographics and attitudes. However, the other (in 1986) identified factors associated with attitudes and beliefs influencing drink driving rather than situational factors; changes in attitudes and behaviour since this study was carried out may account for different factors being identified. 4.5 Passengers Information on the characteristics of people travelling as passengers with drivers who had been drinking is limited to just one of the studies reviewed. The survey in England and Wales in 2002 found that, among all drivers and non-drivers in the sample, a larger proportion of drinkers (15%) compared with 2% of non-drinkers 43

44 A Qualitative Study of Drinking and Driving: Report on the Literature Review had been a passenger of a driver who they believed to be over the legal limit at least once in the past year (Brasnett, 2004). This study also found that 9% of drivers who had not driven while over the limit in the last year had been a passenger of a driver who they believed to be over the legal limit at least once in the past year. These results imply an association between drinking behaviour, drink driving (or not) and travelling as a passenger with a drink driver, which merits further investigation. 44

45 5 THE CIRCUMSTANCES UNDER WHICH PEOPLE DRIVE AFTER DRINKING Box 5.1: Key findings Driving occurs after drinking alcohol in a wide range of places, including clubs, pubs, restaurants, and visiting family and friends. These tend to be casual occasions rather than serious nights out. The drive after drinking alcohol tends to be on local, short journeys where the road is well known and drivers feel safe. Over half of driving after drinking takes place in the evenings, but it also happens in the daytime, late at night and on the morning after drinking. Drivers do not recognise driving on the morning after as drink driving. 5.1 Where? Two studies provided information on where and when people drive after drinking. These journeys typically involve driving home after visiting a club, pub or restaurant, a friend or relative s house, or a night out with friends. One study noted that they tend to be casual nights out rather than a serious night out because those planning to drink alcohol would not take the car for a serious night out (Collins et al., 2008b). However, in Northern Ireland 14% said they would normally drive after drinking at a wedding or christening and 10% would drive after attending a sporting event (Department of the Environment Northern Ireland, 2008). A study of convicted drink-drivers in 1992 found that 38% had been drinking in a pub prior to the offence and 36% had been drinking in a private home (see Clayton, no date). The Scottish study found some explanation of driving when going out for a meal; alcohol was thought by some to have less effect with a meal and to be more socially acceptable, while some did not think drinking with a meal was proper drinking (Collins et al., 2008b). Among year-olds, this study identified an element of driving slightly over the limit, often for convenience, in situations such as driving locally that were associated with social activities such as golf, visiting family and friends, and attending meals. 45

46 A Qualitative Study of Drinking and Driving: Report on the Literature Review The 2007 Scottish survey found that the types of journey involving driving after drinking tend to be local (22% less than a mile and 51% between one and five miles), on quiet roads (53%), in urban areas (39%) or rural towns and villages (40%). Few are on motorways or dual-carriageways (16%), or unlit roads (12%), or rural roads outside towns (14%). Thus, drink driving occurs when the roads are known, the journey time is expected to be short and it feels safe enough to risk taking the car home i.e. local events and frequently made journeys. 5.2 When? The majority (68%) of driving after drinking occasions reported in the 2007 survey in by the 254 people who had driven after drinking in the past year (Collins et al., 2008b) were at weekends (Friday to Sunday). Evening drinking accounted for just over half (57%) of the driving after drinking occasions reported by this group; these tend to be the shorter nights out (with alternative transport being arranged for big occasions or longer nights out), but a fifth had been late at night, 16% had been in the daytime and 7% had been on the morning after they had been drinking. The proportion of occasions that were reported on the morning after drinking was thought to be an underestimate, given that most respondents drove every day. Qualitative interviews carried out as part of this study suggested that driving the morning after drinking is seen as a separate issue from driving on the same night as drinking; it is often seen as accidental and not recognised as drink driving. This was recognised as being potentially more of an issue than evening drinking because it is less easy for the driver to assess whether they are still over the limit or not, and a need for greater guidance on how long it takes to eliminate alcohol was identified. Furthermore, a larger proportion of those who reported driving over the limit reported that they had driven the morning after compared with those who had driven after drinking (but had not thought that they were over the limit). In Northern Ireland almost a third of a sample of 545 motorists who drank alcohol said they would normally drive the morning after they had four (women) or five (men) alcoholic drinks, 55% said they would not and 14% said they do not normally drink that amount (Department of the Environment Northern Ireland, 2008). The proportion of men who would drive the morning after drinking this amount was somewhat higher (34%) than for women (28%). One study asked how long people had left between the last alcoholic drink and driving, the last time they had driven within a few hours of drinking alcohol. The most common response was between one and two hours (31%), and while 16% said that they left between two and four hours and 15% said more than four hours, 13% reported driving within half an hour, and 25% between half an hour and an hour 46

47 after drinking. Men were more likely than women to report driving within half an hour (20% compared with 4%), and those who had reported consuming more alcohol during the week waited less time than those reporting lower levels of consumption during the week. 5.3 Who with? One study the survey in in 2007 (Collins et al., 2008b) asked whether these individuals drink and drive alone, or with others in the car. On the last occasion when respondents drove after drinking, 46% reported that they had driven alone, 46% with one passenger and 7% with more than one passenger. The under 29s were more likely to drive alone than older drivers, while year-olds rarely drove alone for this young age group the drive is part of the group activity. Older drivers would avoid drinking and driving with others in the car because of their responsibility to their passengers. 47

48 6 ATTITUDES OF INDIVIDUALS WHO DRIVE AFTER DRINKING 6.1 Why? motivations/reasons for driving after drinking Box 6.1: Key findings People drive after drinking when they perceive that they are within the legal limit of alcohol consumption for driving. They do so when they feel that they are safe to drive, using their own definitions of safe limits. Circumstances are not an important factor in driving after drinking unexpected events and changes of plan are not common explanations for driving after drinking. However, circumstances are used to explain some driving that is marginally over the legal limit for alcohol. Habitual driving after drinking, and previous experience of driving after drinking without incident and without getting caught, also play a part in decisions to drive after drinking Explanations Five studies provide information on explanations given by drivers for driving after drinking and for drink driving either on the last occasion or the occasion for which they had been arrested. For those driving after drinking when they thought they were under the limit, the most common reason given was that they thought they were under the limit (57% in in 2007 (Collins et al., 2008b, and 63% in England and Wales in 2002 (Brasnett, 2004)). Qualitative research found that many said they drove after drinking because they are allowed to and would not if it was illegal (Collins et al., 2008b). The second main reason given for driving after drinking was that people felt that they were safe to drive (35% and 25% in and England and Wales, respectively). In, some reported that they had their car and needed to take it home (18%), while 19% said they had waited a few hours before driving. A few explained that the reason for driving after drinking was a lack of alternative transport (12% of those in England and Wales), the inconvenience or cost of alternative transport. A perception that they would not be caught did not feature strongly. The times when people drive when they perceive that they are marginally over the legal limit are not planned, but reported to be due to circumstances beyond their 48

49 control arising from social activities, travelling a short distance or to somewhere that has poor public transport (Collins et al., 2008b). In, in 2007, on most of the times when driving after drinking occurred, people had been expecting to drive (73%), although presumably a significant minority had not. A few gave the reason for driving after drinking as not expecting to drink (13%). The balance of the explanations given by convicted drink-drivers and drivers who had driven when they thought they were over the legal limit was rather different from the reasons given by all reporting driving after drinking. More reported that they felt safe to drive, more said that there was no other transport available, or alternative transport was too inconvenient or expensive (although the proportions were still small), and fewer said they thought they were under the legal limit (Collins et al., 2008b; Brasnett, 2004). A study in 1992 found that 39% of convicted drink drivers said they had drunk more than they had intended (Clayton, no date), while a study of convicted drink-drivers referred to rehabilitation found that a quarter said that they thought they were under the limit, another quarter did not think about whether or not they were over the limit, and a quarter said that it was because they did not have far to travel (Inwood et al., 2007) and a sixth reported that they had to go somewhere unexpectedly. The study of convicted drink-drivers in 1992 referred to by Clayton (no date) found that 43% had thought they were over the legal limit, but still drove on that occasion. One study found that those driving when they thought they may have been over the legal limit were not more likely than those who had driven after drinking under the limit to say that this was because they thought they could get away with it (1% in each case Brasnett, 2004), while a survey of convicted drink-drivers found that 19% gave this as a reason (Inwood et al., 2007). A review of previous research on the factors contributing to drink-drive behaviour among young men aged (Davies McKerr, 2007) highlighted the following factors: a deeply embedded drinking culture; a strong belief in the driver s ability to tell whether they are OK to drive ; a lack of clarity about the legal limit and how many drinks are allowed ; previous experience of getting away with it; and a distinction between drunk-driving (which is thought of as wrong) and drinkdriving (which is seen as acceptable). In, peer acceptability was found to be a factor in young people driving after drinking, with some saying that they were encouraged by friends (Collins et al., 49

50 A Qualitative Study of Drinking and Driving: Report on the Literature Review 2008b). When a young driver s friends are drinking, the social stigma of drink driving is reduced and it becomes acceptable for both passenger and driver to drink. Among older people, the study in found that those who habitually drink and drive recognise that it is probably wrong, but because they feel fine and have been driving after drinking for many years, they convince themselves that it is acceptable to continue. Others perceive that older people drink and drive out of habit, since it was not an issue when they started driving, and they therefore see no reason to change now. In rural areas, the survey in found that more people thought they were under the limit than in urban areas (Collins et al., 2008b); it identified a perception that it is relatively safe to drive after drinking in rural areas where the roads are quiet and there are few police. Many of those in rural areas said that they would not consider a public transport alternative if they were driving locally and within their own safe limit. In summary, the most commonly reported explanations for driving after drinking are associated with perceptions about being within the legal limit and feeling safe to drive within personally defined limits, often for short distances on quiet roads. The influence of circumstances is less strong unexpected events and changes of plan are given as explanations, but in relatively small numbers of cases, although one study found circumstances to be a common type of explanation for driving marginally over the limit. Issues with alternative transport do not tend to be reported by many, but are rather more common among those driving over the limit than others driving after drinking. Finally, habit and previous experience of driving after drinking or drink driving without incident or without getting caught also play a part Profile of drinking behaviour including planned and unplanned drinking Box 6.2: Key findings One qualitative study of men aged in social grade C1 and C2 who drive after drinking found that, for planned events, arrangements to avoid driving after drinking are made and drink driving is less forgivable. On unplanned and spontaneous occasions it is seen as more acceptable to let events take their course. Drink driving was often described as something that happens to people rather than something they choose to do. These drivers do not accept responsibility for exceeding the limit on occasions when they do not intend to do so they expect to receive credit for their good intentions. 50

