Response to commentaries

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Commentaries

demonstrated the value of legal limits lower than the current criminal level for blood alcohol content (BAC) of 0.08% in Canada and the United States [7,8]. The legal limit of 0.05% in Australia and many European states is amply supported by research. At a BAC of 0.05%, skills needed for safe driving are impaired significantly, the risk of being involved in a collision is increased significantly and other jurisdictions have shown that lowering legal limits to this level will reduce alcohol-related collisions, injuries and deaths substantially [7,9]. Nevertheless, there has been substantial opposition to initiatives involving changes to the legal limit, primarily from the alcohol industry [10], and to date governments in Canada and the United States appear to have been more persuaded by industry arguments than by the substantial reductions in drunk driving collisions, injuries and fatalities that would result. Another initiative that colleagues in Australia and Europe have shown would reduce deaths and injuries in North America is random breath testing (RBT; [11,12]). RBT permits police officers to request a breath sample without having to document reasonable suspicion that that driver is impaired by alcohol, and thus can increase substantially the ability of police to process drivers at the roadside. Substantial reductions in drunk driving collisions, injuries and deaths have been documented with RBT, and most countries in the developed world have implemented RBT provisions; North American countries are among the exceptions [13]. Drunk driving continues to be a leading cause of preventable death and injury internationally. We continue to learn about the nature of the problem and its prevention [3,14,15], and opportunities for jurisdictions to learn from each other should be embraced. Pechansky & Chandran [1] exemplify what is needed in proposing to learn from North American experience. It is also true that North America needs to learn from the rest of the world as well. Declarations of interest None.

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3. Peden M., Scurfield R., Sleet D., Mohan D., Hyder A. A., Jarawan E. et al. World Report on Road Traffic Injury Prevention. Geneva: World Health Organization; 2004. 4. Canadian Public Health Association. 12 Great Achievements, Motor Vehicle Safety, June. 2010. Available at: http:// cpha100.ca/12-great-achievements/june-motor-vehiclesafety (accessed 3 May 2012. Archived by WebCite at http://webcitation.org/67OOJvPe0). 5. Centers for Disease Control. Achievements in public health, 1900–1999. Motor-vehicle safety: a 20th century public health achievement. Morb Mortal Wkly Rep 1999; 48: 369– 74. 6. Wickens C. M., Butters J., Flam Zalcman R., Stoduto G., Mann R. E. Alcohol control measures in traffic. In: Boyle P., Boffetta P., Zatonski W., Lowenfels A., Brawley O., Burns H. et al., editors. Alcohol: Science, Policy and Public Health. Oxford: Oxford University Press; in press. 7. Mann R. E., Stoduto G., Macdonald S., Shaikh A., Bondy S., Jonah B. The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review. Accid Anal Prev 2001; 33: 61–75. 8. Andreuccetti G., Carvalho H. B., Cherpitel C. J., Ye Y., Ponce J. C., Kahn T. et al. Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time-series analysis (2001–10) conducted in Brazil. Addiction 2011; 12: 2124–31. 9. Mann R. E. Choosing a rational threshold for the definition of drunk driving: what research recommends. Addiction 2002; 97: 1237–8. 10. Chamberlain E., Solomon R. The case for a 0.05% criminal law blood alcohol concentration limit for driving. Inj Prev 2002; 8: 1–7. 11. Homel R. Random breath testing and random stopping programs in Australia. In: Wilson R., Mann R., editors. Drinking and Driving: Advances in Research and Prevention, New York: Guilford Press; 1990, p. 159–202. 12. Dunbar J., Penttila A., Pikkarainen J. Drinking and driving: success of random breath testing in Finland. BMJ 1987; 295: 101–3. 13. Solomon R., Chamberlain E., Abdoullaeva M., Tinholt B. Random breath testing: a Canadian perspective. Traffic Inj Prev 2011; 12: 111–9. 14. Flam-Zalcman R., Mann R. E., Stoduto G., Nochajski T., Rush B. R., Wickens C. M. et al. Does an increase in amount of alcohol treatment improve results? A regression– discontinuity analysis. Int J Methods Psychiatr Res; in press. 15. Mann R. E., Stoduto G., Vingilis E., Asbridge M., Wickens C. M., Ialomiteanu A. et al. Alcohol and driving factors in collision risk. Accid Anal Prev 2010; 42: 1538–44.

ROBERT E. MANN & CHRISTINE M. WICKENS

Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, ON, Canada M5S 2S1. E-mail: [email protected] References 1. Pechansky F., Chandran A. Why don’t northern American solutions to drinking and driving work in southern America? Addiction 2012; 107: 1201–6. 2. Peden M. Global collaboration on road traffic injury prevention. Int J Inj Contr Saf Promot 2005; 12: 85–91. © 2012 The Authors. Addiction © 2012 Society for the Study of Addiction

RESPONSE TO COMMENTARIES We appreciate the insightful responses provided by Drs Pinsky [1], Mann [2], Obot [3] and Caetano [4] on our commentary [5] regarding differences in southern versus northern hemisphere approaches to the control and prevention of drinking and driving (DWI). Dr Obot’s point about the significant burden of alcohol-associated road traffic mortality in sub-Saharan Africa is absolutely correct; the World Health Organization (WHO)’s Global Addiction, 107, 1207–1213

