Drunk Driving: Impacts and Proposed and Future Solutions to Stop or Reduce It

Note to the editor:
This is a research paper, literature review of a topic of my choice, Drunk Driving.
I would like the document to be down to around 15-17 pages with 10-15 sources, APA Style.
The Title can be:Drunk Driving: Impacts and Proposed and Future Solutions to Stop or Reduce It (Can be improved, I may work on it later)
Even though it might need some work, I have organized the paper and connected the dots. The main help I’m looking for is reviewing the articles andon the conclusion part. And check the overall flow of the paper.
Furthermore, I would like the editor contact me if she/he feels I may need additional inputs in some part of the paper; especially, for “Part-3” of the paper. I feel it might need a better article to be reviewed that would talk more clearly about the technological solutions, possible future solutions to reduce or stop drunk driving if applied in the future (I have two article under Part-3 as an example for this); or one of these may also be used. To be clear, I the editor suggests some additional work, other than the editing, I may put a separate order for additional pages.
And I prefer my abstract and summary not to be included under my order unless the editor has to change most part of it. I also prefer to put charts or similar necessary data myself. So, please let the editor exclude the ones I provided in this draft and may not need to add this type of information unless it really has to be included and I may not have access to it to do it myself. I included some in this draft because some of them are part of articles that I copy pasted.
Also please let the editor include the sources from the reference I provided only if she/he used them. She/he may not necessarily review all of the articles I provided under each category, please review only the article that you think would go best with the paper. She/he may also choose not to use the articles provided under any one of the categories and make her/his own input (like I mentioned above, in this case, she/he may let me know if I need to place additional order for the new inputs whenever necessary).
Please let the editor contact me if I may need to be clearer about my above note. Thanks!

Abstract
The review of literature in this paper leads to three main research questions: (1) what are the main problems associated with drunk driving? (2) What are the proposed solutions to reduce or stop drunk driving? (3) What are the possible future solutions to reduce or stop drunk driving?
Under the two first main research questions, the review identifies and categorizes the problems and proposed solutions as economic, legal/political, social/cultural, behavioral/psychological and analyzes them through research findings by reviewing at least one article that focus each categories. It also highlights what the problems look like in different countries and how they have been handled. And generally examines what is known about the effectiveness of these solutions and compares by countries and states, in US. Finally, under the third main research question, it explores what is known to be potentially possible future solutions to reduce and stop drunk driving.
Even though, the paper emphasizes on US, it overviews the global impacts of drunk driving in general.

Summary
Some of negative consequences of road accidents worldwide are millions of deaths, severe injuries, and survivors who suffer from psychological, social and economic impacts. Drunk driving is the most frequent cause of fatal road crashes. It accounts for more than half of fatalities and severe injuries of the total road accidents. Worldwide, an estimated 1.2 million people are killed each year, and more than 50 million injured, and the global economic cost is estimated at US$ 518 billion per year (Peden, 2004). Most countries, from the USA (one of the most developed countries) to low income (under developed or developing) countries have taken measures to eradicate drunk driving. Yet, most of the attempts made to reduce drunk driving are not effective as intended, and none of them could or will stop drunk driving. Hence, without appropriate action like taking the best advantage of what the technology has to offer, road traffic accidents which, currently, are the ninth leading contributors to global burden of disease and injury, are predicted to be the third by 2020 (Peden, 2004).
Despite the fact that several solutions have been proposed with the hopes of reducing or stopping drunk driving, the solutions seem not to have an impact as they are intended; hence, drunk driving is still the same problem as it has been since it started impacting the global society.

Literature Review
PART-1
PROBLEMS:

Legal/Political

Article-1A
THE IMPAIRED DUAL SYSTEM FRAMEWORK OF UNITED STATES DRUNK-DRIVING LAW: HOW INTERNATIONAL PERSPECTIVES YIELD MORE SOBER RESULTS.
Abstract: Focuses on the framework of the U.S. government’s drunkdriving law. General problems with the field sobriety testing as a method of proof in driving while intoxicated prosecutions; Factors that contribute to the ineffectiveness of the utilization of field sobriety tests to prove drunkdriving; Comparison of the country’sdrunkdriving laws with those of Australia, Canada, Great Britain and Scandinavia.
References
Newaz, D. (2006). THE IMPAIRED DUAL SYSTEM FRAMEWORK OF UNITED STATES DRUNK-DRIVING LAW: HOW INTERNATIONAL PERSPECTIVES YIELD MORE SOBER RESULTS. Houston Journal Of International Law, 28(2), 531-572.
http://www.shoreline.edu:2419/ehost/detail/detail?vid=14&sid=2034059a-82d7-4d5b-974e-3a142e8c5767%40sessionmgr198&hid=116&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9h&AN=20714330
Full text
INTRODUCTION
Throughout the world, alcohol is regarded as both the bringer of elation and discontent, as no other substance has been so lauded in verse and song or criticized as frequently as has alcohol.Countries have developed a kind of ambivalence towards alcohol because of the dualistic nature of its exaltation and regulation.While alcohol historically posed no great threat to communities, its devastating effects have become increasingly apparent as an international catastrophe.
Impaired driving is a grave and serious international dilemma that results in countless casualties all over the world.
Despite these tragic consequences, “the incidence of driving while under the influence of alcohol is one of the most frequently committed crimes throughout the world. In Great Britain, sixteen percent of total road deaths are caused by drunk drivers,7while in Ontario, Canada, over 12,000 drunk-driving accidents occur in a single year.The European Commission contends that in its member countries, up to twenty percent of road accident deaths and serious injuries are attributable to alcohol and amount to an estimated loss of life of ten billion euros per year.
In the United States, of the 42,815 total traffic fatalities that occurred in 2002, forty-one percent were alcohol related.In 2002, 258,000 people were injured in alcohol-related crashes.Motor vehicle accidents where the driver is impaired by alcohol cost employers over nine billion dollars a year.
Statistics like these, along with the lobbying of public interest groups like Mothers Against Drunk Driving (MADD)and Students Against Drunk Driving (SADD), have resulted in “the almost schizophrenic development of drinking-and-driving law” in the United States that is aimed at achieving fast and arguably haphazard prosecutions and convictions of those charged with drunk-driving offenses.According to the National Highway Traffic Safety Administration (NHTSA), resolving this problem requires the cooperation of law enforcement, courts, and medical professionals to assist prosecutors in convicting alleged offenders.The effect is that most states have two entirely different methods of prosecution to prove the offense of Driving While Intoxicated (DWI).This system is not only confusing for the jury and unfair to the criminal defendant, but it is also untenable.One method of proof, consisting primarily of evidence from field sobriety tests, is subjectiveand inaccurate,while the other method of proof—breath, blood, or urine tests—cannot be properly implemented.
Drunk drivers create a very serious socialand international problem that needs to be corrected. However, the United States’ use of poor investigatory tools to establish proof,ineffectual sanctions for refusal to submit to a breath test,and convictions that are obtained haphazardly and improperlyis not acceptable. This is especially true given that a myriad of other countries and regions, including Scandinavia, Great Britain, Australia, and Canada, have not resorted to such measures.
This Comment engages in a comparative analysis of international and U.S. drunk-driving laws and proposes an optimal solution to the intersection of two cornerstones of American society—alcohol and driving.Part I explores the specifics of U.S. drunk-driving laws with a focus on the two biggest problems with U.S. drunk-driving prosecution: field sobriety tests and administrative license revocation. Part II reviews how the drunk-driving laws of Scandinavia, Great Britain, Australia, and Canada can “contribute to our understanding of impaired driving countermeasures and of how the current situation in the United States compares to other countries.”Part III uses this international perspective to propose a solution that would make U.S. drunk-driving laws more effectual and balanced.
II. UNITED STATES’ DUAL METHODS OF PROOF IN DRINKING AND DRIVING PROSECUTIONS
To prevail in prosecuting a drunk-driving offense, the state must prove a driver’s intoxication.Two key methods exist to prove this condition: 1) field sobriety tests and 2) the results of chemical testing such as blood, urine, breath, or saliva.
A. The Highly Subjective, Misplaced Field Sobriety Testing System
When an officer stops a carand makes a determination that the driver may be intoxicated,the instructs the driver to perform roadside maneuvers that have become known as field sobriety tests.The officer will testify to the results of these tests, or the tests will be recorded on a videotape that is ultimately played to the jury or judge, or both.
General Problems with the Field Sobriety Testing
System
The use of field sobriety tests as a method of proof in DWI prosecutions is unfavorable because of theoretical and practical problems.
Other Causes for Error
The paradigm which validates field sobriety tests is a fallacy.The tests assume that if a person exhibits poor coordination, balance, or dexterity, then that person is necessarily intoxicated. The tests also presume that a person’s level of intoxication can be measured by the way a person walks, talks, or reacts.It is upon these premises that “courts seem willing to blindly accept a direct relationship between the results of field sobriety tests and a driver’s impairment.
A direct relationship between these inherently unreliable testsand alcohol consumption cannot be proven because countless other reasons may explain a person’s performance on the tests. For example, a person may perform poorly because of nervousness,drowsiness, or fatigueand thus display diminished performance. Also, if a person is more than fifty pounds overweight or over the age of sixty, the standardized field sobriety tests (SFST) have questionable validity.The impediments due to age and weight are gradual, meaning that people who are fifty-five years old or forty-five pounds overweight likely experience the same problems with the test as people who are slightly older or heavier.Thus, NHTSA cutoffs are somewhat arbitrary and illustrate a central problem with the tests: reliance on optimal physical health and age.Even in the most favorable conditions, SFSTs are only accurate eighty percent of the time.Although this appears to be a high rate of accuracy, field sobriety tests are rarely administered under optimal conditions.
Subjectivity Issues
Field sobriety tests are also impaired because they are highly subjective.Police officers make the ultimate, subjective determination of whether to arrest a suspect, and this determination is often incorrect.The 1977 and 1981 NHTSA studies of field sobriety tests show large error rates by police officers.In the 1977 study, police officers mistakenly arrested
Standardization Problems
The standardization of field sobriety tests poses a theoretical problem. NHTSA standardized three field sobriety tests in 1977 to promote reliability, accuracy, predictability, and consistency in a very powerful evidentiary toolthat is often heavily weighted by triers of fact.However, field sobriety tests are not standardized in two ways. First, police officers might not perform the three standardized tests in an unvarying, uniform way. Second, the three SFSTs are not the only tests that are used by police officers; this means that the field sobriety testing experience is not, in and of itself, standardized.
The SFSTs are not always performed uniformly by officers. One reason for this inconsistency is that officers sometimes make mistakes.Couple this with the unfettered discretion that police officers are typically afforded in administering SFSTs,and any practical hope for standardization is essentially lost.
The law in Ohio provides a pertinent example of how the exigency to convict potential DWI offenders has led politicians to bypass standardization.The Ohio Supreme Court has refused to allow police officers any discretion in administering field sobriety tests, even though conditions in the field may be unexpected and imperfect.The court asserted in State v. Homan that a field sobriety test cannot be used as evidence of probable cause for arrest if it is not administered in strict compliance with NHTSA standards because “even minor deviations from the standardized procedures can severely bias the [test] results.”In response to this ruling, the Ohio Legislature amended Ohio’s DWI statute and lessened the compliance standard by allowing field sobriety test evidence if it is conducted in substantial compliance with applicable standards.The Ohio Supreme Court responded judiciouslyby virtually ignoring the statute as it extended its holding of strict compliance in Homan to the exclusion of field sobriety test evidence at trial.
NHTSA has prompted this power struggle between the Ohio Legislature and Judiciary by playing fast and loose. The organization accepts officer deviation from set standards because “ideal conditions do not always exist in the field”,and yet at the same time, NHTSA states “if any one of the standardized field sobriety test elements is changed, the validity is compromised.”NHTSA wants it both ways and hopes that courts will merely view deviations from standardized procedures as affecting the weight of the evidence rather than its admissibility.Courts have not yet been so pigeonholed, and different states apply different standards.This unpredictability illustrates how field sobriety tests are innately nonstandardized.
NHTSA has also fueled this confusion by failing to properly curtail police discretion through the standardization of certain aspects of police conduct.The form and wording of screening questions that officers ask suspects about possible medical problems and conditions are not standardized nor do officer training materials illustrate the proper demeanor and tone for delivering field sobriety test instructions to suspects.NHTSA instructions are placed in quotation marks, and even though this suggests that the instructions are to be read verbatim, NHTSA does not instruct police officers to do so.Standardization is also ignored because officers are not instructed to record their observations immediately.According to NHTSA, the validity of SFST results hinges on whether the officer follows the set procedures for administering the tests.Nevertheless, NHTSA has left many aspects of field sobriety testing nonstandardized.
The testing experience is also not uniform because a police officer has the discretion to administer any combination of field sobriety tests, including nonstandardized and standardized tests.Unfortunately, NHTSA implicitly supports police officers who conduct a random assortment of nonstandardized tests in conjunction with SFSTs.Because NHTSA is a federal agency,
2. Specific Problems with Standardized Field Sobriety Tests
In 1975, NHTSA sought to create a system of tests to be performed by police officers, either at the station or in the field that would detect whether an operator of a motor vehicle was impaired because of alcohol use.Sixteen tests were selected for initial consideration, and ultimately, six tests were chosen for an in-depth, evaluative study.These six tests include the “one-leg stand, walk-and-turn, finger to nose, finger count, alcohol (horizontal) gaze nystagmus, and tracing” tests.After the evaluation, the three best tests—the one-leg stand, walk-and- turn, and alcohol (horizontal) gaze nystagmus—were called the Standardized Field Sobriety Tests (SFSTs) and “were adopted as the only tests to determine sobriety at roadside.”
Horizontal Gaze Nystagmus (HGN) Test: Science or Science Fiction?
The HGN test is a SFST in which a police officer attempts to observe an involuntary jerking in a suspect’s eye while the suspect’s eye gazes to the side.This involuntary jerking becomes pronounced with alcohol use.The officer looks for three “clues” per eye, for a total of six clues that would show pronounced nystagmus.If four or more clues are present, there is a seventy-seven percent chance that the person’s BAC is greater than .08.
Problems with the HGN test are numerous. Enhanced nystagmus may have many other causes besides intoxication.Because nystagmus can occur naturally or be induced by medicationor fatiguein some people, the HGN test is not a reliable tool to assess BACand is thus not “the best psychophysiological test to estimate BAC.”NHTSA admits to the shortcomings of this field sobriety test by qualifying that its validity may not exist independently.This means that a showing of intoxication from the HGN test should only be accepted if other evidence from the arrest, including factors from other field sobriety tests, supports a finding of intoxication.Thus, “continued use of the [HGN test] in the field and courtroom [is] questionable.”Moreover, clinicians indicate that the link between the HGN test and intoxication is only properly determined through a full clinical examination rather than the current method of using a stimulus in the field.The reliability of the HGN test is also brought into question because no studies have addressed the consistency by which officers can estimate the angle of onset of nystagmus.Due to these drawbacks, the reliability and validity of the HGN test is uncertain.
Walk and Turn (WAT) Test: Designed for Failure
The WAT test attempts to prove intoxication by illustrating a suspect’s inability to mentally process information and use his or her body to perform instructions.In a typical WAT test, an officer instructs the suspect to place his or her left foot on a line, which in the field is typically an imaginary line,and walk heel- to-toe for nine steps with his or her hands down at the side.The officer instructs the suspect to stand in a heel-to-toe positionbut typically does not tell the suspect to remain in this position.The officer then demonstrates how to perform the test, while the suspect is standing in this awkward heel-to- toe position.If the suspect moves from this positionor starts the test too soon, then a clue of intoxication is indicated, with a total of two possible clues during the instructional phase. This means that the suspect is being tested before the actual test has begun.This is unfair because the suspect most likely assumes—and rightly so—that the test should not start until he or she begins to walk the line. At the very least, the police officer should inform the suspect when the test actually starts.
Six other clues apply during the actual performance of the test.Two of these clues are particularly troublesome. First, if a suspect does not keep his or her hands completely down by the sides of his or her body during the WAT test, then the police officer notes a clue of intoxication.A clue is noted even if a suspect does not use his or her hands for balance but merely lets them dangle.The WAT test is designed for the suspect to fail because, typically, people do not walk with their hands by their sides; it is extremely unnatural.A suspect may assume that his or her hands should be allowed to dangle, as long as they are not used for balance,because police officers often merely say “keep your hands down to your side” and do not explain the rigidity with which this statement applies.
Second, another clue of intoxication is noted if a suspect turns improperly. The proper way to turn is actually not a turn at all and should not be referred to as such. In reality, it is a series of small steps that a suspect must make after he or she has already walked the line once.The suspect also must turn on the correct foot, which means that the suspect must keep his or her left foot on the line and pivot with the right foot.The reason this sounds complicated is because it is complicated.
There are several reasons why the turn is typically performed improperly that have nothing to do with intoxication. Even though police officers demonstrate how to perform the WAT test, they typically do so only once and in a truncated fashion. Therefore, a suspect’s mistake on the test, especially when turning, may be the result of insufficient instruction rather than intoxication. Also, the turn is performed after the suspect has already walked the line once.Suspects may view walking heel-to-toe as the actual test and may not realize the importance of the turn or that the turn is actually part of the test. Many suspects simply turn around in a normal, natural way—simply spinning around or taking one big step around.
The required series of small steps is simply odd and unnatural,and if a suspect turns in a usual way, by spinning around or taking one big step around, then the police officer finds a clue of intoxication.If almost every single person that performs the WAT test in a given sample does not turn properly, then one should assume the test is likely flawed, rather than assume that every person is intoxicated.For these reasons, many prosecutors do not find the turn to be a conclusive factor in determining whether a person is intoxicated.Instead, the turn is given less weight and viewed more skeptically than other clues.
The WAT test is designed to allow police officers to collect clues. If a suspect does something wrong, it probably has more to do with being human than with intoxication.Each clue is given the same level of accuracy in predictability, even though some clues are inadequate. Ultimately, even if a police officer collects four or more clues, there is only a sixty-eight percent chance that the suspect is intoxicated.For these reasons, the WAT test is flawed.
One Leg Stand (OLS) Test: Designed to Induce Sway
The OLS test, much like the WAT test, is designed to divide the suspect’s attention between listening to and performing instructions. The suspect is instructed to stand with feet together and arms at the side while listening to the instructions. The officer tells the suspect to hold one leg six inches off the ground, point his or her toe forward, keep the hands down by his or her sides, stare at his or her foot, and count out loud until the officer instructs him or her to stop.An officer looks for four clues of intoxication,and if two or more are found, there is a sixty-eight percent likelihood that the suspect is intoxicated.
This test has primarily the same drawbacks as the WAT test. Standing with feet together and arms down at the sides while listening to instructions is not a typical way for a person to stand.Some critics assert that the OLS test is designed to induce sway and imbalance rather than to measure intoxication.Also, even if the test is valid, in optimal conditions it can only predict intoxication sixty-eight percent of the time.Accuracy slightly above fifty percent should not be considered adequate as evidence of the accused at trial.These flaws emphasize this field sobriety test cannot accurately predict intoxication.
Specific Problems with Nonstandardized Field Sobriety Tests
Nonstandardized tests possess “an even greater potential for confusion and prejudice” than do standardized tests.These tests are used quite extensively by law enforcement officers even though studies suggest that they are not indicators of intoxication.The 1977 study fully examined the finger-to- nose,finger-count,and tracing testsand interchangeably examined the letter cancellation,subtraction, counting backwards,and Romberg tests.None of these tests were considered reliable enough to standardize.Moreover, these tests were not selected as indicators of intoxication, and Marcelline Burns, Ph.D., the researcher who conducted the study, referred to the Romberg test and finger-to-nose test as nonpredictive.Thus, the rampant use of these tests by police officers in the field is improper, especially since no valid study supports the tests, and NHTSA has not set performance standards for them.NHTSA only evaluates and accredits its standardized battery of tests.The mere reference to nonstandardized “physical exercises as ‘tests’ [erroneously] suggests that they possess a high reliability value.”
B. The Fledgling, Yet Promising .08 Per Se Statutory System
The second way for the prosecution to prove that a motorist is intoxicated is through a state’s per se law. Every state in the United States has adopted a law which makes it a crime for a person to operate a motor vehicle with a BAC at or above .08.148
The prosecution does not need to prove impairment through the use of subjective field sobriety tests or other means; rather, impairment is assumed because of the correlation between BAC and impaired driving.States have different measures for proving a BAC of .08 or greater, but the most common measure is a breath test.150 The breathalyzer machine is the most common breath test machine, and it analyzes a sample of breath from a person to determine the alcohol content of that person’s blood.Breathalyzer readings are based on scientific proof that there is an alcohol concentration ratio of 1:2100 between blood and breath.The operation of the breathalyzer involves little more than pushing a button; however, the operator must be certified to handle the machine.
1. Tolerable Problems with Breathalyzer Machines
Many critics of the breathalyzer machine state that the ratio of breath to blood does not always apply to every individual.This ratio is based on a model population, and therefore, may vary in its application to some individuals.However, courts give defendants the benefit of the doubt,and if a defendant’s actual alcohol breath-to-blood ratio is lower than 2100:1, then the evidence goes to the jury to be weighed.Another problem is that the breathalyzer measures the person’s BAC at the time the breath test is taken.The relevant consideration, though, is the suspect’s BAC at the time he or she was operating the motor vehicle.The majority view is that extrapolation evidence, which will calculate a person’s BAC at the time of driving, is not required. The minority view finds that this testimony is necessary.There is also the issue of the breathalyzer’s inherent margin of error.Some courts have the jury apply the margin of error to the test results in determining whether the per se statute is violated, while others ignore the margin of error believing that it has already been considered by Congress.This result illustrates how the U.S. criminal justice system has found an effective way not only to deal with the problems of the breathalyzer but to provide an equal playing field for both the prosecution and defense.
2. Lenient Punishment for Refusing a Breath Test
The biggest obstacle in per se .08 statutory enforcement is that in a typical drunk-driving scenario, a person cannot be forced to give a chemical sample.If no chemical sample is taken, then there is no way for the state to prove intoxication under .08 statutes. Thus, a defendant is more than able to refuse a breath test and thwart the effectiveness of per se laws, which makes “the relatively new technology of chemical testing for blood alcohol content [meaningless].”It is unacceptable for the United States to leave the effectiveness of per se regulations, and in essence the ability to obtain drunk-driving convictions, in the hands of defendants who would appropriately, in the spirit of our adversary structure, do everything in their power to cripple the system.
In an effort to combat this possibility and make per se legislation effective, many states compel individuals to provide a sample by suspending the driving privileges of those who refuse to provide a specimen.This compulsion is based on the premise that when a person applies and receives a license, he or she has implicitly agreed to submit to a BAC test if stopped by a police officer with probable cause to suspect intoxication.167 These laws are called implied consent laws168 or administrative license revocation laws.Thus, if a defendant refuses to provide a specimen, the typical punishment in the United States is revocation of the accused’s license.Some administrative171 revocations may last only one month, while others might last a few years.172
Unfortunately, this solution is not good enough for two reasons. First, even if a person’s license is suspended, that person will probably drive anyway.Second, the punishment for refusing to provide a breath, blood, or urine sample is relatively minor compared to the punishment for a drunk- driving offense.Therefore, the most rational thing for a defendant to do is refuse to provide a sample because an advantage is secured in doing so. It follows then that a large number of suspects, or at least those that realize this discrepancy in punishment, are not likely to provide a specimen.Since “unrestricted breath testing may reduce drunk driving fatalities by between one third and one half,”the United States should do more to ensure the retrieval of breath test results. Overall, license suspension does not adequately address how to effectively deter individuals from refusing to provide a specimen; a better solution is needed to ensure the efficacy of .08 statutory legislation. To fashion a proper model for U.S. drunk-driving laws, an international perspective is needed because “much of the progress that has been made in impaired driving in the last decade or more has been facilitated by lessons learned from other countries.”
DRIVING LAWS IN FOREIGN COUNTRIES
A. The Limited Involvement of International Organizations
A true international solution to the United States’ problematic approach to drunk-driving legislation does not currently exist.The World Health Organization (WHO) has identified alcohol as “the fifth largest risk factor for the global burden of injury and disease,”and yet alcohol policies in countries are widely divergent.Since the global community needs an internationally prescribed set of minimum alcohol policies for countries to implement, the WHO has created some tentative international guidelines.Unfortunately, an international alcohol policy would be difficult to implement “as international trade and services agreements (such as GATS, the General Agreement on Trade in Services) impinge on the possibilities to influence . . . the . . . trade . . . of alcoholic beverages. ”Notwithstanding this implementation problem, these proposed international guidelines illustrate that certain policies are preferable to others.Specifically, the WHO has suggested that countries enact per se legislation establishing a BAC beyond which it is illegal to drive and enforce the law through frequent random breath testing (RBT).These guidelines illustrate the importance of per se legislation and its enforcement and highlight two central problems with U.S. drunk-driving laws: the rampant use of field sobriety tests as proof of intoxication and the inability to enforce per se legislation.
B. Why the United States’ System is Impaired: Field Sobriety Tests and Ineffective Enforcement of Per Se Laws
First, the United States is alone in its utilization of field sobriety tests to prove drunk driving.Unlike the rest of the world, the United States has adhered to the “classical” formulation of drunk-driving law,which is proof obtained predominantly through the use of field sobriety tests.187 Even though the United States implicitly claims field sobriety tests are one method used to prove a driver’s intoxication internationally, there is no evidence which substantiates this claim. Some countries regulate drunk driving under the classical formulation rather than through per se laws,but proof is obtained through the testimony of officers and not through field sobriety tests.
Given the drawbacks of field sobriety tests, including reliance “on subjective definitions of impairment . . . making the arrest and successful prosecution of inebriated drivers difficult,”the United States has much to learn from the international community regarding how to effectively and fairly regulate the incidence of drunk driving.
Second, the United States is not properly implementing and enforcing its per se legislation. The establishment of BAC limits has become the international standard for proving drunk- driving cases.Per se statutes, which establish a BAC limit beyond which it is illegal to drive, are the most common framework for this method of proof; a BAC limit of .08 is the most widely adopted limit.However, even in countries that rely on a classical or common law formulation of statutory drunk-driving laws,evidence of breath or blood samples is essentially the only way to prove driver impairment.
The mere establishment of a per se statute in the United States is not sufficient. The Clinton Administration believed that its federal push for a per se .08 law made the United States as tough on drunk driving as Australia and Canada.However, the United States has lagged behind the rest of the world in creating effective alcohol policy,and enacting a per se law does not necessarily bring the United States up to par with Australia and Canada. For example, Australia’s per se BAC limit of .05 is stricter than the United States’ limit of .08.Also, Canada’s punishment for refusing to provide a breath sample does not merely provide for license revocation as in the United States; instead, the punishment for refusing to provide a breath sample is identical to the punishment for impaired driving.Furthermore, Australia, Canada, and Great Britain “have a longer history of drunk-driving interventions than we do in America.”
In order to further explain these differences, the drunk- driving laws of Australia and Canada will be discussed in greater detail, along with those of Scandinavia and Great Britain. Each country’s alcohol policy has a particular strength that should be adopted in the United States. Through this comparative analysis, it will be clear that the United Statesshould rely primarily on per se statutes and the collection of chemical samples, rather than on common law formulations like field sobriety testing, as its legal framework for DWI prosecutions. The United States should also increase the level of punishment for refusing to submit to chemical tests.
C. Scandinavia: The Very Strict Founding Father
The Scandinaviansystem is important because of its historical significance in departing from classical common law notions of drunk-driving enforcement and its strict enforcement of statutory per se laws. When the possibility for chemical testing of BAC became possible in the 1930s,Norway became the first country in the world to enact a per se limit, with Sweden following in 1941.204 Scandinavian countries harnessed the technology of this scientific revolution and parlayed it into legislation that is now internationally recognized as the “Scandinavian model. “Three features generally characterize the system: per se legislation, strict enforcement of breath and blood tests, and punishment that usually includes imprisonment.Scandinavian countries do not consider behavioral observations, like field sobriety tests, to be reliable in comparison to the scientific validity of breath or blood tests.Given the previously discussed drawbacks with field sobriety tests, the United States should adopt a similar system.
The Scandinavian system is a historical symbol of success despite the criticism it has received.Academics and lawyers throughout the world regard the Scandinavian system as the paradigmatic model for successful drunk-driving laws,and as such, it has served as the basis for many countries’ laws, including “the spectacularly successful” British law.Nonetheless, a notable critic asserts that the Scandinavian system has no deterrent effect and refers to the international acclaim of this system as the “Scandinavian myth.”
The fact that the Scandinavian system may not have a deterrent effect is not necessarily damning, especially when applied in the context of U.S. drunk-driving laws. Deterrence should not be at issue or “remain the subject of vigorous sociological dispute”for several reasons. First, deterrence was not the reason why Norway and Sweden passed per se laws.The real reason these countries enacted per se laws was practical in nature—to depart from vague, classical laws referring to intoxication as “driving under the influence.”The United States should also depart from these classical laws because per se statutes and the accompanying BAC limit make it easier to prove intoxication.This in turn “provide[s] for faster disposition of cases without difficult trials.”Therefore, the Scandinavian system should be praised for its lucidity rather than criticized for something it never promised to produce. Second, it is immaterial if the Scandinavian system does not increase deterrence. No impaired driving legislation, including that of the United States, has produced any long-term deterrent results.In fact, it is fruitless to try to prove the deterrent effect of any law because of varying methodologies.
Analyzing the Scandinavian model in the context of the United States, NHTSA’s argument that harsher criminal penalties, as opposed to administrative license revocations, have very little added deterrent effectshould be taken with a grain of salt. This Comment is not necessarily advocating Scandinavia’s semimandatory imprisonment for drunk drivers,lower BAC limits,or wide use of RBT,but rather, it appreciates the fact that these actions denote strict enforcement. The United States needs to adopt Scandinavia’s policy of enacting harsher and stricter penalties. The United States’ problem is its penalties for refusing to provide a breath, blood, or urine sample are too lenient, and thus, it cannot properly regulate and enforce BAC testing.
Scandinavian countries, on the other hand, require persons to submit to BAC tests.In Finland, a test is always compulsory if the police officer suspects the individual has been drinking, and in Denmark, testing is always mandatory if the police require such a test.In Sweden, a person cannot refuse the test; Swedish police can actually force a nonconsenting person to submit to a chemical test if necessary.Enacting a similar policy in the United States may not be wise because it would likely violate a person’s Fifth Amendment right against self-incrimination.However, Scandinavia’s focus on both the absoluteness of per se BAC limits and the strict enforcement thereof should guide future U.S. drunk-driving policy.
D. Great Britain: The Current Leader in Strict Enforcement
It is important to consider drunk-driving laws in Great Britain not only because the United States has historically looked to British law in fashioning its own policy,but also because it is “one of the first and most influential adoptions of the per se approach.”Most importantly, it has one of the most effective enforcement plans in the world.
England passed one of the first laws that regulated impaired driving in 1872. It provided:
Every person . . . who is drunk while in charge on any highway or other public place of any carriage, horse, cattle, or steam engine may be apprehended, and shall be liable to a penalty not exceeding forty shillings, or in the discretion of the court of imprisonment . . . for any term not exceeding one month.
In 1967, Great Britain adopted the Road Safety Act, based upon Scandinavia’s revolutionary experiment in per se statutes regulating impaired driving, which established the BAC “as the scientific criterion of a person’s unfitness to drive.”It gave police wide discretion to demand a test from a driver involved in a traffic violation or accident, or when a police officer had reasonable cause to believe that the driver had been drinking.232
In its current form, Great Britain’s statute provides for a common law formulation where a person is intoxicated if he or she “is unfit to drive through drink.”
A person is presumed unfit to drive if the person’s ability to drive properly is for the time being impaired.”
This evidence is typically obtained through the police officer’s observation of the suspect’s driving, interaction between the police and the driver, and the driver’s behavior and appearance.
Interestingly, most of the drivers are subject to a medical examination; however, the accused must be informed by the doctor of what will occur, and consent must be obtained.
Great Britain provides a per se definition which states that a person is guilty of an offense if the person consumes “so much alcohol that the proportion of it in his breath, blood or urine exceeds the prescribed limit,” Great Britain is able to make its per se law effective because which is a
BAC of .08. Police officers may require a driver to take a test.
If a person refuses to submit to a chemical test without a reasonable excuse, then that person has committed an offense. reasonable “unless the person . . . is physically or mentally unable to provide it or . . . it would entail a substantial risk to
An excuse is not his health.” Requiring a person to submit to a test is definitely an infringement on personal liberty, but Great Britain properly balances this limitation with the excuse provision. punishments for the two offenses are equal.
In many respects, the United States and Great Britain are very similar in their regulation of drunk driving. Both have resisted pressure to lower BAC limits.Also, both never use the enforcement mechanism of RBT to deter drunk drivers. The two real differences, and the two things that the United States can learn from Great Britain, are that Britain does not rely on field sobriety tests, and penalties for refusing to submit to a chemical test are harsher in Britain.The United States would not be able to adopt the latitude afforded to British police in requiring or compelling people to provide a sample,but it could make the punishment for refusal to submit to a test equivalent to the punishment for a drunk-driving offense. Thus, much like Great Britain’s law, states could make refusal to submit to a breath test a separate offense thereby preventing
In Great Britain, the penalties for the offense of failure to provide a sample are practically the same as for the offense of drunk driving can be punished with a possible jail sentence, whereas failure to provide a breath test can only be punished by a fine.243 Thus, this supposed uniformity in punishment may be more form than substance. In practice, though, a jail sentence is rarely imposed for a first offense of drunk driving, and a fine is usually the highest form of punishment given.Thus, realistically, the drunk driving.
However, the offense of 7 individuals from gaining any advantage in refusing to provide a sample.
E. Australia: Enforcement and Federalism Can Co-exist
Australia is very similar to Scandinavia and Great Britain in that it prioritizes the strict enforcement of its per se laws, but it also provides a better comparison to the United States because of the structure of its government. Australia is a federal system like the United States.Its states have the jurisdiction to pass laws relating to drunk driving.Therefore, even in a federal system, drunk driving can be effectively curtailed.
The most internationally recognized feature of the Australian system is its commitment to “the introduction and vigorous enforcement of” RBT to enforce per se laws.The state of Victoria first introduced this technique in 1976, and since then, it has been adopted in the other seven states in the country.As previously mentioned, providing the police with virtually unlimited powers would likely not work in the United States because it would severely infringe on civil liberties.However, two features of the Australian system are responsible for its remarkable success.First, police officers do not attempt to ascertain any evidence of intoxication through the use of field sobriety tests.Second, refusal to take the test is regarded as a failure of that test.
In most Australian states, a refusal to take the test is tantamount to failing and is enforced during both normal and RBT stops. For instance, the Australian Capital Territory institutes a fine, imprisonment for one year, or both for refusal to take a test, which ensures that individuals cannot obtain any advantage by refusal.Also, most of the states provide that it is compulsory for suspects to submit to chemical testing.
Australia illustrates it is possible to have strict, mostly uniform enforcement of per se laws in a federal system. Given the United States’ federal stronghold over influencing state decisions in the realm of drunk-driving laws,259 implementing the reforms suggested by analyzing the laws of Scandinavia, Great Britain, and Australia—which include a de-emphasis on field sobriety tests and a punishment for refusal to submit to a chemical test—would not be difficult.
F. Canada: Putting Field Sobriety Tests Where They Belong
Canadian drunk-driving law is very similar in form to both British260 and American law, although its historical auspices are derived from Scandinavia.261 It provides yet another example of effective enforcement of chemical testing and, most importantly, a solution for the field sobriety testing problem.
The Criminal Law Amendment Act of 1969, which is the Canadian federal criminal law still in effect today, attempts to parallel Great Britain’s Road Safety Act of 1967.262 It also prohibits driving with a BAC exceeding .08, but this is where the similarities end.263 The Canadian law is “weaker and less innovative” than its British counterpart because it does not grant the police carte blanche to demand chemical tests; rather, police must have reasonable or probable cause, or both.264 Its punishment for refusal is a mere fine.This is not disastrous, however, because the Canadian law still makes breath tests compulsory, and refusal to provide a sample is made an offense “equivalent to that of driving with a BAC in excess of 80 mg/dL.”Probably in an attempt to make U.S. law appear on par with the rest of the world, NHTSA has categorized Canadian BAC testing rules as only allowing officers to request a sample.However, in reality, Canadian enforcement is tougher than this because it allows for compulsory testing— something that the United States does not allow.
If there is a snag in the fabric of this carefully woven Canadian law, it is that much like current U.S. law, police officers have to rely on the behavioral actions of the suspect before a breath test can be initiated.Even though Britain and Scandinavia’s laws are arguably more effective because they do not require police officers to so rely,the requirement of probable or reasonable cause is a symbolic hallmark of how the United States, and apparently Canada, seek to protect liberty. Its use, therefore, cannot be undermined.
On the other hand, unlike the United States, Canada does not have a system in place by which this behavioral evidence is viewed to be as valuable as that derived from chemical testing.
Put simply, Canada does not have an entire section of a governmental department devoted to field sobriety testing.Instead, behavioral evidence serves its proper purpose—giving police officers the information needed to develop probable or reasonable cause.Canadian law illustrates that field sobriety testing can serve a vital purpose, but it should not in any way detract from the effectiveness of per se laws by pretending to be an effective way of proving intoxication.
IV. CONCLUSION
The success of the drunk-driving policies in Great Britain, Canada, and Australia may be a result of following the heralded and successful Scandinavian model.The United States has followed this model to the extent that its states have enacted per se statutes, but this is not sufficient. Per se laws are a waste of time without effective enforcement.
There must be some reason why the United States lags behind the rest of the international community when it comes to alcohol policy. Perhaps the United States is different because of lobbying interests by the automobile industry.Perhaps the United States is different because we, as Americans, are different. Whatever the reason, this country should have drunk- driving laws that not only mesh with those of the international community but are also logical and fair.
Advertising campaigns across Texas warn Texas drivers: “Drink. Drive. Go to Jail.”This, however, is not the law. The law is that a person cannot drive with a BAC of .08 or over, which on average, allows a person to drink two alcoholic beverages and legally operate a motor vehicle. The law allows people to drink and drive, but it does not allow people who are intoxicated to drive. The law should be enforced the way it is written—meaning that if .08 is the law, then people should not be convicted unless their BAC is at or above that limit. Unfortunately, the law is enforced in a way that allows both intoxicated and nonintoxicated people to be convicted.
The following problematic hypothetical is commonplace in America.An individual has only one drink and is not intoxicated. That individual drives home and does not use a signal as he is turning onto his home street. He is pulled over by a police officer. That officer notices a smell of alcohol on his breath. The individual tells the officer that he has had only one drink. The officer performs field sobriety tests on the individual, and because of the inherent problems with the field sobriety system, notes a number of clues of intoxication. The individual then refuses to provide a chemical sample because he knows that the punishment for refusal is less severe than it is for drunk driving. Furthermore, he feels that giving the police potentially incriminating evidence violates his right against self- incrimination. In short, the individual is arrested and charged with DWI based on the flimsy evidence of field sobriety tests. The individual is then forced to spend thousands of dollars to get out of jail and hire an attorney. He will probably not spend extra money to go to trial; rather, he will accept probation, a fine, community service, or time already served in jail. The conviction will stay on his record and will not be expunged. All of this results from the individual following the law—believing that he could have one drink and be safe to drive, or rather be safe from breaking the law.
This country needs to make its drunk-driving laws fair to avoid harsh results like these. Per se laws should be the primary method by which intoxication is proven. As it currently stands, most states do not have a mechanism in place to deter people from refusing to provide a breath sample.There is some effort in Alaska and Nebraska to deter refusal, as these states have criminalized the offense of refusal to provide a breath sample and made the punishment equivalent to that of drunk driving.279 Other states should institute similar legislation, and the federal government should induce them to do so.
After examining the laws of Scandinavia, Great Britain, Australia, and Canada, it is clear that the international community does not support the imposition of field sobriety tests or lackadaisical punishment for refusing to provide a breath sample. Much needed reforms can and should occur to make the United States an international leader in the fight to prevent drunk driving.

