ADVANCE PREVENTION OF DRUNKEN DRIVING

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1 ADVANCE PREVENTION OF DRUNKEN DRIVING by A n t t i A l h a, M.D.* i n r e c e n t y e a r s, along with the abundant growth of the motor vehicle, traffic offenses and accidents have greatly increased, a fact that demands increasingly closer investigation of the causes involved. The factors involved in traffic are the road and weather, the vehicle, and the hum an being, the driver. From traffic accident statistics in Finland it can be seen that, of the immediate causes of accidents, road and weather constitute about 5%, deficiency or fault in the motor vehicle, some 3%, and the hum an being and various hum an factors, at least 90%. Moreover, the hum an factor is still proportionally increasing. Among the hum an factors, the share of diseases may be about 0.2%. The role played by several other perm anent, varying, * D r. A lh a is asso ciate p ro fesso r in th e D e p a rtm e n t o f F o re n sic M e d ic in e, C h e m ic al D iv isio n, U n iv e r sity o f H e lsin k i, H e lsin k i, F in la n d. I n D r. A lh a s ab sence, his p a p e r w as p re se n te d a t th e F o u rth In te rn a tio n a l C o n fe re n c e by D r. R o b e rt F. B o rk e n stein, I n d ia n a U n iv e rsity. or changing factors due to individual differences cannot be statistically accurate and their great significance for accidents can be only guesses. Such factors include ability to see traffic signs, to estimate distances and the speed of the vehicle, and the ability to drive when tired or in an emotionally disturbed state of mind. As to the individual factors, the use of too great speeds in driving probably is the most significant basic cause. The drivers are provoked to this through the continuous development of faster motor vehicles and improved roads. I t may thus be asked, is the required technical skill getting the upper hand of the hum an being? A nother contributing cause to traffic accidents th a t is significant in the hum an facto r b u t also entirely w ithout accurate determ ination is the asociality of the persons involved in traffic (Tables 1, 2, and 3. From the tables it can be seen that the factor of traffic asociality most easily defined is drunken driving, the estim ated in- 1. M o to r v eh icles: T a b l e 1 Traffic Statistics from the Finnish Police in 1964 (Population of Finland about 4.6 millions C ars 469,429 M o to rcycles 113,731 M o p e d s (e stim. 265,000 O th e rs 113,694 T o ta l 961,854 T h e in c re a se in th e n u m b e r of c a rs fro m th e fo re g o in g y e a r w as 7 3,4 9 6 = 18.5% 2. T ra ffic offenses: T o ta l 152,641 o f th e m a lc o h o l 6,174 (4 % 3. T ra ffic a c c id e n ts (c o m p a re d to cases in 1963: N u m b e r P e r C e n t In c re a se fro m 1963 T o ta l 29,270 31, of th e m alcoho l 1,916 2, I n ju rie s a n d d e a th s 13,411 15, of th e m alco h o l 1,349 1, D e a th s of th e m a lc o h o l C a r th efts : T o ta l 4,301 S olved cases, d istrib u tio n in ag e g ro u p s: Age T o t. u n d e r 21 O v e r 21 A ll cases N u m b e r P e r C e n t

