Education and information

Long before road users get access to the roads in or on motorized vehicles, they should know what the dangers of drink driving are and develop an attitude against drinking and driving. Besides this they should know what the dangers for drunken pedestrians and drunken cyclists are. The subject of the dangers of alcohol in traffic and what one can do about it should be part of the curriculum in both primary schools and secondary schools. For secondary schools more and more programmes are developed that confront students with the effects of alcohol in an as shocking as possible way. Traffic informers, for instance, are people that are mostly seriously disabled because of a road crash in which they have been at fault (i.e. they were drunk). They tell the students about their crash and how the consequences of the crash have affected their lives. What are known as 'road shows' are plays. In these plays the destructive consequences of road crashes are presented in an as much as possible emotionally charged and moving way. The opposite direction is chosen in an increasing number of high schools in the United States. These programmes are based on the concept of social norms. In these programmes nothing is communicated about the dangers. Instead students are told in a positive manner that the overwhelming majority of the students don't drink and drive. At first, research was carried out to find out if there is a discrepancy between the number of students that students think do drink and drive and how many students actually do. It appears that students mostly overestimate the percentage of students that really do drink and drive. After this, in a very positive manner they are told how many students in reality don't drink and drive. Often these messages are combined with positive strategies to avoid drinking and driving. The assumption is that most students want to conform to what is considered normal in their social environment.

Also in formal driver training for obtaining the driving license, the subject of drinking and driving should be addressed. In some EU member states, still no attention is paid to the drinking and driving problem in basic driver training.

Public campaigns using mass media also aim at raising awareness of the dangers of drink driving and are intended to change attitudes and behaviors. There are very many ways in which this can be done. Some public campaigns only inform about the dangers of drinking and driving. These dangers can be presented in a quite neutral way but they can also be presented in a shocking manner. A more subtle way is not to show people that die in a road crash because of drink driving, but for instance, the remorse a young driver feels when he has to tell the parents of his girlfriend about the crash in which his girlfriend died and he survived. There are also public campaigns with the explicit intention to raise the impression of the chance of getting caught. Another category of public campaigns is the group of campaigns with a positive message. This can be the message that more and more people don't drink and drive and the promotion of strategies to avoid drinking and driving. Examples of this last type are public campaigns to promote designated driving (i.e. the so-called Bob-campaigns in Belgium and the Netherlands).

The effects of education programmes in schools and in basic driver training

The effect of having the subject of drinking and participating in traffic in the curriculum of primary and secondary schools is very difficult to evaluate. What the effects are of paying attention to the drinking and driving problem in basic driver training are also not known. Nevertheless it seems very important that this subject is in the school curriculum and also in the curriculum of basic driver training.

Driver improvement courses on alcohol (rehabilitation courses)

More is known about the effects of driver rehabilitation courses on alcohol for convicted drivers. These mandatory courses are not intended for drivers that are problem drinkers. For these drivers therapy would be more suitable. According to [5] various evaluations of driver rehabilitation courses for drink drivers (not being problem drinkers) indicate that the recidivism rate can be reduced by 50% compared to control-groups without course participation.

Public campaigns

Overall public campaigns seem to be effective [11]. However the effects can differ quite substantially. Public campaigns are more effective when first a study is carried out of how the target group can best be addressed, and when the public campaign is linked with other measures (enforcement and education). There are indications that fear arousing public campaigns regarding drink driving (i.e. a TV-spot in which a driver who had been drinking crashes into another vehicle and dies) are not so effective. Harré et al [19] discovered that a group that had watched fear-arousing clips regarding drink driving afterwards showed more crash-rate optimism than a group that had watched non-fear arousing clips. Crash-rate optimists believe that crashes might happen to others, but not to them. Despite the fact that some public campaigns may have been not so effective, in many industrialized countries the attitude towards drink driving has substantially changed over the past decades (from something that is not so dangerous to something that is considered to be a crime). This is probably caused by a combination of public campaigns and police enforcement.

Safety culture

When a driver has to drive on account of his job, the company of this employee can also take measures to prevent him from driving under the influence of alcohol. Measures of this type are mostly headed under the name 'safety culture'. A company has a safety culture when in all sections of the company, safety is considered to be of the utmost importance, and that the safety aspect is given weight to in all management decisions in all procedures and in all actions. More in particular, a company with a safety culture:

• Has a clear safety policy and the management not only promotes this policy but also the managers themselves act accordingly
• Analyses crashes and near misses made in the past, and is willing to learn from these crashes and near misses (crashes are not analysed in order to blame someone)
• Takes measures that tackle the root causes of crashes.

An example is that after having analysed a crash with all those involved in a Swedish company, the employees themselves proposed to put all the ignition keys of all company cars in a cupboard. This cupboard could only be opened after the employee had successfully done a breath test. The precise effects of the establishment of a safety culture in a company on drink driving are not known.

Summary of effective measures

The problem of drink driving is not new and very many measures have been taken. A very successful measure was the introduction of pocketsize breath testing devices by the police back in the 1970s. Despite the fact that drink drivers now know that they can be caught and that sanctions are tough, and despite public opinion regarding drink driving having changed considerably (most people in Europe nowadays wholeheartedly disapprove of drink driving), alcohol impaired road users are still involved in about a quarter of all fatal crashes in Europe. New and better measures are needed.

Depending on the circumstances the effectiveness of new measures may vary from country to country. However, in general it can be stated that the following measures are effective:

• To have random breath tests for all drivers and not only for 'suspected' drivers
• To raise the chance of getting caught by carrying out more random roadside breath tests (especially at times and spots where drink driving is expected). However it must be noted that an increase in random roadside breath tests is less effective in countries where those test are already carried out on a large scale than in countries where random roadside breath testing is carried out occasionally [14]
• To have a legal limit for the experienced driver of 0.5 g/l or lower and a legal limit for novice drivers of 0 g/l (or just above 0 g/l). However it must be noted that a very low legal limit (lower than 0.5 g/l) for the experienced driver can be counterproductive. This is the case when the energy spend on enforcement of low levels is at the expense of the energy on enforcement of high levels. As the rather small group with high levels is responsible for most of the alcohol related crashes, it is of the utmost importance to tackle the high levels in the first place
• To have alcohol ignition interlocks installed in the cars of severe first time offenders and all recidivists in combination with a driver rehabilitation course
• To have better public campaigns and education programmes (for all age groups) based on scientific research
• Restrict the availability of alcoholic beverages, especially for young novice drivers. This can be done by raising the age limit for buying alcohol and by banning the sales of alcoholic beverages in petrol stations and transport cafes
• In order to monitor the effects of measures it is necessary to improve the registration on the prevalence of drink driving and the involvement of drink drivers in crashes in all EU-member states.

In the long run it may be possible to equip all cars with fraudulent proof alcohol ignition interlocks that cause no inconveniencies for non-drinking drivers.

When developing a policy to combat the drink driving problem in a country, it is important not to single out one of the measures and forget about the others. There is no panacea for the drink driving problem. A package of interrelated measures will offer the best results. The focal point of such a package is the legal limit(s) which ultimately gives driver guidance about society's perception of safe drinking and driving levels.