DEVELOPING COUNTRIES IGNORE DRINKING AND DRIVING PROBLEMS AT THEIR OWN PERIL
Article-1B
DEVELOPING COUNTRIES IGNORE DRINKING AND DRIVING PROBLEMS AT THEIR OWN PERIL.
Abstract: The author comments on the paper “Why don’t northern American solutions to drinking and driving work in southern America?” by F. Pechansky and A. Chandran, which addresses the lack of policies regarding drinking and driving. According to her, lack of data or laws is not a problem in Brazil but lapses in the enforcement of existing laws is. She refers to several studies on drunkdriving and suggests acquiring a better understanding of the problem through research and monitoring.
References
OBOT, I. S. (2012). DEVELOPING COUNTRIES IGNORE DRINKING AND DRIVING PROBLEMS AT THEIR OWN PERIL. Addiction, 107(7), 1209-1210. doi:10.1111/j.1360-0443.2012.03834.x

http://www.shoreline.edu:2419/ehost/detail/detail?vid=16&sid=2034059a-82d7-4d5b-974e-3a142e8c5767%40sessionmgr198&hid=116&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9h&AN=76371724
Full-text
In their paper on drinking and driving, Pechansky&Chandran argue that limited knowledge of the extent of this risky behavior and its consequences might help to explain the lack or inadequacy of policies and strategies to address the problem in southern America com- pared to North American countries. In order to address this gap they propose improvements in data collection, passage of drinking and driving laws, where such laws do not exist, and better enforcement of the laws.
These are essential strategies in a broad and systematic policy response aimed at reducing the health burden attributable to road traffic accidents. However, it seems that in the case of Brazil, the problem is not so much the lack of data or laws but lapses in the enforcement of existing laws. Even with an unsatisfactory situation (as illustrated in the vignette), Brazil is already ahead of many developing countries, especially most countries in the African region, where alcohol policies have not been developed and implemented (although discussions are currently taking place in a few of these countries). It is noteworthy, too, that even where, as in Kenya, a national Alcoholic Drinks Control Act has been passed recently, no provision was made for the control of drunk driving, including specifying the limit of blood alcohol concentration for drivers.
However, there is good reason to be concerned. Com- pared to South America, African countries report very high levels of abstention from drinking; however, the average quantity consumed by drinkers per year is higher than in all regions, the rate of weekly heavy episodic drinking is more than double the global rate (three times more among female drinkers) and the pattern of drinking is of moderate to high risk, all of which support the ‘all-or-nothing’ drinking pattern or habitual drinking to intoxication reported in several studies. It is not surprising, therefore, that the major contributor to alcohol-attributable disease burden in sub-Saharan Africa is unintentional injuries, especially from road traffic accidents. In a region currently experiencing the positive and negative impacts of globalization and rapid economic growth, and where alcohol producers are poised to increase their market shares through unrestrained marketing and promotion and undue influence on policy, the problem will worsen without appropriate responses.
The place to begin, as suggested by Pechansky&Chandran, is in better understanding of the problem through research and monitoring activities. In this regard, the growing interest in alcohol’s harms to others among alcohol epidemiologists might help to focus the attention of national policy makers on road traffic accidents in these countries. Much is expected from this emerging research tradition, but there is already good evidence from studies in developed societies which show that high rates (up to 40% in New Zealand) of crash injuries are suffered by people who were not drinking. That a significantly high proportion of the health and economic burden associated with drunk-driving accidents is borne by innocent passengers or pedestrians should be a sober reminder to policy makers in developing countries that the victim of drunk driving can be anyone.
In sub-Saharan Africa the fundamental policy challenge is recognizing that a problem exists, and that the problem is amenable to effective interventions. There is reason for optimism: the global and regional strategies to reduce harmful use of alcohol developed by the World Health Organization (WHO) have led at least to serious discussions of policy strategies in many African countries, and the involvement of international non- governmental organizations in training on evidence- based policy has helped to focus the attention of experts and policymakers on what works. The gap between countries in how they respond to drinking and driving problems will remain for a long time but any country, whether in Africa or South America, can benefit from available knowledge on policy effectiveness as long as the realities of their particular contexts are always kept in view.
Declaration of interests
ACHIEVING INTERNATIONAL PROGRESS ON ALCOHOL AND TRAFFIC SAFETY
Pechansky&Chandran have provided a thoughtful call-to-action to address drunk driving in South America. The authors provide evidence that drunk driving is a substantial and possibly increasing problem in South America, and contrast the status of the issue there with that in Canada and the United States. They then propose an insightful, three-pronged strategy to address the problem that, if implemented, promises to have a major impact on drunk driving deaths, injuries and collisions. Their recommendations take on added urgency when the projected large increases in collision- related deaths in the developing world are considered. In the same way that we take action to avert the devastating effects of new infectious diseases, we should be preparing for concerted efforts to address the projected increases in alcohol-related and other collision deaths that can be expected in the near future. The course of action proposed by the authors for Brazil and other parts of South America would also save many lives in other parts of the world.
While it is true that in North America efforts to address the drunk driving problem are considered to be an important public health success, it is also true that those of us in North America can continue to benefit from following the general advice provided by Pechansky&Chandran [1]: to collect information on the nature of the problem, enact effective legislation and ensure that police and the legal system are prepared to enforce the legislation. Perhaps, above all, these authors underscore the need to continue to learn from each other. Thus, if Pechansky&Chandran’s advice is followed in Brazil, researchers in North America and other parts of the world can soon look forward to valuable new information from our Brazilian colleagues about drunk driving and effective means to prevent it.
Article-1C
The Role of Political Campaign Contributions From Auto Industry

