Tremendous efforts are expanded to prevent the burden of psychoactive substance use on users, their families and society in general. Yet, globally substance use is growing due to changes in lifestyle, the erosion of powers of censure that have existed in traditional societies and an increased acceptance of such substances. In this commentary, I briefly analyze the ingredients of a successful targeted intervention in North America over the last 20 years against driving while under the influence of alcohol.
The high visibility of a focused consumer group. Since the late 1970s, one of the most visible grassroots organizations, Mothers Against Drunk Driving (MADD), had a significant influence in addressing the problems caused by drunk driving. Born from the grief of a mother, Candy Lightner, whose daughter was killed in broad daylight by a hit-and-run drunk driver whose record involved four prior drunk driving arrests, the organization started in California was soon to grow to several hundred chapters across North America (1). MADD not only fought for harsher penalties against drunk drivers, but developed a range of programs to assist victims in coping with their loss.
A legislative agenda. Since its inception, MADD has been successful in the enactment of more than 1000 new laws at both the local and national levels, including minimum drinking age, server liability laws and sobriety check points. A particularly effective measure was the production and dissemination of a widely published, annual comparative legislative "Rating of the States/Provinces". In fact, MADD appears to have exhibited a stronger influence than the Breathalyzer legislation in reducing drinking-driver fatalities. As an example, in Ontario, Canada, the formation of MADD was associated with a decrease in drinkingdriving fatalities in the period between 1982 and 1996 ranging from 19% to 23% (2). While many changes have been introduced, a proposed reduction of the blood alcohol content (BAC) limit to 0.05 has not achieved a consensus so far.
Services for victims. Grief resulting from a drunk driving crash is not unlike that in which a family member is murdered. The loss is sudden and unanticipated, the death is violent, the crime is senseless. MADD membership fulfills the survivors' compelling desire "to do something", often after a draining courtroom experience. MADD chapters have also provided an opportunity to participate in a victim impact panel as part of driving while impaired (DWI) offenders programs with mixed published results (3). MADD membership reportedly results in a trend of gradually positive attitudes until approximately the 4th or 5th year of activism after which many members will cycle out of the organization.
Influencing social norms. Widespread youth and community programs have resulted in a modification of social norms, arguably the ultimate success in prevention. Drunk-driving "accidents" become "crashes caused by criminal negligence", altering a collective moral mentality. Random breath testing has also resulted in the promotion of "designated drivers" volunteers, whereby one person will elect not to drink to provide safe transportation for the remainder of the party. Free soft drinks will often be provided by the drinking establishment to this driver. This promotion acquires more mass media visibility around year end holidays. Introduction of these measures have had the uniform effect of reducing the incidence of offending drivers who drink over the prescribed limit. There also seems to be a dose effect, as the effect of the restriction appears to be sensitive to the number of random tests per licensed driver (2).
The availability of valid and reliable monitoring data. Alcohol being a legal substance in many countries allows for a degree of monitoring sophistication which is lacking in the study of most illegal psychoactive substances. Drunk-driving statistics provide an objective index of impact influenced by the changes in the availability of alcohol, particularly in countries where random breath testing is legislated and enforced. While clearly not every instance of intoxicated or disabled drinking is recorded, these statistics are a useful barometer of the influence of focused limits on the availability of alcohol on the drunkdriving environment (4).
In summary, the preventive efforts of MADD provide an opportunity to study the impact of a grassroots organization on improving targeted social norms for a licit substance.
References
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