Drink driving is often cited as a road safety success story, yet it remains a major killer and progress has ground to a halt since 2010. The latest report from the Parliamentary Advisory Council for Transport Safety (PACTS), calls for a comprehensive review of the system. In this blog, report contributors Andrea Mohan, Isabelle Uny and Niamh Fitzgerald argue that not only is better law enforcement important but also the problems of mental health and alcohol dependency need to be recognised.
Drink-driving, or driving while over the legal blood alcohol limit, is often viewed as unacceptable. Society usually thinks about drink-driving as driving while being very drunk, perhaps after a party or night out, thus people who drink and drive are seen as selfish, reckless and lawbreakers. But is this always the case? Drink-driving is certainly illegal, and some people who are convicted do drink-drive several times before they get caught. In fact, since 2010, 7% of people convicted of drink-driving had reoffended before. But within this group, there will be people with underlying alcohol problems, including dependence, who drink large amounts of alcohol on a regular, sometimes daily basis. Some people will feel a need to drink in order to function ‘normally’, and they may not feel in control of their drinking. Others may also not think about their drinking as a problem, or may not be ready to acknowledge the extent and consequences of their drinking.
When an alcohol problem is combined with driving, the consequences can be very serious and very scary. A large number of the participants in our study stated that they had a past or current alcohol problem. Some described alcohol being a part of their life from a very young age (as young as eleven) and becoming dependent as a result. Some used alcohol to cope with stress from their work, a problematic relationship, or the loss of a family member. Being alcohol-dependent resulted in them often driving while under the influence of alcohol. For instance, we spoke to people who said they had an alcohol problem and experienced a blackout while driving, meaning that they did not remember driving, and only realised what happened afterwards. Some people admitted there were times when they were aware of driving whilst being drunk, but they did not see this as intentional. Their explanations for their behaviour centred around the need for alcohol due their alcohol dependence overruling other considerations. For example, participants reported that they had to drive to get to work, but needed to have a drink in order to feel steady enough to drive. Thus, in the situation they experienced, drink-driving was necessary in order to get to work (though it is unclear what other options, such as public transport, were considered).
Many people experience both alcohol and mental health problems together, leading to other complex and serious instances of drink-driving. We still have much to understand about the relationship between these two issues, but when they are combined with driving, the consequences can also be very severe. A few of the participants in our study spoke about having a mental health problem which triggered drinking episodes. This may have been on a single occasion, or in cases of more extreme mental illness, there may have been several episodes of excessive and uncontrolled drinking, prior to driving. One person we spoke to reported that they had lived with an undiagnosed complex Post-traumatic Stress Disorder (PTSD) for most of their life. They spoke of having ‘crises’ where they drank daily and uncontrollably, and had no memory of times when they were driving in such instances. A few people also reported experiencing past or more recent trauma which they did not seek help for, but instead used alcohol (and in some cases, drugs) to cope. There were also a few participants who said they developed severe anxiety as a result of their alcohol dependence. In all these cases, the participants’ mental state combined with high amounts of alcohol had led to irrational thinking and decision-making, sometimes resulting in drink-driving.
Our study clearly shows that there is a link between alcohol and mental health problems, and drink-driving. The question is, how do we help people with these problems reduce their chances of drink-driving? Participants who got caught drink-driving received various penalties such as fines, temporary loss of license and suspended prison sentences. Most were also offered a drink drive rehabilitation course. While most told us that these measures rarely (if at all) addressed their underlying alcohol and mental health problems, they acknowledged that being convicted of drink-driving prompted them to seek help for these problems. This means there is an opportunity for the criminal justice system to identify people with these problems, and link them to recovery and support services. Many of our participants received help for their alcohol problems through community recovery groups like Alcoholics Anonymous or local drugs and alcohol rehabilitation services; some joined online support groups and a few used self-help strategies they read in books about alcohol dependence. In receiving help to stop drinking or significantly reduce their alcohol intake, people were able avoid future drink-driving. While participants with a mental health problem also received support, this took a much longer time, mainly because the participants themselves took very long to seek help or be offered adequate support. However, in dealing with their mental health problems, most were able to gain control over their drinking habits and avoided future drink-driving.
The take home message is that we cannot ignore the role that alcohol and mental health problems may play in drink-driving. Preventing drink-driving (i.e. primary prevention) cannot solely focus on law enforcement or deterrence strategies, but should also be included in the public health response to alcohol problems, including interventions to address cheap alcohol, easy availability and widespread marketing that can reduce population-level drinking. More protractive strategies for preventing drink-driving in this group of people would also involve improving the availability of, and access to effective and acceptable support for alcohol and mental health problems as early as possible.
Furthermore, when people do get convicted of drink-driving, this provides an opportunity to intervene to help people address alcohol or mental health problems at an earlier stage where needed. The criminal justice system in the UK needs closer links with treatment, support and recovery services, to enable people to recover and avoid further drink-driving.
Written by Andrea Mohan (University of Dundee), Isabelle Uny (University of Stirling) and Niamh Fitzgerald (University of Stirling)
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.