Challenges for best practice in Drink Driving Management

Professor Mary Sheehan

3rd International Conference on Urban Traffic Safety, Edmonton,17-21 April 2011

Acknowledgements

• CARRS-Q team members: Dr Lisa Buckley, Postdoctoral Fellow Rebekah Chapman, NHMRC PhD Scholar• Key conceptual reference: Fell J.C. & Voas R.B. (2006). Mothers

against drunk driving (MADD): the first 25 years. Traffic Injury Prevention,7, 195 -212.

CRICOS No. 00213J

Overview1. Context of Drink Driving – Contrasting Interventions

2. An Historical Context (1988)

3. The Current Context

4. Education and rehabilitation programs – Re-visited

CRICOS No. 00213J

1. Context of Drink Driving – Contrasting Interventions

Targets of intervention A model for population prevention Task of intervention – (reducing fatalities in

Canada and Australia) The prevention paradox – the inequality

paradox of population approaches and vulnerable groups

Targets: Tiers of Influence on Drink Driving Behaviour

Drink driving behaviour

At risk person

Social & community context

Family, peers, teachers

Drink driving behaviour

At risk person

Social & community context

0.00 BAC for novice and commercial drivers

Education/ media campaigns

General and targeted testing

Targets of intervention

Family, peers, teachers

Drink driving behaviour

At risk person

Family, peers, teachers

Social & community context

School-based education

Targets of intervention

Social & community context

Rehabilitation programs

License loss and suspension

Targets of intervention

Family, peers, teachers

At risk person

Drink driving behaviour

Mandatory Alcohol Ignition Interlock

Jail sentence

Mandatory vehicle impounding

Drink driving behaviour

At risk person

Social & community context

Targets of intervention

Family, peers, teachers

A public health model for population prevention

A model for population prevention:Homogenous effect of a population approach

mean effect

level of risk exposure

After the intervention Before the intervention

Rose ( 1992)

Focus of intervention

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 20060

5

10

15

20

25

30

35

40

45

50

4442

40

3739

40

3735

34 3432

28 29 2830

29 2826

27

2425

28 2826

29 29

Percentage of fatally injured motorists with a BAC of .05 or more in Australia (1981-2006)

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 20070

5

10

15

20

25

30

35

40

45

50

Australia Canada

Focus of interventionPercentage of fatally injured motorists with a BAC of .05 or more in

Australia; .08 or more in Canada

Increase in the variation of risk following a population approach

mean effect

level of risk exposure

After the interventionBefore the intervention

Concentration of benefits

Concentration of risks

Frohlich &Potvin (2008)

CRICOS No. 00213J

2. An Historical Context (1988)

CRICOS No. 00213J

Terminology of drink driving (1988)

Summary of issues Education and

rehabilitation (Mann, Vingilis and Stewart)

University of Chicago Press, 1988

CRICOS No. 00213J

TerminologyTerminology - 1988

Drinking-driving

Drunken driving

Drunk driving –Drunk drivers

DWI (driving while intoxicated)

DUI (driving under the influence)

Alcohol-impaired driving

Variability reflects community attitudinal framing

• The moral drama of drinking driving has been the most vital force at work [RID,MADD]

• Young people have status as a “dangerous class” in America…and are a relatively weak political group. A logical safety conclusion would extend the minimum drinking age to 25 and exclude all women from such legislation. (Gusfield)

• An alcohol safety Ignition Interlock system is at the inaugural trial stage and must be seriously considered for use with recidivists (Voas)

Social control of the drinking driver (1988)

• Alcohol impaired driving is highly resistant and benefits from licence actions and intensive law enforcement with media support have been only short term

• Random Breath Testing is being trialled in New South Wales (Australia) and may have a longer effect (Snortum)

• Benefit-cost research needs to be done (Votey)

• The success of the Scandinavian system is the “per se” legislation (Andenaes)

Social control of the drinking driver (1988)

CRICOS No. 00213J

Chapter 10: Programs to Change Individual Behavior: Education and Rehabilitation in the Prevention of Drinking and Driving (1988)Robert E. Mann, Evelyn R. Vingilis, and Kathryn Stewart

• Countermeasure approaches must understand the independent and interactive influences of both personal factors and environmental factors.

• The most effective way to combat a complex social problem like drinking and driving is to introduce a set of complementary person and environment based countermeasures

• Effective social control will make judicious use of both education and rehabilitation, and environment management countermeasures such as stricter laws, random breath testing, alcohol control, improved vehicle and road design.

