Drinking and Driving in France in : Changes in The Decade and New Perspectives

Transcription

1 Drinking and Driving in France in : Changes in The Decade and New Perspectives M. B. Biecheler-Fretel 1, F. Facy 2, J. F. Peytavin 1 1 INRETS-DERA, 2, avenue du Général Malleret-Joinville, F Arcueil cedex 2 INSERM, U 302, 44, Chemin de Ronde, F Le Vésinet cedex Keywords Alcohol levels, road accidents, convicted drivers, age, health risk Abstract Several sources of data in France are able to describe the different aspects of drinking and driving behavior, including: consumption, preventive tests and offences, medical consulting, and accidents. Analysis of these data over the last decade raises new questions in France about the strategies to prevent road risk and/or health risk. The main data to be analyzed are from: 1) roadside checks ( ), 2) populations and sub populations of drivers involved in accidents with alcohol ( ), 3) populations of drivers convicted for driving under the influence, their punishment by judges ( ), and 4) surveys about medical care needed by offenders ( ). We compare the profiles of offenders and involved drivers, focusing on an analysis by age. The drinking-driving prevention system in the period between 1990 and 2000 appears to have reduced the number of accidents that can be attributable to alcohol. In , alcohol is as much present among young drivers (18-24 yrs) as among the older (25-40 yrs ): from 40% to 50% illegal BAC in fatal accidents on week-end nights. The national testing system results in around 100,000 convictions each year and a third of the cases need medical care.the roads (and the courts) have a massive potential for detecting the alcoholism of older drivers (above 30 years and moreover above 40 years) and the problem consumption of younger drivers. The possibility of using traffic enforcement as a means of educating drivers about alcohol risks will be discussed. Introduction The blood limit 0.8 g/l, as well as its equivalent breath limit 0.4 mg/l, became an indictable offence in On the same year, in 1983, was created the French interministerial national observatory of road safety (ONISR), the role of which was to produce annual statistics and trends in road traffic safety. Concerning alcohol the observatory publishes data resulting from alcohol testing by police forces (accidents, offences and random tests), it publishes also the main statistical features of the judicial treatment of offending. In September 1995 the legal blood limit went further down to 0.5g/l (0.5 pro mille). The decree introduced a distinction between two levels : 0.5 g/l (blood) for a minor offence and 0.8 g/l (blood) for an indictable offence. Most part of the epidemiological knowledge in the field of drink driving behaviour in relation to accidents has been produced by INRETS (1) (2). Two other major contributions are to be mentioned : Got et al (3) studying specifically drivers presumed to be responsible of a fatal accident brought on this point a major contribution ; in the survey by the national institute on medical research (INSERM) and the high committee of studies and information on alcoholism (HCEIA) the distinction between chronic and occasional consumption for drivers involved in accidents had been investigated : 36% of men and 10% of women presented signs of chronic alcoholization (4). Since 1996 the only data available come from the ONISR (5), but these do not include a characterization of alcohol-related