Source: http://www.opensecrets.org/industries/indus.php?ind=T2100

The financial crisis of 2008 and 2009 had a devastating effect on the United States economy, with the automotive industry being hit particularly hard. Although the industry has been in financial trouble for years, the recession made a bad situation much worse.
But as it did for the banking industry, the federal government came to the automotive industry’s rescue.
Two of the “Big Three” automakers, General Motors and Chrysler, have received billions of dollars in federal bailout money. They have also benefited from government financing schemes, expedited bankruptcy proceeding and partial government ownership. In GM’s case, the U.S. government remained majority owner into 2010.
Despite going through bankruptcy and receiving taxpayer bailout money, GM and Chrysler’s federal lobbying efforts have continued at a steady, albeit reduced pace. GM spent $7.1 million on federal lobbying in 2009, down from $13.4 million in 2008. And the new Chrysler Group spent $3.1 million in 2008. Ford spent $5.5 million.
Over the last two decades, GM employees and political action committees have contributed more than $8.5 million in campaign contributions to federal political candidates and committees, with 62 percent going to Republicans.
Recently, however, GM’s habits have shifted. In 2006, Democrats received only 33 percent of GM’s contributions. But in 2008, after retaking Congress, Democrats received 52 percent.
But the auto manufacturers themselves are not even close to being the biggest spenders when it comes to the automotive industry. That honor goes to auto dealers. In 2008, the National Auto Dealers Association, a Center for Responsive Politics “Heavy Hitter,” contributed $3 million to federal level candidates and committees — more than the “Big Three” automakers combined. Republicans received 66 percent of those contributions. In addition, the auto dealers spent $2.1 million on federal lobbying in 2009.
Auto dealers also reaped handsome benefits in 2009 courtesy of the federal government. The so-called “Cash for Clunkers” program subsidized the purchase of thousands of new cars at a cost of $2.9 billion, providing struggling auto dealers and manufacturers with a massive surge in revenue.
Over the last two decades, the automotive industry as a whole gave the vast majority of its federal political contributions of — 74 percent — to Republicans. Even after Democrats regained Congress, they received only 28 percent of campaign contributions from the industry in 2008, and 36 percent during the first three quarters of 2009.
However, as politics change, so may the pattern of campaign contributions. During the first three quarters of 2009, Democrats received 60 percent of campaign contributions from the National Auto Dealers Association, a dramatic change from the 34 percent they received from the association in 2008.
Total for Automotive: $53,059,480
Total Number of Clients Reported: 83 
Total Number of Lobbyists Reported: 420 
Total Number of Revolvers: 289 (68.8%0.

2014 Campaign Contributions from this industry
Client/Parent Total
General Motors
$8,510,000
Alliance of Automobile Manufacturers
$6,691,200
Ford Motor Co
$4,506,708
Fiat SPA
$4,080,000
Toyota Motor Corp
$3,683,000
National Auto Dealers Assn
$3,227,000
Nissan North America
$2,490,000
Honda Motor Co
$2,046,704
Daimler AG
$1,950,293
Assn of Global Automakers
$1,470,000
Volkswagen AG
$1,210,000
Michelin North America
$1,137,310
Continental AG
$1,100,000
American International Auto Dealers Assn
$940,000
Hyundai Motor Co
$738,000
Kia Motors Corp
$680,000
Delphi Automotive
$522,552
Crawford Group
$504,000
Specialty Equipment Market Assn
$460,000
Robert Bosch LLC
$460,000
BMW
$440,000
Quality Parts Coalition
$430,000
American Automotive Policy Council
$400,700
Coalition for Auto Repair Equality
$390,000
Hertz Global Holdings
$360,000
Tata Group
$358,189
TRW Automotive
$320,000
Avis Budget Group
$310,000
Japan Automobile Manufacturers Assn
$240,000
Snoqualmie Indian Tribe
$234,000
Schrader International
$200,000
Tenneco Inc
$200,000
American Automotive Leasing Assn
$200,000
Johnson Controls
$199,300
Motor & Equipment Manufacturers Assn
$183,524
Automotive Service Assn
$180,000
Allison Transmission
$160,000
Friedkin Group
$160,000
JM Family Enterprises
$150,000
Auto Care Assn
$140,000
Porsche Automobile Holding SE
$120,000
Mazda Motor of America
$100,000
JTEKT Corp
$80,000
Hyundai Kia America Technical Center
$80,000
Fallbrook Technologies
$80,000
Golden Gate Bridge Highway & Trans Dist
$80,000
Yamaha Motor Co
$72,000

‎‏‎‎‎‎‎‏‎‏‏‏‎‎‎‏‎‎‏‏‎‏‎‎‏‎‏‏‏‏‎‏‏‏‏‎‏‎‎‎‏‎‎‎‎‎‏‏‏‎‏‏‎‏‏‏‎‏‏‏‎‎‎‎‎‎‎‎‏‎‎‎‎‎‎‎‎‏‎‏‎‏‎‏‏‎‏‏‎Among Federal Candidates, 2014 Cycle; Total: $2,827,850

Name Office Total Contributions
Andrews, Robert E (D-NJ) House $5,000
Barrow, John (D-GA) House $10,000
Beatty, Joyce (D-OH) House $10,000
Becerra, Xavier (D-CA) House $2,500
Bishop, Sanford (D-GA) House $7,500
Bishop, Timothy H (D-NY) House $10,000
Blumenauer, Earl (D-OR) House $7,500
Bonamici, Suzanne (D-OR) House $5,000
Brady, Robert A (D-PA) House $10,000
Braley, Bruce (D-IA) House $5,000
Brown, Corrine (D-FL) House $2,500
Bustos, Cheri (D-IL) House $10,000
Butterfield, G K (D-NC) House $2,500
Cardenas, Tony (D-CA) House $5,000
Castro, Joaquin (D-TX) House $10,000
Clark, Katherine (D-MA) House $4,000
Clay, William L Jr (D-MO) House $6,000
Clyburn, James E (D-SC) House $5,000
Cohen, Steve (D-TN) House $5,000
Connolly, Gerry (D-VA) House $10,000
Conyers, John Jr (D-MI) House $5,000
Cooper, Jim (D-TN) House $3,000
Costa, Jim (D-CA) House $5,000
Courtney, Joe (D-CT) House $3,500
Crowley, Joseph (D-NY) House $10,000
Cuellar, Henry (D-TX) House $10,000
Davis, Susan A (D-CA) House $5,000
DeFazio, Peter (D-OR) House $2,500
DeGette, Diana (D-CO) House $7,500
Delaney, John K (D-MD) House $5,000
DelBene, Suzan (D-WA) House $5,000
Doyle, Mike (D-PA) House $10,000
Duckworth, Tammy (D-IL) House $10,000
Edwards, Donna (D-MD) House $10,000
Engel, Eliot L (D-NY) House $2,500

Top Contributors, 2013-2014
Contributor Amount
Ford Motor Co $1,064,272
General Motors $717,065
Toyota Motor North America $281,500
Alliance of Automobile Manufacturers $85,821
Motor & Equipment Manufacturers Assn $47,750
Fiat SPA $26,985
TymcoInc $10,400
Hfi LLC $6,400
Honda North America $5,250
Contributions to Democrats Republicans Outside Spending Groups

Top Lobbying Clients, 2014
Client/Parent Total
General Motors $8,510,000
Alliance of Automobile Manufacturers $6,691,200
Ford Motor Co $4,506,708
Fiat SPA $4,080,000
Toyota Motor Corp $3,633,000

Auto Manufacturers

Top Recipients, 2013-2014
Candidate Office Amount
Dingell, Debbie (D-MI) $49,541
Peters, Gary (D-MI) House $40,950
McConnell, Mitch (R-KY) Senate $38,600
Upton, Fred (R-MI) House $31,644
Terry, Lee (R-NE) House $29,000