2 308 L A W A N D L A W E N F O R C E M E N T cidence of which, by using different criteria, ranges from 4 to 20% of traffic offenses and accidents. It is also observed that the per cent am ount of alcohol involved cases has increased with the increasing severity of the consequences of traffic offenses. In Finland, legislation on drunken driving (Table 4 is one of the strictest in the world. Despite this, the num ber of cases of drunken driving has continuously increased. It may thus be regarded th a t the prophylactic effect of this legislation has not lived up to expectations. W hen the causes of drunken driving and its increased frequency in Finland are considered on the basis of experience gathered over the years, we may arrive at the following significant points! 1. Public Opinion. D runken driving is not generally regarded as a real crime and the attitu d e tow ard it is not serious enough. 2. Increased Use and Abuse of Liquor. Table 5 shows that consumption of alcohol in Finland, calculated in litres of 100% alcohol per person per year, was in 1964 only 2.2 litres, or among the smallest in the world. However, in recent years, an annual increase of about 4% in the standard of living has gone along with an approximate increase of 5% in the consum ption of alcohol. An estimate based on this means that the aforementioned num ber of litres will in the beginning of the 1970 s exceed 3 litres. I t must be estim ated th a t the in crease in the consumption of alcohol is greatest am ong the young (T able Asociality. According to various criteria, it may be estimated that in 25 to 75% of cases of drunken driving, other forms of asociality are present in the persons involved. A considerable proportion of drunken drivers are repetitious offenders, people driving without a driver s license or with a stolen vehicle. These subgroups have no regard for rules or orders. 4. Alcoholism. Drunken driving is an early and regular feature of alcoholism.* 5. Altered Age Structure. The share of especially young (small cars and also of older age groups (mopeds in the cases of drunken driving has increased (Table Ignorance. Every year new drivers, predominantly young ones, enter traffic. It cannot be assumed that all of them are fam iliar with legislation on drunken driving or conscious of the risk caused even by small amounts of alcohol. This may become apparent in two ways: the effect of the ingested alcohol itself, and, on the other hand, the loosening of inhibitions caused by it which may lead to more severe drinking and carelessness of even known dangers. A driver s license is not required to drive mopeds (motor scooters so that, regarding knowledge of traffic and the dangers involved in drunken driving, such drivers are in a more unfavorable position than drivers of norm al m otor vehicles. * M.M. G la tt: R e c u rre n t D riv in g U n d e r th e I n flu e n c e A lcohol a n d R o a d T ra ffic. Proceedings of the T hird International Conference, L o n d o n B.M.A. H o u se, L o n d o n 1963, p T a b l e 2 Traffic Statistics from the Police in Helsinki in 1964 ( C apital of Finland, Population about 500,000 Registered m otor vehicles , (cars 6 9, 2 9 2, motorcycles 4, 8 6 6, others 1, (mopeds ca. 2 0, Suspected cases of drunken driving... '41 charged T raffic accidents... of them alcohol cases ( %... Injuries and deaths *,053 of them alcohol cases ( 1 2 % D eaths o f them alcohol cases (21% C a r th e fts ( o f th e m a lc o h o l c ases (1 7 %... C h a rg e d a lto g e th e r 411 p erso n s: u n d e r 15 y ears (3 5 % y e a rs (5 8 % D riv in g w ith o u t license... o f th e m a lc o h o l cases (c a. 13% D riv in g w ith o u t re g istry o f th e c a r... n o a lc o h o l cases 7. E sc a p e d b y flig h t fro m th e scene o f th e offense (tra ffic g a n g sterism o f th e m a lc o h o l cases (c a % , :a. 20

3 A. ALHA 309 T a b le 3 Statistics on the Chemically Investigated Drunken Driving Cases in Finland (Blood-alcohol level, etc., investigations centered in the D epartm ent of Forensic M edicine, Chemical Division, University of H elsinki 1. N um ber of investigations: ,336 cases ,920 cases ,536 cases ,000 cases will be exceeded 2. D ata on cases in 1964: M otor vehicle d riv e rs...5,145 cases 97.5% Sort of m otor vehicle known in 4,888 cases: Car... 3,298 cases (67.5% Moped... 1,182 cases (24% M otorcycle cases T racto r cases Special vehicle cases Increase of all cases from 1963: 616 cases Increase of car drivers from 1963: 570 cases W omen 29 cases Blood-alcohol level in suspected cases of drunken driving: No alcohol cases (5.1% Alcohol found but under 1.2 per mille cases (18% Alcohol found over 1.2 per mille... 4,205 cases (76.9% In the group of No Alcohol, drugs were found in 14 cases. T a b le 4 Legislation Concerning D runken D riving in Finland It concerns both being under the influence of alcohol and narcotics. It involves both the road and air traffic, in the latter case both the pilot and the rest of the personnel. Surrendering a vehicle to a drunken person is liable to punishm ent. Submission to blood-alcohol testing is obligatory. Only a doctor is justified to take a blood sample and to perform other examinations requiring medical competence; such examinations shall not cause any particular distress. In connection with taking a blood sample the physician performs a clinical investigation of the state of inebriation according to an approved form. W hen narcotics are suspected, a urine sample is taken for chemical investigation. T here is no convicting lim it of blood-alcohol level. Person found guilty cannot get off w ithout imprisonm ent. T he maximum penalty is 3 years of hard labor; in case of m anslaughter, 8 years of hard labor. T he person found guilty pays on court order the expenses of the forensic m edical investigation. The driving license of a person found guilty is revoked for a certain period upon judgm ent pronounced by the court. T a b l e 5 Consumption of Alcoholic Drinks According to the alcohol legislation in Finland, the sale of all alcoholic drinks, including beer and wines, is a state monopoly. Alcoholic drinks are sold in cities and thickly populated communities in special stores or restaurants w ith official permission. Alcoholic drinks are not sold in rural areas. A purchase license is required in the stores for buying distilled drinks. Alcoholic drinks are sold to persons over 21 years; in restaurants th e age lim it for serving is 18 years. Consum ption expressed in litres of 100% alcohol per person per year: France ( Denm ark ( Italy ( Sweden ( Austria ( Norway ( U.S.A. ( Finland ( (in 1963 = 2.0 D ifferent alcoholic drinks consumed in Finland in 1964: Distilled drinks (0.75 as vodka, others 0.6 Wines M alt drinks Distilled drinks: Sweden ( France ( Austria ( Finland ( (in 1963 = 1.6

