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. 2011 Oct;55:283–291.

Drunk Driving Among Novice Drivers, Possible Prevention with Additional Psychological Module in Driving School Curriculum

Diva Eensoo 1,✉, Marika Paaver 2, Jaanus Harro 2
PMCID: PMC3256821  PMID: 22105403

Abstract

Road traffic collisions caused by drunk driving pose a significant public health problem all over the world. Therefore additional preventive activities against drunk driving should be worked out. The aim of the study was to assess drunk driving in novice drivers after a psychological intervention taking into account also impulsivity, law obedience, and alcohol-related measures. An intervention study was started with 1889 car driver’s license attempters during their driving school studies. Subjects were classified as intervention group (n=1083, mean age 23.1 (SD=7.4) years), control group (n=517, mean age 22.8 (SD=7.1) years) and “lost” group (n=289, mean age 23.0 (SD=6.9) years). “Lost” group subjects had been assigned into the intervention group, but they did not participate in the intervention. Subjects of the intervention group participated in a psychological intervention on the dangers of impulsive behavior in traffic. After a three year follow-up period it appeared that in the control group and in the lost group there was a significantly higher proportion of drunk drivers than in the intervention group, 3.3% (n=17), 3.5% (n=10) and 1.5% (n=10) (p=0.026), respectively. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving (p=0.015), and the impact of the intervention was persistent also in the case of higher scores in Mild social deviance. In subjects with higher scores in impulsivity measures and alcohol-related problems the impact of short psychological intervention was not sufficient for preventing drunk driving. It can be concluded that psychological intervention used during the driving school studies is an effective primary prevention activity against drunk driving. However, for drivers with high scores in impulsivity measures and alcohol-related problems, the short psychological intervention is not sufficient in reducing drunk driving behavior.

INTRODUCTION

Although drunk driving has been decreasing during the last decades [Nochajski and Stasiewicz, 2006] road traffic collisions caused by drunk driving still represent a huge public health problem all over the world. Drinking behavior and drunk driving has been successfully decreased by social marketing campaigns, media advocacy campaigns, and increased drunk driving enforcement [Voas et al., 1997; Clapp et al., 2005]. These are activities on the community level. On the personal level traffic safety baseline knowledge, skills crucial for preventing drunk driving should already be obtained in the family [Jaccard and Turrisi, 1999; Buu et al. 2009] and at school [Perry, 1984; Rothe, 1991]. However, the influence of obtained knowledge and skills on the behavior in traffic is not always persistent [D’Amico and Fromme, 2002; Price et al., 2009]. The actual behavior in traffic depends on the situation and the environment, where a young driver is and what kind of decision he or she is making. In young ages, peers and friends play an important role. They may influence a young driver to drive or not to drive after alcohol use [Turrisi et al., 1993; Poulin et al., 2007]. Young people are more prone to take risks, especially together with peers. A certain amount of risk-taking is a normal psychological attribute necessary for development [McMahon et al., 2008], but young people should evaluate their own risks adequately to save the health and lives of themselves and others. In risk-taking behavior (the personality trait) impulsivity plays an important role. Impulsivity is a multidimensional construct and has several measures [Evenden, 1999]. Several studies have shown that drunk driving as a risk-taking behavior is associated strongly with higher scores of maladaptive types of impulsivity like Thoughtlessness, Disinhibition, but also with higher scores of adaptive types of impulsivity like Excitement seeking [Eensoo et al., 2004; Eensoo et al., 2005; Paaver et al., 2006] and Sensation seeking [Zakletskaia et al., 2009]. Driving school curricula should deal with all risks in traffic. Novice car drivers have to be able to assess their risks in traffic adequately and make right decisions following traffic rules and driving a car without drinking alcoholic beverages.

The aim of our study was to assess drunk driving in novice drivers after a short psychological intervention taking into account also the subjects’ impulsivity, general law obedience and alcohol consumption measures.

METHODS

Study sample

The intervention study was performed in the two biggest cities of Estonia, in Tartu and in Tallinn in 2007, and it was a part of the Estonian Psychobiological Study of Traffic Behavior (EPSTB). The main unit of sampling was a driving-school. In the preparation stage of the study (in 2006) there were 54 driving schools in the list. After contacting them, it appeared that 12 driving schools were no longer working and 17 refused (main reason was deficiency of time) or were not suitable (teaching only servicemen or in Russian language or for applying license of truck-drivers or motorcycle-riders) for the study. Twenty five driving schools were suitable and agreed to participate in the study. The study was carried out with the subjects learning in driving schools with the aim of obtaining a driver’s license. Every first and second group of license attempters attending the driving school during the recruitment period was included in the intervention group and the third into the control group. The psychological intervention study was carried out among 1889 car driver’s license attempters in total, which constitutes about 16% of the subjects having a provisional license in Tartu and Tallinn in 2007. The participants of the study gave their written consent. Of all the subjects invited to participate (n=1972), 95.8% agreed. Subjects were classified as the intervention group (n=1083, mean age 23.1 (SD=7.4) years), control group (n=517, mean age 22.8 (SD=7.1) years) and “lost” group (n=289, mean age 23.0 (SD=6.9) years). The “lost” group subjects had been assigned into the intervention group, but they did not participate in the intervention. The Ethics Committee at the University of Tartu approved this study.

