Wednesday, May 27, 2009

A New List of 39 Recommendations for the 21st Century

In 1982, President Reagan appointed a special commission to study the problem of drunk driving in America. They came up with 39 recommendations, #8 of which was to raise the drinking age to 21 in all 50 states. Of all the recommendations, that was the one that got the most attention, often at the expense of the others. Most of the other 38 were just simple common sense measures, and many of these were implemented to some extent in both the United States and Canada. Interestingly, the decline in alcohol-related traffic fatalities since 1982 occurred at about the same rate in both countries in every age group, with no evidence of divergence in the expected direction despite the fact that Canada did not raise the drinking age to 21. In fact, the decline was slightly faster in Canada (ditto for the UK and Australia as well, who remained at 18). While the problem of drunk driving has been greatly reduced in both the US and Canada, it remains persistent, and progress appears to have stalled somewhat in recent years. 
More than a quarter-century later, a new set of 39 recommendations is long overdue. We know a lot more about the problem now than we did in 1982, and have a better sense of what works in the long run and what does not. The nature of the problem has also changed, with most of the deaths caused by so-called "hardcore" DUI offenders who drive drunk repeatedly. By the time someone finally gets caught even once, they had already driven drunk an average of 88 times--often hundreds of times.  And it's an open secret that the vast majority of them are over 21, with 21-24 year olds being the worst of all.  Thus a multifaceted and wholehearted approach is essential. But what is currently being done is both over-inclusive and under-inclusive, and progress has stalled.  And as long as we keep following outdated methods, we will surely fail to see any further progress.  The updated list, devised by the TSAP, is as follows, with those in red being the highest priorities:
  1. Lower the drinking age to 18, ideally in all 50 states and DC. The more states, the better.
  2. Raise the federal beer tax to its 1951 real value and the liquor tax to its 1991 real value. That would be $2.38/gallon and $21.06/proof-gallon, respectively. Raise the alcopop tax to more than the tax on liquor as well, and make the beer tax proportional to alcohol content. Use the bulk of the revenue for education, treatment, and DUI enforcement.
  3. Lower the blood alcohol limit to 0.05 BAC generally, and maintain the Zero Tolerance law for drivers under 21. Or expand the latter to cover all drivers with less than 5 years of licensed driving.
  4. Increase the number of roving patrols for DUI enforcement, and their publicity. Sobriety checkpoints should be considered a supplement, not a substitute.
  5. Increase alcohol education programs, but make them more honest and comprehensive. An excellent model is AlcoholEdu, by Outside the Classroom. This can also be combined with social norms marketing campaigns.
  6. Toughen the penalties for driving under the influence, but have graduated penalties based on BAC. Drivers with BAC of 0.15 or higher should lose their licenses for at least 10 years, and repeat offenders of 0.08 or more should lose it forever on the second offense.
  7. Make fines for DUI proportional to the relative risk at a particular BAC. For example, 0.15 would be 50-100 times higher than 0.05.
  8. Restrict alcohol advertising to no more than what is currently allowed for tobacco. That means no TV, radio, or billboards.
  9. Increase alcohol treatment. Require all DUI offenders to undergo an alcohol assesment to determine if they have an alcohol use disorder. If so, force them into treatment via DUI court, in addition to other penalties.
  10. For those who fail a breathalyzer, a confirmatory blood test should be offered. If the latter is refused, the former alone should be considered sufficient evidence for a conviction. But no physically forced blood draws should ever be allowed, as they clearly violate the Constitution.
  11. For the eight states that currently lack it, institute administrative license suspension/revocation. The administrative penalty for refusing a breathalyzer or any other test should be greater than or equal to that for failing it.
  12. Have mandatory jail time for all DUI offenses of 0.08 or greater, including first offenses. Make driving with 0.15 BAC or higher a felony on the first offense, and 0.08 or higher a felony on the second offense, punishable by up to 5 years in prison.
  13. Those who kill or seriously injure someone else in an alcohol-related, at-fault crash should get a mandatory minimum of 10 years in prison, permanent license revocation, and forfeiture of any and all vehicles owned by that person upon conviction.
  14. Do not allow plea bargains for any DUI offense.
  15. Do not grant conditional or hardship licenses after conviction for second offenses at any BAC above 0.08.
  16. De-register any car owned (or registered) by a DUI offender, boot it, and confiscate the plates upon arrest. When (if) they get their license back, or get a conditional license, give them special "scarlet letter" DUI plates. 