Effective solutions should use complementary person based (education and rehabilitation) and environment management countermeasures.

CRICOS No. 00213J

3. The current context

• Definitions of drink driving (2011)

• Attitudes – messages – community opinion surveys

• Best practice

• Definitive literature• NHTSA guidelines• GDL – driving age – per se laws – RBT• Alcohol ignition interlocks• A health agenda item

CRICOS No. 00213J

Terminology – 2011

Terminology

Drink driving

Drunken driving

DWI

BAC limits

.10

.08

.05

.03

.02

An example of persistent attitudes An example of

education

Core attitudinal messages: The drinking driver

• Canada: MADD’s mission:

• Australia: Key advertising message:

If you drink and drive you’re a bloody idiot (and if you drink and drive and don’t get caught, you’re

bloody lucky)

is to stop impaired driving and to support victims of this violent crime

Percentage who report driving after the consumption of any alcohol

Year %age from Canada(past 30 days)

% from Australia(usual pattern)

2001 16.7 44.02002 16.1 47.02003 15.8 44.02004 17.8 43.02005 14.7 43.02006 17.5 43.02007 17.6 na2008 18.1 43.02009 19.0 43.02010 24.7 na

TRF (2011), Petroulias (2009).

USA figures

Quoted by Fell and Voas (2006) are much earlier but of interest and probably lower nowDriving after drinking:1983 - 32%1986 - 26%

Percentage who report driving over the legal limit

Year %age from Canada(past 12 months)

%age from Australia(past 12 months)

2007 7.7% na2008 na 5.0%2009 na 4.0%

Beirness &Davis (2007), Petroulias (2009).

USA Figures

Again quoted by Fell and Voas (2006) and again much earlier:

Driving after drinking too much

1984 – 5.5%1986/87 – 4.5%

CRICOS No. 00213J

Key policy initiatives

• Alcohol: No Ordinary Commodity: Research and Public Policy. 2010. Second edition, Oxford University Press.

• Countermeasures that work: a highway safety countermeasure guide for state highway safety offices (NHTSA, 2007).

• Shults, RA, Elder, RW, Sleet, DA et al. (2001). Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Health 2001; 21(4s): 66-88.

• Global Status Report: Alcohol Policy (WHO, 2004).

Countermeasures that work (NHTSA, 2007)

Effectiveness:Demonstrated to be effective by several high-quality evaluations with consistent resultsDemonstrated to be effective in certain situations

Likely to be effective based on balance of evidence from high-quality evaluations or other sourcesEffectiveness still undetermined; different methods of implementing this countermeasure produced different resultsLimited or no high-quality evaluation evidence

CRICOS No. 00213J

Countermeasures that work (NHTSA, 2007)

Countermeasure Effectiveness Use Cost TimeDeterrence: Laws ALR/ALS High High Medium Open containers High Low Short

High-BAC sanctions Medium Low Short

Alcohol-impaired driving law review Low Medium Medium

BAC test refusal penalties Unknown Low Short

Deterrence: Enforcement Sobriety checkpoints Medium High Short Saturation patrols High Medium Short

Preliminary Breath Test devices (PBTs) High Medium Short

Passive alcohol sensors Unknown Medium Short

Integrated enforcement Unknown Low Short

Deterrence: Prosecution and Adjudication Division/plea agreement restrictions Medium Low Short

Court monitoring Low Low Short

DWI courts Low High Medium

Sanctions Varies Varies Varies

CRICOS No. 00213J

Countermeasures that work (NHTSA, 2007)

Countermeasure Effectiveness Use Cost TimeDeterrence: DWI Offender Treatment, Monitoring and Control Alcohol problem assessment, treatment High Varies Varies

Alcohol interlocks Medium Medium Medium Vehicle and license plate sanctions Medium Varies Medium

DWI Offender monitoring Unknown High Varies

Lower BAC limit for repeat offenders Low Low Short

Prevention, Intervention, Communications and Outreach Alcohol screening and brief interventions Medium Medium Short

Mass-media campaigns High High Medium

Responsible beverage service Medium Medium Medium

Alternative transportation Unknown Medium Short

Designated drivers Medium Low Short

Underage Drinking and Alcohol-Related Driving Zero-tolerance enforcement Unknown Medium Short Age 21 enforcement Varies Varies Varies Youth programs High Varies Medium School education programs Unknown Low Long

