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Reducing the Costs of Dnnking and Driving DAVIl) S. REED INTRODUCTION Public concern over the dangers of drunken driving is almost as old as the automobile. Indeed, few authors on the subject can resist citing the "motor wagons" editorial in the Quarterly Journal of Inebriety in 1904. Despite the long history of concern and the many attempts to control the problem, drunken driving is still perceived as a major highway safety problem. Paradoxically, the widespread familiarity in our society with drinking, driving, and their combination may have hindered the development of effective countermeasures. An individual who is very familiar with the elements of a problem may let preconceived notions interfere with the gathering, assimilating, and applying of information. The first section of this paper examines the costs generated by the drinking-driving prob- lem, what part of these costs are potentially preventable, and how the magnitude and distribution of costs might be viewed in assessing the priority of the problem. The next section taps the extensive experience worldwide with programs to reduce drunken driving. We find some David S. Reed, a doctoral candidate in the program in public policy at the John F. Kennedy School of Government, Harvard University, is currently an intern at the Federal Communications Commission. This work was completed during my enrollment at the John F. Kennedy School of Government, Harvard University. I would particularly like to thank Mark Moore and Dean Gerstein, who supervised its preparation. 336

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Reducing the Costs of Drinking and Driving 337 promising avenues for future action and equally important some un- promising avenues that still have vocal advocates. The following section examines efforts to reduce the risk associated with a given amount of drunken driving. Because there have been few such efforts, this section offers few conclusions; it does raise questions that seem to warrant further investigation. -I- The final section examines the manner in which the federal govern- ment has designed and managed programs of drinking-driving counter- measures. It concludes that changes are necessary if we are to learn from experience and improve our ability to reduce the costs of drunken . . arlvlng. COSTS AND THEIR IMPLICATIONS FOR THE ROLE OF GOVERNMENT THE NEED FOR EVALUATION Any attempt to ameliorate dr~nking-driving problems will consume scarce government resources and may impose monetary and nonmo- netary costs (such as some restriction of civil liberties) on individuals. We must therefore determine the costs generated by the problem in order to compare them with the costs imposed by possible solutions. This section examines the magnitude and distribution of costs resulting from drunken driving. It also provides information to help determine the priority of reducing this problem by governmental efforts. This question of costs is of more than academic interest. The comp- troller general of the U.S. (1979, p. 3) estimates that "Federal, State, and local governments spent over $100 million in 1976 for their drinking- driver countermeasure activities." This level of resources, and, as we discuss below, the large human and economic costs potentially at stake suggest the importance of determining the appropriate role of govern- ment in efforts to reduce the costs of drunken driving. PREVENTABLE ACCIDENTS Information presented to policy makers about drunken driving (U.S. Department of Transportation 1968, Noble 1978a, Comptroller General of the U.S. 1979) has typically expressed the importance of the problem in terms of the costs associated with it. For example, Noble (1978a, p. 61) reports that "approximately one-third of the . . . injuries and one- half of the fatalities [from traffic accidents] are alcohol related." The term "alcohol-related" refers to any accident in which a driver, or some-

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338 REED TABLE 1 Percentage of Accident-Involved Drivers and Control Group Drivers Found to Be Within Various BAC Ranges, by Worst Consequence of Accident and Place and Time of Study Fatal,a Vermont, Huntsville, Ala., 1967-1968, 197~1975, BAC (%) Ar~itlent/~natro1 A~nirlent/(~nntrn1 injury, Grand Rapids, Mich., 1962-1963, Accident/Control Property Damage, Grand Rapids, Mich., 1962-1963, Accident/Control <0.01 64~o 84% 0.01~.049 5% 9% 0.05 0~999) 0.10 0.149~31% ~0.015 ~ 73.98~o 88.18% 4.86% 4.29~o 7.97% 4.6B~o 4.84~o 2.11% 8.35% 0.74% ) 81.83~o 89.01% 6.55% 7.76% 4.11~o 2.46% 83.87% 89.01% 6.89% 7.76% 3.54% 2.46% 0.76% 5.70% 0.76% a Vermont data adjusted per Appendix B. Source: Appendix A. Note: BAC levels less than 0.01% are effectively equal to zero. The minimum BAC at which it is illegal to drive in most states is 0.10%. times any person involved in an accident, had a positive blood alcohol content (BAC).i Clearly, a better indication of the importance of solving a problem than calculating the associated costs would be to calculate the costs that would be eliminated if it were solved. To determine the maximum pre- ventable costs of drunken driving, I first examine the BAC levels of drivers involved in various types of accidents and those of control groups of drivers selected at random from times and places similar to those at which the accidents being controlled for occurred. Table 1 shows these data, which I have selected from several studies (also see Appendix A). As Table 1 shows, the BAC levels of drivers involved in more serious accidents are generally higher than those of drivers involved in less serious accidents. Once the distribution of BAC levels among accident-involved drivers and the control groups is known, it is possible to compute how many accidents would be avoided if all driving was done at the risk level associated with the lowest BAC level; that is, accidents that would be prevented by a "perfect" drinking-driving countermeasure. Appendix C demonstrates these computations, and the results are shown in Table 2. Since the figures in Table 2 are based on the association between ' Blood alcohol content (BAC) and the equivalent term blood alcohol concentration refer to the standard measure of the concentration of alcohol present in a person's body at a given time (not including any alcohol that has been drunk but not yet absorbed).