  17. Require ignition interlocks for all conditional licenses, and for any DUI offender that gets their license back, forever.
  18. Make ignition interlocks standard on all newly manufactured vehicles sold in the USA, with use and maintenance of these devices voluntary for non-offenders (but see #19).
  19. Require auto insurance companies to give a deep discount (that more than covers maintenance costs) for non-offenders with an ignition interlock on their vehicles, especially for drivers under 25 (and their parents).
  20. Abolish the "assigned risk" pools for auto insurance, or at least forbid any DUI offenders from joining them. Let them pay the full market cost based on their own risk, without being subsidized by the innocent.
  21. Make it a federal crime to drive drunk across state lines. Punishable by up to 5 years hard labor in federal prison.
  22. Eliminate any rules of evidence that prohibit admission of chemical test refusals--it should be used against a DUI defendant in court.
  23. Make the road test tougher--an hour long like it is in the UK.
  24. Make licenses easier to lose for moving violations, especially during the first two years.
  25. Have driver's ed classes in every high school for free (or a nominal fee).
  26. Prohibit insurance companies from excluding alcohol-related accidents, but require all drivers involved in accidents to be tested for alcohol.
  27. Lift state-mandated smoking bans in bars, which have been shown to increase DUI fatalities.
  28. Extend bar hours to 3 am or later, but have a one-way door policy after 1 or 2 to reduce late night bar-hopping. Or let the locals decide rather than the state.
  29. Raise the gas tax by a penny each week until it is $1.00 higher than it currently is.  Call it "a penny for progress."
  30. Improve public transportation, especially very late at night. Use the alcohol and gas taxes to pay for it.
  31. Lift any "taxi tax" wherever it exists. Or better yet, subsidize taxi service or "Safe Rider" services.
  32. Limit or reduce alcohol outlet density in cities and other high-density areas, but increase it in rural areas. More rural bars within walking distance = less drunk driving deaths.
  33. Dry counties and towns should go wet, especially if their neighbors are wet.
  34. Abolish social host laws, both civil and criminal. Furnishing alcohol to minors should not include merely providing a safer location to drink.
  35. Allow parents to give their kids alcohol before 18 (within reason), and repeal all laws that prohibit it. But hold them accountable for what their under-18 kids do under the influence.
  36. Put a price floor on alcoholic beverages, especially for off-premises sales.
  37. For supermarkets, other non-alcohol-dedicated stores, and bottle shops/off-licenses, limit the quantities of alcohol sold per person per day (or transaction). Reasonable limits include 216 ounces of beer (i.e. an 18-pack), a gallon of wine, or a fifth (750 mL) of liquor.
  38. Kegs and cases should be sold only in beer distributors, which should close at 10 pm. A purchase age limit higher than 18 may be desirable for such bulk quantities, which are very unlikely to be for personal use. Ditto for very large quantities (i.e. multiple liters) of hard liquor.
  39. Forbid the sale of chilled beer or wine at gas stations, or at least to those who are purchasing gas at the same time or otherwise obviously drove there. A degree of separation is necessary. For the same reason, abolish drive-through liquor stores as well.
Recomendation #1 implies that, at the very least, we should repeal the federal highway funding penalty for doing so, and let the states use their Constitutional rights to decide for themselves. Or let them choose but additionally require that the drinking age be no higher than the age for being tried as an adult. Recommendations #3, #4, and especially #22 should take care of any potential adverse effects of unequal drinking ages across states or internationally, as well as dry counties that refuse to go wet.
To avoid collateral damage, recommendation #2 should not apply to microbrewers. Their beer is already relatively expensive anyway, and those who abuse alcohol tend to go for the mass-produced, cheap stuff.
If all 39 of these recommendations were followed, the alcohol-related fatality rates should be cut by more than half in the first few years alone. If only the ones in red were followed, or even just the first six, there would still be a dramatic drop in fatalities in both the short and long term. Some of them, such as #1, are a bit counterintuitive (the whole purpose of this blog explains in detail why #1 is actually a good thing rather than something to fear). But most are simply common-sense measures that are long overdue. And one who thinks holistically about the issues can see how it all fits together like pieces of a puzzle. It is hard to believe that even in 2009, any repeat DUI offender could still have a license at all, and that any state would refuse to do #11. By the same token, it is also baffling how Prohibition still exists in some counties in 2009.