USA Used in majority of states in

varying ways and types of offendersCanada Mandatory in majority of provinces

and linked with rehabilitation programs in some jurisdictions

Europe Used and tested in a large

number of countriesSweden Mandatory for post conviction, used

in vehicle fleets and being investigated as

standard for all vehiclesAustralia Mandatory for recidivists in 4 states

CRICOS No. 00213J

Countermeasure Effectiveness Use Cost Time Alcohol Interlocks Medium Medium Medium

Australia Majority of states

USAMajority of states

Europe A number of countries

Canada Majority of provinces

Countermeasure Effectiveness Use Cost Time Graduated Driver Licensing High Medium Long

Graduated Driver Licensing(Alcohol limitations)

• Minimum drinking age 21yrs – USA since 1987

• Zero tolerance for novice drivers – Australia, Canada and widely established in Europe

BUT• Only 19 of 139 countries with BAC limits have

lower limits for novice driversExtracted from Hingson (2009)

Drinking AgeCountermeasure Effectiveness Use Cost Time Zero-tolerance enforcement Unknown Medium Short Age 21 enforcement Varies Varies Varies

CRICOS No. 00213J

Drink driving: An item on the health agenda

CRICOS No. 00213J

2004 Global Status Report: Alcohol Policy

CRICOS No. 00213J

2004 Global Status Report: Alcohol PolicyBAC level and RBT

Country Maximum BAC level Use of RBTNorway 0.2 OFTEN

Japan 0.3 SOMETIMES

Australia 0.5 OFTEN

The Netherlands 0.5 OFTEN

New Zealand 0.8 SOMETIMES

USA - California 0.8 SOMETIMES

Canada - Ontario 0.8 SOMETIMES

CRICOS No. 00213J

Alcohol in Fatal Crashes (WHO reports – 93 countries)

• WHO recommends 0.05% legal BAC

• Only half of countries with legal BAC limits have a BAC of 0.05% or lower

Extracted from Hingson (2009)

CRICOS No. 00213J

4. Education & rehabilitation programs – re-visited

Key issues in rehabilitation program design

Effectiveness:• Replication of drink driving rehabilitation

program effectiveness findings in Australia, UK, EU finds between 30% and 69% reduction in recidivism with consistent replication of this outcome with high recidivist drink drivers.

• Similar findings in the USA where program was an alcohol treatment rather than drink driving intervention.

 

Key issues in rehabilitation program design (1)

Core elements of effective programs include: • Undertaken in addition to licence restriction and/or

suspension• Group programmes - 10 participants most common size

reported in effective programmes.• Longer rather than shorter programs (approx. 10

sessions over 10 weeks)• Interactive discussion – active learning not didactic

teaching• Use of drinking diaries and trackers to develop strategies

for high potential drink driving situations

Key issues in rehabilitation program design (2)

• Information essential but not sufficient• A focus on personally relevant strategies and skills to

avoid drink driving and group processing of problem solutions

• Staff trained to handle class relationship problems professionally

• Offenders perceive transparent and objective client selection

• A formally structured program defined by a written manual

Key issues in school-based education for senior students:Best practice (1)

Content• Material and knowledge that is consistent with the GLS (Graduated

Licensing System)

• Attitudes that are known to affect risky behaviours (e.g. attitudes to drink driving) using behaviour change theories with demonstrated effectiveness

• Road safety targets that are appropriate for the developmental stage and culturally appropriate e.g. the role of a supportive/protective peer passenger or ‘good mate’

• Emotional messages should not focus on evoking fear, and if used should be accompanied by specific coping strategies and alternative behaviours.

School-based education for senior students:Best practice (2)

Process

• Multiple sessions covering a range of issues

• Use continuity of road safety messages from primary school road safety programs through high school to licensing stage (include passenger behaviour)

• Effective messages need to be delivered through interactive processes and small group discussions

• Programs should be delivered by skilled individuals who can manage the above (e.g. teacher with relevant training)

• Ideally, include parental involvement

Driver education for senior students:Counterproductive issues

• Programs which encourage early licensing – exposure

• Programs which result in over-confidence about driving abilities in participants

• Formative evaluation to ensure program does not encourage at risk behaviours

Buckley & Sheehan (2004)

School based education for senior students

Effectiveness:• Measured by reduced drink driving in later

years rarely tested but the few that do this indicate that model programs are effective in reducing target behaviours

• Attitude and knowledge change achieved by well constructed programmes

Evaluation issues for education programs - SPIY

• Alcohol associated risk behaviours increase through adolescence

Baseline 6 Mth Follow-up Change Baseline

-40

-20

0

20

40

60

SPIY Control

6 Mth Follow-up Change

Passenger of drink driverNot wear a bicycle helmet

Evaluations issues for education programs –target for change

The gold standard for evaluation for drink driving school education programs is change in later drink driving offences

BUTPerhaps the change indicators should be change in the social and community context

Increase in the variation of risk following a population approach

mean effect

level of risk exposure

After the interventionBefore the intervention

Concentration of benefits

Concentration of risks

Frohlich &Potvin (2008)School education

Rehabilitation

ReferencesPetroulias T.(2009) Community Attitudes to Road Safety: 2009 Survey Report.