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Reducing the Costs of Drinking and Driving 339 TABLE 2 Expected Reduction in Motor Vehicle Traffic Accidents If All Drivers Had a Zero BAC Type of Accident, Place and Time Expected Reduction Fatal, Vermont, 1967-1968 Injury, Huntsville, 197~1975 Injury, Grand Rapids, 1962-1963 Property damage, Grand Rapids, 1962-1963 23.7% 15.8% 8.2~o s.75rO Source: Appendix C. BAC and accident involvement, we must ask whether any other factors, correlated with both BAC while driving and accident risk, are con- founding our analysis. There appear to be two confounding factors bias- ing the results in opposite directions. First, there is evidence that greater frequency of drinking is positively associated with more frequent drun- ken driving and negatively associated with accident risk at any given BAC (Borkenstein et al. 1974, Hurst 1973~. As Appendix C shows, the risk of accident as computed from the data on Grand Rapids and Ver- mont is actually lower for the 0.10-0.049 BAC range than for the <0.01 range. The correlations with drinking frequency bias Table 2 toward underestimating the accident reduction, since those who currently drive drunk, if sober, would have a lower accident risk than those who cur- rently drive sober. The second bias results from a disputed but probable positive asso- ciation between "problem drinking" or "alcoholism" and both drunken driving and accident risk while sober (Smart 1969, Noble 1978b, pp. 238-240~. This bias would result in drunken drivers, as a group, having higher accident risk than the general driving population even if they were prevented from driving with positive BAC levels. Available information is not sufficient to quantify either of these biases, therefore I present the expected reductions in Table 2 as they are and hope that the biases are small or cancel each other out. A final caution is that my figures for maximum achievable accident reduction are based on samples at specific times and places. Their va- lidity for the nation as a whole is not ensured. It is heartening that the Huntsville and Grand Rapids studies of injury accidents, despite their spatial and temporal separation, yield reduction estimates within 8 per- centage points of each other. The Vermont data on distribution across

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340 REED BAC ranges of drivers killed is in agreement with several other studies of driver fatalities (Jones and Joscelyn 1978, p. 12, Noble 1978b, pp. 233-240~.2 I have encountered no studies of property-damage-only crashes other than the Grand Rapids study. MAGNITUDE OF PREVENTABLE COSTS The figures on accident reduction can be roughly converted to savings in terms of lives, injuries, and dollars of property damage. In 1977, motor vehicle traffic accidents resulted in 49,500 deaths, 1.9 million disabling injuries, arid $15.5 billion of property damage in the United States (National Safety Council 1976~. (The $15.5 billion figure is based on $520 per accident-involved vehicle [Jones and Joscelyn 19783.) Mul- tiplying these figures by the percentages of accident reductions in Table 2 yields maximum achievable savings in 1977 of 11,700 deaths, 156,000 to 300,000 disabling injuries, and $963 million in property damage (based on the total reduction in accident-involved vehicles). Of course, like any estimates based on sketchy information, these figures must be interpreted with some care. The figures in Table 2 refer to reductions in the number of accidents, not directly to reductions in the consequences of accidents. For instance, alcohol-related accidents more frequently involve only a single car and driver than do accidents in general (Borkenstein et al. 1974, p. 105, Noble 1978b, p. 235~. There- fore, the reduction in the number of people killed, the number of people injured, and the number of cars damaged will be less than the reduction in number of accidents. It is also likely, however, that the average severity of injury and damage in the accidents prevented will be greater than the severity of injury and damage in accidents in general; therefore only in the case of fatalities do the above figures clearly overstate po- tential savings from drinking-driving countermeasures. It is beyond the scope of this paper to develop estimates of preventable costs for all other problems that may compete with drinking-driving for government resources. Table 3, however, provides some perspective. For example, we see from Table 3 that 22 percent of all accidental deaths resulted from alcohol-related traffic accidents and that 10 percent of accidental deaths would have been prevented if all drivers had zero BAC.3 2 I could not produce accident reduction estimates from these other studies because they lacked control groups. 3 Table assumes that 50 percent of all traffic accident deaths are alcohol related (Comp- troller General of the U.S. 1979, Noble 1978b), and that 23.7 percent of all traffic accident deaths would be prevented if all drivers had zero BAC (see Table 2~.