4 310 L A W A ND L A W E N F O R C E M E N T T a b l e 6 Arrests for D runkenness in Finland in 1964 Charged... 68,936 cases N ot charged... 64,613 cases T otal ,549 cases O ver 21 years U nder 2\ years c f S f n not charged charged not charged 61,370 60,979 7,180 3,50s U nder 21 years: 15 years years years total 26 3,000 7,688 10, Increased A m ount of M otor Vehicles. Along w ith the increasing standard of living and dem ands of general evolution, increasingly larger groups acquire m otor vehicles, especially cars. Thus groups of young people, indifferent or ignorant of the dangers of drunken driving, enter traffic in in creasing numbers. 8. T raffic Jam. T he am ount and condition of roads have not been able to parallel growth in num ber and speed of motor vehicles. This has resulted in jams on the driveways in which a smaller driving error th an before becomes an offense. 9. Indifference About Getting Caught. T he control exercised by the officials is and remains only limited. According to various sources it can be estimated that only a fraction, at most perhaps some 10% of people driving u nder the influence of alcohol, are arrested. This has become generally known and it has in a decisive way increased indifference toward the, in itself, strict legislation on drunken driving. Persons condem ned for drunken driving nowadays almost without exception regard their punishm ent a t least partially as unjust because they think that it was merely bad luck to get caught. The points of view presented above which characterize some causes of drunken driving probably give an idea of, among others, why the prophylactic effect of legislation on drunken driving has not lived up to expectations. Drunken driving is a detriment that has sprouted out of human abuse of alcohol, and at present it seems to be indisputably coupled with the growth of motor vehicle traffic and with various individual and social factors. T a b l e 7 D runken D riving and Age. Chem ically Investigated Cases in 1953 and 1963 Age No. of cases per cent No. of cases per cent 15 years years years years years years years over 60 years No inform ation T otal

