It is widely accepted that drink-driving behaviors make significant contributions to driver risks and are associated with elevated rates of risky driving behavior, road col- lisions, and the associated mortality and morbidity from these collisions (Baker et al.
1992). The role that alcohol use is believed to play in collision risk is encapsulated in the legislation of many societies, which have both imposed legal restrictions on the amount of alcohol that may be present in the blood of drivers and applied heavy penalties for drink-driving behaviors.
The fundamental issue with drink-driving and road collisions is that it is a crime.
Someone under the influence of alcohol (and drugs) who is involved in a road colli- sion is committing an offence. Much of the literature focuses on drink-driving arrests rather than the study of road collisions and drink-driving. There have been limited attempts to delineate spatial location and spatial studies to drink-driving road col- lisions. In nearly every Western country and city, there have been many attempts at deterring drivers to not drink and drive. The literature focuses on fatal collisions and blood alcohol levels (as according to Rosman (2001), the linkages between blood alcohol levels and less serious collisions are less well documented).
The main approach adopted in most countries is a very high level of enforcement that is supported by intensive publicity campaigns, particularly television advertising campaigns. Also, even though the use of alcohol-related collisions as a measure of performance for anti-drink-driving enforcement and publicity campaigns has high face validity, it can have biases. First, although random breath testing programs are designed to detect and deter drink-driving, the presence of traffic police on the roads is expected to have knock-on effects into other risky and illegal driving behaviors such as speeding, joyriding, and aggressive driving. Likewise, the presence of anti- speeding traffic enforcement on the roads will have a deterrent effect on other risky and illegal driving behaviors besides speeding. The two enforcement programs are thus expected to have complementary effect on alcohol-related and speed collisions as well as knock-on effects on other types of collisions, which have thus far been ignored in the road safety literature.
There is a clear profile from worldwide data on who are drunk drivers: most offenders are likely to be male; young male manual workers (or unemployed) who drink beer in pubs have been identified as one high-risk group, but so have older professional/managerial men. One major form of data to be collected on drink-driving
is roadside surveys. However, most information is deemed from road collision statis- tics that will report if the driver has been drinking. A study of fatally injured drivers, riders, passengers, and pedestrians detected at least one medicinal or illicit drug in 24% of the sample. Alcohol was present in 31.5% of the sample, 21.5% being over the present legal limit for driving. Whereas the incidence of alcohol in road accident fatalities had reduced from 35% that was 10 years earlier, the incidence of drugs had increased threefold. For a single drug, 11.7% of the fatal injuries tested positive and 6.3% for multiple drug presence. In males, the majority of drug use was in those aged under 40, and in women in those aged 40 and over. This reflected a difference in the type of drug consumed—a higher incidence of illicit drugs being found in males, and medicinal drugs in females. Drug use was the highest (38.5%) among fatalities reported as being unemployed, this group having a particularly high incidence of cannabis and multiple drug use.
Countermeasures include the following:
• Anti-drink-drive publicity campaigns
One of the first anti-drink-drive campaigns was introduced by the British Government in 1967 and was an attempt to promote the introduction of breath testing. Campaigns then ended until 1975 because of the lack of funding. The UK Department of Transport officials believe that recent (1985 to present) advertising campaigns have been effective in reducing injuries.
They point to a large drop in 1987, when the slant of the slogans and adver- tising shifted from warnings about getting caught to an emphasis on the fact that drivers who drink endanger lives—the “Drinking and Driving Wrecks Lives” slogan. Since then, there have been variations on the same theme, including in 1992 a television advert that could be broadcast only after the 9 p.m., watershed showing a girl lying on the pavement covered with blood.
The campaigns are targeted primarily at young men in their late 1920s who are overrepresented in collisions, particularly at Christmas. The pub- licity campaign is believed to have been effective. However, it is difficult to isolate the effect of publicity from the other measures introduced over the same period, such as tougher laws and higher levels of enforcement.
• Breath tests
In the United Kingdom, the number of breath tests has increased greatly during the 1980s but dropped again from 1999/2000. As amended by the Transport Act 1981, Section 7 of the Road Traffic Act 1972 empowers a constable in uniform who has reasonable cause to suspect that a person driving a motor vehicle on a road, who has alcohol in his body, has commit- ted a moving traffic offence, or has been involved in a collision, to require that person to provide a specimen of breath for testing.
• Penalties
Disqualification of 12 months. The size of the fines and the maximum length of period of disqualification depend on the seriousness of the offence, mainly the amount by which the driver is over the legal limit. The normal fine for a basic drink-drive offence is between £400 and £450.
Enforcement 233
The Road Traffic Act 1991 introduced a new offence of causing death by careless driving when under the influence of drink or drugs with a max- imum of 5 years imprisonment, later increased to 10 years, and then to 14 years in 2004. The Road Safety Act 2006 contains provision for serious, including repeat, drink-drive offenders to be made to retake the driving test at the end of their period of disqualification. It also makes provision for the courts, when imposing disqualification as a penalty, to order a reduced period of disqualification if it also makes an order requiring the offender to comply with the conditions of an alcohol ignition interlock program.
