Challenges for best practice in Drink D riving Management Professor Mary Sheehan

1. Challenges for best practice in Drink Driving Management Professor Mary Sheehan 3rd International Conference on Urban Traffic Safety, Edmonton,17-21 April 2011

2. Acknowledgements • CARRS-Q team members: Dr Lisa Buckley, Postdoctoral Fellow Rebekah Chapman, NHMRC PhD Scholar • Key conceptual reference: Fell J.C. & Voas R.B. (2006). Mothers against drunk driving (MADD): the first 25 years. Traffic Injury Prevention,7, 195 -212.

3. Overview • Context of Drink Driving – Contrasting Interventions • An Historical Context (1988) • The Current Context • Education and rehabilitation programs – Re-visited CRICOS No. 00213J

4. 1. Context of Drink Driving – Contrasting Interventions • Targets of intervention • A model for population prevention • Task of intervention – (reducing fatalities in Canada and Australia) • The prevention paradox – the inequality paradox of population approaches and vulnerable groups CRICOS No. 00213J

5. Targets: Tiers of Influence on Drink Driving Behaviour Social & community context Family, peers, teachers At risk person Drink driving behaviour

6. Targets of intervention Education/ media campaigns General and targeted testing Social & community context 0.00 BAC for novice and commercial drivers Family, peers, teachers At risk person Drink driving behaviour

7. Targets of intervention Social & community context Family, peers, teachers School-based education At risk person Drink driving behaviour

8. Targets of intervention Social & community context Family, peers, teachers Rehabilitation programs License loss and suspension At risk person Drink driving behaviour

9. Targets of intervention Social & community context Family, peers, teachers At risk person Mandatory Alcohol Ignition Interlock Jail sentence Mandatory vehicle impounding Drink driving behaviour

10. A public health model for population prevention

11. A model for population prevention:Homogenous effect of a population approach After the intervention Before the intervention level of risk exposure mean effect Rose ( 1992)

12. Focus of intervention Percentage of fatally injured motorists with a BAC of .05 or more in Australia (1981-2006)

13. Focus of intervention Percentage of fatally injured motorists with a BAC of .05 or more in Australia; .08 or more in Canada

14. Increase in the variation of risk following a population approach Before the intervention After the intervention Concentration of risks Concentration of benefits level of risk exposure mean effect Frohlich &Potvin (2008)

15. 2. An Historical Context (1988) CRICOS No. 00213J

16. Terminology of drink driving (1988) • Summary of issues • Education and rehabilitation (Mann, Vingilis and Stewart) University of Chicago Press, 1988 CRICOS No. 00213J

17. Terminology • Variability reflects community attitudinal framing CRICOS No. 00213J

18. Social control of the drinking driver (1988) • The moral drama of drinking driving has been the most vital force at work [RID,MADD] • Young people have status as a “dangerous class” in America…and are a relatively weak political group. A logical safety conclusion would extend the minimum drinking age to 25 and exclude all women from such legislation. (Gusfield) • An alcohol safety Ignition Interlock system is at the inaugural trial stage and must be seriously considered for use with recidivists (Voas)

19. Social control of the drinking driver (1988) • Alcohol impaired driving is highly resistant and benefits from licence actions and intensive law enforcement with media support have been only short term • Random Breath Testing is being trialled in New South Wales (Australia) andmay have a longer effect (Snortum) • Benefit-cost research needs to be done (Votey) • The success of the Scandinavian system is the “per se” legislation (Andenaes)

20. Chapter 10: Programs to Change Individual Behavior: Education and Rehabilitation in the Prevention of Drinking and Driving (1988) Robert E. Mann, Evelyn R. Vingilis, and Kathryn Stewart • Countermeasure approaches must understand the independent and interactive influences of both personal factors and environmental factors. • The most effective way to combat a complex social problem like drinking and driving is to introduce a set of complementary person and environment based countermeasures • Effective social control will make judicious use of both education and rehabilitation, and environment management countermeasures such as stricter laws, random breath testing, alcohol control, improved vehicle and road design. Effective solutions should use complementary person based (education and rehabilitation) and environment management countermeasures. CRICOS No. 00213J

21. 3. The current context • Definitions of drink driving (2011) • Attitudes – messages – community opinion surveys • Best practice • Definitive literature • NHTSA guidelines • GDL – driving age – per se laws – RBT • Alcohol ignition interlocks • A health agenda item CRICOS No. 00213J

22. Terminology – 2011 An example of persistent attitudes An example of education CRICOS No. 00213J

23. Core attitudinal messages: The drinking driver • Canada: MADD’s mission: • Australia: Key advertising message: isto stop impaired driving and to support victims of this violent crime If you drink and drive you’re a bloody idiot (and if you drink and drive and don’t get caught, you’re bloody lucky)

24. Percentage who report driving after the consumption of any alcohol TRF (2011), Petroulias (2009).

25. USA figures Quoted by Fell and Voas (2006) are much earlier but of interest and probably lower now Driving after drinking: 1983 - 32% 1986 - 26%

26. Percentage who report driving over the legal limit Beirness &Davis (2007), Petroulias (2009).

27. USA Figures Again quoted by Fell and Voas (2006) and again much earlier: Driving after drinking too much 1984 – 5.5% 1986/87 – 4.5%

28. Key policy initiatives • Alcohol: No Ordinary Commodity: Research and Public Policy. 2010. Second edition, Oxford University Press. • Countermeasures that work: a highway safety countermeasure guide for state highway safety offices (NHTSA, 2007). • Shults, RA, Elder, RW, Sleet, DA et al. (2001). Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Health 2001; 21(4s): 66-88. • Global Status Report: Alcohol Policy (WHO, 2004). CRICOS No. 00213J