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Commentaries

Status Report on Road Safety highlights DWI as a major problem in many countries in Africa, Asia and Latin America [6]. Evidence-based interventions are needed urgently across most countries in order to combat this important issue. We also appreciate Dr Mann’s points about the continued work that needs to be conducted in the United States and Canada; issues of further lowering the legal blood alcohol concentration (BAC) limit and conducting random breath testing (RBT) are also very much on our minds, as is the constant tension between rigorous public health evidence versus the well-organized lobby of the alcohol industry. In discussing the behavior paradox between US-born Hispanics versus Hispanic immigrants, Dr Caetano highlights an important point—the perception of deterrence may, in fact, be one of the factors that defines behaviors such as DWI, and we might hypothesize that immigrants from countries with lax attitudes towards DWI would have a strong perception of the law and its enforcement when driving in a more organized environment. Gibbs states that deterrence can be ‘[ . . . ] thought of as the omission of an act as a response to the perceived risk and fear of punishment for contrary behavior’ [7]. As Snortum mentions [8], it is the threat of formal sanctions that can be weakened or increased according to drivers’ perceptions of how laws are enforced; this is why RBT might have a role in reducing the prevalence of DWI [9,10]. A combination of efforts stemming from public health professionals, government and law-enforcement personnel, and advocacy organizations such as Mothers against Drunk Driving (MADD), could play a strong role in the efforts to decrease DWI: the goals would be legislative lobbying and increased public awareness, in conjunction with strong and targeted enforcement. The role of these organizations has been recognized in providing critical services in advocacy, legislative lobbying, public education and victim support in the United States; the National Highway Traffic Safety Administration, among others, recognizes the potential impact of these organizations and frequently partners them in control efforts [11–13]. There are many similar advocacy groups in the northern and southern hemispheres [14,15] with track records of lobbying and community education; such organizations can become even more effective in advocacy and public education through involvement in government-run interventions, and resource and training support. We hope the ‘Não foi um acidente’ [‘It was not an accident’] movement [16] mentioned by Dr Pinsky will catch on in Brazil and many other countries; recognizing that drinking and driving is a preventable offense instead of a ‘random accident’ is a change in thinking and culture that, if achieved, will go a long way towards combating this significant public health concern. © 2012 The Authors. Addiction © 2012 Society for the Study of Addiction

Declarations of interest None. Acknowledgements FP was funded by the National Secretariat for Drug and Alcohol Policies, Brazil, the Bloomberg Foundation, RS-10 Road Safety in 10 Countries Project and the Fogarty International Center. AC was funded by the Bloomberg Foundation, RS-10 Road Safety in 10 Countries Project and GAVI’s Hib Initiative, Johns Hopkins University, Department of Pediatrics. Keywords prevention.

Advocacy,

drugged

driving,

policies,

FLAVIO PECHANSKY 1,2 & ARUNA CHANDRAN 3

Department of Psychiatry of the Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil,1 Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre and University of Rio Grande do Sul, Rio Grande do Sul, Brazil2 and International Injury Research Unit, Departments of International Health and Pediatrics, Johns Hopkins University, Baltimore, MD, USA3. E-mail: [email protected] References 1. Pinksy I. The advocacy factor: the importance of grassroots movements in support of DWI policies. Addiction 2012; 107: 1208–9. 2. Mann R. E., Wickens C. M. Achieving international progress on alcohol and traffic safety. Addiction 2012; 107: 1210–1. 3. Obot I. S. Developing countries ignore drinking and driving problems at their own peril. Addiction 2012; 107: 1209–10. 4. Caetano R. The road may be long, but you are on your way. Addiction 2012; 107: 1207–8. 5. Pechansky F., Chandran A. Why don’t northern American solutions to drinking and driving work in southern America? Addiction 2012; 107: 1201–6. 6. World Health Organization (WHO). Global Status Report on Road Safety: Time for Action. Geneva: WHO; 2009. 7. Gibbs J. P. Crime, Punishment and Deterrence. New York: Elsevier; 1975. 8. Snortum J. R. In: Deterrence of alcohol-impaired driving: an effect in search of a cause. Laurence M. D., Snortum J. R., Zimring F. E. editors. Social Control of the Drinking Driver. Chicago, IL: University of Chicago Press, 1988, p. 193. 9. Solomon R., Chamberlain E., Abdoullaeva M., Tinholt, B. Random breath testing: a Canadian perspective. Traffic Inj Prev 2011; 12: 111–19. 10. Watson B. C., Freeman J. E. Perceptions and experiences of random breath testing in Queensland and the self-reported deterrent impact on drink-driving. Traffic Inj Prev 2007; 8: 11–19. 11. Dickman F. B. Alcohol and highway safety in a public health perspective. Public Health Rep 1988; 103: 653–8. Addiction, 107, 1207–1213

Commentaries

12. Fell J. C., Voas R. B. Mothers Against Drunk Driving (MADD): the first 25 years. Traffic Inj Prev 2006; 7: 195– 212. 13. Asbridge M., Mann R. E., Flam-Zalcman R., Stoduto G. The criminalization of impaired driving in Canada: assessing the deterrent impact of Canada’s first per se law. J Stud Alcohol 2004; 65: 450–9.

© 2012 The Authors. Addiction © 2012 Society for the Study of Addiction

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14. http://www.vidaurgente.org.br/site/ [cited 12 March 2012]. Archived at http://www.webcitation.org/ 667Bao3PU 15. http://www.nace.com.mx/ [cited 12 March 2012]. Archived at http://www.webcitation.org/667BgU7UQ 16. http://naofoiacidente.org/blog/ [cited 12 March 2012]. Archived at http://www.webcitation.org/667CHhx6f

Addiction, 107, 1207–1213