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Reducing the Costs of Drinking and Driving TABLE 3 Deaths from Alcohol-Related Motor Vehicle Traffic Accidents, and Deaths Prevented If All Drivers Had Zero BAC as Percentages of Various Categories of Deaths, 1977 341 Cause of Death Related to Drinking-Driving Prevented If All Drivers Had Zero BAC Alcohol-related motor vehicle traffic accidents All motor vehicle traffic accidents All accidents All causes except cardiovascular diseases and malignancies All causes 100% 50% 22% 4% 1% 47% 24~o 10% Do 0% Source: Bureau of the Census (1978' pp. 75, 78~. In considering the data in Table 3, one should be aware that deaths caused by traffic accidents, particularly alcohol-related traffic accidents' occur typically among a younger age-group than deaths from other major causes. For example, Perrine et al. (1971, p. 46) report that of drivers killed in accidents, 47 percent were under 30 years of age, and of those with positive BAC levels, 49 percent were under 30. Many think that deaths of younger persons should be counted more heavily in making policy decisions, because each such death results in more years of life lost. Another problem of weighting involves deaths of drinking drivers themselves versus deaths of innocent victims of drinking-driving acci- dents. I estimate that 61 percent to 78 percent of persons killed in drinking-driving traffic accidents are drivers with positive BAC levels (see Appendix B). One may argue that since people can choose how much to drink before driving, it may not be the proper role of govern- ment to protect them from the consequences of a decision freely made. Alternatively, one might argue that people may drive after excessive drinking due to a momentary lapse of judgment, an episode of severe stress, or a habitual behavior pattern that is difficult to control (i.e., an "addictions. One study reports that 75 percent of drivers admit to driving after drinking at least occasionally (U.S. Department of Trans- portation 1968, p. 614.4 Viewed in this way, drunken driving looks less 4 This is not to say that 75 percent of drivers drive with the high BAC levels associated with greatly increased accident risk (see Table C-1 in Appendix C). However, there is evidence that less frequent drinkers, and less frequent drinking drivers, show elevated accident risk at lower BAC levels than does the drinking-driving population in general (Hurst 1973~.

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342 REED like a risk some choose to take and more like a random risk to which many people will be exposed whether or not they would choose to in a moment of calm reflection. Furthermore, the death or injury of some- one who is driving drunk may impose costs on friends, loved ones, those dependent for financial support, and the economy in general. In setting policy, the proper weight to give to deaths of drunk drivers cannot be determined by empirical or logical analysis, although these may inform the decision. I feel that such deaths should be weighted equally to others for purposes of setting policy, but that we should be wary of providing perverse incentives to potential drunk drivers- a topic I address later in this paper. In conclusion, it seems that drinking-driving countermeasures can be legitimate and useful government actions, but that even if such coun- termeasures were perfectly successful, the savings in lives, injuries, and property loss would be less than widely quoted figures would lead one to believe. Which countermeasures show the best prospect of success is the topic of the rest of this paper. EXPOSURE REDUCTION OVE RVIEW The strategy of drinking-driving countermeasure that occurs first to most people is exposure reduction: reducing the amount of drunken driving that takes place and thereby reducing accident costs. This section ex- amines several potential ways of achieving exposure reduction: General deterrence: countermeasures that seek to prevent drivers in general from combining driving with drinking in excess of legally prescribed limits (0.10 percent BAC in most states). Recidivism reduction (specific deterrence): countermeasures that seek to specifically compel those people who have already been arrested for driving while intoxicated (DWI) not to drive drunk again. Third-party intervention: countermeasures that seek to influence those around potential drunk drivers (servers of alcohol, fellow party guests, or bar patrons, etc.) to prevent them from driving while intox- icated. Altering the legal minimum drinking age. Screening the driving population for those most likely to drive drunk. Installing devices in vehicles to automatically detect drunk drivers. Providing alternative transportation for potential drunk drivers.