Road Safety Report No. 4. Canberra, Dept of Infrastructure, Transport, Regional Development and Local Government.

Ramage-Morin P.L. (2008) Motor vehicle accident deaths, 1979 to 2004. Statistics Canada, Catalogue no. 82-003-XPE –Health reports 19,3. Canada.

Laurence, M.D., Snortum, J.R.,& Zimring, F.E. (1988) Social Control of the Drinking Driver. University of Chicago Press.

Global Status Report: Alcohol Policy (2004),World Health Organization, Dept Mental Health and Substance Abuse, Geneva.

Shapcott G. Road Safety Statistics, DITRD, Australia, Personal communication, December,17,2009.

Sheehan Mary (1994) Alcohol Controls and Drink driving: the Social Context. CR 142, FORS, Canberra.

Beirness, D. J., & Davis, C.G.,(2007) Driving after Drinking in Canada :Findings from the Canadian Addiction Survey . Canadian Journal of Public Health, 98, 477 -479.

Memoire depose a la Commission des transports et de l”environment dans le cadre des consultations sur le projet de loi no.71, loi modifiant le Code de la securite routiere et d’autres dispositions legislatives.(2010), Institut National de Sante Publique, Quebec.

Davies, G.P., Broughton, J., Harland,D.G.,& Tunbridge, R.(1999) Drink/driver rehabilitation courses in England and Wales.TRL Research Report 426. Transport Research Laboratory, Crowthorne.

Mills, K., Hodge, W., Johansson, K.,& Conigrave, K.M.(2008) An outcome evaluation of the New South Wales Sober Driver Programme: a remedial programme for recidivist drink drivers. Drug and Alcohol Review, 27, 65 – 74.

Bartl, G. (2003) Analysis of driver rehabilitation programmes. Paper presented at the GOCA –Your safe Mobility Congress, 22 -24 Oct. Brussels.

Deyoung, D. J.(1997) An evaluation of the effectiveness of alcohol treatment, driver license actions and jail terms in reducing drunk driving recidivism in california. Addiction, 92, 989 -997.

Rose G. (1992) The Strategy of Preventive Medicine. Oxford , England : Oxford University Press.

Frohlich K.L.& Potvin, L. (2008) The Inequality Paradox: the Population Approach and Vulnerable Populations. Am. J. Public Health, 98, 216 – 21.

Fell J.C. & Voas R.B. (2006). Mothers against drunk driving (MADD): the first 25 years. Traffic Injury Prevention, 7, 195 -212.

Mann R.E., Vingilis E.R. & Stewart K.( 1988) Programs to Change Individual Behavior: Education and Rehabilitation in the Prevention of Drinking and Driving. Chapter 10 in Social Control of the Drinking Driver op. cit.

Babor T., Caetano R., Casswell S. et al (2010) Alcohol: No Ordinary Commodity: Research and Public Policy. Second edition, Oxford, England : Oxford University Press.

Countermeasures that work: a highway safety countermeasure guide for state highway safety offices (2007) NHTSA.

Shults, R.A., Elder, R.W., Sleet, D.A. et al. (2001). Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Health 2001; 21(4s): 66-88.

Global Status Report: Alcohol Policy (WHO, 2004).

Buckley, L., Sheehan, M. & Chapman, R. (2009). The impact of a comprehensive school-based injury prevention program for early adolescents on bicycle helmet wearing. Transportation Research Record, 2140, 173-181.

Buckley, L. & Sheehan, M. (2004). Behaviour Change Programs. In The Scientific Basis of Injury Prevention & Control. Mclure, R., Stevenson, M. & McEvoy, S. Melbourne: IP Communications.

Hingson, R. (2009) Presidential paper delivered to ICADTS Executive Board, Washington, D.C.

Questions?

Mark your Diaries!International Council on Alcohol, Drugs and Traffic Safety

Conference (T2013)August 2013, Brisbane Convention and Exhibition Centre