51 Two studies have established the amount of alcohol which people thought they had drunk the last time they had driven after drinking. In the survey in England and Wales, in 2002, drivers who had consumed alcohol before driving in the past year and believed themselves to be under the limit on the last occasion had, on average, consumed what they perceived to be two units (Brasnett, 2004). For those who believed they had been over the limit, the average was four units on the last occasion. The largest amount they reported drinking before driving in the past year was, on average, five units. Almost all (95%) of those who thought they had been over the limit on the last occasion thought they had only been slightly over the limit (21% thought they had drunk less than two units, 44% between two and four units, and 35% more than four units). Of those who thought they had been under the limit, 74% thought they had drunk less than two units, 18% between two and four units, and 8% thought they had drunk more than four units. A study of convicted male drink-drivers in a large metropolitan area in 1992 referred to by Clayton (no date) found that, on average, the drivers reported drinking 12.5 units immediately before the offence; this was considered by the research team to be an underestimate. Further insights into drinking behaviour are found in a qualitative study of men, mainly aged 17 29, living in five areas of England, mainly in social grade C1 and C2 who drink and drive (Davies McKerr, 2007), but who do not regularly do so after five pints or more. For these, the second pint is the key, or tipping point. One pint is seen as under the limit and safe to drive, while three pints is pushing our luck because it would lead to a positive breath test even if the driver feels safe to drive. The decision to have a second pint is the transition point; it is seen as a trivial decision with potentially vast consequences, including a driving ban, a fine, more expensive insurance and a criminal record, while, at the same time, there is the possibility of killing or injuring oneself or others and having to live with that all for the sake of a pint. All of these drivers said that they did not set out to exceed the limit for drink driving and so did not accept full responsibility when they did so. They wanted to receive credit for their good intentions, but would not always accept the blame for having an extra drink or two. The over 30s were less tolerant of going over the personal limit, while the under 25s were more likely to see themselves as at the mercy of events. No one in the study considered that it is morally wrong to drive at, or just above, the legal limit when it is not your intention to do so. For the drivers in this study, spontaneous occasions were seen to be more of a problem than planned events. Planned events provide an opportunity for making arrangements to avoid driving and drinking, so it is seen as less forgivable to drive after drinking then. On spontaneous occasions it was seen as more acceptable to let circumstances take their course. Circumstances were often blamed for forcing 51

52 A Qualitative Study of Drinking and Driving: Report on the Literature Review people into driving after a few drinks in spontaneous events, justified by the cost or availability of taxis, being let down by a designated driver, public transport stopping too early, or needing the car the next day. Drink driving was often described as something which happens to people rather than something they choose to do or allow to happen Planning transport (or not) to avoid drink driving Box 6.3: Key findings In towns and cities, public transport and taxis are seen as a reason for avoiding drink driving. There is resistance to using public transport, particularly in rural areas. The cost of taxis can be a deterrent to their use. Cars are used for convenience and when planning to drink within personal safe limits. Designated drivers are arranged in some cases. Two studies in investigated the way in which people plan their transport to avoid drink driving. The 2007 survey found that, in cities, the availability of buses and taxis is seen as a reason not to drink and drive (Collins et al., 2008b). The 2001 survey found that there was strong resistance to using public transport particularly in rural areas, due to the location, timing and lack of service late at night, with security issues also of concern to young women (Anderson and Ingram, 2001). In this survey, many reported using taxis when planning to drink, often sharing the cost with others. However, the cost of taxis was found to deter some people, even if they had already spent much more than the taxi fare during the evening. In rural areas and small towns, hiring a minibus and driver for a group on a big night out, travelling into larger towns or cities, was relatively common and seen as convenient and costeffective, but required significant advance planning. Where the car is driven to social occasions, the 2007 survey found that this was justified by issues with alternative transport (either being unavailable, inconvenient or expensive) (Collins et al., 2008b). Generally, people reported that, when they took their car to an occasion when drinking alcohol is involved, the intention was to drink within their own self-defined safe limit. When more than this amount of alcohol is consumed, taking the car home afterwards was often explained by the convenience (such as needing the car the next morning) and security (for example, leaving the car in a pub car park could result in it being damaged, stolen or broken into). Designated drivers were mentioned in the 2001 survey. Many reported that they would ensure that one person stayed sober enough to drive, often by taking it in 52

53 turns in groups of friends or between partners; for some partners there was a regular pattern, often with the woman driving home. In these arrangements, many people, particularly women, feel responsible for ensuring that partners and friends who are designated drivers do not exceed the limit. 6.2 Changes in behaviour over time Two studies provide information on changes in individuals behaviour over time, but no studies were found that identified individual changes over time among a representative cross-section of people. A panel study of heavy drinkers found that the proportion who reported that they had driven over the limit in the past year had not reduced between 1999 and 2003 (Dalton et al., 2004), while a study of convicted drink-drivers found that selfreported frequency of drink driving among those who had returned to driving after the end of the disqualification period had reduced since the conviction (Inwood et al., 2007). The study in in 2001 asked people about their perceptions of changes in attitudes and behaviour over time. It was generally felt that drink driving had become less common than 20 years ago due to the emergence of a moral consensus, changes in enforcement, the increase in traffic and thus greater perceived risk of being involved in an accident, and the increasing dependence on the car for example, in employment (Anderson and Ingram, 2001). 6.3 Perceptions of own driving with drinking behaviour Box 6.4: Key findings The terms drinking and driving and drink driving are associated with drinking an amount of alcohol which is significantly over the legal limit of alcohol consumption for driving. Driving after drinking an amount of alcohol which is significantly over the legal limit is seen as irresponsible. Drivers tend to have their own self-defined safe limits for drinking which may be well below the legal limit. The boundary between behaviour which is considered to be acceptable and dangerous is moveable a couple of drinks more than this personal safe limit. There is widespread uncertainty about how the legal limit for drinking alcohol before driving is defined. 53

54 A Qualitative Study of Drinking and Driving: Report on the Literature Review The concept of drinking and driving The study in in 2007 looked at people s attitudes and beliefs about the concept of drinking and driving and found that the term drinking and driving is associated with being significantly over the legal limit, well beyond the point at which it is safe to drive (Collins et al., 2008b). The phrases drink-driving and drinking and driving were not found to be associated with having one or two drinks and then driving, even if this may involve driving near to, or over, the legal limit Acceptability of drinking and driving The study in in 2007 found that driving when significantly over the legal limit (way past the point where it is safe to drive) was considered to be irresponsible (Collins et al., 2008b). Some thought that it was wrong to drive after drinking any amount of alcohol. The study found little evidence that attitudes to drinking and driving are strongly linked to behaviour, rather behaviour was found to be strongly linked to circumstances. In Northern Ireland, 40% of motorists who drink alcohol said they think it is acceptable to drive after one drink (Department of the Environment Northern Ireland, 2008). The proportion who would normally drive after one drink who said they think it is acceptable is much higher (83%) than the proportion of people who would not normally drive after one drink (28%). A study of year-old males who drink and drive, but do not regularly drive after five or more pints, found that all agreed that it is wrong to drive when drunk, and they did not consider themselves to be drunk drivers (Davies McKerr, 2007). However, the boundary between behaviour which is defined as acceptable and that which is considered to be dangerous was found to be moveable, usually a couple more drinks than the amount which an individual considers to be their own safe limit for driving. Moreover, drivers who drive over the legal limit accidentally or when they are only just over the limit were not considered to be bad Feelings of impairment (or not) when drinking and driving personal safe limits A study of drivers in Northern Ireland found that, of those who drink alcohol, 42% said that they personally could not have any drinks without affecting their driving (Department of the Environment Northern Ireland, 2008); 27% said they could have one drink without affecting their driving; 16% said two drinks; 7% said three drinks; 2% said four drinks; and 1% said five or more. There were 5% who did not know how many drinks would affect their driving. 54

55 In this survey, more female motorists (55%) than males (31%) thought they could not drink any alcohol without it affecting their driving. Men had higher thresholds than women before they thought that alcohol would affect their driving. Of those who normally drive after one drink, 10% said that they could not have a drink without it affecting their driving, implying that these people drive while feeling impaired, although the frequency with which they do this was not reported. Most of the drivers who drink alcohol and who said they could not have any drinks without affecting their driving, said they would not normally drive after one drink. Some of the studies referred to drivers having their own self-defined safe limits for drinking when they were driving. In the study in, in 2007, driving after drinking was regarded by respondents as a low-risk activity if it took place within their own self-defined safe limits, and the chance of being caught at such times was perceived to be low (Collins et al., 2008b). If driving after drinking within these safe limits is then repeated without mishap, this reinforces confidence. Drivers described their personal safe limits in terms of numbers of units of alcohol, but not in terms of impairment. Few people thought it was safe for them to drive after drinking more than two units. Generally people reported keeping within their own self-imposed safe limits and feeling that this did not affect their driving ability. Most were convinced that their drinking was usually measured and controlled, rarely well over the limit. The earlier study in, in 2001, found that drivers who set their own personal limits tend to set them well below the legal limit. Of those who had driven after a drink in the last 12 months, 13% said that they did not feel comfortable driving after one drink, 33% said they would feel comfortable driving after one beer and 32% after one glass of wine. A study of men aged who drink and drive, but not regularly after 5 pints or more, were mostly convinced that they were safe to drive within their own personal limit, which was usually between one and three drinks (Davies McKerr, 2007). A study of heavy drinkers found that there is a concept of responsible drinking which involves monitoring drinking to ensure that it is sensible and does not have negative consequences for others (in all aspects of daily life not just driving), by being aware of the potential effects of drinking too much and knowing one s own personal limits (Dalton et al., 2004). When driving, these drinkers had a clear sense of their own personal limit. This personal limit would not necessarily be under the legal limit for driving, but be defined by personal tolerance to alcohol and the fact that they did not feel intoxicated. 55

56 A Qualitative Study of Drinking and Driving: Report on the Literature Review Actions to stay within the limit A study of heavy drinkers found that some reported measures to try and stay within the limit while still driving after drinking some alcohol (Dalton et al., 2004). These included: drinking lower strength drinks; limiting amounts; spreading drinking; and eating. One respondent used a breathalyser to ensure that the limit was not exceeded Perceptions of the legal limit As mentioned in Section 2, the findings of the studies reviewed reflected uncertainties about how the legal limit for drinking before driving is defined. The varying size of drinks outside the licensed environment, the hidden strength of some drinks, and the interaction between alcohol, diet and body mass are all causes of uncertainty. In the survey in in 2007, respondents were unsure about the legal limit and distinguished between their own self-imposed safe limit and the legal limit (Collins et al., 2008b). The general consensus was that a safe amount would probably be one alcoholic drink, while some thought that it was wrong to drive after drinking any alcohol. There was confusion around the number of drinks that are allowed before driving and how this translates into units and milligrams. Among a sample of drivers and non-drivers in England and Wales in 2002, the most common amount thought to be sufficient to be over the limit was two units (34%); 86% of women believed it to be two units or less compared with 60% of men (Brasnett, 2004). In a sample of motorists in Northern Ireland, 45% thought that a driver could have one alcoholic drink without fear of prosecution, 26% thought it was two drinks and 4% thought three, 15% thought none, while 9% did not know (Department of the Environment Northern Ireland, 2008). A survey of men aged who drink and drive, but did not regularly do so after five pints or more, found that they were generally uncertain about the legal limit (Davies McKerr, 2007). Most thought of units or numbers of drinks and had a rule of thumb which was a mixture of their own perception of what is safe for driving and a guess about the limit. The legal limit was perceived by this group as having being set at a safe level, so they were confused by the idea that there is risk attached to driving after drinking below this limit. Some thought that having a limit above zero encourages drink driving. 56