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Reducing the Costs of Drinking and Driving GENERAL DETERRENCE Risk of Punishment 343 The most effective programs of general deterrence seem to have been those that raised drivers' perceived risk of arrest and punishment for drunk driving. The classic program of this type is the British Road Safety Act of 1967. The act "defined driving with a BAC of .08% or higher per se as an offense," and "gave police the power to require pre-arrest roadside tests [for breath alcohol] from drivers who had been involved in traffic accidents or moving violations or where there was reasonable cause to suspect them of drinking and driving. Drivers who refused to provide a breath test were considered guilty" (Cameron 1978, p. 22~. Passage of the act was accompanied by a great deal of publicity and public awareness of its provisions (Jones and Joscelyn 1978, pp. 66-67~. The immediate impact of the act was positive and dramatic. For the 3 months following passage of the act, casualties from traffic accidents were reduced 16 percent from the same period the previous year, and fatalities were reduced 23 percent (Ross 1973, p. 20~. The percentage of fatally injured drivers with BAC levels of greater than or equal to 0.08 percent dropped from 27 percent before passage to 17 percent the following year (Comptroller General of the U.S. 1979, p. 27~. A careful quasi-experimental study by Ross (1973) attributed these reductions substantially to the act and the wide publicity it received. He also noted (p. 75~: Unfortunately. there are many signs that the initial effect of the legislation is diminishing. Although there are problems in speculating on what would have happened in the absence of the legislation, the significant change in the slope of the casualty rate curves . . . suggests that the savings achieved ought to be regarded as temporary. This conclusion is bolstered by the fact that blood analysis of fatalities shows that the initial drop in the percentage with an illegal alcohol concentration. from 25 percent in 1967 to 15 percent in 1968, was progressively diminished and the percentage has now returned to its former level. The trend noted by Ross appears to have continued. By 1975 the percentage of drivers killed in England and Wales in road accidents with a BAC level of 0.08 percent or more had reached 36 percent, substan- tially above its pre-1967 level (Comptroller General of the U.S. 1979, p. 27~. The explanation offered by Ross ( 1973, pp. 75-78), which has achieved wide acceptance, is that the well-publicized passage of the act convinced

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344 REED many drivers that the risk of arrest when driving drunk had become much higher than it used to be be. Potential drunk drivers were deterred by the threat of arrest and punishment. As time went on, however, drivers realized that enforcement was rather slack and that risk of arrest was not all that high. This realization caused an "evaporation" of the act's deterrent effect.5 In September 1975, the Cheshire County Police seemed to recapture the Road Safety Act's deterrent effect through a publicized policy of administering breath tests to all drivers pulled over for violations or involved in accidents during "drinking hours." The resulting accident reduction "evaporated" a month after the policy came to a publicized end (Ross 1977~. How applicable is Britain's experience to that of the United States? Ross (1973, p. 1) asserts that "in broad culture and narrower legal structure Britain is the closest of European countries to the United States." Comparative statistics indicate that Britain is very similar to the United States in number of traffic fatalities per vehicle mile (Borkenstein et al. 1974, p. 20) and has a slightly smaller representation of alcohol- influenced drivers among driver fatalities (Organisation for Economic Co-operation and Development 1978, p. 25~. More convincing is the fact that the Road Safety Act experience has been partially replicated in countries other than Britain. As Robertson (1977, p. 6) describes: A law providing for breath testing and penalties for blood alcohol above .08~o by weight or refusing the test came into force in Canada in 1969 but with less widely publicized predictions of increased chances of arrest than in Britain. Death rates were about 8 percent less than expected in the subsequent two years but, again, the effect of the law was temporary. After 2 years of the law, death rates in Canada returned to levels that would have been expected without the law. In 1978, France amended its drunk-driving law to allow police to 5 There are alternatives to the "evaporation" theory regarding the British Road Safety Act. In support of alternative or supplementary explanations. we should note that since the date of Ross's study, incidence of illegally high BAC levels among drivers killed in Britain has continued to climb, until it now substantially exceeds the incidence before passage of the act. Mere evaporation of the deterrent effect cannot account for this. Other factories) must be strengthening the association between BAC level and driver fatalities over time. It is not certain how much of what Ross observed was due to "evaporation" and how much was the result of the aforementioned unidentified factories). The "evaporation" theory, however, is still attractive as a partial explanation. It is well grounded in theory and predicts the outcomes of several other programs patterned after the British Road Safety Act.

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Reducing the Costs of Drinking and Driving 345 administer breath tests to drivers even in the absence of an accident or traffic violation. Dorozynski and Volnay (1978, p. 44) describe the initial effects (presented here in translation): A certain number of [breath testing] operations were organized immediately, [and] announced in the press, in several French provinces and in Paris. Their results were entirely unexpected: less than O.S~o of the "alcooltests" were pos- itive, and in Paris, zero. Taking account of what is known of the accuracy of the "alcooltest," and of its sensitivity, this roughly indicates that the "French at the wheel" had stopped drinking. While the information from France so far is too sketchy to tell us anything, it does not appear inconsistent with Ross' observations in Britain. Unfortunately, the only agreed-upon success in the United States similar to the British Road Safety Act was a 1-year countermeasure program at Lackland Air Force Base, Texas, in 1959. While the program achieved "a statistically significant decrease of 50% to 60% in the num- ber and rate of accidents, driver injuries, and other injuries during the operational period" (Cameron 1978, p. 23), it is not clear how applicable this experience would be to a civilian environment. Despite the lack of documented successes in the United States for countermeasures to deter drunken driving by increasing the risk of arrest and punishment, this approach appears to have won favor among state highway safety officials. A recent survey by the U.S. General Account- ing Office (Comptroller General of the U.S. 1979) asked officials from the 50 states, the District of Columbia, and Puerto Rico to choose and rank the three most important current or past efforts in their state to combat drunken driving. "Instituting or increasing the use of special police patrols for the drinking driver" was ranked number one by 25 percent of respondents, more than any of the other nine responses. Another 27 percent of respondents ranked it second. Of six states examined in depth in the GAO report (California, Geor- gia, Louisiana, Minnesota, New York, Washington state), five were operating some police patrols targeted at drinking drivers, four reported increased numbers of driving while intoxicated (DWI) arrests, and two reported evaluations of the patrol's effect on accident rates. In King County, Washington, a "drinking-driver emphasis patrol" was operated as part of the federally funded Alcohol Safety Action Project (ASAP). Evaluation failed to find a change in accident fatalities or injuries re- sulting from the patrol, although DWI arrests had increased. In Hen-