• Disqualifications
• Nonlegal penalties
• High-risk offenders
• Experimental educational programs
There has been considerable research conducted on the location of alcohol distri- bution outlets and location of drink-related fatal collisions. Nearly all studies have found a relationship between the two. However, what we are less sure of is the study of the general patterns of the location of drink-driving fatal collisions. It makes sense that the most obvious linkage would be between bars, pubs, and alcohol outlets;
however, there are a large proportion of people to whom this will not apply to. There should be renewed research into the locations of collisions of drunk drivers, examin- ing from a multifaceted angle.
13.3.2 drug-driving
Driving under the influence of drugs (DUID) other than alcohol is now considered to be an increasing cause of traffic accidents worldwide. Exposure to illicit drugs impairs driving ability owing to their effects on the central nervous system, psy- chomotor performance, and risk-taking behavior. Studies have shown the associa- tion between the use of psychoactive substances other than alcohol and increased accident risk.
The rising prevalence of cannabis use, its increased availability and potency, lower prices, widespread social tolerance, and earlier age of onset of use have com- bined to increase the number of users and hence the number of people subject to cannabis use disorders. Peak initiation is at age 18, and 10 years later, 8% of users are marijuana dependent. Most cannabis use is intermittent and time limited; however, users generally stop in their mid-to-late 20s, and only a small minority continues in daily use over a period of years.
Young people also account for a disproportionate number of road traffic acci- dents. According to the National Center for Statistics and Analysis, the fatality rate for teenagers is four times that of drivers age 25–69, and drivers under age 25 account for a quarter of all traffic fatalities. Risk factors for having a fatal traffic accident include being a young man, having psychological characteristics such as thrill-seeking and overconfidence, driving at excessive speed, driving late at night, failing to wear a seat belt, and lacking familiarity with the vehicle. The risk factors
for adolescent marijuana use are somewhat overlapping—delinquency (vandalism, shoplifting, joyriding, etc.), poor school performance, and substance use by self and peers.
The National Highway Transportation Safety Administration reported that in 25% of all motor vehicle collision (MVC) fatalities, the driver had a blood alcohol concentration of 0.01 g/dL (one-eighth the legal limit) or greater, and in 21-year-old drivers, that figure rose to 39%. Drivers with a previous driving while impaired con- viction were responsible for 7.2% of all collisions involving alcohol.
In comparison, the percentage of road traffic accidents in which one driver tested positive for marijuana ranges from 6% to 32%. In one study, 9.7% of cannabis smok- ers reported having driven under the influence (during the course of a year); and that they drove an average of 8.1 times whilst intoxicated. Among those who seek treatment for cannabis problems, more than 50% report having driven while stoned at least once in the previous year (Sewell et al. 2010).
Sewell et al. (2010) identify three types of study that look at drug use, specifically cannabis and road collisions. The first are cognitive studies that measure the effects of smoking marijuana on cognitive processes that are considered to be integral to safe driving. The second are experimental studies on the collision risk of people under the influence of marijuana. The third are descriptive and analytic epidemio- logical studies on the relationship between cannabis use and accidents, usually per- formed through drug testing of injured drivers.
A roadside survey in Thailand showed that prevalence of psychoactive drug use among general drivers not involved in MVC to be 9.7%. Alcohol or psychoactive drugs were found in 4.5% of drivers in a random sampling survey in Norway. A high proportion of injured drivers have been reported to test positive in overseas studies involving psychoactive drug screening. Siliquini et al. (2007) revealed posi- tive psychoactive substances present in 18.5% of the drivers involved in road traffic collisions in Italy. In a Swedish study, 13% of nonfatally injured drivers tested posi- tive for pharmaceuticals that could impair driving. A study conducted in Belgium involving injured drivers showed that 12.3% screened positive for drugs, and about half of them tested positive for alcohol as well. Among injured drivers, there was a much higher prevalence of persons screened drug positive reported from the United States, ranging from 22.6% to 50.9%. In a local epidemiological study, 56% of the deceased drivers from single-vehicle collisions had alcohol and/or drugs in their bodies, 7% were positive for drugs only, and 5% were for both drugs and alcohol.
However, there are no local data on the prevalence of abusive drug use in drivers of nonfatal motor vehicle injuries.
Drug abuse is a social problem in Hong Kong. Apart from heroin, psychoac- tive substances such as ketamine, methamphetamine, and cannabis are commonly abused. DUID has recently gained considerable attention as a potential threat to local road traffic safety. In reply to Legislative Council questions on February 24, 2010, the secretary for Transport and Housing stated that there were four traffic accidents involving drivers suspected of DUID in the past 12 months. This may be an under- estimate, however, due to the limited investigation powers of the police that relate to current legislation about such driving. Abusive drugs are mostly psychoactive sub- stances. Theoretically, they have detrimental effects on psychomotor performance
Enforcement 235
and may impair driving skills. The association between psychoactive substance use and driving impairment had been investigated in various types of studies, involving laboratories, simulators, as well as on-road and field investigations.