Economic
Article-2
Source: http://www-nrd.nhtsa.dot.gov/pubs/812013.pdf
Full text
In 2010, there were 32,999 people killed, 3.9 million were injured, and 24 million vehicles were damaged in motor vehicle crashes in the United States. The economic costs of these crashes totaled $277 billion. Included in these losses are lost productivity, medical costs, legal and court costs, emergency service costs (EMS), insurance administration costs, congestion costs, property damage, and workplace losses. The $277 billion cost of motor vehicle crashes represents the equivalent of nearly $897 for each of the 308.7 million people living in the United States, and 1.9 percent of the $14.96 trillion real U.S. Gross Domestic Product for 2010. These figures include both police-reported and unreported crashes. When quality of life valuations are considered, the total value of societal harm from motor vehicle crashes in 2010 was $871 billion. Lost market and household productivity accounted for $93 billion of the total $277 billion economic costs, while property damage accounted for $76 billion. Medical expenses totaled $35 billion. Congestion caused by crashes, including travel delay, excess fuel consumption, greenhouse gases and criteria pollutants accounted for $28 billion. Each fatality resulted in an average discounted lifetime cost of $1.4 million. Public revenues paid for roughly 9 percent of all motor vehicle crash costs, costing tax payers $24 billion in 2010, the equivalent of over $200 in added taxes for every household in the United States. Alcohol involved crashes accounted for $59 billion or 21 percent of all economic costs, and 84 percent of these costs occurred in crashes where a driver or non-occupant had a blood alcohol concentration (BAC) of .08 grams per deciliter or greater. Alcohol was the cause of the crash in roughly 82 percent of these cases, causing $49 billion in costs. Crashes in which alcohol levels are BAC of .08 or higher are responsible for over 90 percent of the economic costs and societal harm that occurs in crashes attributable to alcohol use. Crashes in which police indicate that at least one driver was exceeding the legal speed limit or driving too fast for conditions cost $59 billion in 2010. Seat belt use prevented 12,500 fatalities, 308,000 serious injuries, and $69 billion in injury related costs in 2010, but the failure of a substantial portion of the driving population to buckle up caused 3,350 unnecessary fatalities, 54,300 serious injuries, and cost society $14 billion in easily preventable injury related costs. Crashes in which at least one driver was identified as being distracted cost $46 billion in 2010. The report also includes data on the costs associated with motorcycle crashes, failure to wear motorcycle helmets, pedestrian crash, bicyclist crashes, and numerous different roadway designation crashes.
State Costs
In recent years, States have continued to increase their involvement in establishing and enforcing laws related to motor vehicle safety. This is due, in part, to Federal legislation enacted to promote highway safety such as The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) which was enacted in 2005 and which provided one time grants to States that enacted and are enforcing a conforming primary seat belt law for all passenger motor vehicles. SAFETEA-LU authorized a total of $770 million in grant money over a six-year period to address roadway and driver behavioral safety activities, especially those designed to increase belt use.
State legislators are often interested in the societal and economic cost of motor vehicle injury as they consider new traffic safety laws, changes to existing laws and funding for enforcement of the laws. This information can assist them in making the case to their constituencies as to the relevance of the laws designed to make the population safer.
A State-specific distribution of total economic costs has been prepared as follows:
• The year 2010 fatalities were obtained by State from FARS. The portion of total National fatalities in each State was then applied directly to the total fatality cost ($46.2 billion).
• State crash incidence data was obtained from individual States for 2008-2010. In cases where data was not available, a factor based on the trend in fatalities within the State was used to estimate crashes from the last years for which complete data was available. The portion of total National crashes in each State was applied to the total cost of all nonfatal injuries, PDOs, and uninjured occupants ($230.9 billion).
• The total costs for each State were then adjusted to reflect locality cost differences based on the ratio of costs in each State to the National total. Medical costs were adjusted based on data obtained from the ACCRA Cost of Living Index and cited by Miller and Galbraith (1995). Lost productivity, travel delay and workplace costs were adjusted based on 2010 per-capita income. Insurance administration and legal costs were adjusted using a combination of these two inflators weighted according to the relative weight of medical and lost productivity administrative costs. All other cost categories were adjusted using a composite index developed by ACCRA (also provided by Miller).
These four adjustment factors were applied separately to the fatal and nonfatal costs for each State. Weights to combine each factor were derived separately from the relative importance of each cost category to nationwide fatal and nonfatal total costs. The sum of fatal and nonfatal costs for each State was then adjusted to force the sum of all States’ costs to equal the National total.
The results of this analysis are depicted in Table 6-1. There is considerable variation in costs among the States with New York, for example, having costs that are 17 times higher than those for Idaho. This is primarily due to the higher incidence of death and injury in New York (a function of population), but also to the higher cost levels in that State. However, as noted by Miller and Galbraith (1995), cost comparisons between States that are based on State injury totals can be misleading because injury totals do not capture differences in nonfatal injury severity between States. This would tend to under State costs in rural States relative to urban States, which typically have lower average speeds and consequently less severe injuries. Ideally, State costs would be based on individual State injury profiles, but these are not available for many Stat
Differences between States may also result from different reporting practices that result in more or less complete recording of injuries from State to State. Differences in roadway characteristics and State of repair may account for some of this discrepancy, though it seems likely that variation in injury reporting is also a contributing factor. Finally, the impact of crash costs must be viewed in the context of each State’s economy. Smaller, less populated States may have lower absolute costs, but they may also have fewer resources available to address these costs. A significant portion of these costs is borne by the general public through State and local revenue, or through private insurance plans. The per capita costs for each State vary from roughly $500 to $1,700 compared to the nationwide average of almost $900. This represents 1.1 to 4.1 percent of the per capita income for each State, with an overall average of 2.2 percent.
Table 6-1. Estimated 2010 Economic Costs Due to Motor Vehicle Crashes by State
(Millions 2010 Dollars) Cost per Capita % per Capita Personal Income
State % Total
ALABAMA $5,076 1.8% $1,062 3.1%
ALASKA $682 0.2% $961 2.2%
ARIZONA $4,753 1.7% $744 2.1%
ARKANSAS $2,692 1.0% $923 2.8%
CALIFORNIA $22,653 8.2% $608 1.4%
COLORADO $4,804 1.7% $955 2.2%
CONNECTICUT $5,635 2.0% $1,577 2.8%
DELAW ARE $782 0.3% $871 2.2%
DIST. OF COL. $999 0.4% $1,659 2.3%
FLORIDA $12,079 4.4% $642 1.6%
GEORGIA $12,485 4.5% $1,289 3.6%
HAW AII $640 0.2% $470 1.1%
IDAHO $1,001 0.4% $638 2.0%
ILLINOIS $12,636 4.6% $985 2.3%
INDIANA $7,362 2.7% $1,135 3.2%
IOWA $2,489 0.9% $817 2.1%
KANSAS $2,783 1.0% $975 2.5%
KENTUCKY $4,988 1.8% $1,150 3.4%
LOUISIANA $6,536 2.4% $1,442 3.8%
MAINE $1,495 0.5% $1,126 3.0%
MARYLAND $5,097 1.8% $883 1.8%
MASSACHUSETTS $6,784 2.4% $1,036 2.0%
MICHIGAN $11,115 4.0% $1,125 3.2%
MINNESOTA $3,502 1.3% $660 1.5%
MISSISSIPPI $3,077 1.1% $1,037 3.3%
MISSOURI $6,381 2.3% $1,065 2.9%
MONTANA $1,018 0.4% $1,030 2.9%
NEBRASKA $1,483 0.5% $812 2.1%
NEVADA $2,277 0.8% $843 2.3%
NEW HAMPSHIRE $1,585 0.6% $1,204 2.7%
NEW MEXICO $2,010 0.7% $976 2.9%
NEW YORK $17,447 6.3% $900 1.8%
NORTH CAROLINA $9,049 3.3% $949 2.7%
NORTH DAKOTA $807 0.3% $1,199 3.0%
OHIO $11,702 4.2% $1,014 2.8%
OKLAHOMA $3,287 1.2% $876 2.4%
OREGON $2,009 0.7% $524 1.4%
PENNSYLVANIA $6,542 2.4% $515 1.3%
RHODE ISLAND $1,858 0.7% $1,764 4.1%
SOUTH CAROLINA $4,594 1.7% $993 3.0%
SOUTH DAKOTA $816 0.3% $1,003 2.6%
TENNESSEE $6,461 2.3% $1,018 2.9%
TEXAS $19,424 7.0% $772 2.0%
UTAH $1,979 0.7% $716 2.2%
VERMONT $613 0.2% $979 2.4%
VIRGINIA $5,707 2.1% $713 1.6%
WASHINGTON $5,174 1.9% $769 1.8%
WEST VIRGINIA $1,680 0.6% $907 2.8%
WISCONSIN $5,239 1.9% $921 2.4%
WYOMING $885 0.3% $1,570 3.3%
T otal $277,020 100.0% $897 2.2%
Alcohol consumption is a major cause of motor vehicle crashes and injury. Over the past two decades, about 40 percent of all motor vehicle fatalities occur in crashes in which a driver or nonoccupant has consumed a measurable level of alcohol prior to the crash, and of these cases, 86 percent involved a level of consumption which met the current typical legal definition for intoxication or impairment, a blood alcohol concentration of .08 grams per deciliter or higher. Over the past two decades, there has been an increased awareness of the problems caused by impaired driving. Many groups from NHTSA to Mothers Against Drunk Driving (MADD), Students Against Destructive Decisions (SADD), and State and local agencies, have promoted the enactment of laws and implemented public awareness campaigns to assist in combating this problem. Legal measures such as administrative license revocation/suspension have been enacted in numerous States. As a result, there has been a marked decrease in the number of fatalities resulting from alcohol-involved crashes. Table 7-1 displays the share of fatalities associated with alcohol involvement (BAC>.01 g/dL) and the current definition of legal intoxication (illegal per se, .08 g/dL) since 1982. Alcohol involvement in fatal crashes has declined from 60 percent of all fatalities in 1982 to roughly 40 percent in 2010, while legal intoxication (defined as a BAC of .08 g/dL or greater) has declined from 53 percent to 35 percent over the same period. While these declines are encouraging, alcohol still remains a significant causative factor in motor vehicle crashes.
All 50 States, the District of Columbia, and Puerto Rico define legal intoxication, the level at which DWI convictions can be made, as having a BAC of .08 or higher. FARS data indicates that fatalities involving legally intoxicated drivers or nonoccupants account for 86 percent of the fatalities arising from all levels of alcohol involvement.
Fatalities:
FARS provides detailed information about all traffic fatalities that occur within 30 days of a crash on a public road. Each case is investigated and documentation regarding alcohol involvement is included. Alcohol involvement can be indicated either by the judgment of the investigating police officers or by the results of administered BAC tests. Cases where either of these factors is positive are taken as alcohol-involved and any fatalities that result from these crashes are considered to be alcohol-involved fatalities. In addition, there are a large number of cases where alcohol involvement is unknown. In 1986, NHTSA’s National Center for Statistics and Analysis (NCSA) developed an algorithm based on discriminant analysis of crash characteristics that estimates the BAC level for these cases (Klein, 1986). In 1998, NHTSA developed a more sophisticated technique to accomplish these estimates using multiple imputation (Rubin, Schafer, & Subramanian, 1998), and substituted this method beginning with the 2001 FARS file. NHTSA has recomputed previous FARS files using this method and alcohol involvement rates based on the new method are routinely published by NHTSA and used in this report. The total number of alcohol-involved fatalities by BAC level is shown in Table 7-1 from 1982 through 2011. In
2010, about 86 percent of all fatalities that occurred in alcohol-involved crashes were in cases where a driver or pedestrian had a BAC of .08 or higher.
Alcohol use by
the vast majority of alcohol-related traffic crashes, but a significant number of crashes occur where pedestrians or bicyclist alcohol use was indicated, while drivers were not drinking. Table 7-2 summarizes the incidence of alcohol-related crashes based on driver BAC, while Table 7-3 shows the incidence of fatalities where pedestrians or bicyclists were using alcohol, but not drivers. In 2010, 85 percent of all drivers is the focus of most behavioral programs and State laws. Drivers are involved in fatalities that occurred in alcohol-involved crashes were in cases where a driver had a BAC of .08 or higher. About 5 percent of all alcohol-related traffic fatalities involve alcohol use by pedestrians rather than motor vehicle drivers. Of these cases, over 90 percent involve alcohol impairment (BAC = .08 or higher) on the part of the pedestrian.
Figure 7-A illustrates the historical trend of overall fatalities plotted against alcohol-related and alcohol impaired fatalities. Their general trends are similar, but there was a noticeable decline in alcohol-related fatalities as a proportion of total fatalities during the 1990s. Overall alcohol-related fatalities declined from 60 percent of total fatalities in 1982 to about 40 percent by 1997. Since that time, the proportion has remained roughly constant. A similar trend is evident for fatalities in crashes involving alcohol impairment. Alcohol impaired fatalities declined from 53 percent of all fatalities in 1982 to about 34 percent in 1997, and have remained at roughly 35 percent through 2010.
Nonfatal Injuries:
NHTSA collects crash data though a two-tiered system, a system that was redesigned in 1988 to replace the former NASS; the NASS Crashworthiness Data System and the General Estimates System comprise this new method.
The CDS is a probability sample of a subset of police-reported crashes in the United States It offers detailed data on a representative, random sample of thousands of minor, serious, and fatal crashes. The crash in question must be police-reported and must involve property damage and/or personal injury resulting from the crash in order to qualify as a CDS case. It must also include a towed passenger car or light truck or van in transport on a public road or highway. Injuries in vehicles meeting these criteria are analyzed at a level of detail not found in the broader GES.
In contrast, the GES collects data on a sample of all police-reported crashes, without a specific set of vehicle and severity criteria. Although GES collects data on a broader array of crashes, it collects less information on each crash, limiting possible analysis of alcohol involvement. Cases are restricted to a simple “yes,” “no,” or “unknown” alcohol indication on the police crash report, as observed by the reporting police office. Actual BAC test results are not available through the GES sample.
The GES provides a sample of U.S. crashes by police-reported severity for all crash types. GES records injury severity by person on the KABCO scale (National Safety Council, 1990) from police crash reports as discussed at the beginning of Chapter 2.
KABCO ratings are coarse and inconsistently coded between States and over time. The codes are selected by police officers without medical training, typically without benefit of a hands-on examination. Some of the injured are transported from the scene before the police officer who completes the crash report even arrives. Miller, Viner, et al. (1991) and Blincoe and Faigin (1992) documented great diversity in KABCO coding across cases. O’Day (1993) more carefully quantified variability in use of the A-injury code between States. Viner and Conley (1994) probed how differing State definitions of A-injury contributed to this variability. Miller, Whiting, et al. (1987) found police-reported injury counts by KABCO severity systematically varied between States because of differing State crash reporting thresholds (rules governing which crashes should be reported to the police). Miller and Blincoe (1994) found that State reporting thresholds often changed over time.
Thus police reports inaccurately describe injuries medically and crash databases inaccurately describe motor vehicle crash severity. We adopted a widely used method to refine crash and injury severity. Developed by Miller and Blincoe (1994), numerous studies have used this method, notably in impaired- driving cost estimates in Blincoe (1996); Miller, Lestina, and Spicer (1998); Blincoe et al. (2002); and Zaloshnja and Miller (2009).
To minimize the effects of variability in severity definitions by State, reporting threshold, and police perception of injury severity, the method uses NHTSA data sets that include both police-reported KABCO and medical descriptions of injury in the Occupant Injury Coding system (OIC; AAAM, 1990, 1985). OIC codes include AIS severity score and body region, plus more detailed injury descriptors. We used both 2008–2010 CDS and 1984–1986 NASS data (NASS; NHTSA, 1987). CDS describes injuries to passenger vehicle occupants involved in tow-away crashes. The 1984–1986 NASS data provides the most recent medical description available of injuries to medium/heavy truck and bus occupants, nonoccupants, and others in non-CDS crashes. The NASS data was coded with the 1980 version of AIS, which differs slightly from the 1985 version; but NHTSA made most AIS 85 changes well before their formal adoption. CDS data was coded in AIS 90/98 with coding shifting to AIS 2005 Update 2008 in 2011. We differentiated our analysis of the two versions of AIS because AIS 90/98 scores and OIC codes differ greatly from codes and scores in AIS 85, especially for brain and severe lower limb injury. Garthe, Ferguson, and Early (1996) find that AIS scores shifted for roughly 25 percent of all OICs between AIS 85 and AIS 90/98.
We used 2008–2010 CDS and GES non-CDS weights to weight the CDS and NASS data, respectively, so that they represent estimated counts of people injured in motor vehicle crashes during 2008–2010. In applying the GES weights to old NASS, we controlled for police-reported injury severity, restraint use, alcohol involvement, and occupant type (CDS occupant, non-CDS occupant, and nonoccupant). Weighting NASS data to GES restraint use and alcohol involvement levels updates the NASS injury profile to reflect contemporary belt use and alcohol-involvement levels, although it is imperfect in terms of its representation of airbag use in non-tow-away crashes. At completion of the weighting process, we had a hybrid CDS/NASS casualty-level file—that is, we had an appropriately reweighted NASS record for each injured survivor in each non-CDS crash. Similarly, we reweighted the 2008–2010 CDS file to match GES counts in order to get appropriately weighted unit records for CDS sample strata. From this file we obtained counts of alcohol cases based on all indicators of alcohol use to obtain an initial count of alcohol involved crashes from police-reported crashes. The results are shown in the upper part of Table 4 below:
As noted in chapter 5, GES has historically undercounted police-reported crashes on the order of 10 to 13 percent. Our most recent analysis indicates an undercounting of roughly 10.7 percent for 2010. We therefore multiplied incidence by 1.107 to adjust for systematic undercounting in GES of police crash reports. Also as previously noted, a significant portion of crashes are not reported to police. We assume that these underreporting rates apply to alcohol-involved crashes as well as to overall crashes. We thus divided by estimated fractions reported to the police: 1.0 for people with critical to fatal injuries, 0.953 for people with MAIS3 injuries, 0.794 for MAIS2, 0.725 for MAIS1, 0.469 for uninjured people in injury crashes, and 0.406 for crashes without injuries.44 The results of these adjustments are shown in the lower half of Table 7-4.
Underreported Alcohol:
Although police accident reports typically include an indication of whether alcohol was involved, the nature of accident investigations often precludes an accurate assessment of alcohol involvement at the crash site. Police underreporting of alcohol involvement has been well documented in numerous studies. Typically, studies on underreporting compare the results of BAC tests administered in medical care facilities to police reports of alcohol involvement. In a 1982 study of injured drivers, Terhune found that police correctly identified 42 percent of drivers who had been drinking. These rates of identification improved at higher BAC levels, ranging from only 18.5 percent of those with BACs of .01to .09, to 48.9 percent for those with BACs of .10 or greater. In a 1990 study, Soderstrom, Birschbach, and Dischinger found that police correctly identified alcohol use in 71 percent of legally intoxicated, injured drivers. Earlier studies by Maull, Kunning, and Hickman in 1984 and Dischinger and Cowley in 1989, found that police correctly identified 57.1 percent and 51.7 percent of intoxicated drivers, respectively. The Dischinger and Cowley study also found a lower identification rate for “involved but not intoxicated” drivers of 28.6 percent. In a 1991 study of injured motorcycle drivers, Soderstrom, Birschbach, and Dischinger found that police correctly identified only half the drivers with positive alcohol readings later identified by the hospital.
These early studies demonstrate that during the late 1980s and early 1990s, the police were identifying approximately half of all legally intoxicated drivers, and about one quarter of all drivers who were alcohol involved, but not legally intoxicated. It is clear from the studies that police are more accurate in identifying alcohol involvement as the BAC rate increases. This may reflect the more obvious nature of impaired behavior on the part of drivers who have higher BAC levels, as well as a tendency to investigate more thoroughly the more serious crashes that result from higher BACs.
In several previous versions of this report (Blincoe&Faigin, 1992, and Blincoe, 1996) the studies cited above were used to estimate the impact of police underreporting of alcohol involvement. In the most recent version (Blincoe et al., 2002), more updated information was used. However, those studies are over a decade old, and when applied to current data, they produced results that imply a higher rate of alcohol involvement in less severe injuries than in fatalities and more severe injuries. This is both counter-intuitive and at odds with historical alcohol involvement patterns. Moreover, over the last decade there has been a concerted effort on the part of Federal, State and local governments to reduce alcohol-related crashes, and this may have improved the rate of alcohol reporting during accident investigations. Data that was more recent was therefore needed to make this adjustment for 2010 data.
The Crash Outcome Data Evaluation System (CODES) is a system that links existing crash and injury data so that specific person, vehicle, and event characteristics can be matched to their medical and financial outcomes. At the time of the 2002 study there were 25 States participating in this program and 17 of these States are part of a data network supporting NHTSA highway safety programs. An effort was made to contact all States participating in NHTSA’s CODES project to determine whether data was available that could be used to estimate current alcohol reporting rates. For a variety of reasons, only one State, Maryland, had data that was properly linked to allow a comparison between alcohol assessments in police reports and actual measured BACs. The Maryland data represented 2,070 cases admitted to the R Adams Cowley Shock Trauma Center between 1997 and 1999. The basis for this data was thus similar to most of the studies cited above from the late 80s and early 90s.
An analysis of this data indicated that police were correctly identifying 74 percent of all alcohol involved cases where BACs equaled or exceeded .10 g/dL, and 46 percent of all cases where BACs were positive, but less than .10. This represents a significant improvement from the corresponding rates of only 55 percent and 27 percent that were found in the earlier studies. This was consistent with the expectation that reporting rates have improved, and, when applied to police-reported rates in the NHTSA data bases, the more recent factors produce overall estimates that are consistent with FARS rates of involvement for fatal crashes. However, although this data produce logical results, they were gathered from only one State and there are no data to confirm whether the Maryland experience is typical of the Nation. These estimates were thus subject to the caveat that these results have not been verified by broader studies from more diverse regions. One of the previous studies (Soderstrom, Birschbach, &Dischinger, 1990) was conducted at this same facility and found a higher rate of alcohol recognition than the other studies previously discussed. A second caveat is that, because this data was collected at a trauma unit, they may reflect the more serious cases rather than a sample of all injury levels. There are two different, somewhat offsetting biases that could result from this. Trauma unit cases are more likely to involve emergency transport and treatment which may occur before police are able to gain access to drivers to determine alcohol involvement. This could result in police missing a larger portion of trauma unit cases. On the other hand, the severity of the crash may prompt a more thorough investigation by the police, resulting in a higher rate of correct alcohol identification. It is not clear what the net effect of these biases would be.
Given these caveats, this current paper is based on a more recent study that analyzed what portion of U.S. nonfatal crashes are alcohol-involved and how well police and hospitals detect involvement (Miller et al., 2012). In that study, a capture recapture model estimated alcohol involvement from levels detected by police and hospitals and the extent of detection overlap. The authors analyzed 550,933 Crash Outcome Data Evaluation System driver records from 2006-2008 police crash report censuses probabilistically linked to hospital inpatient and emergency department (ED) discharge censuses for Connecticut, Kentucky (admissions only), Maryland, Nebraska, New York, South Carolina, and Utah. They then computed National estimates from NHTSA’s General Estimates System.
Nationally an estimated 7.5 percent of drivers in nonfatal crashes and 12.9 percent of nonfatal crashes were alcohol-involved. (Crashes often involve multiple drivers but rarely are two alcohol-involved.) Police correctly identified an estimated 32 percent of alcohol-involved drivers in non-fatal crashes including 48 percent in injury crashes. Excluding Kentucky, police in the six States reported 47 percent of alcohol involvement for cases treated in EDs and released and 39 percent for admitted cases. In contrast, hospitals reported 28 percent of involvement for ED cases and 51 percent for admitted cases. Underreporting varied widely between States. Police-reported alcohol involvement for 44 percent of those who hospitals reported were alcohol-involved, while hospitals reported alcohol involvement for 33 percent of those who police reported were alcohol-involved. Police alcohol reporting completeness rose with police-reported driver injury severity. At least one system reported 62 percent of alcohol involvement. Based on the combined results from the 6 States that had both admitted and ED data, police records account for 30 to45 percent of total actual alcohol involvement, depending on injury severity. These rates and the resulting estimates of alcohol involvement are summarized in Table 7-5. Note that although fatalities are listed in Table 7-5, they were not examined in the capture-recapture analysis. As noted previously fatal crashes are investigated much more thoroughly than nonfatal crashes and NHTSA’s FARS, through both documentation of police and medical records and through modeling for unreported cases, is believed to account for all alcohol involvement in fatal crashes.
Table 7-5. Total Alcohol Involvement Adjusted for Unreported Cases
Injury severity Total Incidence Percent Identified Alcohol Involved Percent Involved
PDO 18,508,632 42.90% 2,629,458 14.21%
MAIS0 4,583,265 42.90% 651,054 14.21%
MAIS1 3,459,200 45.40% 340,897 9.85%
MAIS2 338,730 42.60% 57,728 17.04%
MAIS3 100,740 39.70% 24,638 24.46%
MAIS4 17,086 40.60% 4,292 25.12%
MAIS5 5,749 30.10% 2,110 36.70%
Fatal 32,999 100.00% 13,323 40.37%
BAC Levels:
BAC levels are difficult to determine from injury data. Although there are some indications of BAC included in CDS data, the GES has no such indicators. To determine BAC levels, an initial assessment was made that virtually all police-reported BACs for nonfatal crashes represent BACs that are at the .05 BAC level or higher. It is illegal per se in every State to drive a motor vehicle with a BAC of .08 or higher. Some State laws establish lesser included offenses at lower BAC levels (most typically at .05 BAC). Unless a crash involves a fatality, police generally do not test or use the alcohol checkbox unless they suspect the driver might be near these levels. In fact, except for fatal crashes, some States do not even allow testing unless a BAC over .08 is suspected. Low BAC levels (especially below .05) are thus unlikely to be registered in police records. An examination of available data from NHTSA’s CDS and NASS data systems bears this out. For nonfatal crashes, less than half of 1 percent of nonfatal injuries were recorded as BACS being between .01 and.04 g/dL. However, this primarily represents a limitation in data gathering rather than an indication of near complete absence of crashes at these lower BAC levels. An estimate of crashes at these BAC levels was thus derived from crash probabilities.
Subcategories of BAC levels were calculated as a function of odds ratios for crashes at each specific BAC level compared to exposure at those levels. Odds ratios were derived from a study of relative crash risk conducted by Dunlap and Associates (Blomberg, Peck, Moskowitz, Burns and Fiorentino, 2005). In this study over 2,800 crashes and nearly 15,000 drivers in Long Beach, California and Fort Lauderdale, Florida were sampled to determine the relative risk of crashes at different BAC levels. Logistic regression techniques were used to create a relative risk model which indicated a notable dose-response relationship beginning at 0.04 percent BAC and increasing exponentially at >=.10 percent BAC. The results of this model are summarized in Figure 7-B below:
Figure 7-B. Relative Risk of Crash by Blood Alcohol Concentration (Source: Blomberg, Peck, Moskowitz, Burns &Fiorentino, 2005)
The authors found some level of added crash risk beginning at roughly .04 BAC, but this risk rises noticeably at .08 BAC and rises exponentially from .10 BAC and beyond. For example, at .04 BAC the risk of a crash is 18 percent higher than at zero BAC, but at .08 BAC the risk of a crash is 2.69 times as high and at .10 BAC it is 4.79 times as high. To determine BAC distributions, the relative risk ratios of each individual BAC category were combined with exposure data from the same study to estimate the relative risk factor for each grouped BAC category. These grouped relative risk factors were then combined with National exposure data from Lacey et al. to determine the distribution of each grouped BAC category as follows:.
The broader categories are those derived above for nonfatal injuries, which were all assumed to be BAC>=.05, and the difference between these and the total incidence, which represent 0-.04 BAC. Essentially, this divides alcohol BAC cases into two broad categories at the .05 BAC level. The .08+BAC category was then derived using the above formula from the >=.05 BAC total and the .01-.04 BAC category was derived from the =.08 BAC=.01+ Total
PDO 15,879,174 341,369 162,584 2,125,505 2,629,458 18,508,632
MAIS0 3,932,211 84,534 40,255 526,265 651,054 4,583,265
MAIS1 3,118,303 67,037 19,459 254,401 340,897 3,459,200
MAIS2 281,002 6,041 3,672 48,015 57,728 338,730
MAIS3 76,102 1,636 1,634 21,368 24,638 100,740
MAIS4 12,794 275 286 3,731 4,292 17,086
MAIS5 3,639 78 144 1,888 2,110 5,749
Fatal 19,676 1,002 859 11,462 13,323 32,999
T otal 23,322,901 501,972 228,893 2,992,635 3,723,500 27,046,401
% of Crash- Involved People 86.23% 1.86% 0.85% 11.06% 13.77% 100%
% of Miles Driven 97.18% 1.96% 0.39% 0.47% 2.82% 100%
Relative Risk 1.0000 1.0645 1.6581 17.9870 4.7477
The results illustrate the disproportionate impact that high BACs have on crash incidence. Less than 1 percent of overall miles are driven by impaired drivers (.08+ BAC), but they account for over 11 percent of all vehicle crashes, and over 80 percent of all alcohol related crashes, including 86 percent of all fatalities.
Figure 7-C illustrates the relative incidence of alcohol impaired and not impaired crashes to all crashes. Alcohol involved crashes account for 40 percent of all fatal crashes. There is a clear trend towards increased alcohol involvement as injury severity increases. This figure illustrates the fact that alcohol not only increases the likelihood of crashes, but their severity as well.
Figure 7-D illustrates the relative incidence of crashes at various BAC levels. The vast majority of all alcohol related crashes occur at legally impaired BAC levels of .08 and above.
Alcohol-Involved Crash Costs:
The costs of alcohol-involved crashes tend to exceed those of non-alcohol-involved crashes due to a variety of factors. The first is a general tendency toward greater relative severity of alcohol-involved crashes. For all crashes, fatalities are approximately 0.8 percent of injured survivors. This rate nearly quadruples for crashes involving alcohol. Similarly, the rate for critical injuries (MAIS 5) triples for alcohol cases and for severe injuries (MAIS 4) it more than doubles. The more severe and expensive injuries represent a much higher portion of alcohol-involved cases. A second factor is demographics. Males are disproportionately represented in alcohol-involved crashes and this makes the cost for each alcohol-involved case higher. This occurs because males have higher earnings and participation in the work force than females; thus there is a higher lost productivity cost associated with these crashes. In non-alcohol-involved crashes, the gender distribution is more evenly distributed. In addition, the victims of alcohol-involved crashes tend to be of an age group where lost productivity is maximized by the discounting process.
Unit costs specific to alcohol-involved crashes were developed by extracting cases with police-reported alcohol from the previously discussed file based on 2008-2010 weights. As noted above, virtually all of these cases represent crashes with BACs of 0.5 or greater. Unit costs for these crashes were thus weighted by the relative incidence of 0.05 BAC+ cases within all positive BAC cases. The unit costs of cases with BACs of 0.0-0.04 were then derived as a function of the relative incidence and cost of the 0.05+BAC crashes and All Crashes as follows:
Injury Subtotal Congestion Costs Property Damage Economic Subtotal
*Note: Unit costs are expressed on a per-person basis for all injury levels. PDO costs are expressed on a per-damaged-vehicle basis.
Table 7-9. Average Unit Costs, All Positive BAC Injuries and Fatalities (2010 Dollars)
PDO MAIS0 MAIS1 MAIS2 MAIS3 MAIS4 MAIS5 Fatal
Medical $0 $0 $4,071 $25,933 $74,729 $201,152 $450,168 $11,317
Emergency Services $28 $21 $89 $194 $416 $838 $855 $902
Market Productivity $0 $0 $3,083 $41,342 $115,857 $185,008 $361,237 $1,156,859
Household Productivity $60 $45 $1,027 $12,349 $35,658 $46,339 $110,232 $315,326
Insurance Admin. $191 $143 $4,588 $10,932 $25,772 $39,369 $81,707 $28,322
Workplace Costs $62 $46 $341 $2,644 $5,776 $6,361 $11,091 $11,783
Legal Costs $0 $0 $1,685 $8,017 $20,842 $37,358 $94,990 $106,488
Injury Subtotal $341 $255 $14,883 $101,411 $279,050 $516,425 $1,110,280 $1,630,997
Congestion Costs $1,077 $760 $1,109 $1,197 $1,434 $1,511 $1,529 $5,720
Property Damage $2,444 $1,828 $5,404 $5,778 $10,882 $16,328 $15,092 $11,212
Economic Subtotal $3,862 $2,843 $21,396 $108,386 $291,366 $534,264 $1,126,901 $1,647,929
QALYs $0 $0 $24,382 $362,068 $864,455 $2,111,048 $4,970,847 $8,495,097
Comprehensive Total $3,862 $2,843 $45,778 $470,453 $1,155,821 $2,645,312 $6,097,748 $10,143,026
*Note: Unit costs are expressed on a per-person basis for all injury levels. PDO costs are expressed on a per-damaged-vehicle basis.
Table 7-10 lists the aggregate 2010 costs of alcohol related crashes, and Table 7-11 lists the proportion of total economic crash costs that each BAC level represents. Alcohol is involved in crashes that account for 14 percent of the costs of PDO crashes, 17 percent of the costs that result from nonfatal injuries and 48 percent of the costs that result from fatalities. Overall, these crashes are responsible for 21 percent of total economic costs. The impact of alcohol-involved crashes on overall costs is thus higher than would be indicated by the alcohol-involved incidence rates. Overall, alcohol involved crashes cost $59 billion in economic costs in 2010, with 84 percent of this or $50 billion, occurring in crashes where the highest BAC was >=.08.
Table 7-10. Summary of Total Economic Costs by BAC Level (Millions of 2010 Dollars)
BAC= 0 BAC=.01-.04 BAC=.05-.07 BAC>=.08 BAC=.01+ Total
PDO $61,325 $1,318 $628 $8,209 $10,155 $71,480
MAIS0 $11,179 $240 $114 $1,496 $1,851 $13,030
MAIS1 $61,503 $1,322 $424 $5,547 $7,294 $68,797
MAIS2 $28,280 $608 $401 $5,248 $6,257 $34,537
MAIS3 $20,726 $446 $478 $6,255 $7,179 $27,905
MAIS4 $6,488 $139 $153 $2,000 $2,293 $8,781
MAIS5 $3,950 $85 $163 $2,131 $2,378 $6,327
Fatal $24,207 $1,651 $1,416 $18,889 $21,955 $46,163
T otal $217,659 $5,810 $3,778 $49,774 $59,362 $277,020
% Total Alcohol Costs NA 9.79% 6.36% 83.85% 100.00% NA
% Total 78.57% 2.10% 1.36% 17.97% 21.43% 100.00%
162
Table 7-11. Percent of Economic Injury Costs by Alcohol Involvement Rate
BAC= 0 BAC=.01-.04 BAC=.05-.07 BAC>=.08 BAC=.01+ Total
PDO 85.79% 1.84% 0.88% 11.48% 14.21% 100.00%
MAIS0 85.79% 1.84% 0.88% 11.48% 14.21% 100.00%
MAIS1 89.40% 1.92% 0.62% 8.06% 10.60% 100.00%
MAIS2 81.88% 1.76% 1.16% 15.19% 18.12% 100.00%
MAIS3 74.27% 1.60% 1.71% 22.42% 25.73% 100.00%
MAIS4 73.89% 1.59% 1.74% 22.78% 26.11% 100.00%
MAIS5 62.42% 1.34% 2.57% 33.67% 37.58% 100.00%
Fatal 52.44% 3.58% 3.07% 40.92% 47.56% 100.00%
T otal 78.57% 2.10% 1.36% 17.97% 21.43% 100.00%
Table 7-12 lists the aggregate 2010 comprehensive costs of alcohol related crashes, and Table 7-13 lists the proportion of total comprehensive crash costs that each BAC level represents. Alcohol is involved in crashes that account for 14 percent of the societal harm of PDO crashes, 20 percent of the harm that result from nonfatal injuries, and 45 percent of the harm that result from fatalities. All alcohol involved crashes are responsible for 28 percent of total societal harm from motor vehicle crashes, but crashes with BAC>=.08 are responsible for 85 percent of this or 24 percent. The impact of alcohol-involved crashes on overall costs is thus higher than would be indicated by the alcohol-involved incidence rates. Overall, alcohol involved crashes cost $243 billion in comprehensive societal costs in 2010, with 85 percent of this or $207 billion, occurring in crashes where the highest BAC was >=.08.
Table 7-12. Total Comprehensive Costs by BAC Level (Millions of 2010 Dollars)
BAC= 0 BAC=.01-.04 BAC=.05-.07 BAC>=.08 BAC=.01+ Total
PDO $61,325 $1,318 $628 $8,209 $10,155 $71,480
MAIS0 $11,179 $240 $114 $1,496 $1,851 $13,030
MAIS1 $133,586 $2,872 $905 $11,829 $15,606 $149,192
MAIS2 $122,842 $2,641 $1,742 $22,776 $27,158 $150,001
MAIS3 $80,593 $1,733 $1,900 $24,845 $28,477 $109,070
MAIS4 $32,241 $693 $758 $9,902 $11,353 $43,594
MAIS5 $19,783 $424 $882 $11,560 $12,866 $32,649
Fatal $166,673 $10,163 $8,713 $116,259 $135,136 $301,809
T otal $628,223 $20,084 $15,642 $206,876 $242,602 $870,826
% Total Alcohol Costs NA 8.28% 6.45% 85.27% 100.00% NA
% Total 72.14% 2.31% 1.80% 23.76% 27.86% 100.00%
163
Table 7-13. Percent of Comprehensive Injury Costs by Alcohol Involvement Rate
BAC= 0 BAC=.01-.04 BAC=.05-.07 BAC>=.08 BAC=.01+ Total
PDO 85.79% 1.84% 0.88% 11.48% 14.21% 100.00%
MAIS0 85.79% 1.84% 0.88% 11.48% 14.21% 100.00%
MAIS1 89.54% 1.92% 0.61% 7.93% 10.46% 100.00%
MAIS2 81.89% 1.76% 1.16% 15.18% 18.11% 100.00%
MAIS3 73.89% 1.59% 1.74% 22.78% 26.11% 100.00%
MAIS4 73.96% 1.59% 1.74% 22.71% 26.04% 100.00%
MAIS5 60.59% 1.30% 2.70% 35.41% 39.41% 100.00%
Fatal 55.22% 3.37% 2.89% 38.52% 44.78% 100.00%
T otal 72.14% 2.31% 1.80% 23.76% 27.86% 100.00%
Alcohol Crash Causation:
Inebriated drivers often experience impaired perceptions that can lead to risky behavior such as speeding, reckless driving, and failure to wear seat belts. They also experience reduced reaction times, which can make it more difficult for them to perform defensive safety maneuvers. As a result, there is a general tendency to equate the presence of alcohol with crash causation. However, there are clearly some instances in which crashes would occur regardless of whether the driver had consumed alcohol. For example, if a distracted texting driver were to run into a driver with a positive BAC who was stopped at a red light, a police investigation or medical records might record that the struck driver had a positive BAC, even though that driver was not at fault. In this case, the crash would be recorded as alcohol- involved, even though alcohol was not a causative factor.
Miller, Spicer and Levy (1999) estimated the percentages of alcohol-related crashes that are actually attributable to alcohol. In this study they examined the probability of crash involvement for drivers based on their BAC level and then removed the normal risk of crash involvement without alcohol from the overall risk found for drivers with positive BACs. Their study found that 94 percent of crashes at BACs of .10 or higher, and 31 percent of crashes with positive BACs less than .10, were actually caused by alcohol. The remaining crashes were due to bad weather, poor road conditions, non-drinking drivers, etc. Currently .08 BAC is considered to be the definition of “illegal per se” alcohol impairment rather than 0.10. More recently, Blomberg et al. (2005) examined the relative crash risk of drinking and non- drinking drivers. The methods and results of this study were discussed previously (see Figure B above). Table 6 displayed the relative risk for various BAC categories that were derived from Blomberg and colleagues’ BAC specific risk factors. These factors can be used to estimate the incidence of crashes where alcohol consumption actually contributed to the crash occurrence across the various BAC groupings examined in this report. These proportions were estimated as the ratio of the added risk in an alcohol involved crash to the total risk in this crash. Specifically:
y=(r-1)/r
where: y = proportion of BAC + crashes that are attributable to alcohol. r= relative risk ratio of specific BAC category
Table 7-14 and Figures 7-E and 7-F illustrate the results of this process. The second to the last row in Table 7-14 lists the relative risk calculated from data in Dunlop, while the last row lists the proportion of injuries in each BAC category that are attributable to alcohol. Roughly 6 percent of BAC = .01-.04 injuries, 40 percent of BA = .05-.07 injuries, and 94 percent of BAC>= .08 injuries are attributable to alcohol. The increasing proportions are expected since higher BAC levels cause more inebriation, with its associated reduction in awareness and motor skills. Overall, about 79 percent of injuries from crashes recorded as alcohol-involved can be attributed to alcohol as a causative factor. This is roughly the same percentage calculated in Blincoe et al., 2002 (80.8 percent), which was based on the earlier Miller, Spicer, and Levy analysis. Alcohol thus appears to be a causative factor in roughly 80 percent of cases coded as alcohol-involved, but is irrelevant to crash causation in the other 20 percent of cases.
Table 7-14. Injuries Attributable to Alcohol Use by BAC Level
Injury severity BAC=.01-.04 BAC=.05-.079 BAC>=.08 BAC=.01+
PDO 20,688 64,529 2,007,336 2,092,553
MAIS0 5,123 15,977 497,007 518,107
MAIS1 4,063 7,723 240,257 252,043
MAIS2 366 1,458 45,346 47,169
MAIS3 99 649 20,180 20,928
MAIS4 17 113 3,524 3,654
MAIS5 5 57 1,783 1,845
Fatal 61 341 10,825 11,226
T otal 30,421 90,846 2,826,257 2,947,525
Relative Risk 1.0645 1.6581 17.9870 4.7477
% Attributable to Alcohol 6.06% 39.69% 94.44% 79.16%
To estimate the economic cost of crashes actually attributable to alcohol, the incidence from Table 7-14 was combined with the unit costs from Tables 7-7 and 7-8. The results, summarized in Table 7-15, indicate that alcohol causes crashes that result in roughly $49 billion in economic costs annually. This accounts for 82 percent of the crash costs associated with crashes that are considered alcohol-involved.
It represents 18 percent of all crash costs (including those without alcohol involvement), accounting for 11 percent of PDO costs, 14 percent of nonfatal injury costs, and 40 percent of fatality costs.
Table 7-15. Economic Crash Costs Attributable to Alcohol Use by BAC Level (Millions of 2010 Dollars)
Injury severity BAC=.01-.04 BAC=.05-.079 BAC>=.08 BAC=.01+ Total
PDO $80 $249 $7,752 $8,081 $71,480
MAIS0 $15 $45 $1,413 $1,473 $13,030
MAIS1 $80 $168 $5,239 $5,488 $68,797
MAIS2 $37 $159 $4,956 $5,152 $34,537
MAIS3 $27 $190 $5,907 $6,124 $27,905
MAIS4 $8 $61 $1,889 $1,958 $8,781
MAIS5 $5 $65 $2,012 $2,082 $6,327
Fatal $100 $562 $17,838 $18,500 $46,163
T otal $352 $1,499 $47,007 $48,858 $277,020
% of Total Alcohol Involved Costs Attributable to Alcohol 6.06% 39.69% 94.44% 82.31%
% of Total Costs Attributable to Alcohol 0.13% 0.54% 16.97% 17.64%
Table 7-16. Percent of Total Economic Costs Attributable to Alcohol
Injury
severity BAC=.01-.04 BAC=.05-.079 BAC>=.08 BAC=.01+
PDO 0.11% 0.35% 10.85% 11.31%
MAIS0 0.11% 0.35% 10.84% 11.30%
MAIS1 0.12% 0.24% 7.62% 7.98%
MAIS2 0.11% 0.46% 14.35% 14.92%
MAIS3 0.10% 0.68% 21.17% 21.95%
MAIS4 0.10% 0.69% 21.51% 22.30%
MAIS5 0.08% 1.02% 31.80% 32.90%
Fatal 0.22% 1.22% 38.64% 40.08%
T otal 0.13% 0.54% 16.97% 17.64%
To estimate the comprehensive cost of crashes actually attributable to alcohol, the incidence from Table 7-14 was combined with the unit costs from Tables 7-7 and 7-8. The results, summarized in Table 7-17 and 7-18, indicate that alcohol causes crashes that result in roughly $199 billion in comprehensive societal costs annually. This accounts for 82 percent of the comprehensive crash costs associated with crashes that are considered alcohol-involved. It represents 23 percent of all crash costs (including those without alcohol involvement, accounting for 11 percent of societal harm from PDOs, 16 percent of harm from nonfatal injuries, and 37 percent of harm from fatalities.
Table 7-17. Comprehensive Crash costs Attributable to Alcohol Use by BAC Level (Millions of 2010 Dollars)
Injury severity BAC=.01-.04 BAC=.05-.079 BAC>=.08 BAC=.01+ Total
PDO $80 $249 $7,752 $8,081 $71,480
MAIS0 $15 $45 $1,413 $1,473 $13,030
MAIS1 $174 $359 $11,171 $11,705 $149,192
MAIS2 $160 $691 $21,509 $22,361 $150,001
MAIS3 $105 $754 $23,463 $24,323 $109,070
MAIS4 $42 $301 $9,351 $9,694 $43,594
MAIS5 $26 $350 $10,918 $11,293 $32,649
Fatal $616 $4 $109,796 $110,416 $301,809
T otal $1,217 $2,754 $195,374 $199,346 $870,826
% of Total Alcohol Involved Costs Attributable to Alcohol 6.06% 17.61% 94.44% 82.17%
% of Total Costs Attributable to Alcohol 0.14% 0.32% 22.44% 22.89%
Table 7-18. Percent of Total Comprehensive Costs Attributable to Alcohol
Injury
severity BAC=.01-.04 BAC=.05-.079 BAC>=.08 BAC=.01+
PDO 0.11% 0.35% 10.85% 11.31%
MAIS0 0.11% 0.35% 10.84% 11.30%
MAIS1 0.12% 0.24% 7.49% 7.85%
MAIS2 0.11% 0.46% 14.34% 14.91%
MAIS3 0.10% 0.69% 21.51% 22.30%
MAIS4 0.10% 0.69% 21.45% 22.24%
MAIS5 0.08% 1.07% 33.44% 34.59%
Fatal 0.20% 0.00% 36.38% 36.58%
T otal 0.14% 0.32% 22.44% 22.89%