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346 REED nepin County, Minnesota, emphasis patrols were also operated as part of ASAP. "Alcohol involvement in fatal crashes was reduced from 63 percent in 1972 to 38 percent in 1976" (Comptroller General of the U.S. 1979, p. 22~. Even in the absence of a control group, this finding is very suggestive of success. From present evidence, then, it appears that when drivers' perceived risk of arrest and punishment for drunk driving is sufficiently increased, drunk driving is deterred and accidents are reduced. In Britain, fatalities from traffic accidents decreased by 23 percent in response to the Road Safety Act, and similar legislation in Canada brought about a temporary reduction of 8 percent. In order to sustain a high perceived risk of arrest and punishment, the risk must be made high and kept high. Targeting patrols by day of week, time, and geographic location; legislative and technical progress toward making breath tests for alcohol easier to administer; and simplifying the process of making a DWI arrest and providing police with motivation to make such arrests are all ways to increase the risk of arrest. Using such methods, ASAPs were able to double and triple the number of DWI arrests, although it is unclear how much of this increase resulted merely from charging drivers with DWI rather than a specific moving violation (Zimring 1978 pp. 151- 152~. What remains unknown is just what levels of risk are necessary to achieve various degrees of deterrence and what it would cost to bring about such increases in risk. These questions appear to require empirical study. Severity of Punishment If increasing risk of punishment can deter drunken driving, then what about increasing severity of punishment? It seems at first glance easier and less expensive to hand out stiffer penalties to convicted drinking drivers than to beef up enforcement. The archetypes of the severe pun- ishment approach are the Scandinavian countries. Imprisonment or fines exceeding one-tenth of the convicted person's after-tax income, com- bined with license suspensions exceeding 1 year, are common punish- ments for first DWI offense in these countries. The Scandinavian drunk-driving laws are widely reputed to be effec- tive deterrents, and there is anecdotal evidence in accord with this rep- utation, but during a 3-month study in Scandinavia, Ross (1975) was unable to find any scientific evidence that the laws had deterrent effects. He then performed time series analyses of drunk driving and traffic

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Reducing the Costs of Drinking and Driving 3~17 Control group was six cars going in the same direction at same place, time of day, and day of week as each accident in case group. "All site visits were made in 1960, within a few weeks of the calender week of occurrence" (p. 812~. Of the control group 0.39 percent refused the BAC test. BAC test was performed by the municipal medical examiner on each member of case group. TABLE A-7 New York: Survey Results and Relative Risk BAC # Control No Control # Accident % Accident Ratio Risk 0 195 77.38 14 41.18 0.53 1.00 <0.02 14 5.56 0 0.00 0.00 0.00 0.02~.099 34 13.49 3 8.82 0.65 ~ 1.23 0.1~0.249 9 3.57 2 5.88 1.65 3.12 0.25 0.399 0 0.00 15 44.12 I have interpolated these results into my standard BAC categories by assuming uniform density of observations within each of the study?s BAC categories. <0.01 202.00 80.31 14.00 41.12 0.51 1.00 0.01-0.049 19.48 7.75 1.10 3.23 0.42 0.82 0.05-0.099 21.09 8.39 1.86 5.46 0.65 1.27 0.10-0.149 2.96 1.18 0.66 1.94 1.64 3.21 ~0.15 5.99 2.38 16.43 48.25 20.27 39.73 The predominant flaw of this study is the small sample size, which allows us to put little confidence in the results. VERMONT M. W. Perrine, Wailer, J. A., and Harris, L. S. (1971) Alcohol and Highway Safety: Behavioral and Medical Aspects. National Highway Traffic Safety Administration technical report DOT-HS-800-599. Wash- ington, D.C.: U.S. Department of Transportation. Case group was fatally injured drivers in Vermont from July 1, 1967, to April 30, 1968. Control group was pooled data of: (1) six drivers at same place, time of day, and day of week as each observation in case group, either within a few weeks or one year after accident being matched; and (2) six drivers at same place, time of day, and day of week as each observation from