When we say graduated penalties, the table below is a good guide to what they should be:

BAC ThresholdFirst offenseSubsequent offenses within 10 years
(under 21 or novice, administrative only)

1-2 drinks
$250 fine
30 day suspension
No jail
Alcohol education program
$500 fine
6 month suspension
No jail
Ignition interlock upon regaining license until 21
(administrative only)

2-3 drinks
$500 fine
Up to 90 day suspension
(6 month suspension)
No jail
Alcohol education program
$750 fine
Up to 6 month suspension
(1 year revocation or until 21, whatever is longer)
No jail
Ignition interlock 1+ year upon re-license

3-5 drinks
$1000 fine
Minimum 1 year revocation
(or until 21, whatever is longer)
Up to 6 months in jail
Ignition interlock 5+ years after re-license
$2500 fine
License revoked possibly forever
Mandatory 1+ year in jail (possible felony)
Possible vehicle forfeiture upon conviction

4-7 drinks
$5000 fine
Minimum 5 year revocation
Mandatory 6 months jail, up to 1 year
Ignition interlock forever
$7500 fine
License revoked forever
Mandatory 5 years prison (felony)
Vehicle forfeiture upon conviction

7+ drinks
$10,000 fine
Minimum 10 year revocation
Mandatory 1 year in prison, up to 5 years (felony)
Ignition interlock forever
$20,000 fine
License revoked forever
Mandatory 5+ years prison (felony)
Vehicle forfeiture upon conviction

NOTES:  1) Any alternatives in parentheses refer to drivers under 21 or novice drivers who had their licenses less than 5 years. 2) Any vehicles owned by the driver should be de-registered and the plates confiscated in the event of a license suspension/revocation, 3) "No jail" does not preclude detaining a driver overnight or up to 24 hours in the drunk tank, 4) For all of the above cases, mandatory alcohol abuse assessment and treatement (if indicated) should be done, 5) For first offenders who qualify, diversion to DUI court may be the best choice, 6) Offenses that occur during a suspension or without a license should result in permanent license revocation and/or vehicle forfeiture, as well as mandatory jail time, 7) For BAC below 0.08, penalties listed are administrative only, and there is no criminal conviction.  Above 0.08, the penalties are criminal and are additional to any administrative license suspensions. 8) Number of drinks is a very rough guide, and it assumes consumption in 2 hours, reasonably full stomach, no other drugs, and a body weight of 150 lbs.  There is much variation by individual and circumstance.

Recommended administrative license suspensions/revocations above 0.08:

Test failure, first offense:  90 day suspension (6 months if under 21 or novice)
Test failure, second offense in 5 years: 1 year revocation (or until 21, whatever is longer)
Test refusal, first offense:  1 year suspension or revocation
Test refusal, second offense in 5 years: 2 year revocation (or until 21, whatever is longer)

Conditional licenses should only be given for grave reasons, be highly restricted, and require ignition interlocks.

Driving with a  BAC above 0.08 with kids under 16 in the car should be an automatic felony, and treated like 0.15+.

In other words, though we've clearly wrestled the problem to the ground by the mid-1990s, we have unfortunately allowed ourselves to become complacent and distracted.  It's time to finish the job.

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