57 6.3.6 Perceived risks The survey in in 2007 found that the worst risk of driving after drinking alcohol, which was mentioned spontaneously, was killing someone (Collins et al., 2008b). This risk was only considered in hindsight, not at the time of driving, due to a belief that an accident would be unlikely because they were in control and would drive carefully. Qualitative interviews in the study in, in 2001, suggested that people who drink at a level which is around the legal limit for driving are more likely to think about the risk of being caught than about the risk of being in an accident (Anderson and Ingram, 2001). Men, particularly, would often say that their driving was safe, even after drinking. A study of untreated, harmful drinkers found that none of those interviewed considered that drink driving is an acceptable risk and several thought it to be most serious because of the potential for killing others (Dalton et al., 2004). Some regretted past occasions when they had driven after drinking Perceived causes of accidents A survey in England and Wales in 2002 (Brassnett, 2004) asked about factors in road accidents. Just over half (53%) of drivers who had driven when they thought they were over the limit believed that drink driving was very often, or always, a factor in road accidents (compared with 63% of all respondents drivers and non-drivers). Speeding and drugs were given as the second most common factors in accidents. 6.4 Knowledge and understanding of laws and penalties Box 6.5: Key findings The likelihood of getting caught is perceived to be low. As a result, the consequences of being caught are not of great concern. Some of the penalties for drink driving are little known, including the criminal record. Several of the studies found that the likelihood of getting caught while drink driving was perceived to be low. In England and Wales in 2002, 55% of those who had driven when they thought they were over the limit in the past year believed that it was unlikely that drink drivers would be caught by the police even if they drove while over the limit once a week (Brasnett, 2004). 57

58 A Qualitative Study of Drinking and Driving: Report on the Literature Review The study in in 2007 also found that those who drive after drinking did not generally believe that they would be caught. The reasons given for the risk being thought to be low were the small number of police on the roads, the fact that most drivers had never been stopped by the police, and those that had been stopped had not been breathalysed (Collins et al., 2008b). Many thought that if they were careful to avoid accidents and their car was in good working order, then the police would be unlikely to stop them and conduct a breath test. In Northern Ireland, 39% of motorists who drink alcohol think it is likely that they would be stopped by the police if they were drinking and driving (Department of the Environment Northern Ireland, 2008). Men (37%) were rather less likely than women (42%) to think that they would get stopped by the police. A 1986 national survey of drivers aged in England and Wales who drink away from home on some occasions found that drivers in areas with high levels of breath testing for drink-driving enforcement were significantly less likely to drink and drive than those in areas with low levels of enforcement (Riley, 1991). However, drivers in areas with high levels of enforcement did not perceive a higher risk of being caught than those in areas with low levels of enforcement. The effect of high levels of enforcement appeared to be to reinforce social pressures against drink driving and to increase the awareness of the greater risk of accidents after drinking. As the risk of getting caught by the police was considered to be low, the consequences of being caught were not a great concern (Collins et al., 2008b). Some perceived the chance of being caught to be higher at times of anti-drink-drive campaigns and would modify their behaviour at such times. As mentioned earlier, perceptions about how the legal limit for alcohol before driving is defined were often vague or inaccurate. Awareness of penalties was also found to be limited in one of the studies: in, in 2007, the proportion of drivers interviewed that mentioned particular penalties for drink driving are listed below (Collins et al., 2008b). Some of the penalties were little known, including the criminal record, despite its far-reaching consequences: 77% mentioned being disqualified; 54% mentioned a fine; 54% mentioned losing their licence for a year; 35% incorrectly thought there would be points on the licence; 6% mentioned a criminal record; and 5% mentioned having the conviction recorded on the driving licence. Perceptions of the penalties varied between age groups, for example yearolds were most likely to mention a criminal record, while over 60s were least likely 58

59 to mention losing their driving licence. A lack of knowledge of the penalties may lead some drivers to underestimate the risks. 6.5 Views on consequences The study in in 2007 found that many of those who drive after drinking do not appear to have seriously considered the consequences of being caught (Collins et al., 2008b). When asked to consider the effects of being caught, the main impacts recognised were: gaining a criminal record and the possibility of this resulting in losing a job and future employability, embarrassment and humiliation. Drivers who had been disqualified described the trauma of being arrested and held in custody, and the embarrassing, inconvenient and costly consequences of being convicted and disqualified. A study of men aged who drink and drive, but not regularly after 5 pints or more, found that many did not realise that being over the limit is a criminal offence, and a majority did not realise that a first drink-drive offence results in a criminal record (Davies McKerr, 2007). A study of convicted drink-drivers found that being disqualified from driving was more difficult to cope with than other penalties, as this resulted in losing jobs, earning opportunities, status and the trust of those most important to them (Beirness et al., 2008). Other impacts mentioned were: loss of employment, being passed over for promotion, inconvenience (for themselves and others), loss of income, loss of status or respect, the stigma of being a drink driver and a criminal, and the longterm loss of trust. For the family members of these convicted drink-drivers, the impacts mentioned included the inconvenience of acting as a chauffeur, difficulties with relationships, and the changing family dynamics after one had lost their driving licence. The social stigma attached to being a family member of a drink driver was seen as being worse than being a drink driver. There were also financial impacts resulting from the unexpected additional costs associated with the conviction, the rehabilitation course and transport costs. Another study of convicted drink-drivers (referred to by Clayton (no date) and carried out in 1992) found that some of the worst consequences of being convicted for drink driving which were mentioned tended to be associated with specific groups (see Section 4.4 for the details of the groups): greatly increased car insurance costs (Young Irresponsible); inconvenience of not having a car (Persisters); loss of job (this happened to 15% of the sample as a result of their conviction); and loss of mobility (Devastated Professionals). 59

60 7 DRIVING UNDER THE INFLUENCE OF DRUGS Box 7.1: Key findings Drug driving is reported as being less prevalent than drink driving. Drug driving is far more prevalent among those under the age of 40 than among older people 3 6% of drivers under 40 report driving under the influence of illicit drugs in the past 12 months. Drug driving occurs more among single people and those who drive less frequently than among others. Drug driving journeys are often for social reasons and over short distances. But for problem drug users, all driving is under the influence of drugs. 7.1 Prevalence and incidence A national survey of people in Great Britain in 2008 found that 2% of drivers aged 18+ admitted to driving after smoking cannabis and 2% after taking Class A drugs (Angle et al., 2008). Other studies focus on specific groups and do not provide evidence on prevalence in the population as a whole; key results are presented in Table 7.1. A survey of drivers who had driven on rural roads in in the past year found that 15% had driven on urban roads and 16% had driven on rural roads after taking any kind of drug (including prescription drugs) in the past 12 months (Collins et al., 2008a). In 2005, a survey of drivers in aged found that 6% had ever driven after using illicit drugs within a time period when they were likely to have been impaired, and 3.5% had done so in the past year; the authors estimated that after taking account of under-reporting, 11% might ever have driven while impaired and up to 6% in the previous year. An earlier survey of drivers in aged between 17 and 39, which was reported in 2000, found that 9% had ever driven under the influence of a recreational drug and 5% had done so in the previous 12 months (Ingram et al., 2000). In 1999, a roadside survey of drivers crossing s four toll bridges on Friday and Saturday nights found that 3% of drivers aged 40 and over reported that they had ever driven within 12 hours of using illegal drugs compared with 16% of those aged (Neale et al., 2000). This study also included qualitative research among people attending night clubs and dance events, and found that, while drug 60

61 driving is associated with this lifestyle, most drug driving involved cannabis and occurred at times when they were not travelling to or from clubs or dances. A difference was identified between driving after using cannabis and other recreational drugs. The number who had driven after using cannabis was much larger than the number who had driven after ecstasy, cocaine, amphetamines or LSD; cannabis driving was a routine part of daily life, while driving after using other drugs took place less often and mainly in the early hours of Saturday and Sunday mornings. Table 7.1: Prevalence of driving after using illegal drugs Prevalence Sample Year and place Source 2% had driven after smoking cannabis 2% had driven after taking Class A drugs Drivers aged , Great Britain Angle et al., 2008 Driving after taking drugs in past 12 months (including prescription drugs): 15% on roads in a built-up area; and 16% on rural roads 6 11% had ever driven while under the influence of illicit drugs 3.5 6% had done so in the past 12 months Drivers aged 17+ who had driven on rural roads in past year 2007, Drivers aged , Collins et al., 2008a Myant et al., % had ever driven under the influence of any recreational drug 5% had driven under the influence of any recreational drug in past 12 months Drivers aged (n = 1,008) No date, Ingram et al., 2000 Drivers who had ever driven within 12 hours of using illegal drug: 16% of those aged 17 39; and 3% of those aged 40+ Drivers at toll bridges on Friday/Saturday nights 1999, Neale et al., Who? A survey of drivers aged in in 2005 found that the prevalence of drug driving did not differ between men and women or within age groups within the sample (Myant et al., 2006). Drug driving in the past year was more common among single people than those living with a partner. Those who drove less frequently (less than once a week) were more likely to report drug driving than frequent drivers. In contrast, a survey of people at clubs and dance events in found that drug driving appeared to be more common among men than women, and that people engaged in drug driving less frequently as they grew older (Neale et al., 2000). In contrast to the 2005 survey, an earlier survey in found that, among year-olds, driving under the influence of illegal drugs appeared to be most prevalent among those aged and more common among men than women (Ingram et al., 2000). 61