2 accidents. A previous work (6) has shown that the dissuasive prevention system to drinkdriving based on legislation and enforcement tended over to reduce the number of accidents that can be attributable to alcohol consumption. In this paper we will firstly control that this trend proves to be stable in 1999 and We then will present some results helping to discuss to which extent the system for preventing and punishing drink-driving constitutes a framework for detecting alcohol risks, road risk as well as health risk. Methods and data Evaluation of trends at the national level Since there has been no scientific survey of alcohol levels on roads during the nineties, available data come from official sources based on enforcement roadside checks. They were obtained from the drink-driving monitoring activities of police officers between 1990 and 2000 (5). Data about subsequent convictions are provided by the Ministry of Justice (7). Alcohol levels of drivers involved in injury accidents from 1990 to 1996 have been obtained from the INRETS report file, where are collected one out of fifty accident records each year since 1987 (8). The specific exploitation of this 1/50 e file on the alcohol factor was interrupted in So in order to investigate the more recent distributions of alcohol levels for drivers involved in injury accidents we used the French national accident file (the BAAC -Bulletin d Analyse d Accident Corporel de la circulation file). To describe synthetically the prevalence of alcohol in accidents, among the criteria found to be linked to the presence of alcohol in epidemiological studies we selected : age, time and day on which the accident occurred, and seriousness. A preliminary examination of the data led us to select three periods in day :7h-13h, 14-20h and 21h-6h. An analysis through age of road versus heath risk We used age as the pertinent criteria to evaluate the road and health risks of the population. The seven age categories selected correspond to a common basis through the different sources (< 18, 18-19, 20-24, 25-29, 30-39, and >60). Two sources of data, one national and one local, allow to estimate what proportion of drivers arrested with illegal blood alcohol level (BAC) need a medical care. Drivers tested positive when driving are generally invited by courts to attend an alcohologic consultation in a specific health center, to be informed or oriented The national association for prevention of alcoholism (ANPA) register the drivers consulting and is able to distinguish two groups : those who have a problematic consumption and those who need information on road and/or health risk (9). The survey conducted by INRETS in the French department of Val d Oise, allows to estimate what proportion of drivers arrested with illegal BAC need a medical care (10). In this experiment, the drivers were invited, before their judgment to perform biological tests and then to attend a alcohologic consultation. For each driver the doctor make a diagnosis (occasional consumption or alcohol problem). The results provide an estimation of the presence an alcohol related health problem among illegally drink-drivers. Results 1 Enforcement and alcohol related to accident trends ( ) Roadside breath tests : enforcement trends ( ) Under the current legal framework alcohol tests are compulsory in cases of injury accidents or when an offence has been committed. Random tests are carried even when no accident or offence has taken place. A feature of random breath tests is that they cover the entire population of drivers on a non-selective basis. Table 1 shows the way the number of breath tests (both random and those administered after an offence) have changed over the decade. The number of random breath tests has risen steadily over the decade, from 2,900,000 tests

3 in 1990 to 7,900,000 in For the first time in 2000, we observe a slight decrease : this mean that probably the preventive system has reached its maximum capacity. On the other hand, he number of tests after offences (about 1.5 million) remains more or less the same throughout the period The percentage of positive random tests has risen after 1995 : from 1% or 1.1% on to 1.3% or 1.4% on This is in part be attributable to the lowering of the legal limit to 0.5 g/l in September 1995 which means that levels of between 0.5 and 0.8 now count as positive (6). Table 1 : Random breath tests and breath tests after an offence ( ) Breath tests performed Percentage of positive tests Year Random tests Tests after an offence Random tests Tests after an offence ,881,232 3,812,442 4,614,079 5,542,319 6,270,045 6,650,690 6,286,419 6,677,808 6,908,932 7,925,604 7,804,267 1,619,531 2,205,045 1,662,413 1,579,987 1,664,788 1,595,707 1,532,461 1,522,785 1,491,951 1,332,022 1,409, % 1.1% 1.2% 1.3% 1.4% 1.4% 1.3% 3.6% 3,0% 3,8% 3.0% 3.4% 3.8% 3.6% From: ONISR(5) Drink-driving offences and sentences ( ) In 1998, 20% of drink-driving offences came under the minor offence category and 79% were indictable offences. The percentage of minor offences came up to 23% in 1999 and 24% in 2000 while the percentage of indictable offences came down to 77% and 76%. Drink-driving offences account for around 23% of the indictable offences dealt by the courts (23% in 1998 and in 1999). They represent throughout the 1990s, over convictions each year ( in 1998 and in 1999). This is the judicial response to the intensive screening testing by police forces that has been growing since the last ten years. The recidivism rate is increasing each year (national estimation of 10% in 1999 (5)). The punishment of drink-driving is slowly shifting from imprisonment to fines and measures concerning driving license. In 1999 we observe as first sentences : custodial imprisonment 6%, suspended imprisonment 54%, fines 21%, driving disqualification 19% ; when the first sentence is prison or fine, most part of time a second sentence is the disqualification from driving. In case of suspended sentence, the use of probation with compulsory treatment is not largely used in France but it is slowly increasing : 21% of suspended sentences in 1999 vs 14% in Overall, the suspended imprisonment with probation is applied in 1999 to 11% of the offenders. Drivers involved with alcohol in accidents: general trends ( ) In the period the number of injury accidents fell continuously (from in 1990 to in 2000).The general trend has been a 25% fall.table 2 gives the proportion of drivers, involved in those accidents, with an alcohol level over the legal limit. In 1999, drivers have been involved in injury accidents : 14% of their alcohol levels were not determined and of the known cases 5.5% were over the legal limit 0.5g/l. In 2000, drivers have been involved in injury accidents : 12 % of the alcohol levels were not