Behavioral/Psychological:
Article-3A
From the brain to bad behavior and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol.

Abstract
Driving while impaired by alcohol (DWI) is responsible for substantial mortality and injury. Significant gaps in our understanding of DWI re-offending, or recidivism, reduce our ability to practically assess recidivism probability and to match interventions to individual risk profiles. These shortcomings reflect the baffling heterogeneity in the DWI population and the limited focus of much existing DWI recidivism research to psychosocial, psychological and substance use correlates. Approach. This narrative review summarizes the evidence for the contribution of neurocognitive and psychobiological mechanisms to DWI behavior and recidivism. Given the nascent nature of this literature, insight into the putative contribution of these mechanisms to DWI is also drawn from other experimental literatures, particularly those on alcohol use disorders and cognitive and behavioral neuroscience. Key Findings. Alcohol-related neurotoxicity and dysregulation of hypothalamic– pituitary– adrenal axis and serotonergic systems may underlie certain offender characteristics consistently correlated with heightened DWI risk, persistence and intervention resistance. Their markers are less vulnerable to sources of bias than subjective psychosocial indices and are more far-reaching than alcohol abuse in explaining DWI behavior and recidivism. Implications. The investigation of neurocognitive and psychobiological mechanisms in DWI research is a promising avenue for discerning clinically meaningful subgroups within the DWI population. This can lead to research and development in alternative assessment and more targeted intervention technologies. Conclusion. Multidimensional research in DWI and recidivism offers novel avenues for increasing road safety.[Brown TG, Ouimet MC, Nadeau L, Gianoulakis C, Lepage M, Tremblay J, Dongier M. From the brain to bad behaviour and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol. Drug Alcohol Rev 2009;28:406–418] [ABSTRACT FROM AUTHOR]