Measures obtained in driving school

During the first meeting with the researchers at the driving schools the subjects filled in Impulsivity inventories Barratt Impulsivity Scale with 31 items by using the 4-point scale (1 = never or rarely, 4 = almost always, BIS-11) [Barratt, 1994] and Adaptive and Maladaptive Impulsivity Scale with 24 items by using the 5-point scale (1 = very false, 5 = really true, scales of Fast decision-making, Thoughtlessness, Disinhibition and Excitement seeking) [Eensoo et al., 2007]. The Social Motivation Scale, with 9 items by using the 3-point scale (1 = not really likely, 3 = very likely), was used to measure Mild social deviance [West, 1993]. Alcohol-related problems were measured by the TWEAK questionnaire with 5 items relating to tolerance (T), worried (W), eye openers (E), amnesia (A), and cut down (K) (total score 0–7) [Russell, 1994]. The subjects also filled in a questionnaire about their socio-economic status (gender, education, income).

Intervention

The psychological intervention (lasting for one and a half hours) on the topic of impulsive behavior in traffic was carried out by a psychologist among the intervention group during the next lesson. The methodology of the intervention was developed by the study-team. The intervention used active learning method [Exley and Dennick, 2004] with lectures, teamwork and discussions. One starting point in the intervention was the basic position of cognitive-behavioral therapy, where the human behavior depends on the circumstances of how he or she thinks in these situations. Group activities and the lecture demonstrated how people can detect their own feelings and thoughts, monitor and modify their behavior in traffic and thereby control their behavior - established presumption to enhance self-regulation abilities of impulsive behavior in traffic. In the past, an intervention based on the cognitive-behavioral therapy was successfully implemented among aggressive drivers [Deffenbacher et al., 2000]. The second starting point in the intervention consisted of the improvement of perception of personal risks: The lecture provided tips for self-monitoring one’s own tendencies of impulsivity, subjects were directed to acknowledge their potential personal risks, assess the likelihood of these risks, as well as to see the opportunities a person has to reduce his or her own risks in traffic. The lecture concentrated on the issue of impulsive behavior in traffic using the results from our own studies [Eensoo et al., 2004; Eensoo et al., 2005; Paaver et al., 2006]. The effect of the treatment on subject’s perception of personal risks during driving school studies on reduced number of traffic accidents has been shown in Denmark [Carstensten, 2002]. The causes of actual traffic accidents and possible psychological risk factors of the participants in traffic accidents were analyzed during as a teamwork. The aim of the group discussion was to demonstrate that in case of traffic collisions among other factors an important role is played by personal behavior. An earlier study has shown that the use of personal imagination about getting into traffic accidents has been successful in traffic safety interventions [Falk and Montgomery, 2007].

Driving while impaired (DWI)

Data of three years penalties for drunk driving were obtained from the police database. According to the Estonian traffic law, 1.0 g of the driver’s blood may not constitute more than 0.20 mg of alcohol (0.2 per mil, 0.2‰). All drunk drivers were penalized once during the following period. For analyses subjects were divided as drunk drivers (drunk driving, yes=1) and controls (drunk driving, no=0).

Statistical analyses

Statistical analysis was performed using SAS (version 9.1). Nominal variables were described using frequency tables, and Pearson’s Chi-square test was used to compare different groups. The Kruskal-Wallis test was used to compare groups according to the variable with nonparametric distribution (age). For analyzing the occurrence of the event (police penalty for drunk driving) during the follow-up period Cox regression models were performed.

RESULTS

There were no significant differences between the study groups by age (Kruskal-Wallis test), median, 25%, and 75% quartiles respectively in the control group 20.3, 17.9, 25.6, in the intervention group 20.4, 17.9, 25.5, and in the “lost” group 20.8, 18.1, 24.9 years. Also there were no significant differences between study groups in gender, educational status, and income (see Table 1 in the appendix). Significant difference between study groups appeared in drunk driving (Chi-square test, p=0.026). During the follow-up period there were significantly higher proportions of drunk drivers in the control group and in the “lost” group than in the intervention group (Table 1). All drunk drivers were males.

For additional analysis only intervention and control groups were included. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving (p=0.015). Analyzing possible interactions between psychological intervention and measures obtained in driving school, several models were built (Table 2).

Table 2.