29. Countermeasures that work (NHTSA, 2007)

30. Countermeasures that work (NHTSA, 2007) CRICOS No. 00213J

31. Countermeasures that work (NHTSA, 2007) CRICOS No. 00213J

32. USA Used in majority of states in varying ways and types of offenders Canada Mandatory in majority of provinces and linked with rehabilitation programs in some jurisdictions Europe Used and tested in a large number of countries Sweden Mandatory for post conviction, used in vehicle fleets and being investigated as standard for all vehicles Australia Mandatory for recidivists in 4 states CRICOS No. 00213J

33. Australia Majority of states USA Majority of states Europe A number of countries Canada Majority of provinces Graduated Driver Licensing (Alcohol limitations)

34. Drinking Age • Minimum drinking age 21yrs – USA since 1987 • Zero tolerance for novice drivers – Australia, Canada and widely established in Europe BUT • Only 19 of 139 countries with BAC limits have lower limits for novice drivers Extracted from Hingson (2009)

35. Drink driving: An item on the health agenda CRICOS No. 00213J

36. 2004 Global Status Report: Alcohol Policy CRICOS No. 00213J

37. 2004 Global Status Report: Alcohol Policy BAC level and RBT CRICOS No. 00213J

38. Alcohol in Fatal Crashes (WHO reports – 93 countries) • WHO recommends 0.05% legal BAC • Only half of countries with legal BAC limits have a BAC of 0.05% or lower Extracted from Hingson (2009) CRICOS No. 00213J

39. 4. Education & rehabilitation programs – re-visited CRICOS No. 00213J

40. Key issues in rehabilitation program design Effectiveness: • Replication of drink driving rehabilitation program effectiveness findings in Australia, UK, EU finds between 30% and 69% reduction in recidivism with consistent replication of this outcome with high recidivist drink drivers. • Similar findings in the USA where program was an alcohol treatment rather than drink driving intervention.

41. Key issues in rehabilitation program design (1) Core elements of effective programs include: • Undertaken in addition to licence restriction and/or suspension • Group programmes - 10 participants most common size reported in effective programmes. • Longer rather than shorter programs (approx. 10 sessions over 10 weeks) • Interactive discussion – active learning not didactic teaching • Use of drinking diaries and trackers to develop strategies for high potential drink driving situations

42. Key issues in rehabilitation program design (2) • Information essential but not sufficient • A focus on personally relevant strategies and skills to avoid drink driving and group processing of problem solutions • Staff trained to handle class relationship problems professionally • Offenders perceive transparent and objective client selection • A formally structured program defined by a written manual

43. Key issues in school-based education for senior students:Best practice (1) Content • Material and knowledge that is consistent with the GLS (Graduated Licensing System) • Attitudes that are known to affect risky behaviours (e.g. attitudes to drink driving) using behaviour change theories with demonstrated effectiveness • Road safety targets that are appropriate for the developmental stage and culturally appropriate e.g. the role of a supportive/protective peer passenger or ‘good mate’ • Emotional messages should not focus on evoking fear, and if used should be accompanied by specific coping strategies and alternative behaviours.

44. School-basededucation for senior students:Best practice (2) Process • Multiple sessions covering a range of issues • Use continuity of road safety messages from primary school road safety programs through high school to licensing stage (include passenger behaviour) • Effective messages need to be delivered through interactive processes and small group discussions • Programs should be delivered by skilled individuals who can manage the above (e.g. teacher with relevant training) • Ideally, include parental involvement

45. Driver education for senior students:Counterproductive issues • Programs which encourage early licensing – exposure • Programs which result in over-confidence about driving abilities in participants • Formative evaluation to ensure program does not encourage at risk behaviours Buckley & Sheehan (2004)

46. School based education for senior students Effectiveness: • Measured by reduced drink driving in later years rarely tested but the few that do this indicate that model programs are effective in reducing target behaviours • Attitude and knowledge change achieved by well constructed programmes

47. Evaluation issues for education programs - SPIY • Alcohol associated risk behaviours increase through adolescence 6 Mth Follow-up Change Not wear a bicycle helmet Passenger of drink driver

48. Evaluations issues for education programs –target for change The gold standard for evaluation for drink driving school education programs is change in later drink driving offences BUT Perhaps the change indicators should be change in the social and community context

49. Increase in the variation of risk following a population approach Before the intervention After the intervention Concentration of risks Concentration of benefits level of risk exposure Rehabilitation mean effect School education Frohlich &Potvin (2008)

50. References Petroulias T.(2009) Community Attitudes to Road Safety: 2009 Survey Report. Road Safety Report No. 4. Canberra, Dept of Infrastructure, Transport, Regional Development and Local Government. Ramage-Morin P.L. (2008) Motor vehicle accident deaths, 1979 to 2004. Statistics Canada, Catalogue no. 82-003-XPE –Health reports 19,3. Canada. Laurence, M.D., Snortum, J.R.,& Zimring, F.E. (1988) Social Control of the Drinking Driver. University of Chicago Press. Global Status Report: Alcohol Policy (2004),World Health Organization, Dept Mental Health and Substance Abuse, Geneva. Shapcott G. Road Safety Statistics, DITRD, Australia, Personal communication, December,17,2009. Sheehan Mary (1994) Alcohol Controls and Drink driving: the Social Context. CR 142, FORS, Canberra.