Alcohol misuse: tackling the UK epidemic - London

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BMA Board of Science Measures to reduce drink-driving Considerable reductions in the incidence of drink-drive road incidents and related deaths have occurred in the UK since 1980. This has most likely resulted from numerous factors including police enforcement of drink-drive legislation, the use of portable devices to measure samples of drivers’ breaths, tough penalties for drink-driving (prison terms, fines and mandatory disqualification), high level anti-drink-drive campaigns, and improvements in automobile design. As noted previously, however, the number of fatalities and serious injuries resulting from drinkdrive road crashes remains significantly high. In the UK, the BAC limit is 80mg/100ml which is among the highest in Europe (see Figure 17). Research has found that there is a marked deterioration in driving performance between a BAC of 50mg/100ml and 80mg/100ml. The relative crash risk of drivers with a BAC of 50mg/100ml is double that for a person with a zero BAC, and the risk rises to 10 times for a BAC of 80mg/100ml. 114 Drinking by drivers with a BAC between 50mg/100ml and 80mg/100ml is a significant but largely hidden cause of road traffic crashes, and has been estimated to account for 80 road deaths a year in England. 173 Studies in Sweden, Australia and the USA have consistently found lowering legal blood alcohol limits 116, 145, 153, 174-178 to produce reductions in the incidence of drink-driving and related crashes. Newly qualified drivers are felt to be particularly at risk of alcohol-related road crashes as a result of their limited driving experience. As noted previously, the highest rates of drink-drive accidents per 100,000 licence holders occur in the 17 to 19 age group, followed by those in the 20 to 24 age group. 97 Evaluation of the introduction of lower BAC limits as part of new driver licensing systems have shown them to be effective in reducing collisions among young drivers and novice drivers. 179-182 In the USA and Australia, the introduction of BAC limits between 10 and 20mg/100ml for young 116, 145, drivers aged under 21 have been found to reduce levels of drink-driving and fatal road crashes. 153, 183-185 In Spain, it is illegal for all newly qualified drivers to drive with a BAC in excess of 15mg/100ml for the two years after they have obtained their driving licence. Enforcement of drink-drive legislation is essential for compliance. In the UK, this is operated through selective breath testing and high-profile media campaigns. Selective breath testing requires police to have judged that a motorist has consumed alcohol before implementing the test. This deterrence-based policy is insufficient as many offenders may be able to avoid detection. Random breath testing permits police to stop motorists who are not suspected of committing an offence or of being involved in an incident. This is an advantageous approach as motorists are unable to influence the likelihood of being tested. With the exception of Denmark and the UK, random breath testing is permitted throughout the EU. 186 Research in Australia has found that highly visible, random testing can have a sustained and significant effect in reducing levels of 145, 153, 176 drink-driving, alcohol-related road traffic crashes and associated injuries and fatalities. One study found random testing to be twice as effective as selective testing, with a reduction in fatal crashes of 35 per cent and 15 per cent respectively. 176 Alcohol misuse: tackling the UK epidemic 57
BAC (mg/100ml) 58 100 90 80 70 60 50 40 30 20 10 0 Croatia Czech Republic Hungary Romania Slovakia Estonia Norway Zero BAC limit BMA Board of Science It is essential that further measures are implemented to build on progress achieved over recent years in reducing the levels of drink-driving and associated problems in the UK. This includes a reduction in the legal BAC limit from 80mg/100ml to 50mg/100ml, r and consideration for further reductions for all newly qualified drivers. It is also important that a consistent approach is adopted across the EU where cross-border travel is commonplace. This requires standardisation of the maximum legal BAC while driving among the EU member states. The use of highly visible, selective and non-selective breath testing programmes is a key component of effective enforcement of drink-drive legislation. Recommendations The legal limit for the level of alcohol permitted while driving, attempting to drive, or being in charge of a vehicle should be reduced from 80mg/100ml to 50mg/100ml throughout the UK. Legislation permitting the use of random roadside testing without the need for prior suspicion of intoxication should be introduced throughout the UK. This requires appropriate resourcing and public awareness campaigns. Figure 17 – the maximum BAC legal limit for selected European countries s Poland Russia Sweden Spain Lithuania Austria Belgium Bulgaria Denmark Finland Alcohol misuse: tackling the UK epidemic France Germany Country Greece Iceland Italy Lativa Netherlands Portugal Republic of Macedonia Serbia Slovenia Switzerland Turkey Luxembourg Malta Republic of Ireland United Kingdom Cyprus r A zero limit for the level of alcohol permitted while driving is not practical as there will be cases where an individual would register slightly above zero even when they had not been drinking; diabetes and the use of mouthwash can both cause an above-zero level. The BMA doubts whether an absolute zero would be enforceable and acceptable to the public but argues that a 50mg level, which would bring the UK in line with most other European countries, would be effective and beneficial. s The maximum BAC legal limit for Croatia, Czech Republic, Hungary, Romania and Slovakia is zero. The Department of Road Transport in Cyprus has announced plans to reduce the BAC legal limit in Cyprus to 50mg/100ml
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BMA Board of Science Alcohol misuse
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ii BMA Board of Science Editorial b
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iv BMA Board of Science Acknowledge
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vi BMA Board of Science Glossary No
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viii BMA Board of Science Recommend
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x BMA Board of Science Alcohol misu
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xii BMA Board of Science Alcohol mi
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4 BMA Board of Science Consideratio
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Page 112 and 113: vi Contents Introduction...........
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Page 116 and 117: 2 heavier smoking, drinking and mor
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6 The data for 1998 shows a 21 per
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8 Interventions in adolescent nutri
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10 The efficacy of traditional educ
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12 The treatment of individuals wit
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14 Smoking, drinking and drug use A
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16 The use of illicit substances, a
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18 smoking prevalence was highest a
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20 Interventions in adolescent drug
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22 be expensive given the amount co
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24 is potential to use the media, n
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26 Summary Adolescents in the UK ar
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28 Mental health problems in adoles
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30 Risk factors for conduct, depres
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32 Currently, specialist mental hea
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34 Sexual health Adolescents and se
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36 interferes with the adolescent
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38 Interventions in adolescent sexu
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40 The timing of educational interv
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42 Helping adolescent parents The h
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44 are more difficult to reach than
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46 The way forward This report has
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48 Annex 1 BMA policy on adolescent
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50 References 1 Lobstein T J, James
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52 56 Social Exclusion Unit (1998)
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54 115 Charles Gallichan (2003) Pub
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56 173 NHS Centre for Reviews and D
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Subject: Young People and Alcohol D
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Call for Evidence: Children and You
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5. Do you know of any international
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Alcohol misuse: tackling the UK epidemic - London

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