5 A. A L H A 311 There should, however, be something that could be done in order to prevent drunken driving in advance. Measures aimed at this have been given much consideration everywhere, and it is possible to present the following points of view. 1. Legislation (a Widening the sphere of guilt. Guilt can be extended to include passengers and other persons who, despite opportunity of doing so, have not prevented the occurrence of the criminal offense of drunken driving. This, however, again brings us face to face with public opinion. (b Sentencing the person to pay a big fine and forfeit his motor vehicle to the state. Such powerful economic ways of punishment have been repeatedly suggested; however, because of their heavy influence on the families of persons convicted for drunken driving, they have not gained general support, and we are again face to face with public opinion and indifference about getting caught. (c Convicting limit of blood-alcohol level. A convicting lim it facilitates jurisdiction, but at the same time it substantially limits the free judgm ent of the court of law. In principle, the lim it permits the consumption of some amount of alcohol, for instance, a limit of 0.5 per mille corresponds with about 30 grams of absolute alcohol in the body or two to three drinks. This is rather doubtful from the point of view of traffic morale which should strive for total abstinence. The statistics reveal that almost 80% of persons examined in cases of suspected drunken driving have a blood-alcohol level in excess of 1.2 per mille or an am ount that offhand makes the criminal offense of drunken driving quite probable. Thus the convicting limit would have significance in a small part of cases of drunken driving only. Moreover, its ordaining would only be a legislative measure whose prophylactic significance remains doubtful unless it is at the same time possible to eliminate indifference about getting caught. 2. D riving License (a Getting the driver s license. When new driving permits are granted or old ones renewed, a closer scrutiny than before should be made of the suitability, sociality, and alcohol consumption patterns of applicants. Cancellation of the driving license for a certain period is regarded as the most feared punishm ent in cases of drunken driving, and not w ithout reason, because its effects may bear a wide influence upon the earnings of the families concerned. (b Expansion of the obligation to acquire driving licenses. A driving license should be required of all motorists, including those who drive mopeds. Mopedists are responsible for a great number of cases of drunken driving and of severe traffic offenses and accidents. In their group, repeated drunken driving is a common phenomenon. Obligatory driving licenses undoubtedly would improve order among the mopedists in traffic. (c Age limit for driving license. It might be possible to consider lowering the age limit for driving license, which a t present is 18 years, to, for instance, 16 years. Experience has taught th a t young people regard driving licenses as a precious treasure, the losing of which may be regarded by them as th eir greatest misfortune. Increased responsibility might perhaps educate young people also for later years. O n the other hand, there are no statutes concerning the upper age limit. I t should be placed somewhere around 70 years. 3. Control of Traffic Greatly increased traffic imposes insuperable barriers on the potentialities of continuous and effective traffic control by the police, and, therefore, activities can only be limited and tem porary in nature as far as prevention of drunken driving is concerned. Control exercised by officials and especially surprise checkoffs bear, however, considerable significance upon general improvement of order in traffic. In planning such surprise checkoffs, experience gained through statistics on the time of occurrence of drunken driving should be taken into account (Figures I, II, and I I I. Thus in Finland, surprise checkoffs and other measures of tightened control should be especially required during the warm season, weekends, evenings, and nights. 4. Education Experience gained during many decades in the U nited States and Germany has shown that continuous pedestrian traffic education, started as early as at the age of 6 years, has resulted in excellent results in reducing traffic mortality among children. Thus it should be dem anded that in Finland, effective and continuous traffic education should be officially arranged for children. In addition to knowledge of traffic rules, special emphasis should be given in this education to adequate attitudes toward traffic as well as to such human impediments as fatigue, disturbed state of mind, diseases, and ingestion of drugs and alcohol.

6 312 L A W A N D L A W E N F O R C E M E N T Uuo- In conclusion, it may be regarded that the most im portant factors in advance prevention of drunken driving are education, elucidation of the suitability of applicants for driving license, and traffic control exercised by police. M on th F ig. I : M onthly distribution of drunken driving cases. 5,536 cases chem ically investigated in Correspondingly, instruction given in schools for drivers of motor vehicles should be improved and controlled. By means of such effective education to healthy and tem perate traffic, started since childhood, it is possible to change the attitude of public opinion toward drunken driving into a new p attern so that driving in a drunken state is condem ned, instinctively and w ithout reserve. Time.ni^ht Fig. I l l : Daily distribution of drunken driving cases. 5,536 cases chemically investigated in N o, of C a s e s MONDAY o -4 - m o TUESDAY WEDNESDAY THURSDAY FRIDAY Fig. I I : Week-daily distribution of drunken driving cases. 1,240 cases chemically investigated in January-June, Sa t u r d a y SUNDAY

II: ALCOHOL - RELATED CRASHES

II: ALCOHOL - RELATED CRASHES BACKGROUND AND DEFINITIONS 1. Impaired driving incidents. As used here, an impaired driving incident is one where there was an arrest for driving while under the influence