62 A Qualitative Study of Drinking and Driving: Report on the Literature Review Data on people killed in road accidents who had been using illicit drugs found that 71% were under the age of 40 compared with 27% of those who had not used any drugs, and that there was a higher prevalence among unemployed people (39%) than others (Tunbridge et al., 2001). Data from blood samples of drivers tested for alcohol in showed that illicit drugs occurred predominantly among those under 40 (90%): 38% of drivers tested aged had been using illicit drugs compared with 36% of those aged 20 24, 23% of those aged and 8% of those aged (Keigan et al., 2004). 7.3 Circumstances The survey of year-old drivers in in 2005 found that most driving after using illicit drugs took place for social reasons: half were to, or from, someone s home and most were for short distances (Myant et al., 2006). However, problem drug users in this age group said that they were almost always under the influence, so all their driving was under the influence. The survey of clubbers found that drug driving mainly involved cannabis and was not associated with travelling to or from club or dance events (cannabis tended to be smoked during the week at home or at friends homes) (Neale et al., 2000). Among clubbers, it was less common to take steps to avoid drug driving than it was to avoid drink driving. Many of the clubbers had, in the past, arranged a designated driver to avoid drink driving, but hardly any had arranged one to avoid driving after using drugs. While some reported that they had tried to prevent friends from driving because they were drunk, few said that they had ever attempted to stop someone who had been using illegal drugs from driving (Neale et al., 2000). Reasons given for drug driving in the survey of year-old drivers in in 2005 fell into two groups: the lack of deterrents to dissuade them (most people do not believe that their driving is adversely affected by taking drugs and the perceived risk of being caught is generally low) and the positive incentives associated with the convenience of using personal transport and being able to make social journeys. Recreational drug users drive while they are impaired as part of their social activities, while for problem drug users, driving enables them to collect drugs more quickly and conveniently, and makes it easy to travel away from their home area to do so (Myant et al., 2006). In this study, those who had not driven while under the influence of drugs in the previous 12 months were defined as having given up drug driving and they shed some light on circumstances and reasons for drug driving. This group were more likely to be with a partner than those who had been drug driving in the past year. The main reasons given for stopping were increased responsibility, the desire to 62

63 avoid shame and the implications of getting caught. Giving up drug driving was not associated with advancing age or maturity within this group of year-olds. According to the interviews with clubbers, the influence of both behavioural and situational factors contributed to drug driving among men: men were perceived as being more likely to take drugs, while, at the same time, being more susceptible to pressure from their peers and more likely to believe that it is acceptable to drive while under the influence of drugs (Neale et al., 2000). 7.4 Passengers In the survey of year-old drivers in in 2005, 13% reported that they had ever been a passenger with someone who was under the influence of illicit drugs. Passengers were more likely than drivers to be concerned about the driver being able to drive safely (Myant et al., 2006). The survey of people visiting clubs and dance venues found that it was extremely common in this group to have been a passenger of a driver who had used illicit drugs, generally many times (Neale et al., 2000). The reasons for being the passenger of a drug driver were generally the convenience of a lift home (which, in turn, was explained by not having money for, or access, to taxis, bad weather, being a long way from home late at night, and thinking that there was no alternative transport). Also, some were less careful and more likely to accept a lift after taking drugs themselves. There was a high level of belief that drug use does not affect the ability to drive (and some thought that drugs improve driving skills), but many reported that they had, at some time, been anxious while travelling with a drug driver. These bad experiences had generally been when the driver had used drugs other than cannabis, but it did not appear to put people off accepting lifts when convenient. (This links with the suggestion in Section 3 that it is easier to take a risk than refuse a lift with a drink driver.) The risks of being a passenger with a driver who has been using illegal drugs were believed to depend on the type and amount of drugs, and the driver s tolerance, among other factors. 7.5 Attitudes and beliefs Box 7.2: Key findings There is a lack of concern with the effect of drugs on driving. Driving after using cannabis is seen as less dangerous than after using ecstasy, cocaine, amphetamines or LSD. The risk of being caught driving under the influence of drugs is perceived to be low. Knowledge on the laws and penalties relating to drug driving is poor. 63

64 A Qualitative Study of Drinking and Driving: Report on the Literature Review A study of young drivers perspectives on good driving found that cannabis was mentioned as something that reduced aggression and might make for better, calmer, driving. It found that different drugs are used in different ways by young people and that sensation, thrill-seeking, excitement and risk are not the only reasons why young people consume drugs and alcohol (Christmas, 2007). The study of year-old drivers in analysed propensity for sensation seeking and found that those who had ever, or in the past year, driven while under the influence of illicit drugs, had significantly higher scores on a sensation-seeking scale than those who had not done so and those who were not drug users (Myant et al., 2006). Most drug drivers in this study (63%) were not concerned about the effect of drugs on driving and almost half thought that drugs did not affect their driving; a few thought that drugs made their driving better (for example, because cannabis made them drive more carefully). Some drug users thought that drugs were detrimental to their concentration and reaction times even when driving slowly. Those interviewed while attending clubs and dance events considered that driving under the influence of cannabis was much less dangerous than driving after ecstasy, cocaine, amphetamines or LSD, and a large proportion thought that cannabis might improve or have no impact on driving skills (Neale et al., 2000). The effect of drugs on driving was believed to depend on a range of factors, such as the quality and quantity of drugs, the individual, and the drug driving circumstances, as well as the type of drug; many said that they knew how their driving was impaired and compensated for this (Myant et al., 2006). The risk of being caught drug driving was perceived to be low because the effect on driving was generally thought to be minimal and so would not attract the attention of the police, and, even if caught, accurate testing was not considered to be possible. Some of the problem drug users had been stopped and tested, but with negative results, even after heavy consumption (Myant et al., 2006). Among clubbers, knowledge of the law on illegal drugs and driving was poor (Neale et al., 2000). Paradoxically, illicit drug users in in 2005 agreed that there should be laws against drug driving (Myant et al., 2006). This implies a lack of connection in their minds between using these drugs (whether or not they are driving) and breaking the law. 64

65 7.6 Drugs, alcohol and driving Box 7.3: Key findings There is some association between drink driving and drug driving. But drink drivers and drug drivers are not necessarily the same people. Drug driving is perceived to be less dangerous than drink driving. Two studies of the incidence of drugs in drink drivers, based on analysis of evidential blood samples taken after a driver had been stopped on suspicion of driving above the legal limit for alcohol, found that 18% (in (Tunbridge et al., 2000)) and 22% (in (Keigan et al., 2004)) of drivers tested positive for illicit drugs. By comparison, in the study, 20% of drivers tested positive for alcohol above the legal limit. In both studies, cannabis was the most common drug: 8% tested positive for cannabis in the study and 17% in the study. The survey of drivers aged in in 2005 found an association between drug driving and drink driving, speeding and being involved in an accident in the past five years, which suggested that there is a personality characteristic underlying risky behaviour (Myant et al., 2006). Just over a third of those who had driven after using drugs in the past 12 months had also driven under the influence of alcohol. Among clubbers, driving after drinking alcohol over the legal limit was generally perceived to be more dangerous than driving after using illegal drugs (Neale et al., 2000). One survey which asked year-olds in about past drinking and driving, as well as driving after using illegal drugs, found that drink drivers and drug drivers are not necessarily the same people (Ingram et al., 2000). 65

66 8 IMPLICATIONS FOR THE QUALITATIVE RESEARCH The literature review has produced wide-ranging insights into drink drivers and those who drive after drinking, and where, when and how often they do so. These provided a sound basis for developing the qualitative research in the second phase of this project. The results of the literature review contributed to the design of the qualitative research, particularly in relation to the sample selection and the coverage of the interviews. 8.1 Sample selection It was clear that, as well as the obvious groups of respondents (those who have been caught driving over the limit and people who drive knowingly over the limit), it would also be important to include people who drive thinking they are under the limit. The review indicated that, while the emphasis should be on men and younger people, women and older people should also be included as these do make a significant appearance in the drinking and driving statistics, and that all social classes should be covered. The literature showed that the type of area in which people live affects their choices and decisions in terms of making social journeys, the options and scope for planning to avoid driving after drinking, and perceptions about police presence and the risks of driving after drinking. Thus, sample areas were selected to represent different kinds of area in terms of the degree of urbanisation so that interviews could include people in very different kinds of geographical settings, with all that this implies in terms of the availability of public transport, the distances people have to travel for social purposes, and their perceptions of the likelihood of having an accident or being caught. The surveys identified that, while some people habitually drive after drinking, there are many who do this only rarely. The research selected respondents who had driven after drinking very recently, so that real occasions were fresh in their minds. This was important because it enabled the study to take a detailed forensic approach to understanding real occasions, providing the opportunity to delve beneath conditioned responses and defences, and to obtain some fresh insights (see Section 8.2 below). 66

67 8.2 Interview coverage The literature shows that behaviour is not strongly related to expressed attitudes to drinking and driving. The disjunction between attitudes and behaviour was thought to be interesting, but would probably require an oblique approach, especially to ensure that the interviews penetrated barriers of denial and defensiveness. Drinking and driving now has more stigma attached to it than it once had. To persist with the practice in the face of years of campaigns and enforcement suggests people are justifying what they do to themselves, and the interviews would need to try to uncover how and why this is. The literature shows that people offer circumstantial excuses; an important part of this project would be to try and map and unpack these to see what sorts of circumstantial excuses are offered, their perceived validity and whether or not they seem open to a solution from the perspective of drivers themselves. The interviews should also examine how people talk about the occasions when they drive after drinking. What detailed information and understanding of these occasions can be obtained from the perspective of the driver? What can be learned about how accounts are constructed and how people square what they do with what they (think that they) believe or feel about driving after drinking? The approach to the interviews was based heavily on getting detailed narrative accounts and, to help in this, a journey sheet was used to get people involved and thinking in advance about recent journeys. This set the tone for the interview itself, where respondents were repeatedly asked for live and recent examples of driving after drinking. The literature demonstrates links between drinking behaviour and drinking and driving behaviour, and the interviews were designed to obtain a better understanding of these and this was a key feature of the interviews. This included drinking at pubs and in other public settings, but also drinking in domestic settings at home or other people s homes. The focus on the domestic settings was an important part of the interviews, especially with upwards trends in drinking at home. How people regard their drinking behaviour may affect how they construe their driving after drinking behaviour, of which the interviews were also designed to gain a better understanding. 67