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378 REED a group of crashes occurring in Vermont in 1966 and resulting in an injury warranting hospitalization, each observation of which was chosen as a close match to one observation in the case group. The report's account of control group selection is unclear and self- contradicting. The report justifies pooling the two samples by showing that there is a significant difference in the distribution within either sample of only 3 of 22 variables. I suspect that the control group shows fewer high BAC levels than were actually present among drivers at times and places similar to those of case group crashes. Of control group 1.3 percent refused the BAC test. BAC test was performed on all members of the case group. The lowest BAC category used in the report is <0.02. I have inter- polated into my standard BAC categories by assuming that the density of observations in the interval 0.01 SAC <0.02 is the same as the density in the interval 0.02 ~ BAC ~0.04. All other categories in the report are comparable to mine. TABLE A-8 Vermont: Survey Results and Relative Risk BAC # Control % Control # Accident Do Accident Ratio Risk <0.01 942.10 83.74 47.62 44.92 0.54 1.00 0.01~.049 104.90 9.32 5.38 5.08 0.55 1.02 0.05-0.099 54 4.80 9 8.49 1.77 3.27 0.1~0.149 13 1.16 14 13.21 11.39 21.07 ~0.15 11 0.98 30 28.30 28.88 53.43 The "risk" figures for the higher BAC categories are probably biased upward somewhat due to flaws in the control group. APPENDIX B: ADJUSTING VERMONT DATA TO REFLECT ALL FATAL ACCIDENTS The Vermont Study (see Appendix A) reports the BAC levels only for fatally injured drivers, but for purposes of computing the possible savings from drinking-driving countermeasures we need to know the BAC dis- tribution of all drivers involved in accidents in which anyone was killed. To adjust the Vermont data to reflect all fatal accidents, I use data presented by Sterling-Smith (1976, p. 135~. Sterling-Smith studies the drivers judged to have been "most responsible" for each of 267 fatal traffic accidents in the Boston area from 1971 to 1974. He presents a breakdown of this group of drivers by BAC range and whether the fatality was the driver or another person. Table B-1 shows these results.

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Reducing the Costs of Drinking and Driving TABLE B-1 Number of Drivers Responsible for Fatal Accidents, Boston, 1971-1974 BAC (5to) Driver Killed Other Killed <0.01 29 1 16 0.01-0.04 6 13 ~0.05 68 35 TOTAL 103 164 Source: Sterling-Smith (1976, p. 135~. 379 Table B-1 cannot be directly applied to the Vermont data. Since Boston is much more urbanized than Vermont, there is a greater density of vehicles and pedestrians for a driver to collide with, and we would expect a lower ratio of driver fatalities to all fatalities than in Vermont. The data bear this out. According to Table B-1 driver fatalities comprise 39 percent of fatal accidents in the Boston area, whereas Perrine et al. (1971, p. 42) report that the ratio in Vermont in the early 1970s was 59 percent. To adjust the Boston data to those of Vermont, I reduced the number of nondriver fatalities ("other killed") until driver fatalities comprised 59 percent of total fatalities. I multiply the number of nondriver fatalities in each BAC range by 72/164 to arrive at the figures in Table B-2. TABLE B-2 Adjusted Number of Drivers Responsible for Fatal Accidents BAC (%) Driver Killed Other Killed Total Killed <0.01 29 5 1 80 0.01-0.04 6- 6 12 ~0.05 68 15 83 TOTAL 103 72 175 By dividing the "total killed" figure by the "driver killed" figure for each BAC range in Table B-2, I obtain for each range an estimate of the ratio of all fatal accidents to driver-fatal accidents in Vermont. Let us call the ratio for the ith BAC range Ri. The percentage of driver fatalities in each BAC range, as listed in Appendix A, is D'. Then it is clear that the percentage of all fatalities in the ith BAC range is Ti = ~;ij; lOO~o.

