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Abstract
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[DUI or DWI? Driving under the influence (DUI) is the most commonly used abbreviation to denote an impaired driving offense. In this publication, DUI is the most frequently used term to describe alcohol- and drug-impaired driving. Other abbreviations, such as driving while intoxicated (DWI), operating under the influence (OUI) and operating while impaired (OWI) may be used when discussing specific state laws or programs. Currently, the acronym DWI is discouraged because this acronym is commonly used in the medical literature for a type of radiography (diffusion-weighted imaging).]
Alcohol-impaired fatalities accounted for 29 percent of all U.S. motor vehicle deaths in 2018, the lowest percentage since 1982 when the National Highway Traffic Safety Administration (NHTSA) began reporting alcohol data. This was sparked by a 3.6 percent decrease in alcohol-impaired driving fatalities from 2017 to 2018 (National Center for Statistics & Analysis [NCSA], 2019). Thanks to the efforts of Mothers Against Drunk Driving (MADD), NHTSA in partnership with State Highway Safety Offices (SHSOs) and state and local law enforcement, as well as Responsibility.org, Students Against Destructive Decisions, the National Safety Council, and many other organizations, the nation's roadways are become safer.
Even with this progress, impaired driving remains a major highway safety problem nationwide. In 2018, an average of one alcohol-impaired driving fatality occurred every 50 minutes, which translates to 29 deaths each day. This may seem difficult to comprehend given the stigma associated with drunk driving, but 10,511 people lost their lives in motor vehicle crashes involving at least one driver with a blood alcohol concentration (BAC) of .08 g/dL or higher. Even more startling is that these deaths accounted for nearly one third of all people killed on our nation's roadways (NCSA, 2019). These, however, are only the alcohol-impaired driving motor vehicle fatalities. There are more than 111 million self-reported episodes of alcohol-impaired driving among U.S adults annually, equating to 300,000 incidents a day (Centers for Disease Control [CDC] and Prevention, 2019).
Clearly, when it comes to drunk driving there is a disconnect between drivers' attitudes and their behavior resulting in a significant danger on the road. According to the AAA Foundation for Traffic Safety's 2018 Traffic Safety Culture Index (2019), more than 95 percent of drivers indicated that driving after drinking enough alcohol to be over the legal limit is very or extremely dangerous. But approximately 11 percent of those same motorists admitted to engaging in this dangerous behavior in the past month. National Safety Council (NSC) research mirrors the AAA findings, but even more troubling is that nearly half of the motorists who said they drove over the legal limit, felt they were unsafe behind the wheel and 47 percent said they almost crashed (2017).
Impaired driving, however, is not solely alcohol related. Drugs—both legal (including prescription and over-the-counter medications as well as cannabis in some states) and illegal—are playing an increasingly more prevalent and dangerous role in motor vehicle crashes. Between 2006 and 2016, the rate of fatally injured drivers (with known test results) that tested positive for drugs increased from 28 percent to 44 percent (Fatality Analysis Reporting System [FARS] as cited in Hedlund, 2018). The most commonly ingested substances included stimulants (e.g., cocaine, methamphetamine), depressants (e.g., Xanax, Valium), narcotic analgesics (opioids, heroin), dissociative anesthetics (e.g., PCP, ketamine), cannabis, and a combination of these and other drugs (Sobriety Testing Resource Center and Drug Recognition Expert [DRE] Evaluations System as cited in International Association of Chiefs of Police [IACP], 2019).
Combining substances, even at low levels, can significantly increase crash risk. This is referred to as polysubstance use and despite the danger of consuming alcohol and drugs or multiple drugs, the behavior is on the rise. For example, Denver, Colorado (the first state to legalize recreational cannabis), experienced a 300 percent jump in polysubstance-impaired driving cases from 2013 to 2016. Alcohol and THC (tetrahydrocannabinol), the main psychoactive compound in cannabis that gives the sensation of being high, were the most common combination (Ma, 2019). In Washington State, drivers convicted of impaired driving were two and five times more likely to test positive for polysubstance use than alcohol and THC-only, respectively (Grondel, Hoff & Doane, 2018). Nationwide in 2016, 50.5 percent of fatally injured, drug-positive drivers had two or more drugs in their system and 40.7 percent were found to have alcohol in their system (FARS as cited in Hedlund, 2018).
All motorists who drive impaired—regardless of the substance—pose a hazard to themselves and others but the greater the level of impairment the higher the crash risk. While a BAC of .08 g/dL is the legal limit in all states (the exception is Utah, where the legal limit is .05 g/dL), 66 percent of the drivers involved in fatal crashes in 2018 had BAC levels at or above .15 g/dL, with the most frequent being .16g/dL (NCSA, 2019). Looking at the states, the percentage of fatalities involving a driver with a BAC of .15 g/dL or higher ranged from a high of 31 percent (Montana) to a low of 12 percent (Kentucky and West Virginia), compared to the national average of 19 percent. Perhaps most alarming is that these high-BAC impaired drivers are involved in more than 60 percent of the alcohol-impaired driving deaths each year (NCSA, 2019). Drivers with BACs of .08 g/dL or higher, who were involved in fatal crashes, were also 4.5 times more likely to have prior convictions for driving under the influence (DUI) than drivers with no alcohol (9 and 2 percent, respectively). These repeat offenders cause about one-third of all impaired driving deaths annually, a statistic that has remained relatively unchanged for years (NCSA, 2018). That combined with a 16 percent increase over the past 10 years in the number of alcohol-impaired drivers killed in crashes who also tested positive for drugs (Nordstrom, 2019), gives an entirely new meaning to the term high-risk impaired driver or HRID.
This publication focuses on the challenges and opportunities associated with the high-risk impaired driver—a person who lacks the restraint or self-control to resist driving impaired (Kean, Maxim & Teevan as cited in Lowe, 2014). A high-risk impaired driver is likely to drive with a BAC of .15 g/dL or higher—or after consuming drugs or a combination of alcohol and drugs—and to do so repeatedly as evidenced by having more than one DUI arrest. Whatever the impairing substance, the high-risk impaired driver is highly resistant to changing his/her behavior despite sanctions, treatment or education and poses an elevated crash risk (Holmes & Dalbec, 2015). To reduce recidivism, stop the revolving door and save lives, more must be done to identify and address the high-risk impaired driver. |