68 9 REFERENCES 2CV (2008) Insight and Action to Help Reduce Levels of Hazardous and Harmful Drinking. Qualitative Research Debrief. London: 2CV. Anderson, S. and Ingram, D. (2001) Drinking and Driving: Prevalence, Decision Making and Attitudes. Edinburgh: Central Research Unit, Scottish Executive. Angle, H., Kirwan, S., Buckley, K. and Goddard, E. (2008) THINK! Road Safety Campaign Evaluation Annual Survey 2008 Report. BMRB Social Research for the Department for Transport. London: Department for Tranpsort. Beirness, D. J., Clayton, A. and Vanlaar, W. (2008) An Investigation of the Usefulness, the Acceptability and Impact on Lifestyle of Alcohol Ignition Interlocks in Drink-Driving Offenders. Road Safety Research Report No. 88. London: Department for Transport. Boreham, R., Fuller, E., Hills, A. and Pudney, S. (2006) The Arrestee Survey Annual Report: October 2003 September Home Office Statistical Bulletin 04/06. London: Home Office. Brasnett, L. (2004) Drink Driving Prevalence and Attitudes in England and Wales: Home Office Report No London: Home Office. Christmas, S. (2007) The Good, the Bad and the Talented: Young Drivers Perspectives on Good Driving and Learning to Drive. Road Safety Research Report No. 74. London: Department for Transport. Clayton, A. B. (no date) Drinking and Driving in Great Britain: Which Way Forward? (accessed on 19 January 2010) Collins, E., Eynon, C., MacLeod, P., Stradling, S., Crinson, L., Scoons, J. and Broughton, J. (2008a) Rural Road Safety: Drivers and Driving. Edinburgh: Scottish Government Social Research. Collins, E., Dickson, N., Eynon, C., Kinver, A. and MacLeod, P. (2008b) Drinking and Driving 2007: Prevalence, Decision Making and Attitudes. Edinburgh: Scottish Government Social Research. Cunliffe, J. and Shepherd, A. (2007) Re-offending of Adults: Results from the 2004 Cohort. Home Office Statistical Bulletin 06/07. London: Home Office. Dalton, S., Orford, J., Webb, H. and Rolfe, A. (2004) Birmingham Untreated Heavy Drinkers Project. Report on Wave 4. London: Department of Health. Davies McKerr (2007) Anti-Drink Drive Adcept Research Debrief. London: Davies McKer. 68

69 Department of the Environment Northern Ireland (2008) Northern Ireland Road Safety Monitor Belfast: Department of the Environment Northern Ireland. Department for Transport (2008) Road Safety Compliance Consultation. London: Department for Transport. Engineer, R., Phillips, A., Thompson, J. and Nicholls, J. (2003) Drunk and Disorderly: A Qualitative Study of Binge Drinking Among year-olds. Home Office Research Study 262, Home Office Research Development and Statistics Directorate. London: Home Office. Ingram, D., Lancaster, B. and Hope, S. (2000) Recreational Drugs and Driving: Prevalence Survey. Edinburgh: Scottish Executive Central Research Unit. Institute of Alcohol Studies (2009) Drink Driving Fact Sheet. St Ives, Cambridgeshire: Institute of Alcohol Studies. Inwood, C., Buckle, G., Keigan, M. and Borrill, R. (2007) Extended Monitoring of Drink Drive Rehabilitation Courses: Final Report TRL Report No Wokingham: TRL Limited. Jackson, P. (2008) A Review of Methodologies Employed in Roadside Surveys of Drinking and Driving. Road Safety Research Report No. 90. London: Department for Transport. Johnson, F. W., Gruenewald, P. and Treno, A.J. (1998) Age-related differences in risks of drinking and driving in gender and ethnic groups. Alcoholism: Clinical and Exploratory Research h., 22(9), Keigan, M., Tunbridge, R. and James, F. (2004) The Incidence of Drugs in Drink Drivers. Behavioural Studies Seminar. TRL Staff Paper. Crowthorne: Transport Research Laboratory. Lader, D. (2009) Drinking: Adults Behaviour and Knowledge in Opinions (Omnibus) Survey Report No. 39. Newport: Office for National Statistics. Lyle Baillie International (2005) Summary of scientific evidence behind Just one drink impairs driving. Report to Department of the Environment, Northern Ireland and National Safety Council, Republic of Ireland. Maycock, G. (1997) Review of Drinking and Driving. TRL Report No Crowthorne: Transport Research Laboratory. Myant, K. Hope, S., McIntosh, J., O Brien, T., McKegany, N. and Stradling, S. (2006) Illicit Drugs and Driving. Edinburgh: Scottish Executive Social Research. Neale, J., McKeganey, N., Hay, G. and Oliver, J. (2000) Recreational Drug Use and Driving: A Qualitative Study. Edinburgh: Scottish Executive Central Research Unit. Ormston, R. and Webster, C. (2008) Scottish Social Attitudes Survey 2007: Something to be Ashamed of or Part of Our Way of Life? Attitudes Towards Alcohol in. Research Findings 66. Edinburgh: Scottish Government. 69

70 A Qualitative Study of Drinking and Driving: Report on the Literature Review Riley, D. (1991) Drink Driving: The Effects of Enforcement. Home Office Research Study 121. London: HMSO. Robinson, S. and Lader, D. (2009) Smoking and Drinking Among Adults, General Household Survey Newport: Office for National Statistics. Rose, G. (2000) The Criminal Histories of Serious Traffic Offenders. Home Office Research Study No Briefing Note 5/00. London: Home Office. Smith, L. and Foxcroft, D. (2009) Drinking in the UK: An Exploration of Trends, York: Joseph Rowntree Foundation. Smith, L. R., Buckle, G., Keigan, M., Buttress, S. and Stone, J. (2004) The Drink/ Drive Rehabilitation Scheme: Evaluation and Monitoring. Final Report. TRL Report No Crowthorne: Transport Research Limited. Sykes, W., Groom, C., Kelly, J. and Hopkin, J. (2010) A Qualitative Study of Drinking and Driving Report of Findings. Road Safety Research Report No 114. London: Department for Transport. Tunbridge, R., Keigan, M. and James, F. (2001) The Incidence of Drugs and Alcohol in Road Accident Fatalities. TRL Report No Crowthorne: Transport Research Laboratory. Xu, Y. (2009) Drinking and driving. Reported Road Casualties, Great Britain: London: The Stationery Office. 70

71 APPENDIX 1 Documents reviewed summary of scope and key points 71

72 72 Table A1.1: Documents included in Reference Status of review/scope the literature review 2CV (2008) Study of harmful drinkers to inform the social marketing strategy for the Department of Health s alcohol harm reduction, includes observational study, indepth interviews and monitoring alcohol reduction exercise Anderson and Ingram (2001) Nationally representative survey of 1,004 drivers in, and in-depth interviews and group interviews. Includes explanation of how dealt with the sensitivity of the subject Information on characteristics 6/10 drivers say they had ever driven within a few hours of having an alcoholic drink, 4/10 in last year. 1/5 say have ever driven when they might be over limit, 1/20 in last year. Age and gender differences Information on attitudes/ awareness Information on behaviour Technical limitations Detailed qualitative segmentation Drinking diary Understanding of hazardous and harmful barriers drinkers accounting for to reducing alcohol consumption. discrepancies between claimed, Recommendations for strategies perceived and actual behaviour. Understanding of attitudes and motivations behind harmful drinking. Segmentation (mentioned in reference 24 explained in detail here) Perception of amount comprising Information on strategies is more own safe limit. Majority of drivers detailed than in 2007 report. did not think alcohol had a Many plan to avoid driving when significant negative effect on likely to be drinking. Those who their driving ability and were drive, but try to stay within the unconcerned about the limit, are under pressure to drink possibility of being stopped by young men feel excluded and the police or being involved in an self-conscious. Little enthusiasm accident for public transport; taxis and shared minibuses more popular. Reasons why people choose to drink and drive, risk with next day driving, justified with a variety of reasons. Information on a limited number of drink-drive journeys. Identified groups: chronic drink driver; lad s night out; quiet back-road driver the one-off ; 3 pints on an empty stomach; golf club dinner; truly drunk driver; and next day driving. Perceptions of changes in their own behaviour over time A Qualitative Study of Drinking and Driving: Report on the Literature Review (continued)

73 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Angle et al. (2008) 2,009 interviews with people aged 15+ in Great Britain in October 2008, of which 1,227 were drivers; small sample of motorcyclists also studied 5% of drivers 18+ had ever been convicted for any driving offence, 5% had been banned. 51% had never had any driving penalty Drink driving is the most commonly mentioned in the top 3 road safety issues most important to address 67% of drivers and 75% non-drivers; drug driving mentioned as one of top 3 by 28% of drivers and by 29% of non-drivers. Younger drivers and those with less than 3 years driving experience were more likely to mention drink drive as top 3 issue. Agreement with statements about road safety. Agreement with statements about powers the police should have for breath-testing procedures. Per cent of drivers and nondrivers who think driving after taking drugs and after drinking 2 pints is unacceptable. Agreement with statements about the danger of drink and drugs Factors influencing how safely you drive visible police presence thought to be most effective. Prevalence of dangerous driving (at all and in last year) how often dangerous behaviour and how many people they know behave in this way (hypothesis that more socially acceptable if perceive more people behaving like thiseven if illegal): drive when unsure if you are over the legal alcohol limit; drive when over the legal alcohol limit; drive after smoking cannabis; and drive after taking class A drugs. Passenger experiences travel with driver under influence Beirness et al. (2008) In-depth interviews with convicted offenders Demonstration used sample of offenders from Driver and Vehicle Licensing Authority (DVLA); mainly men, all ages, but most aged 25 44, 41% single, 48% work part-time Impact of conviction on themselves and family. Alcohol consumption last week ranged from 2 to 200 units, mean 32 Response rate to invitation was only 17% Boreham et al. (2006) People arrested for drink driving in (also includes other offences) Age distribution and whether or not taken heroin, crack or cocaine in the last 12 months (continued) 73

74 74 Table A1.1: (continued) Reference Status of review/scope Brasnett (2004) Office for National Statistics (ONS) omnibus results: 1,648 people 16+ interviewed of whom 1,083 had driven in previous year. Crime and Justice (C&J) Survey 2003 source of data on prevalence of self-reported drink driving Information on characteristics Information on attitudes/ awareness 17% of men drive over the limit, Drink driving thought to be the 6% of women. (C&J Survey 17% most common factor in road and 10%.) accidents. 26% of year-olds Attitudes to drink driving, risks, admitted to driving over the limit enforcement and penalties were in past year. similar regardless of how much Men were most likely to alcohol people reported drinking have driven after drinking what before driving. they thought to be under the limit. Half thought that even if 13% of all respondents had been someone drove over the limit a passenger with a driver once a week for a year they were thought to be over the limit in the unlikely to be caught by the past year these tended to be police. drinkers. Driving over the limit explained More frequent drinkers more by the following: likely to have driven after felt safe to drive (49%); drinking thought I was under limit (27%); no other transport available (12%); alternative transport too inconvenient (4%); and did not think I would get caught (1%). Driving under the limit: thought I was under the limit (63%); and felt safe to drive (25%). General attitudes towards penalties harsher than in specific scenarios Information on behaviour Technical limitations 44% of drivers had driven after drinking some alcohol in the previous year. 12% of drivers had driven after drinking what they believed to be over the limit in the past year (14% in C&J Survey), but most had done so only once or twice, with 1/5 of them once a month or more. Driving when perceived to be under the limit more frequent: 31% 1 per month or more. Amount of alcohol drunk before driving on last occasion: average 2 units if believed to be under the limit, 4 units if thought to be over the limit A Qualitative Study of Drinking and Driving: Report on the Literature Review (continued)