BROWN, T. G., OUIMET, M. C., NADEAU, L., GIANOULAKIS, C., LEPAGE, M., TREMBLAY, J., & DONGIER, M. (2009). From the brain to bad behavior and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol. Drug & Alcohol Review, 28(4), 406-418. doi:10.1111/j.1465-3362.2009.00053.x
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Full text
Introduction
Driving while impaired by alcohol (DWI) has significant individual, social, health and economic consequences. In the USA, traffic crashes are the leading cause of death for people aged 1 to 33 years, with alcohol being implicated in 41% (i.e. 17 419 deaths) of all fatal crashes in 2002. In 2003, 2800 Canadians died, and 17 000 suffered serious, often disabling injuries from motor vehicle crashes [3]. Over one-third of these fatalities were associated with DWI. Although the overall rate of North American DWI convictions declined significantly in the 1980s and 1990s through a variety of measures, recent trends suggest an upturn. Similar trends are found in other countries.
The consensus among highway safety advocates and public health professionals is that a conviction for DWI provides a singular opportunity to identify individuals at high risk to re-offend and to match them to appropriate treatment. Nevertheless, practical accomplishment of this objective has been elusive. The DWI offender population is markedly heterogeneous in its characteristics, and members fall on a continuum of risk from first-time offenders unlikely to re-offend to those who persistently drink and drive and are resistant to deterrent and remedial measures. Disentangling this heterogeneity, and its meaning to the risk of re-offending, has been problematic.
Methodological and conceptual challenges limit the ability of research to provide evidence-informed procedures to reliably differentiate between high- and low- risk offenders. One methodological concern involves sampling. Studies typically involve convicted DWI offenders in remedial programs. Although convenient, this recruitment strategy is highly sensitive to local, legal and geographic dispositions regarding DWI intervention. It also fails to sample from two important subgroups who together account for the majority of drivers in the DWI population, namely those who drive impaired but are not caught and convicted, and those who, following a conviction, fail to participate in remedial programs to reacquire a license.
The use of DWI arrest and conviction as dependent or independent variables is another methodological concern. The likelihood of a DWI arrest and conviction can be influenced by multiple factors. These include existing criminal and traffic safety laws [e.g. legal blood alcohol concentration (BAC) levels] that may differ substantially between jurisdictions, geographic factors (e.g. rural vs. urban settings), availability of public transportation, police presence and law enforcement, apprehension modalities (e.g. erratic driving, random breath testing, road checkpoints), prosecution and effectiveness, and socioeconomic factors that could determine access to competent legal representation. These potential sources of bias are tangentially related to the risk of impaired driving and complicate comparisons between studies.
Data validity is also problematic. Self-report measures are highly susceptible to distortion, especially when collected in the often adversarial environment of DWI assessment and enforcement. This has led to interest in biological measures of problem drinking as an alternative to self-report data. High BAC level at the time of arrest has been posited as an indicator of a hardcore offender, but its causal and predictive significance is uncertain. Indices, such as g- glutamyltransferase, carbohydrate-deficient transferase, aspartate aminotransferase, alanine aminotransferase and mean corpuscular volume have been proven useful for detecting the organic alterations related to alcoholism. However, alcohol’s role in DWI is distinct from its role in alcoholism. Biomarkers of severe alcohol abuse reflect a statistically significant correlate of DWI rather than a clear causal factor or reliable predictor. It is noteworthy that results from the 2006 Behavioral Risk Factor Surveillance System indicated that 84% of impaired drivers were binge drinkers, 88% of all impaired driving episodes involved binge drinking, and almost half of all impaired driving episodes involved non-heavy drinkers. These findings have been corroborated internationally. Moreover, the sensitivity of biomarkers drops drastically in individuals who are younger and exhibit less severe drinking patterns, characteristics frequently observed in first-time offenders.
An additional challenge in the DWI research is conceptual. A number of established models (e.g. criminal justice and addiction models) in the DWI field have focused the research on individual psychosocial and psychological factors to explain and predict DWI behavior and recidivism, as well as to guide intervention efforts. The findings emerging from this body of work indicate that DWI and/or recidivism status are associated with male sex, greater alcohol abuse severity and dependence, more drug abuse problems, greater hostility, sensation seeking and psychopathic deviance, more psychosocial dysfunction and disrespect for laws, sanctions and legal authorities, family history of alcoholism and more frequent engagement in other risky driving behaviors, including driving with a suspended license.
Despite these characteristics’ statistically significant relationship to DWI, their contribution to our understanding of persistent DWI and our ability to predict risk is weakened by factors other than the methodological limitations noted above. These include: (i) the heterogeneity of the DWI population, especially in the first-time offender subgroup; (ii) the limited contribution of individual characteristics to DWI-related variability; and (iii) poor understanding of how certain individual characteristics aggregate to better explain vulnerability, risk and treatment outcome. Consequently, it is not surprising that although the ‘best’ assessments show sufficient sensitivity to correctly predict approximately 70% of recidivists, their specificity, at approximately 40% (i.e. 60% false–positive rate), is too low to be considered dependable. The inability to discern characteristics that reliably differentiate DWI risk may also contribute to the modest impact of contemporary intervention strategies. Depending on the jurisdiction, offenders receive either uniform interventions or specific intervention regimens based upon criteria with little established discriminative power. This has led some authorities [30] to conclude that current understanding of DWI still fails to account for the fundamental contributory processes, such as cognitive and psychiatric factors, which could lead to more effective assessment and intervention.
An alternate position is that correlates of DWI cluster in ways that could serve to discriminate meaningful subtypes within the DWI population. From this perspective, the key features that characterize a particular subtype all share a common underlying mechanism that, in turn, could more fundamentally explain DWI risk, persistence and intervention effectiveness. In the study of alcoholism, probing putative genetic, biological and cognitive mechanisms has advanced knowledge concerning the nature of heterogeneity in the alcoholism population, as well as the clarification of clinically meaningful subtypes at which more targeted interventions may be directed. Consistent with this purview, several investigations have approached DWI from biological and genetic viewpoints.
This review considers the evidence for putative neurocognitive and psychobiological models of DWI behavior, particularly persistent DWI. We use a narrative synthesis approach [48], based mostly upon the published English language, peer-reviewed literature, to summarize the evidence for the influence of these mechanisms on DWI behavior. We limit the scope of this review to alcohol-impaired driving and relevant findings from more mature, parallel literature (e.g. that on alcohol use disorders). Driving under the influence of other drugs is a growing concern and relevant to several topics addressed here. Nevertheless, we espouse a more narrow focus on alcohol-impaired driving because the drug-driving research is controversial, often contradictory, and complicated by multiple conceptual and methodological issues beyond the scope of this review [49]. Next, we consider what implications this broadened purview might hold for our understanding of recidivism and for advancing our capacity for accurate assessment, prediction and intervention. Finally, in broad strokes, we outline the implications of the findings for future multidimensional research in the field.
The neuropsychology of DWI
Driving while impaired by alcohol offenders pose a significant risk for crashes and injury and face substantial consequences. For recidivists in particular, these can include social sanctions, fines of several thousands of dollars, loss of license, incarceration and mandated participation in evaluation and intervention programs.
Why, then, do some DWI offenders just not seem to understand and go on to recidivate? A driver’s ability to regulate behavior, exercise appropriate decision making in potentially risky contexts and learn from past experience is essential to safe driving. Indeed, cognitive decline associated with Alzheimer’s disease and other sources of brain damage has been consistently linked to driving competence and elevated crash risk. Moreover, alcohol-related cognitive deficits have been associated with the potential to benefit from psycho- therapeutic intervention. This section reviews the evidence concerning cognitive functioning in DWI offenders.
The available data suggest that some DWI offenders exhibit significant cognitive impairment. An early study [62] found that 57% of offenders produced test scores indicative of memory problems, compared with 21% in normative samples. A more recent study [63] found that 73% of 134 recidivists attending a court-mandated resi- dential program showed impairments in one or more cognitive areas. Notably, recidivists performed more poorly than normative groups on tasks of memory and executive function. Executive functioning is involved in higher-level cognitive processes required for the forma- tion of successful goal-directed behavior, including planning and initiation, anticipation of consequences of actions and the ability to adjust behavior based upon environmental feedback (i.e. decision making).
Cross-sectional work by our research group corroborated these findings. We found that, in a community-recruited sample of sober (when tested) DWI offenders with from two to eight convictions, approximately 70% exhibited impairment on at least one index of neurocognitive capacity. These impairments occurred mostly in problem solving, cognitive flexibility, working memory and visuospatial tasks. We also found that declines in memory and visuospatial abilities were associated with greater frequency of past DWI offences. When combined, these two variables accounted for an additional 19% of variance in DWI frequency, independent of age, education and years of driving experience. The findings are consistent with the hypothesis that increased recidivism risk is influenced by impairment severity in these cognitive domains. In contrast to the study of Glass et al. [63], however, we detected little evidence of a relationship between DWI frequency and impulsivity, a feature commonly attributed to recidivists, despite using more specific measures of this characteristic. Discrepancies in the findings could be attributable to methodological differences between studies, including sampling, the specific neurocognitive domains assessed and the measures employed. Moreover, both studies leave unclear the causal relationship of cognitive impairment to DWI or the persistence of deficits observed in this population.
How might deficits arise in DWI offenders? The most obvious mechanism involves consequences of alcohol abuse. Ouimet et al. found significant inverse relationships between several cognitive abilities and self- reported and biological measures of severe alcohol abuse. Although transient cognitive impairments with alcohol misuse are predictable, ample evidence shows that individuals with a history of alcoholism show impairment in neurocognitive performance long after alcohol use cessation. In particular, impairments have been found in visuospatial abilities, declarative memory, language skills, motor and perceptual abilities and executive functions. At the same time, not all DWI offenders are alcohol- dependent. Hence, the observed deficits in DWI offenders in the above studies may reflect transient consequences (e.g. being hung-over) of recent episodic binge drinking in some, and/or more lasting con- sequences of alcohol misuse in others. In addition, compared with alcohol-dependent individuals, DWI recidivists have been observed to report twice the frequency of alcohol-related physical trauma [78].Thus, it is plausible that head injury could also contribute to cognitive impairments in some offenders.
DWI offenders’ vulnerability to cognitive deficits may have genetic origins. Normal neurodevelopment in adolescence can be easily disrupted with even sporadic episodes of excessive alcohol consumption. Genetic risk for binge drinking in adolescents, and consequently the high BAC associated with brain neurotoxicity may be transmitted both biologically (e.g. inheritance of immunity to alcohol’s sedative effects) [83] and socially (e.g. being raised in an environment in which heavy drinking frequently occurs). In DWI, the potential contribution of both biological and social genetics to DWI risk is supported by data linking the early onset of problem drinking to a greater probability of DWI and recidivism in adulthood.
The pathways linking cognitive functioning to specific behavioral outcomes like DWI are complex and multidirectional, and likely operate through the mediating and moderating interactions between deficits and individual and environmental factors. Several scenarios are plausible. The most obvious one is that cognitive integrity essential for appropriate decision making and safe driving behavior will be acutely impaired by alcohol intoxication. Hence, consistent with the addiction model of DWI, the more frequently an individual with access to a motor vehicle experiences acute alcohol intoxication, the greater the risk of DWI.
At the same time, the evidence summarized previously suggests that executive functioning and memory and visuospatial impairments appear most associated with recidivism in DWI offenders. Occasions where drinking and driving may be coupled in time present a challenge for executive functioning, requiring individuals to inhibit behavior that is high-risk, but rewarding (i.e. a night out of heavy drinking), choose between riskier and safer courses of action (e.g. driving impaired or finding alternate means of transportation) or anticipate the potential for DWI and its negative consequences. Working memory deficits in particular may impair appropriate decision making by, for example, making less salient signals more difficult to keep in mind than highly salient signals. From this perspective, in a decision-making context preceding a drink-driving opportunity, a high salience signal (e.g. the immediate benefits of driving to and from a drinking venue) would take precedence over a low salience signal (e.g. the unknown probability of experiencing negative consequences associated with a highly unlikely DWI arrest). Decision making in situations in which the probability of a specific outcome (i.e. an arrest for DWI) is small or unknown appears most susceptible to working memory deficits [89]. Because visuospatial abilities are so vital to driving, deficits in this area could further contribute to poorer driving performance, crashes and arrests. Finally, deficits in executive function and visuospatial abilities, and the accompanying DWI risks, will be compounded by acute drinking.
Interactions between neurocognitive capacities, personality and situational factors may also influence DWI behavior. Research into the neurogenetics of alcoholism has posited a typological structure, Type II alcohol- ism, characterized by male sex, early onset of alcohol abuse, antisocial and disinhibited personality traits, executive functioning deficits, sensation seeking and a more chronic and refractory course. The structural and functional brain anomalies that contribute to these behaviors are likely inherited and thus predate alcohol use. One study has showed a putative mechanism between Type II alcoholism and behavioral disinhibition deficits. Finn et al. found that on a version of the Go/NoGo task, a test that measures impairments in learning to inhibit previously rewarded responses, individuals with early onset alcohol dependence and conduct disorder had greater difficulty learning to inhibit their performance to avoid aversive and non-aversive punishments, compared with controls and alcohol-dependent individuals without conduct disorder. This research is pertinent to persistent DWI, in that the Type II cluster of characteristics bears close resemblance to that found in persistent DWI offenders. Certain contexts could pose additional challenges for neurocognitive functioning. For example, competent self-control, planning and memory might be of critical importance to successfully negotiate rural settings where public transportation alternatives are lacking, or situations where normative social rules concerning DWI are more permissive.
Neurobiological mechanisms of DWI 409
Recidivism may signify refractoriness to current DWI remedial measures. Poorer cognitive performance has been associated with inferior outcomes from alcoholism and substance abuse intervention in adults and adolescents, as well as with treatment attrition. A recent study by our research group provided evidence of linkage between cognitive functioning and treatment engagement in DWI. We found that offenders who chose not to participate in DWI countermeasure programs for significant periods had poorer cognitive function on several dimensions compared with offenders who had not delayed. Of particular note, poorer performance on a Go/NoGo task contributed significantly to prediction of non- engagement status, a finding consistent with those of Finn et al. above. Individuals with poor performance on this task have difficulty in delaying immediate gratification.
These findings may explain why non-involvement or significant delay in engagement in DWI remedial pro- grams is so widespread, with rates as high as 80% in some jurisdictions Engagement in DWI remedial programs requires, among other capacities, inhibiting immediate gratification associated with nonparticipation in DWI remedial programs (e.g. drive without a license, and/or avoid significant cost and effort by not participating), while choosing to experience immediate negative consequences associated with participation (i.e. payment of all fines and costs, full compliance with effortful and difficult behavioral change) in order to attain a positive consequence (i.e. relicensing) that may only be realized a year or two later. In sum, there may be an important disconnect between certain DWI remedial strategies and the neurocognitive characteristics of many DWI offenders.
A recent investigation in alcohol abuse addressed the influence of neurocognitive performance on another aspect of treatment outcome. Using semantic and procedural learning tasks, Pitel et al. found that alcohol-dependent individuals had more difficulty in acquiring complex, novel information compared with controls. In addition, alcohol-dependent individuals employed less efficient, more cognitively demanding strategies that activated inappropriate brain systems, indicating functional reorganization. These findings suggest that the ability to acquire new coping strategies for dealing with alcohol misuse in treatment (e.g. anticipation and avoidance of high-risk drinking triggers, drink refusal skills) may also depend to some degree on the level of cognitive impairment.
Sex effects
Given the greater prevalence of DWI in men compared with women, and the similarities in the characteristics associated with DWI recidivism and Type II male pattern alcoholism, it is tempting to speculate whether sex effects in neurocognitive functioning could be relevant to DWI behavior as well. Sex differences in alcohol’s effect on the organism are well-documented. Women, compared with men, show accelerated deterioration in the liver, heart and muscles, as well as in psychosocial and psychiatric functioning, after consuming smaller volumes of alcohol for shorter periods of time.
Sex effects have also been observed in the pattern of vulnerability to alcohol neurotoxicity of specific brain functions and structures. Compared with alcohol- dependent men, alcohol-dependent women show poorer performance on tests of visuospatial abilities, verbal and non-verbal working memory, motor control [98] and perceptual and visual planning [99]. Interestingly, in one study, relative preservation of executive functioning was found in women compared with men. Women also show greater susceptibility to psycho- motor impairment at lower BAC following alcohol consumption in specific driving-related competencies (e.g. reaction to visual stimuli, manual dexterity).This observation has been corroborated in more naturalistic driving contexts, in which crash risk was higher at BAC 0.05% in women compared with men, and the highest fatality odds were associated with female sex and BAC greater than 0.30%.
Recent neuroimaging studies, although few in number, have corroborated these findings [102]. Greater reductions have been observed in hippocampal and cortical volumes in alcohol-dependent women compared with non-alcohol-dependent controls, and alcohol-dependent men with longer drinking histories. These anomalies may normalize to some extent with extended abstinence, although some alterations appear to persist. Although these studies indicate that alcohol’s impact may be sex-specific, the neurobiological substrates of these differences are less certain. One hypothesis is that the lower concentrations of alcohol-metabolizing enzymes in the gastrointestinal tract and lower body water content in women lead to higher BAC compared with men at similar levels of alcohol consumption.
Sex differences in the trajectory to DWI may be influenced by neurocognitive factors. Women, com- pared with men, tend to exhibit safer driving behaviors in general. DWI in women has been observed to more frequently involve alcohol misuse, whereas DWI in men has more often been linked to a generalized pattern of risky behaviors associated with executive capacities, including seatbelt non-use, speeding and smoking [105,106]. A similar pattern has been observed in simulated driving conditions under which men were more likely than women to engage in
© 2009 Australasian Professional Society on Alcohol and other Drugs
dangerous driving and risk taking after consuming alcohol [107].
Preliminary data we have collected [108] support the neurocognitive underpinnings for these differences in DWI behavior. In a sample of female DWI offenders (n = 27), 82% exhibited impaired performance on at least one test, particularly in visuospatial abilities and working memory. However, higher executive functions of planning and problem solving appeared relatively preserved. These early findings, with the other behavioral observations noted above, suggest that executive functioning deficits are less influential in female offenders than in male offenders. Moreover, in light of the added risk male sex poses for DWI, executive functioning may play a particularly important role in overall DWI risk, not only by impairing planning and decision-making capacities, but also by contributing to behavior that is more likely to result in detection and arrest (e.g. risk-taking driving behavior).
In conclusion, neurocognitive deficits have been observed in DWI offenders. These impairments may contribute to several behavioral pathways to DWI. Acute alcohol misuse results in predictable, transient impairments in cognitive abilities and driving performance. Hence, more frequent impairment in these areas resulting from repeated drinking is a pathway consistent with a predominant role of alcoholism in some offenders (i.e. the addiction model of DWI). In contrast, alcohol’s effects on the brain are highly variable and based upon multiple factors, including inherited vulnerability, age of onset of problem use, pattern of use, current drinking status and sex. The contribution of neurocognitive features to DWI is also likely to involve complex interactions with psychosocial, psycho- logical and substance use variables associated with DWI behavior. These may include access to a vehicle and the need or desire to drive, acute alcohol impairment, sex-based behavioral patterns, risk-taking and impulsive personality tendencies and exposure to situations in which effective decoupling of alcohol- impaired driving and intervention benefits may challenge higher-order cognitive capacities.
The psychobiology of DWI
Several lines of evidence indicate that hormonal and neurotransmitter systems influence the genesis and maintenance of alcoholism. The hypothalamic– pituitary–adrenal (HPA) axis and serotonergic systems are two such conduits. This section reviews the evidence of how these systems may also play a role in DWI risk.
Activation of the HPA axis occurs with exposure to physiological and psychological stressors, such as cold, pain and anxiety- or fear-provoking experiences. In humans, the major hormones of the HPA axis are corticotropin releasing hormone (CRH), adrenal corticotropic hormone and cortisol. CRH is synthesized and released in the hypothalamus by neurons of the paraventricular hypothalamic nucleus. CRH is trans- ported to the anterior pituitary and stimulates the release of adrenal corticotropic hormone, which in turn stimulates the synthesis and release of cortisol by the adrenal cortex. Dysregulation in HPA axis function may result from heavy drinking and alcoholism, among other factors, and may persist long after alcohol use cessation. Specifically, alcohol-dependent individuals exhibit higher basal plasma cortisol levels and blunted (i.e. reduced) cortisol responses to exogenous CRH administration and to both physiological and psychological stressors.
HPA axis dysregulation may contribute to increased alcohol intake. It may heighten experiences of anxiety and craving and increase alcohol’s reinforcing effects through cortisol’s modulation of mesolimbic dopaminergic transmission. These effects may contribute to a more intervention refractory pattern of problem drinking. Moreover, blunted reactivity has been observed in the nondrinking children of alcohol-dependent parents, signifying that HPA axis dysregulation, and the added vulnerability it contributes for alcohol abuse, may be an inherited trait. Besides its role in alcohol abuse, HPA axis dysregulation, specifically reduced cortisol reactivity, is manifested in behaviors often co-occurring with alcohol abuse, including lowered fear reactivity, aggression and impulsive behaviors and psychopathic personality traits. Similarly to cortisol response, reduced platelet monoamine oxidase (MAO) levels have been associated with features consistent with severer forms of alcoholism (i.e. Type II), including impulsive personality problems, sensation seeking and aggression.
Because both DWI recidivism and HPA axis dysregulation share certain behavioral features, our research group explored whether HPA axis activity could be a psychobiological marker of DWI risk. In a preliminary study [134], we collected salivary cortisol, a readily available index of HPA axis activity, from a sample of 104 male DWI offenders at 30 min intervals during a taxing 6 h sociodemographic, neurocognitive and psychological assessment that also involved venous puncture and urine testing. Among repeated DWI offenders (n = 62), a significant inverse relationship emerged between cortisol response and past frequency of DWI convictions, with cortisol response accounting for approximately 18% of the variance in DWI frequency (r = -0.42, P 0.005).This relationship was more powerful than all of the self-reported psychosocial (i.e.
Neurobiological mechanisms of DWI 411
Michigan Alcoholism Screening Test, Drug Abuse Screening Test, Alcohol Use Disorders Identification Test, Mortimer-Filkens Questionnaire) and biological (e.g. g-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, mean corpuscular volume) assessments of problem drinking that we employed, and that are commonly used in clinical alcohol and DWI screening protocols. Not surprisingly, cortisol response was also negatively correlated to certain drinking measures. Nevertheless, once the variance associated with age and alcohol abuse severity were accounted for, cortisol response still significantly contributed 9% of unique variance to DWI frequency, or 25% of the total variance accounted for by the model.
A follow-up study, incorporating a standardized psychosocial stress paradigm and a non-DWI driver comparison group, confirmed the robustness of these initial findings, as well as their specificity to DWI offenders. They simultaneously shed light on what behavioral pathway to DWI HPA axis dysregulation could signify, other than alcohol abuse. A significant inverse relationship was found between cortisol response and experience seeking from the Sensation- Seeking Scale, a finding previously observed in DWI offenders, as well as in other non-alcohol- dependent populations in which risk taking is prevalent (e.g. college students) [138,139]. As such, these find- ings provide a psychobiological basis for long-standing hypotheses concerning the role of sensation seeking as an underlying feature in male DWI.
It is noteworthy that much of the research into the HPA axis related to alcohol abuse has been conducted in men. Cortisol is highly susceptible to female hormonal cycles, which are difficult to experimentally account for. However, other investigation suggests that the linkage between HPA axis dysregulation and risk-taking behavior may not readily extend to women. Given putative links between sex differences in DWI and those in alcohol-related neurocognitive capacities, it is plausible that these differences may extend to psychobiological processes as well. Additional studies on psychobiological mechanisms in female DWI, although methodologically more demanding, are required.
To our knowledge, there is only one other set of published reports on a psychobiological mechanism of DWI risk. Specifically, it explored platelet MAO activity as a peripheral marker of serotonergic activity. Lower levels of platelet MAO were found in DWI offenders compared with non-DWI controls, along with indicators of impulsive and risk-taking and sensation-seeking characteristics. Hence, the investigators concluded that the lower platelet MAO level observed in drunk drivers indicated increased propensity to possess impulsive personality traits.
In sum, findings from two lines of research suggest that specific hormonal markers differentiate between DWI offender and non-DWI populations. Moreover, in the case of cortisol responses, the magnitude of attenu- ation is associated with frequency of DWI, an indica- tion of DWI persistence as well as of intervention resistance. Both cortisol and MAO activity are non- specific markers of behavioural risk. Rather, they may act through multiple behavioural pathways to increase DWI risk. These pathways include: (i) acute, chronic and severe alcohol abuse; (ii) inherited and more intrac- table alcohol abuse; (iii) impulsive personality features; (iv) risk-taking and sensation-seeking characteristics; and (v) reduced arousal to situations (e.g. a crash or near-crash situation) that usually provoke strong nega- tive emotions (e.g. fear and anxiety) in others. Along with increasing risk of DWI, these characteristics could in some individuals weaken the basis upon which current preventative and deterrent measures are based, namely the effectiveness of deterrent measures based on fear of consequences and psychosocial interventions for substance abuse.
Implications
The addition of neurocognitive and psychobiological analyses promises to broaden the scope of DWI research and intervention as it has done in other health areas. Methodologically, psychobiological and neuropsychological measures avoid the shortcomings inherent in self-report and other subjective, more distal behavioral indicators upon which most of our current knowledge of DWI offenders is based. Conceptually, such measures come closer to the underlying genetic and biological substrates of individual behavioral differences. In alcoholism, linking differences on a genetic level to those on a functional neurological level, and ultimately to individual behavioral outcomes, is being promoted as a way to elucidate clinically meaningful phenotypes and develop targeted interventions [142]. This approach also seems relevant to DWI.
We have considered these mechanisms in isolation from one another. We did so because of the embryonic stage of the research; there is simply a lack of data on possible interactions between these two systems in DWI offenders. Nevertheless, the notion that multiple mechanisms influence behavior and may act on each other is inescapable. For example, strands of evidence from the aging research suggest that cortisol and other stress-related glucocorticoid hormones cross the blood–brain barrier. Over time, these hormones can negatively impact brain structures involved in memory and learning, such as the hippocampus, the frontal lobes and amygdala, and further complicate age-related cognitive decline. Advances in this area by neuroscience research are also relevant to DWI research.
We now turn to a discussion of the practical implications of this research in DWI assessment and intervention, and for future exploration.
Assessment
Neurocognitive health is an obvious facet of one’s ability to drive safely. Some investigators argue for neurocognitive evaluation to validate the assessment of an individual’s fitness to drive, an assessment typically in the form of a physician’s clinical examination. The neurocognitive ‘fitness to drive’ approach has focused primarily on neurodegenerative conditions, such as Alzheimer’s disease. Nevertheless, chronic neurocognitive impairments because of alcohol, drugs and psychoactive prescription medication use seem reasonable targets for evaluation as well. Although this may be feasible in the most extreme cases of impairment, not enough is yet known concerning the precise cognitive capacities required for safe driving, although the real-time imaging studies of driving are promising in this regard. More research is needed to investigate the link between neurocognitive capacities and driving-related competencies and to prospectively appraise the predictive value of neurocognitive indicators on future recidivism risk and intervention outcome.
For the moment, the value of psychobiological markers of DWI in the assessment of DWI risk is more theoretical than practical. Several challenges confront application of the psychobiological findings to assessment of DWI risk. First, longitudinal study is needed to confirm the predictive value of psychobiological markers to recidivism. HPA axis measurement requires a stress induction paradigm that currently is impractical for clinical application. Moreover, sex and circadian cycles influence hormonal function, and there are no cut-offs to distinguish between normal and abnormal hormonal secretion in the DWI population [146]. Hor- monal anomalies are non-specific, observable in several health and mental health conditions, such as chronic stress, anxiety, schizophrenia and depression [147– 149]. Individuals with comorbid mental health issues and alcohol problems do seem overrepresented in DWI offenders, at least in those undergoing mandated inter- vention [23]. At the same time, the contribution to DWI recidivism of specific mental health problems, other than alcohol and substance abuse, awaits further clarification.
Intervention
The neuropsychological and psychobiological findings, although nascent, suggest possible avenues for research and development of novel approaches to psychosocial and pharmacological DWI intervention. The use of neurocognitive and psychobiological markers, or their behavioral correlates, to identify individuals within specific offender subgroups could contribute to more accurate clinical intervention provision. For example, one DWI study provided evidence that matching Motivational Interviewing, a psychosocial intervention that taps into an individual’s personal motivational schema rather than a social norm-based motivational representation, to Type II alcoholism characteristics provided added benefits in reducing recidivism. Remediation to improve neurocognitive functioning may also be beneficial in some cases in which significant deficits are uncovered at the time of DWI assessment. The use of objective measures to clarify subgroup membership could refine analogous matching protocols.
Future research could also explore whether individuals with a particular neurocognitive profile fare better with specific types of intervention. For example, passive restraint measures, like interlock devices, may provide better outcomes for individuals with important impairments than psychotherapeutics that rest on the ability to remember complex intervention content, self- regulate, learn and implement new behavioral strategies, and which may be more suitable for those with intact neurocognitive capacities. Moreover, investigation is needed to determine whether paradigm-shifting strategies for DWI remediation could improve engagement. A remedial strategy that provides more immediate incentives for positive DWI behaviors (e.g. vouchers or fine reductions for early and complete participation) might be particularly relevant for offenders who are prone to seek immediate gratification and fail to value delayed positive consequences. An analogous approach involving offering vouchers for treatment attendance has produced consistently positive results in drug-dependent individuals and individuals with frontal lobe lesions [151] that appear similar to those observed in DWI offenders.
Although the biological routes from psychobiological dysregulation to increased drinking are not fully under- stood, possible mechanisms include modulation of mood and anxiety symptoms, dopaminergic release in the nucleus accumbens and/or hippocampal and amygdala activation. In alcoholism, clarification of such mechanisms has opened up new avenues for targeted biological intervention development [152]. For example, genetic coding for the serotonin transporter or the 5-Hydroxytryptamine-3 antagonist receptor proteins has been posited as a basis for tailoring pharmacological treatments to individual patient characteristics. In one study, individuals with Type II alcoholism characteristics fared better following serotonergic pharmacotherapy treatment with a 5-Hydroxytryptamine-3 antagonist (OndansetronTM) than did individuals with Type I alcoholism [153,154]. Similar results suggest that genetic variations [i.e. heterozygous (Asp40/ Asn40) or homozygous (Asp40/Asp40)] for the OPRM1 Asp40 allele interact with the opioid antagonist medication naltrexone hydrochloride to produce better alcohol abuse outcomes [155]. These findings may be relevant to DWI offenders as well, especially in offenders for whom a genetically loaded form of alcohol abuse is the most obvious pathway to DWI risk.
Conclusions
Driving while impaired by alcohol recidivism is a major cause of preventable injury and mortality. Thus far, efforts at reduction of DWI have focused primarily on deterrence, assessment of risk based mainly on alcohol abuse indicators and universal intervention strategies. However, these approaches may not adequately account for individual differences that are predictive of outcome. Not surprisingly, some drivers who constitute the highest risk on our roads appear impervious to these measures. This review has described the preliminary evidence for neurocognitive and psychobiological mechanisms that may be common to the characteristics consistently correlated to DWI, recidivism and intervention resistance. The findings are consistent with those emerging from the multidimensional investigation of other problem behaviors and their treatment. As such, they hold promise for the development of more targeted strategies for the reduction of DWI.