4 determined and of the known cases 5.5 % were over the legal limit 0.5g/l. In 1999 (resp 2000) drivers (resp 1154 drivers) have been involved in fatal accidents, the alcohol levels were unknown in 26% (resp 24%) of the cases, and of known cases 16,4% (resp 16,2%) were over the legal limit. Since 1993 the BAAC information on alcohol has improved and the most probable is that information about alcohol from treatment of INRETS PV and BAAC figures are very similar now. For instance the1996 percentage of unknown levels in the 1/50 e PV file was 14% for injury accidents and 21% for fatal accidents, to be compared to 12% and 24% and in the national file BAAC It appears that on the decade the weight of the alcohol factor in accidents do not increase and even would tend to decline. Thus it is possible to extrapolate to the entire decade the conclusions drawn two years ago from a analysis of specific accident series : there has been a greater reduction for the categories of accidents where alcohol is most frequently present than for those where it is generally rare. Table 2 : Accidents and drivers involved in accidents : percentages of illegal alcohol levels (the percentages are calculated on known cases) Year Number of Injury accidents of which Fatal Accidents Accident involved drivers Accident involved drivers % results over the legal limit Injury accidents Fatal accidents % 15% % 16% % 22% % 19% % 19% % 24% % 24% % 16.4% % 16.2% * Before 1996 the legal level was 0,8 (blood), since it is 0,5 (blood) From : PV-INRETS Fontaine et Gourlet (8) and BAAC file exploited by Peytavin in Structure of drink-driving by age (1999) Comparison of driving while impaired and accident involved drivers Table 3 gives the distribution by age of the drivers found with alcohol levels over the limit when involved in accidents on the one hand and when arrested on roads on the other hand. The figures are given for the year 1999 at the national level. The last column gives the ratio of over road-risk by age. Young drivers and from 20 to 24 years old are overrepresented in alcohol-related accidents compared with the population of the same age driving under influence (ratios 2.6 and 1.5) ; drivers in the age class years are also over-represented in accidents but in a less extent (ratio 1.2). A switch occur beyond 30 years : the years old drivers are over represented among DUI than among alcoholrelated accidents involved drivers (ratio 0.9) ; this observation becomes sharper after 40 years : the ratio is 0.7 for the years class. Above 60 years, drivers are equally represented among crash involved with illegal BAC and drink-driving offenders. Frequency of alcohol problems among convicted drivers The Val d Oise survey (8) reveals that a large part of drivers convicted for DUI need medical care for a alcohol problem. Around 60% (62%) of those drivers with an alcohol level over 1.4 g/l (blood) when arrested have an health problem with alcohol. This frequency relatively