75 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Christmas (2007) Effect of young people s attitudes and mindsets on driving (17 25) Good driving thought of as mastering the physical activity, the social activity (operating in a shared space), the emotional activity (preserving appropriate frame of mind to drive well in the face of distractions and annoyances), being law abiding. Alcohol thought by some to reduce mental alertness and the ability to process information or increase aggression. Varying uses of different drugs; beware of older researchers drawing wrong conclusions about young people s use of drugs Workshops with 6 groups of year-olds (55 total) Clayton (no date) 293 interviews with male drinkdrivers convicted in 1992 and follow-ups with 15. Also group discussions Cluster analysis of behaviour, demographics and attitudes 5 groups: Persisters; Refuters; Devastated Professionals; Young Irresponsible; and One-Offs 1992 Collins et al. (2008a) Study of drivers on rural roads to gain insights into tackling rural road accidents. Omnibus survey of 992 drivers aged 17+, face-toface interviews with 1,020 rural road drivers; 6 focus groups of yearold men driving on rural roads, also accident data analysis (Stats19) 20% of drivers on built-up roads reported driving after drinking compared with 16% on rural roads. Driving when thought to be over the limit 2% on built-up and 1% on rural roads Perceived cause of rural road Little difference accidents 28% relatively high compared with Stats19 in the extent of driving after drinking between rural and urban roads (continued) 75

76 76 Table A1.1: (continued) Reference Status of review/scope Collins et al. (2008b) 1,034 drivers in and 6 focus groups and 6 in-depth interviews with people admitting to driving after drinking. Comparisons with 2001 survey (Anderson and Ingram, 2001). Cunliffe and Shepherd (2007) Statistical studyof re-offending rates (any offence) of adults 18+ by age and gender separates drink drivers and other offences Dalton et al. (2004) Panel of 307 untreated heavy drinkers interviewed in 4 waves over 6 years; 2003 survey compared with earlier waves. Mean consumption in the week before the interview was 79 units in wave 1 and 67 in wave 4 Information on characteristics Driving after drinking any alcohol 43% (ever) and 25% in last 12 months 154 incidents per 100 drivers. Greater proportion of men, those aged and in higher social grades had driven after drinking. Rural residents no more likely than urban to drive after drinking or drink drive, and incidents of driving after drinking in past 12 months less in rural areas (139/ 100 rural, 163/100 urban). 1/5 drink drivers aged Age and gender of convicted drink drivers Information on attitudes/ awareness Covers the concept of drink driving, attitudes, safe limits and consequences. Attitudes not strongly linked to behaviour; instead, behaviour linked to circumstances Information on behaviour Technical limitations year-olds less likely to report driving after drinking any alcohol than others, also less incidents of driving after drinking in the past 12 months. The over 60s have a lower prevalence, but higher incidents in the last 12 months than other groups. Fewer women than men have driven after drinking. Timing of drinking, types of journey, reasons also reported Average number of days before re-offending,250 for drink drivers Gender, age and ethnic origin of No one considered drink driving 27% had in the past year driven heavy drinkers, employment to be an acceptable risk; several a car while intoxicated or after status, social class, income, drug thought it most serious because consuming 2 or more units of use compared with the general of the potential for killing others. alcohol over the previous hour. population more professionals/ Some regretted past occasions. employers and managers, more The concept of responsible Some take steps to avoid drink unemployed and more users of drinking may explain the disparity driving: cannabis and other illegal drugs). between attitude and behaviour. limit amount; Life events associated with Conceptualised responsible lower strength drinks; reduced drinking drinking as a process of selfmonitoring and being sensible DIY breathalyser testing book taxi; and to make sure own drinking did not have negative consequences for others. Being sensible relied on being aware of the potential effects of drinking too much and knowing own personal limits. Own limits were personal tolerance when they did not feel intoxicated, not necessarily under the legal limit A Qualitative Study of Drinking and Driving: Report on the Literature Review (continued)

77 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Davies McKerr (2007) Research to develop ideas for the THINK! drink-drive campaign in Qualitative research to inform the communication strategy, focus on men aged year-old men more intractable than older and younger men year-old men more mature and considered, and did not consider themselves to be a problem. Younger people most easily influenced Campaigns viewed as being aimed at drunk drivers; men drinking 1 3 pints do not see it as being aimed at them. Personal consequences most compelling (seen to be more pertinent than claims of increased risk to others and of crashing). Need to get under people s skin direct, almost personal, communication to the drink driver. Unintentional drinking just above the limit is not seen as morally wrong. Understanding of limited, confusion legal limit is The issue of limits comes down to the second pint the transition moment between what is seen as safe driving and pushing one s luck. Spontaneous occasions are often where problem occurs Department of the Environment Northern Ireland (2008) Attitudes to road safety and awareness of Just One campaign 86% think the police should be able to stop drivers for a random breath test. 64% think penalties are not harsh enough. Perceived likelihood of being stopped by police by age. How many drinks can you have without affecting your driving 42% said none. By age and gender. Acceptable to drive after 1 drink/ 2/3/. Agreement with statements about drinking and driving. Knowledge of limits for drink drive and units of alcohol in different drinks 2 main occasions for driving after 1 drink evening at a friend s house (42%) and night out with friends (31%). 21% of motorists who drink would normally drive after 1 drink. 34% of men and 28% of women would normally drive the morning after an evening of heavy drinking. 61% would not travel in a car with a driver who has had 1 drink 77 (continued)

78 78 Table A1.1: (continued) Reference Status of review/scope Engineer et al. (2003) 16 focus group discussions in 8 locations across England and Wales with year-olds having regular experience of binge drinking; 123 participants. 10 groups had been involved in offending or disorder after drinking in the previous year (victim or offender). Focus on experience of crime disorder and risk-taking, and links with drinking patterns, attitudes to drinking alcohol and the effects of binge drinking. No specific coverage of drink driving Information on characteristics Binge drinking definitions summarised. Defined here subjectively: feeling drunk either on a weekly basis or at least once a month Information on attitudes/ awareness Desire to push limits and difficulty judging limits of consumption. Fun to lose control. Freedom or escape. Some relieve stress or anger. Some planned their big nights out, many had found a social drink turn unexpectedly into a drunken evening. Social and peer group norms significant; some justified misbehaviour, thinking drunkenness to be an acceptable excuse Information on behaviour Technical limitations Reasons for risk taking: perceived necessity; and alcohol makes people become more reckless, overconfident or determined to do as they pleased. Some had used illegal drugs, but others were cautious. Hard drugs enable them to keep drinking for longer A Qualitative Study of Drinking and Driving: Report on the Literature Review Ingram et al. (2000). Household survey of yearold drivers in, computer-assisted self-interview More males than females among drink drivers. indication that people refrain from drink driving as they get older (and responsibilities increase) Some indication that those who take risks in one area are more likely to take them in another e.g. drink drive or drug drive and excessive speeding or excessive alcohol consumption Prevalence of drink driving and drug driving 5% had driven when they thought they were over the alcohol limit in the last year (continued)

79 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Institute of Alcohol Summary of statistics from a Convicted drink drivers: Prevalence of driving under the Studies (2009) range of sources covering: 9/10 male. influence of alcohol or drugs: 5% the prevalence of drink High-risk offenders peak at age of drivers aged 18+ admitted to driving; high-risk groups: driving over the limit, 13% said other drugs; and young male manual/ they had driven when unsure blood alcohol levels in unemployed; and whether they were over the limit casualties and fatalities older professional/ managerial men. Of convicted drink drivers: 12% convicted of a second offence within 10 years; 40% have previous convictions for other types of offence; twice as likely to have a criminal record as others of same age and gender; and highest rate of drink-drive accidents per licence holder is a man under 34, peak Inwood et al. (2007). Monitoring for a further 3 years. Included postal survey of referred offenders Circumstances around offence. Attendees more likely than nonattendees to have been involved in an accident Alcohol-related knowledge and perceived behavioural control over drinking and driving. Attitudes to drinking and driving compared for attendees and non-attendees. Opinions on reducing drinking and driving and motivations to attend course Reported driving style and drinkdrive behaviour Potential for nonresponse bias Jackson (2008) Summarises the proportion of drivers identified over the legal limit in the past roadside surveys In 1998, 1% of drivers on weekend nights were over the legal limit. In 1999, 0.7% were over the limit (thought to be under-reported) 79 (continued)

80 80 Table A1.1: (continued) Reference Status of review/scope Keigan et al. (2004) Sample of 2,000 evidential blood samples, Lader (2009) 2,243 home interviews with ages 16+ in Omnibus Survey Information on characteristics Drug use by age and gender, compares illegal and medicinal. Regional variations For key points see NHS information centre report. Additional points summarised here. Gives age, gender and socialeconomic group (SEG) distribution of people buying alcohol from different types of outlet Information on attitudes/ awareness Information on behaviour Technical limitations 23% of drink drivers tested positive for one drug (illegal or medicinal) three-quarters of these were for cannabis. 4% more than one drug. Shows the association between drugs and the level of alcohol Circumstances in which people drank last week: home 45% male, 60% female; other home 9% male, 11% female; and pub/bar 35% male, 17% female. Older people more at home; variations with SEG and gender. Drinking companions LyleBaillieBrief summary of evidence from Limited statistics on accident International (2005) a wide range of studies on the involvement at different levels of nature of alcohol impairment blood alcohol concentration (US) relevant to driving at different levels of consumption A Qualitative Study of Drinking and Driving: Report on the Literature Review Maycock (1997) Review of data sources and research studies. Includes roadside surveys Drivers in more affluent areas and managerial and professional occupations tend to be under represented in the High Risk Offender scheme and those in less well-off areas and in manual occupations tend to be overrepresented. Information on age and gender. Data from roadside surveys on incidence of driving with and without alcohol on weekend evenings 1997 (continued)

81 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Myant et al. (2006) Survey of 1,031 drivers aged Qualitative interviews with those who have driven under the influence of drugs in the past year, or longer, or have been passengers A third had ever used drugs, estimate 16% in past 12 months, more common among men than women; tend to be infrequent drivers. Cannabis most common. Differences with age and whether they live with a partner. Estimate 11% had ever driven while likely to be impaired, 6% in the past 12 months (estimates take account of under-reporting). Problem drug users were almost always under the influence so always drive under the influence Explanations for drug driving 2 key themes: positive incentives for drug driving (convenience of own transport and being able to make social journeys); and a lack of deterrents to dissuade (most people do not believe they were driving adversely affected, and most perceive that the risk of being caught is low). Used Arnett s sensation-seeking scale to place respondents on a spectrum of sensation seeking to develop explanatory framework for drug use and driving. Score higher for those reporting an involvement in other types of risky driving than among those who did not. Opinions on what would stop people drug driving advertising, education and more police on the roads Association between drug driving and drink driving, speeding, being involved in an accident in the past 5 years. Circumstances of drug driving where going from and to. Recreational drug users mainly at weekends for short distances. People who had given up drug driving were more likely to be with a partner. Increased responsibility, desire to avoid shame and implications of getting caught were the main reasons given for stopping (continued) 81

