Holiday Joy and Anguish

By Richard L. Brown, MD, MPH

I hope you and your loved ones had very happy holidays. Unfortunately, many Americans didn’t – and that’s because of drunk driving. During most of December, 28 percent of traffic fatalities in the United States involve an intoxicated driver. But between Christmas and New Year’s, that rate climbs to a staggering 40 percent.

According to the National Institute on Alcoholism and Alcohol Abuse, “two to three times more people die in alcohol-related crashes than during comparable periods the rest of the year.” And more than one-third of those who die are not intoxicated.

In Wisconsin, the problem is particularly concerning as we lead the nation in the proportion of adults who anonymously report driving drunk. In 2011, the most recent year in which data is available, there were 184 alcohol-related fatalities on Wisconsin roads.

What can we do about this?

Typically, one suggestion is to increase drunken driving penalties. Wisconsin is one of the few states in the country where first-time drunk driving is not a misdemeanor conviction. Unfortunately, while stiffening penalties would send a long, overdue message that drunk driving is not to be tolerated, research has shown stiffer penalties seldom deter illegal behaviors when most individuals do not believe that they will be caught. Therefore, a measure that is more likely to deter drunk drivers is to expand sobriety checkpoints, because checkpoints increase the perceived likelihood of apprehension. This would necessitate changing Wisconsin state law, which currently prohibits sobriety checkpoints even when localities would like to implement them.

Another typical suggestion is to clamp down on repeat offenders. For example, every U.S. state has some version of an ignition interlock law. Requiring ignition interlock devices does not eliminate drunk driving but does substantially reduce it. However, most drunk drivers involved in fatalities are not repeat offenders. A comprehensive strategy must also reduce drunk driving by those who have never been caught before.

The following graph illustrates the problem:

DrunkDrivingChart

About two-thirds of the differences in rates of drunk driving across states can be attributed to differences in rates of binge drinking. This finding suggests that we will not substantially decrease drunk driving and related fatalities and injuries in Wisconsin unless we decrease binge drinking.

Decreasing binge drinking may sound challenging, but all that is needed is the political will to implement policies and programs that have been proven to work in many other places across the U.S., including reducing alcohol access and raising alcohol prices through higher excise taxes. See healthfirstwi.org and collegedrinkingprevention.gov for more information.

And of course, systematic delivery of SBIRT in clinics and hospitals would also help decrease binge drinking. One study in Wisconsin primary care clinics found that brief interventions reduced car crashes among binge drinkers by 50 percent the following year.

So, as this year’s holiday season fades, let’s stiffen our resolve to prevent the deaths and injuries that we can inevitably expect next holiday season and throughout the year. Please join me in a New Year’s resolution to do whatever possible to make SBIRT routine in Wisconsin healthcare settings.



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