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

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

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 020 7944 8300 Web site www.dft.gov.uk/pgr/roadsafety/research/rsrr # 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 www.nationalarchives.gov.uk/informationmanagement/our-services/click-use.htm To order further copies contact: DfT Publications Tel: 0300 123 1102 Web: www.dft.gov.uk/orderingpublications ISBN 978 1 84864 064 1 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 020 7944 4673. Printed in Great Britain on paper containing at least 75% recycled fibre.

CONTENTS ACKNOWLEDGEMENTS 6 EXECUTIVE SUMMARY 7 1 INTRODUCTION 12 1.1 The research 12 1.2 Approach 12 1.3 Scope of the review 13 1.4 Overview of the material 13 1.5 Terminology 13 1.6 Outline of the report 14 2 BACKGROUND 15 2.1 National statistics on drinking and driving 15 2.1.1 Road accidents and casualties 15 2.1.2 Convictions 17 2.2 Attitudes and beliefs about drinking and driving 18 2.3 Drinking patterns 20 3 PREVALENCE AND INCIDENCE OF DRINKING AND DRIVING 23 3.1 Driving combined with drinking 23 3.2 Reported over the limit driving after drinking 26 3.3 Convicted driving over the limit 30 3.4 Passengers 30 4 WHO DRIVES AFTER DRINKING? 32 4.1 Socio-demographics and drinking behaviour 32 4.2 Socio-demographics and drinking combined with driving 33 4.2.1 Gender 33 4.2.2 Age 35 4.2.3 Social grade 37 3

4.2.4 Area 37 4.2.5 Links with other driving offences 38 4.3 Demographic profile 38 4.4 Typologies and clusters 41 4.5 Passengers 43 5 THE CIRCUMSTANCES UNDER WHICH PEOPLE DRIVE AFTER DRINKING 45 5.1 Where? 45 5.2 When? 46 5.3 Who with? 47 6 ATTITUDES OF INDIVIDUALS WHO DRIVE AFTER DRINKING 48 6.1 Why? motivations/reasons for driving after drinking 48 6.1.1 Explanations 48 6.1.2 Profile of drinking behaviour including planned and unplanned drinking 50 6.1.3 Planning transport (or not) to avoid drink driving 52 6.2 Changes in behaviour over time 53 6.3 Perceptions of own driving with drinking behaviour 53 6.3.1 The concept of drinking and driving 54 6.3.2 Acceptability of drinking and driving 54 6.3.3 Feelings of impairment (or not) when drinking and driving personal safe limits 54 6.3.4 Actions to stay within the limit 56 6.3.5 Perceptions of the legal limit 56 6.3.6 Perceived risks 57 6.3.7 Perceived causes of accidents 57 6.4 Knowledge and understanding of laws and penalties 57 6.5 Views on consequences 59 4

7 DRIVING UNDER THE INFLUENCE OF DRUGS 60 7.1 Prevalence and incidence 60 7.2 Who? 61 7.3 Circumstances 62 7.4 Passengers 63 7.5 Attitudes and beliefs 63 7.6 Drugs, alcohol and driving 65 8 IMPLICATIONS FOR THE QUALITATIVE RESEARCH 66 8.1 Sample selection 66 8.2 Interview coverage 67 9 REFERENCES 68 APPENDIX 1: Documents reviewed summary of scope and key points 71 5

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

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 2000. 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

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 17 24 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 17 24. 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 2002. 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

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 30 59 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 17 29 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 17 29 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

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

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

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

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

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

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 17 24. 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. 2.1.1 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 2002. 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

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 16 19 who were killed were over the legal limit (23%) and 33% of drivers aged 20 29 who were killed were over the limit. In 2007, drivers aged 20 24 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 16 24 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 25 59 (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 17 24. 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 17 24 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

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 17 25 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 17 19-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. 2.1.2 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 25 34 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

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

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

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 16 24-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 25 44. In this study, average weekly alcohol consumption was estimated at 12.7 units (18 units for men and 7.7 20

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 20 30 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 16 24-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

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 16 24-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

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 1999. 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

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 2007. 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, 2001 25% 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, 2004 37% 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, 2001 20% 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, 2008 24

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 2007. 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