Aricle-3B
Heritability of DUIConvictions: A Twin Study of Driving Under the Influence of Alcohol.
Background: The study was undertaken to assess the relative contributions of genetic and environmental influences on drunk-driving. Methods: Driving records of a cohort of male and female twins (N = 17,360) from the Mid-Atlantic Twin Registry were examined. Structural equation models were used to estimate the magnitude of genetic and environmental effects on male and female phenotypes, and test for gender differences. Results: There were significant gender and age effects. Compared with females, males were five times more likely to engage in driving under the influence. Among persons aged 21–49 years, the risk for drunk-driving was eight times that for those aged 50+ years and five times greater than those ≤20 years. In both males and females, aged 21–49 years, a large proportion (57%) of the variance in drunk-driving was due to genetic factors and the remaining 43% due to individual specific environmental influences. Conclusions: Drunk-driving is under significant genetic influence in both males and females. Our findings suggest that a different set of genes influence DUIs in men and women. [ABSTRACT FROM PUBLISHER]

Copyright of Twin Research & Human Genetics is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Anum, E. A., Silberg, J., &Retchin, S. M. (2014). Heritability of DUI Convictions: A Twin Study of Driving Under the Influence of Alcohol. Twin Research & Human Genetics, 17(1), 10-15. doi:10.1017/thg.2013.86
http://www.shoreline.edu:2419/ehost/detail/detail?vid=23&sid=32998f87-e7f5-4afa-8073-80ef0c98c8e8%40sessionmgr114&hid=128&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9h&AN=94282592

Criminality and continued DUI offense: criminal typologies and recidivism among repeat offenders.
We examined over 20,000 arraignment records to define criminal typologies and post-treatment driving under the influence of alcohol (DUI) convictions for a select cohort of 1,281 repeat DUIoffenders who were offered and elected treatment as an alternative to incarceration; we compared this information with a similar data analysis collected 20 years previously. Analyses of 8,600 prior-to-treatment convictions defined four basic crime profiles: only DUI and other substance-related offenses (60%), plus crimes against property (18%), plus crimes against people (8%), plus crimes against both property and people (13%). During the six years after inpatient treatment, 15.5% of the cohort was convicted of another DUI. The re-offense rate was significantly different across criminal types and was not related to the time post treatment years at risk. The findings show there has been no significant improvement in treatment outcome over the last 20 years. New and innovative DUI offender policies and practices are needed to better engage the heterogeneous offender population, and reduce the incidence of repeat DUI. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Copyright of Behavioral Sciences & the Law is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

LaBrie, R. A., Kidman, R. C., Albanese, M., Peller, A. J., & Shaffer, H. J. (2007). Criminality and continued DUI offense: criminal typologies and recidivism among repeat offenders. Behavioral Sciences &The Law, 25(4), 603-614. doi:10.1002/bsl.769
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Social/cultural
Article-4
Source: http://www.popcenter.org/problems/drunk_driving/

Factors Contributing to Drunk Driving
Understanding the factors that contribute to drunk driving in your jurisdiction can help to frame local analysis, to identify effective remedial measures, to recognize key intervention points, and to select appropriate responses.
Cultural and Economic Factors
Drunk driving is very much the result of a cultural norm that emphasizes drinking alcohol as a form of entertainment and driving as both transportation and entertainment. 27 Cultural drinking habits also shape drunk driving patterns. For example, drunk driving will be more concentrated on weekend nights in countries where such nights are considered prime time for heavy drinking. The extent of drunk driving also depends, obviously, on the availability of vehicles, so it is less likely in societies and communities where vehicles are prohibitively expensive.
Low Risk of Apprehension
Perhaps the single most significant factor in explaining why people drive while impaired is that they believe that there is little risk that they will be caught by policeand statistically, they are correct. By some estimates, the average drunk driver will drive while impaired between 80 and 2000 times for every time he is apprehended, depending on the enforcement capacity of the local police. 28 In fact, most drivers believe they are more likely to be involved in a crash than they are to be stopped by police.29
Even the most committed police agencies and officers can stop or arrest only a very small percentage of the impaired drivers who are on the road at any one timeprobably less than one percent. There are several reasons this is so.
• At least in the United States, police must ordinarily reasonably suspect a driver is impaired or has committed some other traffic violation in order to stop and detain the driver, and some drunk drivers are able to operate a vehicle without displaying obvious indicators of intoxication such as weaving or crossing the center line of the road.
• There are far fewer police officers on duty at any one time than the public commonly imagines.
• There are many competing priorities for police attention, particularly at times when drunk driving is at its peak.
• Processing a drunk driving arrest is time-consuming, typically taking two to four hours.
The low probability that they will be stopped or arrested by the police on any particular trip undoubtedly leads many drivers to conclude that they can drink and drive without getting caught.
Detecting drunk driving is not as easy as it might seem. Those without specialized training in detecting alcohol impairment even medical professionals are notoriously poor at estimating alcohol impairment. For police, detecting drunk driving typically requires two separate judgments: first, that a vehicle is being operated by an impaired driver; and second, that the driver is impaired by alcohol or another controlled substance. Each judgment is in turn subject to two kinds of errors: first, that the driver is impaired by alcohol when in fact he is not (false positive); and second, that the driver is not impaired by alcohol when in fact he is (false negative).
Compounding the difficulty of estimating impairment is the fact that some police officers try to arrest only those drivers who they believe have high blood alcohol concentrations, either because they prefer to prosecute only strong cases or because they do not want to be criticized for wasting scarce police resources on borderline cases. Consequently, some officers systematically fail to arrest impaired drivers because they are only searching for the most impaired.

Although police want to create the impression that all drunk drivers will be arrested, in reality only a small percentage of drunk drivers on the road at any particular time will in fact be stopped or arrested. Drunk Busters of America
Over-serving
Serving obviously intoxicated guests and patrons increases the risk of drunk driving, especially when drinking occurs at a location that most guests and patrons must drive to. Absent adequate enforcement of the laws that prohibit serving intoxicated patrons, overserving is notoriously common. The combination of the social pressure put on servers by patrons and the economic pressure to maximize profit can often overwhelm a servers better judgment.
Community Design
Perhaps obviously, drunk driving is more common where licensed establishments are located far from where people live and work. Accordingly, drunk driving is likely to be more common, proportionate to the number of drinkers, in rural or suburban settings. Where people can easily walk or take public transportation in order to drink at a licensed establishment, drunk driving is proportionately less common.

References
Newaz, D. (2006). THE IMPAIRED DUAL SYSTEM FRAMEWORK OF UNITED STATES DRUNK-DRIVING LAW: HOW INTERNATIONAL PERSPECTIVES YIELD MORE SOBER RESULTS. Houston Journal Of International Law, 28(2), 531-572.
http://www.shoreline.edu:2419/ehost/detail/detail?vid=14&sid=2034059a-82d7-4d5b-974e-3a142e8c5767%40sessionmgr198&hid=116&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9h&AN=20714330
Focuses on the framework of the U.S. government’s drunk driving law. General problems with the field sobriety testing as a method of proof in driving while intoxicated prosecutions; Factors that contribute to the ineffectiveness of the utilization of field sobriety tests to prove drunk driving; Comparison of the country’s drunk driving laws with those of Australia, Canada, Great Britain and Scandinavia.

OBOT, I. S. (2012). DEVELOPING COUNTRIES IGNORE DRINKING AND DRIVING PROBLEMS AT THEIR OWN PERIL. Addiction, 107(7), 1209-1210. doi:10.1111/j.1360-0443.2012.03834.x
The author comments on the paper “Why don’t northern American solutions to drinking and driving work in southern America?” by F. Pechansky and A. Chandran, which addresses the lack of policies regarding drinking and driving. According to her, lack of data or laws is not a problem in Brazil but lapses in the enforcement of existing laws is. She refers to several studies on drunkdriving and suggests acquiring a better understanding of the problem through research and monitoring.
Blincoe, L. J., Miller, T. R., Zaloshnja, E., & Lawrence, B. A. (2014, May). The economic and societal impact of motor vehicle crashes, 2010. (Report No. DOT HS 812 013). Washington, DC: National Highway Traffic Safety Administration.
http://www-nrd.nhtsa.dot.gov/pubs/812013.pdf

PART-2
PROPOSEDSOLUTIONS:
Article-5
Drinking and driving is greatly influenced by contemporary social attitudes towards the practice. And although laws and law enforcement can help change social attitudes, the reverse is much more likely: that is, that changes in social attitudes will lead to stricter laws and law enforcement. The general trend in social attitudes at least in the United States, Canada, Europe, Scandinavia, Australia, New Zealand, and Japan has been toward a lessened tolerance for drinking and driving.
There is a broad range of social policy changes that can significantly reduce drunk driving ax policy, urban planning, roadway design, vehicle safety, alcohol advertising, and emergency medical care, among others.
For the most part police can only influence these policies indirectly, through advocacy. The responses below are those that police have some capacity to influence directly, at least at the local level.
As is often the case, a combination of responses is likely to prove more effective than any single response. Legislatures and police agencies commonly implement a combination of responses that are effective in the aggregate, making it difficult or impossible to know which particular responses were effective and which were not.
Responses may work more or less well when applied to high-risk drunk drivers (those who are highly committed to driving while impaired) than when applied to occasional drunk drivers.
Specific Responses to Reduce Drunk Driving
Source: http://www.popcenter.org/problems/drunk_driving/3
Legislation
Reducing the legal limit of per se violations. Most jurisdictions have enacted laws specifying that certain measurable levels of alcohol are per se violations of the law, irrespective of proof that the alcohol actually impaired the ability of the driver to operate the motor vehicle.
Reducing the legal limit of per se intoxication for adult drivers. Most countries and U.S. states set the level of per se intoxication at .08
The legal limits are often even lower for drivers of commercial vehicles
Reducing the legal limit of intoxication and vigorous enforcement of drunk driving laws have been shown to reduce the number of alcohol-related traffic fatalities, especially when combined with administrative license suspensions.
Reducing the legal limit of per se intoxication for repeat offenders. Some jurisdictions set lower per se intoxication levels for persons who have previously been convicted of drunk driving. There is some evidence that this is effective.
Reducing the legal limit of per se violations for underage drivers. Many countries and U.S. states have enacted laws that prohibit underage drivers from having any measurable level of alcohol in their systems (so-called zero tolerance laws). Although zero tolerance laws are usually not strictly enforced, they do appear to have some deterrent effect on young drivers.
Requiring drivers to submit to blood alcohol testing if arrested for drunk driving. Nearly all jurisdictions require drivers to submit to blood alcohol testing when asked by police. In the United States, such requests can only be made if police have probable cause to believe that a driver is intoxicated. In Europe and Australia, however, such requests can be made without any prior evidence of intoxication. So-called random breath testing has proven to be effective in reducing drunk driving in Australia, not merely because it increases the risk of detection, but because it also reduces the social pressure to drink and drive by giving people a ready justification for not doing so.
Raising the minimum legal drinking age. The legal drinking age in all U.S. states is now 21 years of age and there is evidence that these laws have helped reduce the number of underage drivers who are involved in alcohol-related crashes. It is likely that standardizing the minimum legal drinking age has also helped reduce the number of alcohol-related crashes that occur near the borders of states that formerly had different minimum drinking ages.
Prohibiting open alcohol containers in moving vehicles. Drinking while driving is especially risky because freshly imbibed alcohol is likely to cause maximum impairment to the driver. Prohibiting open containers in moving vehicles serves to restrict the availability of alcohol to drivers. There is some evidence that prohibiting open containers of alcohol in vehicles helps reduce the number of alcohol-related crashes.
Requiring drivers and passengers to wear seat belts. Although it has no particular effect on drunk driving itself, requiring drivers and passengers to wear seat belts helps reduce the severity of injuries in vehicle crashes. Drunk drivers and drunk passengers, however, are less likely than others to wear seat belts,and because drunk drivers are more likely to drive recklessly, they and their passengers are at higher risk of injury than non-drinking drivers and passengers.
Enforcement
The main goal of drunk driving enforcement should be to raise the perception among drinking drivers that they will be stopped and investigated for drunk driving. This can be achieved in two ways: first, by increasing the total number of drivers stopped by police; and second, by improved detection of alcohol impairment once a stop is made. There is some evidence that the latter method is more efficient and effective. Training police officers in drunk driving enforcement is therefore critical, but the value of the training depends upon whether the police agency supports drunk driving enforcement by its officers.
Increasing the number of police stops of suspected drunk drivers during high-risk periods. Because convincing drivers that they will get caught is perhaps the most important factor in deterring drunk driving, police should significantly increase the number of stops of suspected drunk drivers, particularly during times when the risk of drunk driving crashes is at its highest.This can be done by increasing the patrol time of officers looking for drunk drivers, streamlining the arrest process, encouraging citizens to report drunk drivers,and increasing the emphasis that is placed on drunk driving interdiction and enforcement.
The procedural requirements for processing a typical drunk driving arrestand consequently, the overall time it takes police to make an arresthave increased steadily over the years, serving as a disincentive to officers to make a formal arrest (see www.trafficinjuryresearch.com/publications/pub_details.cfm?intPubID=131, Simpson and Robertson, 2001).
Emphasizing enforcement may require police departments to authorize officers to use alternatives to arrest once they have determined that a driver has been drinking, lest scarce enforcement resources be exhausted by time-consuming arrests. A variety of alternatives exist, the effectiveness of which will depend on the particular circumstances of each incident. These alternatives include:
• warning the driver;
• requiring a sober passenger to drive;
• allowing the driver to call a sober driver to pick him up;
• giving the driver a ride home or to some other safe place;
• following the driver home to ensure his safety;
• confiscating the keys to the vehicle; or
• requiring the driver to take alternative transportation such as a taxi or bus.
The use of such alternatives can create a dilemma for police departments, because in some circumstances authorizing officers to not make drunk driving arrests when there are grounds to do so can expose the department to civil liability;
Much of the police concern about civil liability for failing to arrest drunk drivers emanated from a Massachusetts Supreme Judicial Court opinion holding that police have a special relationship to motorists injured by a known drunk driver who police failed to take into custody.
On the other hand, however, mandating that an arrest be made every time there are grounds to do so can discourage officers from stopping suspected drunk drivers out of a concern that processing the arrest will leave them unavailable for other duties, thereby undermining the goal of convincing drunk drivers that they are at risk of being stopped by police. Police should consult local legal counsel to craft policies that will enable officers to remove drunk drivers from the roads safely without resorting to arrest, while at the same time protecting officers and departments from potential civil liability.
Conducting sobriety checkpoints. Sobriety checkpoints have been shown to reduce the incidence of drunk driving and alcohol-related crashes anywhere from 15 to 25 percent. Their use is generally supported by the public.Sobriety checkpoints can be either selective or random: that is, all drivers on a particular roadway can be checked for sobriety or only those who meet certain criteria. Some jurisdictions conduct them regularly; others only during special enforcement periods.To be most effective, checkpoints should be highly visible, so that drivers perceive that their risk of being stopped and arrested has increased.Police should consult with counsel to determine the legality of and conditions under which sobriety checkpoints may be conducted.
In the United States, once a driver is stopped at a sobriety checkpoint, police must decide whether there are grounds to test him for alcohol impairment. By some estimates, police fail to detect signs of impairment in one-half of drivers with blood alcohol concentrations higher than the legal limit, so sobriety checkpoints are hardly foolproof.
Sobriety checkpoints are typically costly, although even regularly conducted operations that require only a few officers can be effective.Sobriety checkpoints are not necessarily the most efficient method of detecting and apprehending drunk drivers: regular or saturation police patrols in which drunk driving is a high priority often yield more arrests for the resources invested. However, sobriety checkpoints often produce the added benefit of apprehending drivers for violations other than just drunk driving.
Training police officers to detect impaired drivers. Specialized training including understanding the physical and verbal cues that indicate alcohol impairment can help improve the ability of police officers to detect drunk drivers. The Standardized Field Sobriety Test (SFST) appears to be the most accurate of the tools that have been developed to assist police in recognizing indications of alcohol impairment. Endorsed by the U.S. National Highway Traffic Safety Administration, the SFST includes a horizontal gaze nystagmus test, a walk-and-turn test, and a one-leg stand test. A combination of tests is usually called for, because some drinkers, particularly serious alcoholics, can perform certain tasks even while profoundly impaired.
Using preliminary breath testing devices. Preliminary breath testing devices (PBT) are typically small and easy to operate. Some devices are passive sensors that can detect the presence of alcohol from within a few inches of a drivers face. Passive devices ordinarily do not require an officer to meet any evidentiary standard over and above the one required to stop the vehicle in the first instance. Other devices, which require a driver to blow into a tube or other aperture, ordinarily do require that the officer first have reason to believe that the driver has been drinking. Both types of devices aid officers in the field in determining that there is probable cause to believe that a driver is alcohol-impaired, usually with the net effect of increasing the likelihood of arrest. There is some evidence that jurisdictions that use PBT have lower alcohol-related fatality rates than those that do not.
Random breath-testing whereby police have the legal authority to stop and demand an alcohol breath test from any driver at any time has been demonstrated to be particularly effective,but is impermissible in the United States as a constitutional matter.
Curtailing Driving Privileges
Suspending or revoking driver licenses administratively. Suspending or revoking the licenses of those convicted of drunk driving is one of the most effective methods for reducing alcohol-related crashes, but its effectiveness is limited by the capacity of police and others to enforce the conditions of suspension and revocation; moreover, this method is only effective, if at all, during the period of suspension or revocation. Administrative license suspensions suspensions imposed by a licensing agency rather than by the courts have proven more effective than judicial sanctions in some U.S. states, but not others.
By some estimates, over three-fourths of drivers with suspended or revoked licenses continue to drive nonetheless.In fact, many drivers with suspended or revoked licenses never even bother to apply for license reinstatement when they are eligible to do so. One of the unintended consequences of mandatory license suspension and revocation laws is that judicial and law enforcement resources are consumed dealing with those who continue to drive under suspension or revocation.
Imposing graduated licensing systems for young drivers. SeveralU.S. states have enacted so-called graduated licensing for young drivers. Typically, these systems grant young drivers limited privileges in their early driving years, such as restricting the number of passengers, the hours of operation, the use of cell phones while driving, or the types of vehicles that may be driven. These systems have been shown to have a positive effect on young drivers attitudes about drinking and driving, on their willingness to either drink and drive themselves or ride in vehicles with drinking drivers, and on reducing their involvement in fatal and injury crashes.
Impounding, immobilizing, or confiscating the vehicles of drunk drivers. Impounding the vehicles of drivers whose licenses have been suspended or revokedfor whatever reason, including drunk drivingis effective in reducing the likelihood that a driver will be charged with driving offenses, including drunk driving, or will be involved in a traffic crash. However, the mere threat of impoundment does not deter driving after suspension or revocation: a vehicle must actually be impounded to influence a driver’s behavior. In some jurisdictions, police return the vehicle to its owner if the offender satisfactorily completes an alcohol treatment program and reimburses the government for the costs associated with impoundment.Impoundment or forfeiture is often complicated by the fact that the vehicle used by a habitual drunk driver is owned by someone else or that other members of the drunk drivers family might be inconvenienced by the loss of the vehicle.
An alternative to impoundment is temporary immobilization by the use of a device that either prevents the motor from operating or locks the vehicles wheels.
In some jurisdictions, police and prosecutors apply for judicial forfeiture of the vehicle, thereby permanently depriving the offender of its use. There is some evidence that impoundment and immobilization are as effective as forfeiture as well as less costly and time-consuming for enforcement officials.
In spite of the availability and apparent effectiveness of these responses, they are often not employed by police and prosecutors.
Confiscating license plates from convicted drunk drivers. Confiscating the license plates of convicted drunk drivers is an effective way to discourage them from further drunk driving because it raises the probability that they will be stopped by police. Confiscation is a judicial sanction in some U.S. states and an administrative one in others. There is some evidence that confiscation of license plates would be more effective if it were more widely used and more widely publicized. Alternatively, some jurisdictions require convicted drunk drivers to display specially-marked license plates on their vehicles.

