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Article Excerpt
A SIGNIFICANT ISSUE IN TRAFFIC SAFETY has been the characterization of road users who most contribute to the alcohol-related crash problem. As early as 1967, a report by the Department of Transportation (1968) identified the "problem drinker" as an important target for alcohol safety programs. Vingilis (1983), in a review of studies on the drinking status of impaired drivers, concluded that 30%-50% of the drivers in alcohol-related crashes or arrests have "drinking problems." In 1990, Wieczorek et al. reported that 51% of driving under the influence (DUI) offenders who were referred for treatment met the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R; American Psychiatric Association, 1987), criteria for alcohol dependence. A number of such interview studies have been conducted (Cavaiola and Wuth, 2002; Jones and Lacey, 2002; Miller and Windle, 1990; Vingilis, 1983). These studies have produced a broad range of estimates of the involvement of problem drinkers and dependent drinkers based on the particular sample of arrested drivers or the measures used.
A follow-back study (i.e., based on reports from family and associates) conducted by Baker et al. (2002) gave some support to those who argue that "problem drinkers" are the main contributors to fatal crashes. In their study of 818 fatally injured drivers, 21%-61% of the fatally injured drivers with blood alcohol concentrations (BACs) of [greater than or equal to] .15% could have been classified as problem drinkers before their crash involvement, compared with 1%-7% of the fatally injured drivers with BACs of .00%. The authors noted, however, that many high BAC drivers in fatal crashes were not found to be problem drinkers. These two findings are at the core of an ongoing debate about the type of drinker that contributes the most to the incidence of fatal crashes. This debate centers on the magnitude of the contribution of "hard core" drinking drivers to the alcohol-related crash problem. Simpson and Mayhew (1991) define "hard core drivers" as "individuals who frequently drive after drinking, usually with high BACs ([greater than or equal to] .15%), and who have a history of arrests and convictions for impaired driving." The term has been adopted by several governmental and private organizations such as the National Transportation Safety Board, the National Highway Traffic Safety Administration (NHTSA), and the National Commission Against Drunk Driving. The use of the term varies somewhat, but it basically encompasses multiple offenders who repeatedly drive under the influence and first offenders who are arrested with high BACs (.15%).
On one side of the debate, Simpson and Mayhew (1991) emphasized the contribution of hard core drivers to the crash problem by claiming that they account for more than 50% of alcohol-related crashes occurring at night. Researchers and policy makers concerned by this finding emphasize the need for programs targeting these hard core drivers. On the other side of the debate, some authors (e.g., Hedlund and Fell, 1995; Jones and Lacey, 1998, 2000) have argued that although hard core drivers are overrepresented among high BAC drivers in fatal crashes, they account for only a small proportion of all fatal crashes. What type of drinker contributes the most to the fatal crash problem?
The answer to this question involves important policy issues. At stake is the optimal allocation of increasingly scarce resources. Policy makers must decide whether to allocate resources to specific deterrence programs designed to reduce recidivism among the relatively small number of high-risk DUI offenders, general deterrence programs aimed at the much larger number of lower risk drivers in the general drinking public, or both. Optimizing resource allocation between these programs is not straightforward for three reasons. First, programs aimed at the drinking public (such as increased enforcement using checkpoints and public information campaigns) are substantially different from those directed at hard core drivers (such as intensified court monitoring, jail time, and extended treatment programs). Second, laws and programs related to these policies are enacted at the state level, where state traffic safety funds are generally extremely limited. Third, although the relationship of acute BAC to crash involvement is known (Borkenstein et al., 1974), there is substantially less information on the drinking characteristics of drivers and crash involvement.
In contrast to the wealth of information on BACs at the time of crashes, information is relatively limited on the drinking characteristics of drivers in fatal crashes. Our review of both sides of the hard core driver debate demonstrates that such information is very limited because of the inability to study fatally injured drivers directly. We used two data sets for this study: the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2004), a recent national household survey of alcohol consumption by U.S. residents, and the Fatality Analysis Reporting System (FARS; NHTSA, 2002a). From the NESARC, we determined the prevalence of alcohol-use disorders in each state. These data were then related to the proportion of the state's fatal crashes that involve a drinking road user as recorded in the FARS. Because of the current limitation in the data on the contribution of different types of drinkers to the fatal crash problem and the comprehensiveness of the two data sets at our disposal, we believe the information provided by this study, albeit imperfect, will be highly relevant to state policy makers and useful to the research community in suggesting new lines of research.
Method
We used the NESARC to estimate the number of adult Americans ages 18 or older with alcohol-use disorders in each state. Conducted in 2001-2002, the NESARC is a household face-to-face survey conducted by the U.S. Bureau of the Census of a representative sample of the U.S. population, including citizens and noncitizens (NESARC website http://niaaa.census.gov/index.html). NESARC's target is the civilian noninstitutionalized population, ages 18 and older, residing in the 50 U.S. states and the District of Columbia. The survey covers drinking in the last 12 months and provides measures for alcohol dependence and alcohol abuse, with abuse and dependence as defined by the Diagnostic and Statistical Manual of Mental...
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