Drunk Driving and Public Health Overview

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 106 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

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_at_phsj.org