82 82 Table A1.1: (continued) Reference Status of review/scope Neale et al. (2000) Qual interviews 61 drug users attending night clubs in. Self-completion survey: 88 dance/nightclubs. Survey on main toll bridges at peak drug-driving times. 10 focus groups Information on characteristics Drug driving more common among males than females and less common as get older. Drug driving more common than drink driving among clubbers Information on attitudes/ awareness Cannabis driving considered less dangerous than driving after ecstasy, cocaine, amphetamine or LSD. Common to report being anxious while travelling with a drug driver but little evidence that this prevented the acceptance of a lift. Frightening experiences with drugs other than cannabis. Those who had drunk driven were as willing as those who had not to accept the higher level of danger and stupidity involved, so cannot assume that people who have behaved in a particular way are more likely to argue that it is acceptable and safe. The role of friends and peers drug driving often socially acceptable and normal within the friendship groups of those who drug drove. Poor knowledge about the legal position on drugs and driving and many confused on the laws of alcohol use Information on behaviour Technical limitations Incidence of illegal drug taking and driving afterwards widespread among clubbers and dance survey, but low at toll bridges. Most drug driving involved cannabis and was not associated with clubs or dance. Passengers reasons for being a passenger with a drug driver mostly related to the convenience of a lift home (several reasons). Some more likely to accept a lift if intoxicated themselves they do not care. Behavioural and situational factors contribute to male drug driving. Many clubbers had arranged a designated driver for drinking, but not for drug taking. Some clubbers had tried to stop someone from drink driving, but hardly any had done so for drug driving A Qualitative Study of Drinking and Driving: Report on the Literature Review Ormston and Webster (2008) 1,500 face-to-face interviews with self-completion questionnaire in Focus on attitudes, awareness and knowledge among general population. Summary and main report available None general population survey Views on drinking in Scottish culture, cause of problems, role of alcohol in social events. Attitudes to alcohol misuse using scenarios to represent different types of drinking behaviour. Awareness of units and consumption guidance. Variations in views and attitudes with age and gender, SEG, etc. Frequency of drinking, who people drink with (continued)

83 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Riley (1991) 1986 national survey of 1,700 drivers aged in England and Wales who sometimes drove a car or van in leisure time and who drank at least occasionally away from home. Beliefs, attitudes and behaviour towards drinking and driving. Are differences in drink driving linked with local level of enforcement and perceptions of enforcement? Little information on sample characteristics A third of drivers said it was difficult to avoid some drinking and driving if they were to have a social life. Less than half of young men thought it likely that they would drive at least once in the next year when they were over the legal limit. Drivers in high enforcement areas did not estimate a greater likelihood of being caught than those in low enforcement areas. High enforcement reinforces social pressures against drink driving and increases awareness of the greater accident risk for alcohol-impaired drivers. Drink driving associated with five factors: regard drinking and driving as important for one s social life; beliefs about the increased chance of being stopped by the police and concern over consequences; beliefs about the dangers of drinking before driving; beliefs about the likelihood that family or friends would disapprove; and experienced effects of alcohol on moods and behaviour Drinking away from home most drivers drank away from home at least once a week. Men most often gave the risk of legal sanction as a reason for cutting down on drinking before driving, while women were most frequently concerned with the risk of being in an accident. Drivers in high enforcement areas were less likely to drink than those in low enforcement areas 1986 (continued) 83

84 84 Table A1.1: (continued) Reference Status of review/scope Robinson and Lader (2009) Household survey in Great Britain alcohol consumption, comparison with previous surveys, drinking patterns Rose (2000) Compares convicted drink drivers with those committing other serous traffic offences main interest is in information on previous criminality. Interviews with police on how incidents arise Smith and Foxcroft (2009) (Summary and full report available) Systematic review of research on trends in alcohol consumption from general population surveys, data on sales and spending and national statistics. Information on characteristics Decline in per cent of young women (16 24) drinking heavily. More frequent and heavy drinking among higher income and non-routine occupational background than lower income and routine occupation background Proportion with previous convictions. Twice as likely to have a criminal record compared with the general population of same age and gender Increase in drinking among Women Middle age and older age groups Very young adolescents Possible recent decrease in drinking among year olds. Trends in drinking at different levels discussed. Possible reasons for main trends discussed. Information on attitudes/ awareness Information on behaviour Technical limitations 72% of men and 57% of women had an alcoholic drink in the past week; 24% of men and 15% of women drank heavily on at least 1 day in the past week. Over 65s had the highest per cent not drinking in a week and the highest per cent drinking every day A Qualitative Study of Drinking and Driving: Report on the Literature Review Smithet al. (2004) Drink drivers convicted in 2000 Age and ACORN category of Reconviction rates course 02 in Great Britain who were referred drink drivers, per cent attendees and non-attendees, (Note, TRL 662 referred to rehabilitation. of high risk offenders; course under and over 30, gender and (Inwood et al., 2007) Investigation of course providers attendance rates by gender age, ACORN longer-term and courts practices and views ACORN and High Risk Offender monitoring of same status group up to 5 years) (continued)

85 Table A1.1: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Tunbridge et al. (2001) Post-mortems of 1,184 casualties dying within 12 hours of a road accident occurring between Of the 533 drivers, positive tests for: medicinal drugs, 5%; illicit drugs, 18%; alcohol over the legal limit, 20%; and drugs and alcohol, 7.5%. Details of the types of drugs are given cannabis most frequent. For all road users (not just drivers) shows differences with age, region of Great Britain and SEG: highest drug use among unemployed 1/6 of all cases occurring possible selection bias, but small effect on level of drug use shown Xu (2009) Statistics on drink-drive accidents and casualties, over time trends Age and mode used by drink drivers killed, rate per 100,000 population in different regions, over the limit and over twice the limit. Car drivers in drink-drive accidents per licence holder and per mile driven. Seasonal and time of day variations in drink-drive accidents. Breath testing and failures by age and gender 85

86 86 Table A1.2: Other references, not included in literature review Reference Status of review/scope Alcohol Concern (2009) Drinking Patterns Summary Sheet Alcohol Concern (2009) Young People Summary Fact Sheet One-page summary of fact sheet that is available to buy. Sources of information not listed One-page summary of published fact sheet. Sources not listed Information on characteristics Information on attitudes/ awareness BOMEL Ltd (2004) Safety Study of relation between Driver attitude scoring for Includes survey based on the Culture and Work-related organisation s safety culture positive and negative Theory of Planned Behaviour Road Accidents. Road Safety and attitudes of its drivers to attitudes to road safety to analyse driving attitudes Research Report 51. London: safe driving. Survey of 7 and behaviour. Presented Department for Transport companies company car with 4 driving violation drivers and HGV drivers scenarios (including drinking using semi-structured and driving), and rated on a 5 interviews. point Lickert scale how they Reports review of literature feel about the consequences of their behaviour, the pressure they would feel to carry out the behaviour and belief about the ease or difficulty with which the behaviour can be performed Information on behaviour Technical limitations A Qualitative Study of Drinking and Driving: Report on the Literature Review British drivers don t know drink drive limit. 4 News, 25 March 2009, AXA survey of 800 drivers (source not found on AXA website) Only 39% correctly stated that the legal alcohol limit for driving is the equivalent of one pint of beer. However, 28% think the limit is higher, with 13% believing that the legal maximum is the equivalent of a pint and a half of beer. The survey revealed that 13% of drivers think they can down two pints of beer and still drive legally. A worrying 2% minority said the limit was even higher than two pints of beer No information on sample (continued)

87 Table A1.2: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations British Medical Association (2009) Drinking and Driving Policy Paper, health_promotion_ethics/ alcohol/drinkdrive.jsp last accessed 22 January 2010 Butcher, L. (2009) Driving: drugs. House of Commons Briefing note SN/BT/2884, House of Commons Business and Transport section Comment on government policy includes no new information Summary of policy developments and research A 1998 study showed that, compared with 10 years previously, 5 times as many people killed in road accidents had a trace of an illegal drug. Cannabis was the most common: 12%. Class A drugs most likely to have an effect on driving found in 6% of cases Central Office for Information Understanding of research Harmful drinkers found Awareness. Frequency of consumption is (2007) Social Marketing and expert views on across all social groups. Broad comparison of a key factor in unit Strategy for Harmful Drinkers. excessive drinking Tend to be older and, unlike attitudes, motivations and consumption. Stage 1: Final Scoping Report binge drinkers, do not drink beliefs compared with more Triggers and process of to get drunk. moderate drinkers reaching the point of harmful Uses stats from the General drinking. Household Survey (GHS) Discussion of how to 2005 influence change and the role of communication versus social marketing Cuppleditch, L. and Evans. W. Convicted drink drivers (2005) Re-offending of Adults: (custodial or community Results from the 2002 Cohort. sentence) and rate of reoffending during subsequent Home Office Statistical Bulletin 25/05. London: Home 2 years Office. Note. results from 2003 and 2004 cohorts in separate reports Age and gender distribution of convicted drink drivers. Rate of re-offending in age and gender groups 87 (continued)

88 88 Table A1.2: (continued) Reference Status of review/scope Information on Information on attitudes/ characteristics awareness Davies, G. P. and Broughton. Analysis of criminal and Offending background, J. (2002) Criminal and motoring offences committed ACORN classification of area Motoring Offences of Drink by drink driving offenders of residence, gender and age Drivers who are High Risk before and after they became Offenders. TRL Report No. High Risk Offenders 551. Crowthorne: TRL Ltd Department for Transport Summary of 3 studies on the (2000) The Attitudinal Theory of Planned Behaviour Determinants of Driving and its application to driving Violations. Roads Safety violations. Drink driving is one Research Report 13. London: of the violations included in Department for Transport scoring Information on behaviour Technical limitations Entec UK Limited (2002) The Assembly of international Higher scores on sensation- Differences in attitudes and Men 3 times more likely to International Contribution of Individual literature on individual seeking scales, risk-taking, knowledge between drink- report driving after drinking literature need Factors to Driving Behaviour: differences that could be anger/hostility and low level drive offenders and non-to pick out UK- Implications for Managing applied in occupational road of risk perception are offenders. based findings Work-related Road Safety. safety policies associated with drinking and Strong link between social Research Report 20. London: driving. deviance and drink driving Health and Safety Executive Higher scores on violations suggested as one venturesomeness and manifestation of social impulsivity associated with deviance substance abuse. More negative life events associated with drink driving A Qualitative Study of Drinking and Driving: Report on the Literature Review Everest, J. T, Banks, S., Level of alcohol in road Social background (marital Drinking habits of drivers and Hewer, P. A. and Mineiro, J. accident casualties attending status, SEG, annual mileage). motorcyclists frequency of (1991) Drinking Behaviour an A&E in , and Distribution of accident time, drinking in pubs and at home, and Breath Alcohol results of home interviews day and month for drivers distance travelled prior to Concentrations of Road with a sample with different BrAC levels. accident, drinking in 12 hours Accident Casualties. TRL Distribution of BrAC prior to accident Report No. RR331. concentration drivers by Crowthorne: TRL Ltd gender (continued)

