1. Drunk Driving and Public Health Overview Martin Donohoe, MD, FACP

2. Drunk Driving- Epidemiology MVAs the #1 cause of death age 6-33 2/5 people in the US will be involved in an alcohol-related MVA during their lifetimes 39.3% if the 42,000 traffic fatalities in 1997 were alcohol - related 1.2 x 10 6 alcohol-related MVA injuries/yr. - one every 26 seconds

3. Drunk Driving- Epidemiology 51% of U.S. drivers acknowledge drinking alcohol 2.5% of adults over 18 admitted to an average of 26 episodes of driving while intoxicated in 1993 –total = 1.23 million episodes/yr. for the entire U.S. 18% of high school students admit to driving after drinking during two-week study period in 1997 –12% drove after 5 or more drinks

4. Drunk Driving- Epidemiology Chance of arrest/drunk driving episode = 1/50 - 1/2000 Conviction rates for impaired drivers requiring admission to a hospital or trauma center range from 4 - 51% (avg. = 24%) Conviction rates are higher for impaired drivers who are not injured

5. Drunk Driving- Epidemiology Of those arrested and convicted, 1/5 - 1/3 will be arrested again persons with 1 drunk driving conviction have 9x the baseline population mortality rate; 2 convictions  36x –both have higher rates of subsequent traumatic injury, # of hospital days, and health care costs intoxicated patients with no traumatic injury are 3x more likely to get substance abuse counseling than intoxicated, injured patients

6. Reasons for Lax Enforcement Inability of police to identify legally - intoxicated drivers (50% at sobriety checkpoints) Chain of evidence problems Time constraints Sensitivity toward injured driver

7. Drunk Driving- Epidemiology Direct Economic impact of alcohol- related crashes was $46.1 billion in 1990 78% of ER physicians favor mandated reporting laws

8. Other Key Points Physicians under-recognize EtOH abuse (up to 25% of hospitalized patients meet criteria for alcohol abuse. Drivers often impaired due to other illegal substances –of injured motorists in Illinois, 32% were legally drunk, 23% has positive urine drug screens (9% cocaine), 45% overall impaired, only 16.5% of those were cited.

9. Other Key Points Other factors can impair driving ability –seizure disorders, dysrhythmias, AICD misfirings, syncope, vision impairment, dementia, youthful irresponsibility Alcohol is involved in 67% of homicides, 69% of assaults, and 56% of domestic violence episodes

10. Other Key Points Tackling the problems of impaired drivers requires a multi-pronged approach: –  alcohol availability –  alcohol taxes (equitable) –P-care screening –treatment programs –law enforcement –Note: red light cameras may increase crashes and injuries as drivers slam on brakes to stop at intersections

11. Other Mandated Reporting Laws –infectious disease –criminal violence –child abuse, elder abuse, domestic violence –disorders causing lapses of consciousness –occupational injuries and pesticide poisoning –patient neglect or abuse in another facility –substance abuse in pregnant women –sexual abuse by other physicians/therapists

12. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org