In some states, special license plates are issued to convict drunk drivers to discourage them from driving.
Sanctioning Convicted Drunk Drivers
There is an obvious case to be made for tailoring the sanctions imposed upon a convicted drunk driver to the likelihood that he will repeat the offense in the future. The challenge for the courts is to determine which offenders are likely to become repeat drunk drivers. Many courts require even first-time offenders to undergo alcohol assessments to determine whether they are social or problem drinkers. There is evidence that high blood alcohol concentration and a prior history of drunk driving or other traffic violations are significant predictors that an offender is likely to drink and drive again. In jurisdictions where they are in use, the data from alcohol ignition interlocks can be useful in predicting who is likely to continue drinking and driving.
Requiring convicted drunk drivers to install electronic ignition locks on their vehicles. Electronic ignition locks (interlocks) have been shown to be effective in reducing the likelihood that a convicted drunk driver will be rearrested for drunk driving, at least while the ignition lock requirement remains in effect. However, the deterrent effect does not necessarily last once the requirement is lifted.Drivers ordered to use ignition locks are commonly charged for their installation and maintenance. Where interlocks are optional, any alternative sanction should be sufficiently harsh to motivate the offender to use the interlock. Where the device requires a driver to periodically retest in order to keep the engine running, an offender is less likely to enlist a sober person to start the vehicle. One of the advantages of interlocks over license revocation and vehicle confiscation is that it allows the offender and his family to continue to use the vehicle for legitimate purposes such as employment. Obviously, this response will not be effective where a convicted driver has access to other vehicles that are not equipped with interlocks.
Ignition interlock devices require the driver to blow into a device that is connected to the vehicles ignition. If the driver’s blood alcohol concentration is above a set point, usually around .02, the vehicle will not start.
Requiring convicted drunk drivers to complete alcohol assessment, counseling, or treatment programs. There is some evidence that successful completion of mandatory alcohol assessment and treatment programs can reduce the likelihood that those with clinically diagnosed alcohol problems will be rearrested for drunk driving. Depending on the quality of the program, the incidence of repeat drunk driving and alcohol-related crashes can be reduced by as much as 5 to 10 percent. There is some hope that new pharmaceutical treatments for alcoholism may also help reduce drunk driving by hard-core drunk drivers; as of yet, however, such treatments have not been widely tested.
Confining convicted drunk drivers to their homes. In lieu of incarceration, some jurisdictions sentence convicted drunk drivers to home confinement. Compliance is typically monitored electronically. There is conflicting evidence regarding the effectiveness of home confinement.
Monitoring Drunk Drivers
Closely monitoring high-risk drunk drivers. Closely monitoring drivers who have demonstrated that they are at high risk for driving while impaired has the potential to reduce the likelihood that they will be involved in alcohol-related traffic crashes.Such monitoring can be done by police, corrections officials, or treatment providers.
However, at least one intensive supervision programa day treatment center that provided supervision, reporting, employment, counseling, education, and community resource referrals in a nonresidential facilitydid not prove to be any more effective at reducing repeat offending than did a standard probation program.
Reducing Alcohol Consumption
Reducing the consumption of alcohol. Reducing the total volume of alcohol consumed in a community can have a number of positive effects on public safety, including a reduction in drunk driving.This is especially true when young drivers are denied alcohol.
Alcohol consumption can be reduced in a variety of ways, including:
• increasing the price of alcohol by raising taxes or prohibiting discount sales
• restricting the number of bars and liquor stores; However, too few sales outlets may result in drinkers driving farther to get alcohol, thereby increasing the risk they will be involved in alcohol-related crashes.
• strict enforcement of the drinking age;
• regulating drink specials; and
• raising public awareness through educational campaigns.
Suing alcohol beverage servers for serving intoxicated patrons who then drive and cause traffic injuries. Lawsuits brought against persons and establishments that serve alcohol to patrons who then drive while intoxicated and cause injury (so-called dram shopliability) can potentially discourage overserving patrons, thereby reducing drunk driving. However, the effectiveness of this response is limited because such suits are relatively rare, some jurisdictions protect licensed servers from such liability, and liability awards are often paid by insurance companies rather than by the offender directly. Liability insurers sometimes offer lower premiums to establishments that adopt responsible service practices, but some owners choose not to purchase liability insurance and either close their businesses or declare bankruptcy when they are sued.
Suits against private individuals are even more rare and difficult to win than suits against business owners. For a variety of reasons, both licensed servers and private hosts are reluctant to intervene in the drinking habits of their guests and patrons.
Training alcohol beverage servers to recognize signs of impairment and enforcing laws prohibiting serving impaired patrons. Beverage server training programs have shown some positive effects in reducing alcohol-related traffic crashes in the jurisdictions where they have been adopted, but mandatory programs do not appear to be any more effective than do optional ones.
The states of Oregon and Wisconsin mandate such server training.
Servers learn how to promote eating, to slow drinking, to call for alternative transportation, to stop serving, and to have drinkers wait before driving. Sufficiently strict enforcement of laws prohibiting serving intoxicated patrons is essential in motivating servers to heed the advice of these programs; otherwise, the pressure to continue serving intoxicated patrons can be too great for many servers to resist. One of the dilemmas of mandatory training is that in jurisdictions where successful completion of a training program confers immunity on a server, its net effect may be to shield servers from dram shop liability without substantially reducing the likelihood that intoxicated patrons will be served. On balance, however, responsible beverage service training appears to be a good idea.
Enforcing laws prohibiting serving minors and intoxicated persons. Enforcement of laws that are designed to prohibit serving minors and intoxicated persons in licensed establishments can help control a range of alcohol-related problems, including drunk driving. Enforcement efforts should be targeted at establishments where a high proportion of drunk drivers were last drinking. Unfortunately, such enforcement is rare in most jurisdictions, especially as it relates to serving intoxicated persons. This may be because police and other enforcement agents feel that they lack the resources to devote to this activity, perceive that provable cases are difficult to make, or are reluctant to face resistance from the restaurant and tavern industry.
Public Education
Discouraging drinking and driving through public education and awareness campaigns. It is difficult to change public attitudes and behaviors with respect to drinking and driving through public education campaigns, at least in the short-term. This is especially true among those at highest risk for drunk driving. Nonetheless, such programs can help build public support for addressing the problem and can help publicize changes in drunk driving laws. When they are used, public education and awareness campaigns to discourage drinking and driving should be tailored to particular segments of the population. Although young drivers are especially difficult to persuade, such campaigns are more likely to be effective if they exploit the influence of peers on the behavior of young drivers and emphasize the negative social consequences of drinking and driving rather than the health and legal risks. Programs that seek to correct young peoples misperceptions about how much their peers drink (so-called social norming) hold promise for reducing alcohol consumption.
Messages that focus on alternate forms of transportation, knowing when one has reached the point of intoxication, helping out friends who are too drunk to drive, and the provisions and enforcement of new drunk driving laws are most likely to be effective.Teaching young people how to keep their peers from driving while intoxicated is effective, as are school-based programs intended to discourage students from riding with drunk drivers. Young people are more willing to intervene effectively to prevent their peers from driving while intoxicated than are adults. The use of celebrities and appeals to fear and emotion are not particularly effective among young people.

While it is difficult to change public behaviors with respect to drinking and driving, publicity campaigns can help build support within the community for addressing the problem. University of Oklahoma Police Department
Alternative Transportation
Providing alternative transportation options to drinking drivers. Alternative transportation options include designated drivers and free taxi or limousine rides. There is evidence that drinking drivers, even heavy drinkers, will use alternative transportation if it is made readily available. There is also evidence that alternative transportation programs can significantly reduce the incidence of drunk driving and alcohol-related traffic crashes and injuries. Such programs are most successful when drivers are not forced to leave their vehicles at the drinking location: the best programs take the drinker to the drinking location and then return him to his home.
A pilot program in Wisconsin used business marketing principles to develop and promote taxi and limousine transportation to, from, and between bars in a rural community. Rather than trying to discourage drinking, the initiative acknowledged the local bar culture and sought to address patrons specific reasons for driving after drinking. An initiative in Wisconsin known as Safe Ride that provides funding assistance to taverns to promote alternative transportation for patrons is partially funded by a surcharge on drunk driving convictions. An evaluation of the initiative concluded that it is cost-effective.
Designated driving is now a well-established method for avoiding drunk driving, particularly among U.S. college students. However, there are any number of ways in which designated driving plans can go awry: the designated driver can change his mind and drink; the vehicle owner can change his mind and refuse to allow the sober person to drive; the drinkers in the group can drink more heavily than they would otherwise, which in turn can cause other problems. To date, there is insufficient evidence of the effectiveness of designated driver campaigns, either those directed at the general population or those targeting patrons of particular drinking establishments. However, designated driving appears to be a good idea that should continue to be promoted even if it is not as effective as was originally hoped.
Environmental Design
Locating licensed establishments in areas that reduce the need for patrons to drive. Limiting the number of licensed establishments that are only accessible by car seemingly has the potential to reduce drunk driving; however, the effectiveness of this response has not been properly evaluated. Obviously, there are practical limits as well, especially in rural areas. There are, however, strong arguments in favor of distributing licensed establishments throughout a community and sufficiently close to residential areas so that at least some patrons can walkor at least not drive farto these establishments.
Relaxing or staggering mandatory bar closing times. As may also be the case with other alcohol-related problems, relaxing or staggering mandatory closing times has the potential to lower the concentration of impaired drivers on the roads immediately after all the bars close. However, whether the net effect of this measure would be to increase overall alcohol consumption or to encourage drinkers to drive in search of a bar with a later closing time has not been studied.
Responses With Limited Effectiveness
Increasing the severity of penalties for drunk driving. By itself, increasing the severity of penalties for drunk driving does not appear to have a significant deterrent effect. This is so for several reasons.
• Most drunk drivers do not believe they are likely to get caught on any particular trip, so they tend not to take the severity of the punishment into account.
• If police officers believe that the potential punishment is unduly harsh, they may be less likely to arrest drunk drivers. So too with judges and jurors, who may be less likely to convict or impose stiff penalties.
• Incarcerating more drunk drivers or incarcerating them for longer periods can so overburden existing jail resources that police are forced to curtail drunk driving enforcement.
Incarcerating convicted drunk drivers. Although the general public is likely to insist upon punishing drunk driversparticularly repeat offendersresearch suggests that conventional punishments such as fines and incarceration are among the least effective methods of controlling drunk driving. In addition, using jail resources for drunk drivers becomes more difficult to justify as those resources become scarce. The threat of incarceration, however, is often useful as leverage to compel convicted drunk drivers to accept alternate sanctions such as alcohol treatment, alcohol ignition interlocks, or vehicle forfeiture.
Even where jail time is required by law, many offenders do not actually spend the mandatory minimum time in jail. There are a variety of ways around mandatory minimums: for example, some offenders are credited with having served a full day in jail even if they are only incarcerated for a few hours. Moreover, mandatory minimum jail sentences raise the stakes of drunk driving convictions, which in turn leads to more vigorous legal defenses, delays in case processing, fewer guilty pleas, jail and court crowding, and so forth, all of which creates a counter-pressure to process drunk driving cases more quickly.
Fining convicted drunk drivers. Fining convicted drunk drivers has not shown any significant deterrent effect, either on the offender or the general public. There is typically a high rate of failure to pay fines by convicted offenders. The primary purpose of fines is to offset the cost of enforcing drunk driving laws and of processing cases.
Recovering costs from drunk drivers. Some jurisdictions allow the police to recover the costs of processing drunk driving arrests. Although the effectiveness of this response has not been adequately evaluated, there is little reason to believe that it has any greater deterrent effect than does the imposition of fines. It does have the advantage, however, of channeling revenue back to police, which should reinforce enforcement efforts.
Requiring drunk drivers to listen to victim impact panels. Victim impact panels force convicted drunk drivers to listen to testimony from the victims of drunk driving, their family members, the police, and medical professionals regarding the impact that drunk driving has on individuals and society. In spite of the powerful and immediate emotional impact of these panels, their effectiveness seems to be short-lived: the evidence is that they only prevent offenders from being rearrested in the short term, usually within two years. Moreover, their impact appears to depend heavily upon the particular testimony of the panelists, something that is difficult to standardize.
Prohibiting drive-up alcohol sales. Although permitting drivers to purchase alcohol through drive-up windows appears to be a bad idea for a number of reasons, there is inconclusive evidence that the practice has any significant effect on alcohol-related crashes. This is probably because it is relatively easy to purchase alcoholeven if a driver has to step out of his vehicle to do soas most convenience stores and many gas stations sell alcoholic beverages.
Providing driver education courses in high schools. One unfortunate effect of providing driver education courses in high schools is that it encourages more young drivers to get their licenses, which in turn leads to more young drivers getting in alcohol-related crashes. This is not to say that driver education courses do not have positive effects, but rather that their effectiveness in reducing drunk driving appears to be limited.

PART-3
POSIBLE FUTURE (technological) SOLUTIONS:
Article-6
CARS WITH DRIVERS WILL SOON BE LIKE FISH WITH BICYCLES
Source:http://www.highbeam.com/doc/1G1-371931722.html
Imagine a Thelma and Louise remake, circa 2030. Climax of the movie: Two women sit in a convertible facing the edge of the Grand Canyon. Police surge toward them from behind.
Louise looks at the dashboard. “OK, Google Car — go!”
The car does nothing. The police close in. A disembodied voice chirps from the car speakers, “I’m sorry, it is unsafe to proceed.”
“Damn autonomous cars!” Thelma yells as she pulls a revolver and shoots the dashboard.
Self-driving cars have become inevitable. In May, California’s Division of Motor Vehicles unveiled its first set of rules for autonomous vehicles. Google says its cars have driven more than 700,000 miles and tests show they can watch for pedestrians and other surprises as well as human drivers. Intel jumped in the other day, announcing its driverless car chip. Progress is coming fast and furious.
When a radical new technology arrives, at first we tend to think of it as a modification of an existing technology. Put a motor on a four-wheel chassis and all you’ve got is a carriage that doesn’t require a horse, right? Television seemed like radio with pictures. Cellphones seemed like telephones that could move around. Yet in each case, the new item opened up possibilities no one expected. Cars led to suburbs and shopping malls. Cellphones became pocket computers that are changing dating, banking, eating and just about everything else.
The first surge of autonomous vehicles probably won’t even carry humans. One of the most intense emerging battle zones in retail is same-day, nearly instant delivery — Wal-Mart and other brick-and-mortar retailers think they can fight Amazon by delivering orders from local stores in an hour or two. Amazon fired a shot back by saying it is working on delivery by drones that will land a package on your doorstep.
But the idea of drone delivery is wishful thinking, like a hangover-less bourbon. “The laws of physics still apply,” says Paul Saffo of Foresight at Discern Analytics. He doesn’t see how drones could ever carry enough packages to make the economics work, not to mention all the other attending problems. Who’s liable if the family dog attacks a drone, or when a sudden rain makes drones short out and drop pizzas on unsuspecting pedestrians?
What makes more sense for this upcoming battle? Autonomous vehicles built to drive up to your door with a package or food order and text you to come out and get it. To do that job, the vehicle doesn’t have to look like anything we’ve seen before. Throw out seats or headroom for a human. Make the things electric. Design something unique — maybe a cross between a U-Haul trailer and R2-D2. In a couple of decades, they will be whizzing all over city streets.
At the same time, Western societies are aging. When people get too old, they have to stop driving, and by 2030, more than 20 percent of the U.S. population will be over 65. So we will all welcome a solution that gives the elderly cars that drive themselves.
But why do a one-for-one replacement of regular cars for driverless cars? Robin Chase, founder of Zipcar, imagines a situation more like an on-demand autonomous car subscription service — the offspring of Uber and Zipcar. A fleet of such cars would be stationed all around town. You’d use your phone to call for the nearest one, which would pick you up within five minutes. The service wouldn’t take you cross-country, but it certainly would take you across town to the Old Country Buffet.
There’s no reason for such vehicles to look anything like today’s cars. Most trips will involve taking one person a short distance, so maybe these cars will look like the new three-wheeled one-seater called Elio — minus the steering wheel. These services will change the way we think about personal transportation — instead of something to own, it will be something to subscribe to. Cars will go through the kind of shift music is going through now as it moves to subscription services: We used to own music, whether as LPs, CDs or MP3s, but soon we’re just going to rent it.
All told, the most profound impact of autonomous cars and trucks could be the end of the very idea of a car or truck. Driving a car might become like riding a horse: something rich people do for fun on weekends.
Chase believes that if we don’t think differently about cars — if we just replace human-driven cars with computer-driven cars — it will turn into a nightmare. Today, cars stay parked on average 95 percent of the time. If everybody comes to own an autonomous car, a lot of people will send them out to run errands — send the car to pick up a kid or go get itself repaired. If that leads to the same number of cars per person and lowers the time an average car stays parked to even 90 percent, traffic would explode. In a subscription model, cars would be shared, vastly lowering the number of cars per person.
A transformation of transportation will have all sorts of consequences. Some will be rough. The job of “driver” — whether of taxis or UPS trucks — could go the way of elevator operators and milkmen. “Paradise by the Dashboard Light” will wind up being a song about a bygone era when you could actually sneak away in a car. Since a subscription car would always know where you are, the privacy of a car will be no more.
If people no longer drive, then driving drunk will become something previous generations used to quaintly worry about. Autonomous cars could do for drinking what birth control pills did for sex.
It has always been a bad idea to put humans in control of 2,000 pounds of metal and glass hurtling down a sliver of pavement at 60 miles per hour. In the U.S. alone, car crashes kill 33,000 people a year and suck $277 billion out of the economy, according to The National Highway Traffic Safety Administration. In a world of autonomous, subscription-based Uber-Zip pod cars, nobody could drive off a cliff. The Thelma & Louise 2030 script would have to turn Brad Pitt into a nerdy coder who helps them override the Google Car programming with their smart earrings.
Article
GOOGLE CAR:
Source:http://discovermagazine.com/2015/jan-feb/50-google-car
John Leonard watched spellbound from the back seat as the Lexus he was riding in drove through downtown Mountain View, Calif., one July day. The steering wheel spun right and left without a driver touching it. The car stopped at lights, switched lanes and even punched its accelerator as it merged into traffic.
For Leonard, a roboticist at MIT, riding in a car outfitted with Google’s self-driving technology reminded him of another iconic moment in transportation: when the Wright brothers ushered in the age of air travel 111 years ago. “Honestly,” he says, “I felt like I was on the beach at Kitty Hawk.”
In 2014, it became more credible than ever that all cars will drive themselves someday. Google began building 100 more prototypes over the summer — this time, without steering wheels — and several mainstream car manufacturers, including BMW and Audi, demonstrated their own self-driving prototypes.
A Google car senses its surroundings through radar, cameras and range-finding lasers spinning atop the vehicle to create a 360-degree view of pedestrians, vehicles and intersections. But Google’s real trick is the map stored in the car’s computer. The sensor-loaded cars are driven manually to scan roads in advance, revealing potholes, stop signs and other features that are then processed into a detailed map and downloaded to the autonomous car. This pre-mapping vastly simplifies the computing that a Google car has to do in real time, potentially reducing its price tag.
The challenge will be to create these centimeter-scale maps for thousands of roads worldwide and constantly update them as they change, says Alberto Broggi, an engineer developing self-driving cars at the University of Parma in Italy. “If you have wrong data, it would kill you,” Broggi says. Autonomous cars will also need to read gestures and other cues from cyclists, pedestrians and traffic cops.
The mapping challenge, in particular, could take 30 years to address, says Leonard, though he admits, “Sometimes you need younger people who don’t know how hard something is.”
A self-driving Lexus navigates its way through Mountain View, Calif.
A prototype of Google’s new self-driving car has built-in sensors designed to “read” city streets.

Reference
(Some of theseare the sources I used for the summary above)
Buu, A., Dabrowska, A., Mygrants, M., Puttler, L. I., Jester, J. M., &Zucker, R. A. (2014). Gender differences in the developmental risk of onset of alcohol, nicotine, and marijuana use and the effects of nicotine and marijuana use on alcohol outcomes. Journal of Studies on Alcohol and Drugs, 75(5), 850-8. Retrieved fromhttp://search.proquest.com/docview/1564157025?accountid=1164
Cook, L. (2014, 07). Don’t drink and drive if you want to avoid these insurance rates.U.S.News& World Report, 1. Retrieved from http://search.proquest.com/docview/1554559689?accountid=1164
Hansen, B. (2013). Punishment and deterrence: Evidence from drunk driving. Rochester: Social Science Research Network. doi:http://dx.doi.org/10.2139/ssrn.1956180 http://www.shoreline.edu:2360/docview/1095372234/896F0954CC684EE5PQ/1?accountid=1164

Lerner, Barron H,M.D., PhD. (2011). Drunk driving, distracted driving, moralism, and public health. The New England Journal of Medicine, 365(10), 879-81. Retrieved from http://search.proquest.com/docview/888193753?accountid=1164
Barron H. Lerner is a doctor, historian, bioethicist and a member of the faculty at the New York University Langone School of Medicine. He received his M.D. from Columbia in 1986 and his Ph.D. in history from the University of Washington in 1996. Lerner practices internal medicine and teaches medical ethics and the history of medicine.
Peden, M., Hyder, A. A., Scurfield , R., Sleet, D., Mohan, D., Jarawan, E., &Mathers, C. (2004). World report on road traffic injury prevention. Geneva: World Health Organization. http://whqlibdoc.who.int/publications/2004/9241562609.pdf
Staff, P. (2013). Drunk driving timeline Leading Issues Timelines. Retrieved from
http://sks.sirs.com/cgi-bin/hst-article-display?id=SWA1435-0-5119&artno=0000268799&type=ART&shfilter=U&key=Drunk%20driving%2C%20Timeline&title=Drunk%20Driving%20Timeline&res=Y&ren=Y&gov=Y&lnk=N&ic=N
TED. (2011, May 31). Sebastian Thrun: Google’s driverless car [Video file]. Retrieved from