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380 REED Table B-3 shows Ti for each BAC range. The control group figures need no adjustment, so they are merely reproduced in Table B-3 as they appeared in Appendix A (with the three highest BAC ranges summed). TABLE B-3 Percentage of Drivers Involved in Fatal Accidents, and of Control Group Drivers, Estimated to Be Within Three BAC Ranges BAC (DO) Accident (5to) Control (%) 84 <0.01 64 0.01-0.04 5 30.05 31 APPENDIX C: RELATIVE RISK AND ACCIDENT REDUCTION CONTROLLED EPIDEMIOLOGICAL STUDIES Among the most valuable studies of drinking-driving problems are con- trolled epidemiological studies, such as those reviewed in Appendix A of this paper. In these studies, a random (or exhaustive) sample of drivers involved in accidents in a set geographic area and time period is made. The BAC of each driver in the sample is measured at the time of the accident. These drivers constitute the "accident group." In addition, researchers match a "control site" to each observation in the accident group. The control site is ideally the same place, at the same time of day and day of the week, under similar weather conditions, and otherwise nearly identical to the circumstances under which the accident being matched occurred. Several drivers passing each control site are randomly selected and their BAC levels measured. These ob- servations constitute the "control group." Drivers in both the accident group and control group are classified into BAC ranges, and the results are presented in Table C-1. I use the results of a controlled epidemiological study, as presented in Table C-1, to estimate the results of an imaginary experiment that is impractical to actually perform. The imaginary experiment is to ran- domly sample "units of accident exposure" and record driver BAC and whether an accident occurs for each unit of exposure selected. A unit of accident exposure would be a period of driving during which a "stand- ard" driver would have some particular expected number of accidents.

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Reducing the Costs of Drinking and Driving TABLE C-1 Results of a Controlled Epidemiological Study Number of Accident BAC Range Group Drivers Number of Control Group Drivers O a`, c<, 1 al Cl n a,, en 381 For example, driving for 1 hour (or 1 mile) at night in the rain on a narrow twisting road would constitute more units of exposure to accident than would 1 hour (or 1 mile) of driving on a sunny day on a well- designed expressway. If we could perform the imaginary experiment, then we could answer two important questions: (1) What are the probabilities of an accident occurring when one unit of accident exposure is driven by a driver at various BAC levels? (2) What would be the reduction in number of accidents if all driving was done by drivers in the lowest BAC range? ESTIMATING RELATIVE RISKS What is the probability that a random unit of exposure results in an accident, given that the driver is in some particular BAC range? To answer this question, I invoke Bayes's theorem: P`A~i~ - (A n i) = . p (i) ~ where (1) P(A~i) is the probability that a given unit of exposure results in an accident, given that the driver is in the ith BAC range. UP n id is the probability that a randomly chosen unit of driving results in an accident, and that the driver is in the ith BAC range. P(i) is the probability that a randomly selected unit of ex- posure is driven by a driver in the ith BAC range. 'The Bayesian analysis used in this and the following section has been applied to drunk driving before, notably by Hurst (1970, 1973~.

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382 Also from Bayes's theorem: Substituting (2) into (1~: REED P(Ani) =P(i~A)P(A). P`A~i' P(i~A) P(A) . (2) (3) Referring back to Table C-1, we see that Pupil) = at/~.ai, since the accident group is a random sample of units of exposure resulting in accidents. We can use c,/Ici as a proxy for P(i), because the probability of a driving trip being included in the control group is primarily deter- mined by the likelihood that a similar trip resulted in an accident. Thus, the control group approximates a random sample of units of exposures We can thus rewrite (3) as: 2 The probability of any given trip being included in the control group can be expressed as: P(T ~ C) = N E D (SIN - R), where P(T ~ C) is the probability that trip T becomes an element of the control group. N is the number of trips (including trip T) to which trip T could be matched as a control (i.e., the number of trips passing sites for which the site of T might be a control site). is the mean exposure to accident of each of the N trips. D is the risk multiplier due to the fraction of drivers among the N trips who have elevated BAC levels. S is the number of trips sampled at each control site. R is the probability that trip T ends in an accident before the car reaches the site where it would have been sampled for the control group. I make the simplifying assumptions that L) approaches one and R approaches zero. We are left with: P(T ~ c) = ES. S is a constant, so the probability that trip T is included in the control group is ap- proximately equal to the expected value of the exposure to accident of trip T.

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Reducing the Costs of Drinking and Driving We can thus rewrite (3) as: P` OCR for page 336
384 REED Note that as long as P (A~O) remains constant, relative risk for BAC range i is a linear function of P(A~i). Also, ci approximates a linear function of Ej (see note 2~. Thus, we can rewrite (6) as: IBi = P(A o) Ci ~ (7) where Bi is a linear function of Bi A I will refer to Bi as the relative number of accidents involving drivers in BAC range i. If all drunken driving was eliminated, without changing any individual's driving patterns (mileage, route, etc.), then we would compute a new Bi for each BAC range merely by setting relative risk for every range equal to one. Thus, if a "perfect" drinking-driving coun- termeasure was to go into effect, the total expected relative number of accidents would be: A IB;= Ec;. (8) In Table C-3' I present Bj for each BAC range' and IBi' for each of the studies in Table C-2, computed both with and without a "perfect" drinking-driving countermeasure in effect. The percentage change in B when the perfect countermeasure is figured in predicts the percentage change in the absolute expected number of accidents if such a counter- measure was implemented. TABLE C-3 Relative Number of Accidents Involving Drivers in Various BAC Ranges, Without and With a Perfect Drunk-Driving Countermeasure, for Four Studies Injury. Injury, Grand Property Damage. Fatal, Vermont Huntsville' Ala Rapids. Mich Grand Rapids, 1967-1968 1974-1975 1962-1963 Mich., 1962-1963 BAC (%) (Without/With) (Without/With) (Without/With) (Without/With) <0.01 84 84 88.2 88.2 89.0 89.0 89.0 89.0 0.01-0.049 6 9 6.0 4.3 7.0 7.8 7.0 7.8 0.05-0.099 9.4 4.7 4.5 2.5 3.8 2.5 0.10-0.149 41 7 5 7 2 1 ~ 8 6 ~ 0.8 6.4 0.8 ~0.15 9.4 0.7 ) ~ SUM 131 100 118.7 100.0 109.1 100.1 106.2 10().1