89 Table A1.2: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Gwilliam, R. (2008) Behave Recommendations for policy Summarises long-term trends Discussion of THINK! Summary of theories about Yourself Road Safety Policy interventions including drink in casualty reduction and campaign focus. Given behaviour change in the 21st Century. London: driving. Review of evidence number of driving research showing perceived Parliamentary Advisory includes drink-driving case disqualifications. risk of having accident or Council for Transport Safety study Data on time of day of drinkdrive accidents shows low, suggests continuing to being caught drink driving is morning after effect. match fear of detection with Important to target groups fear of punishment. other than young men Role of shame and embarrassment. Suggests understanding more about fear, emotion and shame, and discovering the boundaries before an audience will switch off. Discussion of grey area on limits. Elaboration of Likelihood Model and Effortful Deliberation. Provision of coping strategies important, especially for young drivers e.g. designated driver, but evidence on efficacy in the UK not yet sufficient Hamilton, K. and Kennedy, J. (2005) Rural Road Safety: A Literature Review. Scottish Executive Social Research. Edinburgh: Scottish Executive Review of published literature mainly from UK on information relating to road accidents on rural roads No concrete evidence that drink driving is more prevalent in rural areas, but public perception that it is more of a problem (based on Anderson and Ingram above) (continued) 89

90 90 Table A1.2: (continued) Reference Status of review/scope Information on Information on attitudes/ characteristics awareness Information on behaviour Technical limitations Hope, S., McKeganey, N. and Planned study extending an Prevalence of illicit drug use Planning to assess extent to Four reasons to be examined: Stradling, S. (2005) Illicit earlier study in in and driving which drivers contrive to contrived compulsion; drugs and driving: prevalence Survey of 1,000 drivers place themselves in situations reward; and attitudes. Behaviour aged 17 39, qualitative where it is likely that they will absence of risk or Research in Road Safety, interviews with those who use drugs and drive by censure; and 15th Seminar. London: have driven under the studying the way that drug low awareness of Department for Transport influence of drugs in the past drivers construct their impairment. year, or longer, or have been accounts of drug driving. Note, outcome not mentioned passengers Previous research indicates a in Myant et al. (2006) Report of actual study is pattern to ways of recounting Myant et al. (2006) experiences of road safety violations which absolve them of responsibility suggest that drivers set-up situations in which they are required to drink and drive, e.g. drive to a friend s house where drugs will be part of the social interaction and then for some reason they must drive home; presented as a one-off. Analysis will look at unifying themes among one-off accounts of drug driving. Hypothesis that sensation may be primary explanation for violations among young people, contrived compulsion may be a better explanation among older drivers. Note, analysis of these aspects does not appear in the actual report A Qualitative Study of Drinking and Driving: Report on the Literature Review Inwood, C. (2007) The drink Key findings of Smith et al. Includes comparisons with drive rehabilitation project. (2004) attendees and non-attendees Behavioural Research in Road Safety 2007: 17th Seminar. London: Department for Transport (continued)

91 Table A1.2: (continued) Reference Status of review/scope Townshend, J. M. and Duka, Methodological study of ways T. (2002) Patterns of alcohol of measuring alcohol drinking in a population of consumption in study of young social drinkers: a university students comparison of questionnaire and diary measures. Alcohol and Alcoholism, 37( 2), Information on Information on attitudes/ characteristics awareness Information on behaviour Technical limitations Lancaster, B. and Dudleston, Qualitative research to Pivotal role that alcohol plays Main drinking place pubs. Problem drinkers A. (2001) Attitudes Towards explore views and in Scottish society, with many Drinking to get drunk Alcohol: Views of Problem experiences of alcohol and people identifying alcohol as Drinkers, Alcohol Service alcohol-related services, the main focus of their life Users and their Families and perceptions of how far Friends. Health and services meet needs and Community Care Research ideas for other services. Programme Research Interviews with people with Findings No. 12. Edinburgh: alcohol problems, families Scottish Executive Central and friends Research Unit Morning After drivers targeted Central Police study More than 80% of drivers Too brief BBC News, questioned in research by the news.bbc.co.uk/1/hi/ police admitted to driving the scotland/tayside_and_ morning after a night-time central/ stm last drinking session accessed 22 January 2010 (continued) 91

92 92 Table A1.2: (continued) Reference Status of review/scope NHS Information Centre Model-based Estimates of Binge Drinking for Local Authorities in England neighbourhood-statistics/ neighbourhood-statistics: model-based-estimates-ofhealthy-lifestyle-behavioursat-pco-level accessed 22 January 2010 RAC (2008) Report on Motoring 2008: Report One 20 Years of Motoring 1988/ Norwich: RAC. Survey of 1,116 motorists (with valid licence and drive at least once a month) shared views on motoring in 2008 and how it has changed since 1968 online survey. Nationally representative in terms of age, gender, SEG and region Information on characteristics Indicates variations in binge drinking between areas Information on attitudes/ awareness Three-quarters of drivers support a reduction in the legal limit for drink driving. Three-quarters say random breath testing would be acceptable, and 7/10 say the drink-drive limit should be reduced to no alcohol at all Information on behaviour Technical limitations Model-based estimate A Qualitative Study of Drinking and Driving: Report on the Literature Review Register of drug and alcohol research in Northern Ireland. Includes brief summaries of studies Anti-drink driving strategy development research, Attitudes and behaviour of young adult drinkers in Northern Ireland, Continuous household survey biannual to 2003, includes information on drink driving and driving and drinking, and also attitudes. Courses for drink-driving offenders annual since 2000 (continued)

93 Table A1.2: (continued) Reference Status of review/scope Royal Society for the Discussion of policy options Prevention of Accidents (2007) lowering legal limit for BrAC, Drinking and Driving Policy wider police powers to Paper. Birmingham: RoSPA. require tests, random breathtesting, sobriety checkpoints, penalties and sentencing, rehabilitation, education and publicity. Includes examples of policy measures in other countries Stead, M., Gordon, R., Holme, Initiatives successfully used in I., Moodie, C. Hastings, G. other fields which can help and Angus, K. (2009) inform new strategies for Changing Attitudes, alcohol-related harm Knowledge and Behaviour: A Review of Successful Initiatives. York: Joseph Rowntree Foundation Stone, J., Buttress, S. and Summarised in TRL 662 Davies, G. P. (2003) Drink/ (Inwood et al., 2007) drive Rehabilitation Courses: Survey of Non-attenders. TRL Report No Crowthorne: TRL Ltd Information on Information on attitudes/ characteristics awareness Summarises statistics on breath testing, including hour of day, casualty statistics, age of drink drivers, drink-drive accidents per licensed driver by age group Information on behaviour Technical limitations Tancock, N. Risky business. Focus on harmful drinkers On the surface, harmful Defined 9 different types of How the alcohol social over 35. Qualitative drinkers are no different from drinker in segments fitting marketing strategy for research included days people drinking at lower risk into social and individual England can help harmful observing the life of harmful levels, but they are deeply dimension; any one individual drinkers help themselves.drinkers attached to alcohol some can move through all groups Presentation. saw it as part of the national in a day or a week Note, for an explanation of identity the segments see also 2CV (2008) 93 (continued)

94 94 Table A1.2: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations The NHS Information Centre, Compilation of statistical In 2007, 73% of men and Knowledge of units and Drinking patterns, alcohol lifestyles statistics, information on drinking 57% of women reported recommended maximum. buying Statistics on alcohol England, habits, knowledge and drinking alcohol on at least 1 Attitudes to own drinking by The Health and Social attitudes towards drinking day in the previous week; age and gender (from Health Care Information Centre and health-related effects of 13% of men and 7% of survey for England, 2007): alcohol misuse (Main sources women drank every day. 16% of men and 14% of GHS and ONS survey) Includes per cent drinking women who had drunk in last heavily on at least 1 day and year would like to drink less per cent drinking more than the recommended number of units per week. 33% of men and 16% of women classed as hazardous drinkers. Drink in last week most common among professionals/manager (80% of men, 60% of females); heavy drinking also 43% professionals/manager, 32% routine-manual. Among those of working age, those employed were more likely to drink in the past week than unemployed/inactive heavy drinking also. Drinking associated with higher income, married/cohabiting more than single. Regional variations heavy drinking more in North West and Yorkshire and Humberside, least in West Midlands A Qualitative Study of Drinking and Driving: Report on the Literature Review (continued)

95 Table A1.2: (continued) Reference Status of review/scope Information on characteristics Information on attitudes/ awareness Information on behaviour Technical limitations Valentine, G., Holloway, S. L., Telephone interviews with Drinking cultures vary Men drank heavily and alone Jayne, M. and Knell, C. 1,000 adults, in-depth between different parts of the more than women. (2007) Drinking Places. Where interviews with key country, embedded in Young men often have a People Drink and Why. York: stakeholders. Inter- historical, socio-economic culture of showing off, Joseph Rowntree Foundation generational interviews with and cultural contexts. competing in the amount and 10 families. Observations of Young people ignored health speed of drinking; buying behaviour. Investigation of implications of binge drinking rounds and all drinking the cultures of alcohol and justified it as a phase same. consumption in two areas without recognising the Women usually focus on the urban and rural and a potential long-term risks. social side of drinking, less range of drinking practices Women s drinking viewed concerned about showing off, from abstinence to binging more negatively than the skip drinks and buy different same behaviour in men. drinks, enabling them to Public drinking less control their drinking. respectable than drinking at Significant consumption in home. the Muslim community Some men changed drinking mainly men starting to drink patterns on becoming a in mid to late teens in informal father (less money and time), locations through peer while women focus on the pressure and curiosity, but conflict between drinking and not continuing once married. maternal responsibilities Domestic drinking: (especially young and lone three-quarters of all sample mothers). regularly drank at home and Home drinkers, even those two-thirds at family and with excessive consumption, friends homes regarded this as unremarkable and felt insulated from public health messages. Some tried to justify why public health concerns were irrelevant to them Walen, A. and McKenna, F. (2002) Cradle Attitudes: Grave Consequences. Basingstoke: AA Foundation for Road Safety Research. Summary report of work to trace developmental pathway from young pedestrians through people too young to drive, but aware of driving process, to drivers. Internet survey of 350 drivers Risk-taking behaviour more common in males than females. Many of the attitudes and behaviours associated with risky drivers also present among year-olds Risky attitudes and behaviours associated with age, gender and to some extent SEG Anti-social behaviour predicts violational behaviour such as jumping red lights and drink driving. Competitiveness found to be a better predictor of violations than sensation seeking 95