5 unfrequent before 25 years (12%) is growing fastly, reaching 41% in the range years, 64% in the range and culminating at 72% in the range years. Adjusting the results to be representative of all offenders of Val d Oise (extropolating this frequency 62% to unknown data and supposing that levels under 1.4 represent occasionnal consumption) lead to estimate to 42% the overall part of drivers with need medical care. The estimation from the national ANPA file is lower: 34% of the drivers consulting after road arrest were orientated towards medical circuit. Anyway more than one out of three drivers alcohol offenders present an health risk (9). Table 3 : The distributions by age category of drivers involved in accidents and drivers convicted for DUI (year 1999) Age % illegal BAC of drivers involved Involved drivers with illegal BAC Offenders (indictable offences) Ratio % illegal BAC/ % offenders < % 0.6 % 0.1 % yrs 4.2 % 4.1 % 1.6 % yrs 6.3 % 18.1 % 11.7 % yrs 6.7 % 18.1 % 14.8 % yrs 6.5 % 26.9 % 29.1 % yrs 5.4 % 28% 38.3 % 0.7 Over 60 yrs 2.5 % 4.3% 4.4 % 1 Total 5.5% 100% 100% 1 From: BAAC file exploited by Peytavin in 2002, Annual judicial statistics (7) Prevalence of illegal alcoholisation in accidents ( ) Table 4 shows the proportions of drivers involved in accidents with an alcohol level over the legal limit. The results confirm previous features of the phenomena, with the high presence of alcohol on nights, on week-ends and especially on week-end nights whatever the age. Table 4. Drivers involved in injury and fatal accidents in 1999 : % illegal alcohol levels by category of day, period of day and age (the percentages are calculated on known cases) Weekday 7h-13h Weekday 14h-20h Weekday 21h-6h Week-end 7h-13h Week-end 14h-20h Week-end 21h-6h Injury Fatal Injury Fatal Injury Fatal Injury Fatal Injury Fatal Injury Fatal < yrs yrs yrs yrs yrs >60 yrs Total From : BAAC file exploited by Peytavin in 2002 Discussion Alcohol investigation practices have been improving during the last ten years as well for injury accidents (fatal or not) as for fatal accidents. The results of investigation show that the prevalence of illegal alcohol levels in road accidents does not increase and even would tend

6 to diminish, especially for fatal accidents. This progress is attributable to the massive alcohol screening enforcement on roads. To day more than 9 billions of screening tests a year are performed, of which around are positive leading to convictions ( ). In front of this preventive-repressive system, drivers involved in injury accidents involved have an alcohol level over the blood limit 0.5 g/l representing 5.5% of the drivers involved. Alcohol, whatever the age is linked with specific accident profiles : fatal accidents on nights, week-ends and especially on week-end nights. The system for preventing and punishing drink-driving, based in France on intensive roadside screening tests, leads to detect among the drivers convicted each year, of whom more than one out of three need medical care for an alcohol problem. When two types of risk are associated with drinkdriving, the critical age threshold, where health risk becomes predominant on road risk is 30 years and more clearly 40 years. The number of suspended imprisonment with probation (11%) is not in proportion with the convicted drivers with alcohol problems (more than 33%), so that the important challenge is to develop more effective interventions for alcohol offending drivers. The analysis by age stresses the fact that it is important to recognize the road risk problem of the younger and the frequent health risk problem of the older. As alcohol has been classified by experts as an «hard drug» (9), it becomes a priority to use traffic enforcement system as a means of educating drivers about alcohol risks References 1. Biecheler-Fretel M B et al. Alcool, conduite et insécurité routière. Synthèse des travaux de l ONSER. Cahier d études ONSER n 65, avril Biecheler-Fretel M B, Filou C, Fontaine H. Drink driving and alcohol related accidents,trends an appraisal In : Synthèse INRETS n 35, pp Got C, Faverjon G, Thomas C. Alcool et accidents mortels de la circulation. In Bulletin d Information du HCEIA, 1984 ; 1: Haut comité d études et d information sur l alcoolisme (HCEIA). Alcool et Accidents. Ouvrage collectif, série documents, ed : La Documentation Française, 1985, pp ONISR (Observatoire National Interministériel de Sécurité Routière). La Sécurité Routière en France. Bilan de l Année Ed : La documentation Française, Paris Biecheler-Fretel M B, Filou C. Drinking and driving in France in the nineties, can evaluation help prevention? In : Proceedings of the 15 th International Conference, Stockholm 2000, vol 2 : Annuaire de la justice. Édition Séries ; Ed: La Documentation Française 8. Fontaine H, Gourlet Y. Mobilité et Accidents, année Rapport sur convention DSCR/INRETS, juillet 1998, pp Facy F et al. Dépistage de l alcoolémie sur route, délits de conduite en état alcoolique et consultations en centre d alcoologie. To be published in Recherche-Transports-Sécurité (accepted march 2002). 10. Biecheler M B, Peytavin J F. Preventing drink-driving and reoffending : the experiment conducted in the french département of Val d Oise ( ). In proceedings of the 16 th International conference on alcohol, drugs and traffic safety Roques B P. La dangerosité des drogues. Rapport au secrétariat d état à la santé, Ed Odile Jacob, 1999