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386 REED Nichols, J. L., Weinstein, E. B., Ellingstad, V. S., and Struckman- Johnson, D. L. (1978) The specific deterrent effect of ASAP education and rehabilitation programs. Journal of Safety Research X(4: 177-187. Noble, E. P., ed. (1978a) Third Special Report to the U.S. Congress on Alcohol and Health. Rockville, Md.: National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health, Education, and Welfare. Noble, E. P., ed. (1978b) Third Special Report to the U.S. Congress on Alcohol and Health. Technical Support Document. Rockville, Md.: National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health, Education, and Welfare. Organisation for Economic Co-operation and Development (1978) New Research on the Role of Alcohol and Drugs in Road Accidents. Paris: Organisation for Economic Co- operation and Development. Perrine, M. W., Waller, J. A., and Harris, L. S. (1971) Alcohol and Highway Safety: Behavioral and Medical Aspects, Final Report. Washington, D.C.: National Highway Traffic Safety Administration, U.S. Department of Transportation. Preusser, D. F., Ulmer, R. G., and Adams, J. R. (1976) Driver record evaluation of a drinking driver rehabilitation program. Journal of Safety Research VIII(No. 3, Septem- ber):98-105. Robertson, L. S. (1977) Evaluation of Community Programs. Washington, D.C.: Insur- ance Institute for Highway Safety. Robertson, L. S., Rich, R. F., and Ross. H. L. (1973) Jail sentences for driving while intoxicated in Chicago: A judicial policy that failed. Law and Society Review (Fall):55- 67. Ross, H. L. (1973) Law, science, and accidents: The British Road Safety Act of 1967. Journal of Legal Studies II(1~:1-78. Ross, H. L. (1975) The Scandanavian myth: The effectiveness of drinking-and-driving legislation in Sweden and Norway. Journal of Legal Studies IV(2~:285-310. Ross, H. L. (1977) Deterrence regained: The Cheshire constabulary's "breathalyzer blitz." Journal of Legal Studies 6(January):241-249. Scotch, N. A. (1979) Proposal for a Project to Study the Raising of the Drinking Age in Massachusetts. Department of Socio-Medical Sciences, Boston University School of Medicine. Smart, R. G. (1969) Are alcoholics' accidents due solely to heavy drinking? Walter, J. A. Impaired driving and alcoholism: Personality or pharmacologic effect? Smart, R. G. Dr. Smart's reply. Journal of Safety Research I(4~:170-178. Sterling-Smith, R. S. (1976) Psychosocial Identification of Drivers Responsible for Fatal Vehicular Accidents in Boston. Washington, D.C.: National Highway Traffic Safety Administration, U.S. Department of Transportation. U.S. Department of Transportation (1968) Alcohol and Highway Safety Report. Wash- ington, D.C.: U.S. Department of Transportation. U.S. Department of Transportation (1979a) Alcohol Safety Action Projects Evaluation Methodology and Overall Program Impact, Vol. 3. National Highway Traffic Safety Administration (DOT-HS-803-896~. Washington, D.C.: U.S. Department of Trans- portation. U.S. Department of Transportation (1979b) Results of National Alcohol Safety Action Projects. National Highway Traffic Safety Administration (DOT-HS-804-033~. Wash- ington, D.C.: U.S. Department of Transportation. Wilde, G. J. S. (1971) Road Safety Campaigns: Design and Evaluation. Paris: Organisation for Economic Co-operation and Development. ~ . ~ _ _ _ , ,

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Reducing the Costs of Drinking and Driving 387 Wilde, G. S., O'Neill, B., and Cannon, D. (1975) A Psychometric Investigation of Drivers' Concern for Road Safety and Their Opinions of Various Measures for Accident Pre- vention. Kingston, Ontario: Queen's University. Zimring, F. E., (1978) Policy experiments in general deterrence: 1970-1975. Pp. 140-173 in Alfred Blumstein et al., eds., Deterrence and Incapacitation: Estimating the Effec- tiveness of Criminal Sanctions on Crime. Washington, D.C.: National Research Council.