Hazard ratios for drunk driving (drunk drivers vs controls) depending on not participating in the intervention (Control group=1 and Intervention group=0) and other risk factors

Models Hazard ratio 95% CI
1) Intervention 1.86 1.01–1.45(*)
BIS-11 1.10 1.03–1.09 *
2) Intervention 1.72 0.92–3.23
Fast decision-making 1.09 1.01–1.17 *
3) Intervention 1.68 0.90–3.15
Thoughtlessness 1.10 1.03–1.18 *
4) Intervention 1.69 0.90–3.16
Disinhibition 1.05 0.98–1.13
5) Intervention 1.66 0.88–3.10
Excitement seeking 1.14 1.06–1.22 *
6) Intervention 1.92 1.04–3.57 *
Mild social deviance 1.14 1.05–1.24 *
7) Intervention 1.77 0.96–3.29
TWEAK 1.42 1.22–1.65 *
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*

p<0.05, drunk drivers (drunk driving, yes=1) were significantly different from controls (drunk driving, no=0);

(*)

p=0.053, significant difference between groups disappeared after adjusting by age.

The models showed that adjusting by BIS-11 (Model 1) or Mild social deviance (Model 6) the effect of the intervention remained statistically significant. Drunk drivers (drunk driving=yes) were more likely no-participants in the intervention and had higher scores in BIS-11 or Mild social deviance than controls (drunk driving=no). It is known that impulsivity decreases with age. After adjusting the impact of intervention on drunk driving both by BIS-11 and age, significant impact of intervention on drunk driving disappeared. So it appeared that in the case of higher scores in impulsivity measures (BIS-11, Fast decision-making, Thoughtlessness, Disinhibition, Excitement seeking, Models 1–5) and TWEAK (Model 7) the impact of psychological intervention is not sufficient for preventing drunk driving.

DISCUSSION

The study sampling was carried out on the basis of the list of driving schools. It was surprising that one fifth of the driving schools had finished their business during the one-year preparation stage of the study. The reasons might be different, for example working in the conditions of developing market economy is quite difficult for new and small driving schools. Also the activity license for working is needed and it should be applied for regularly. According to the regulations curricula for driving schools has been established. It comprises lessons and practice about safe traffic behavior and communication with other vehicle occupants and pedestrians. Additionally, the applied psychological intervention gave new scientific-based knowledge about impulsive behavior in traffic, possibilities for self-monitoring and enhanced self-regulation abilities through the lecture, teamwork and discussions.

In Estonia a Graduated Driver Licensing (GDL) system exists for new car drivers. Subjects with a provisional license are not allowed to exceed speeds over 90 km/h when driving a car. The provisional license period is two years. Before getting full driving-license novice drivers have to participate in additional lessons and practice on topics of eco-driving and skidding-driving. Subjects who want to participate in driving school studies are required a minimum age – 6 months before turning 16. Novice drivers younger than 18 years old can drive only under supervision of an adult person with a full driver’s license.

Subjects of our study were divided into intervention group and control groups using a systematic sampling method. Although before the study the aim of the study was explained and all participants gave their written consent, out of the 1372 subjects assigned into the intervention group, 21.1% did not participate in the intervention. These subjects were assigned into the “lost” group. As the study groups were not significantly different in respect to main socioeconomic characteristics - age, gender, education and income - it is possible to investigate the impact of the intervention. Although study groups seemed to be similar, there might be some measures that are more distinctive for the “lost” group. At the same time not participating in the intervention might be occasional, for example not participating due to illness. It might also raise a hypothesis that the intervention group has higher consciousness than the “lost” group, while participation in the learning process needs purposefulness. It has been shown that success in the learning process is associated with higher consciousness [Kaufman et al., 2008]. In our study consciousness was not measured. Although the control group and the “lost” group were not significantly different in respect to drunk driving, we analyzed them separately due to the unknown factor in the “lost” group.

In this work only data from police records on drunk driving were used. In one earlier study with male car drivers we have analyzed both police-referred driving while impaired by alcohol (DWI) and self-reported driving after drinking (DAD) [Eensoo et al., 2005]. We found that in the control group 38% of the men reported DAD (Control II) and in the DWI group 22% subjects denied DAD (DWI I). Analyzing the formed groups separately it appeared that the differences were the most distinct between Control I group (controls who denied DAD) and DWI II group (DWI subjects who reported DAD). The best predictor of drunk driving was the measure of alcohol-related problems. Platelet monoamine oxidase (pl-MAO) activity is a peripheral marker of serotonergic activity in the central nervous system [Fahlke et al., 2002]. Pl-MAO activity is lower in alcohol dependent subjects [von Knorring and Oreland, 1996]. We have shown that the DWI I and DWI II groups’ mean pl-MAO activities were both significantly lower compared to Control I and Control II groups [Eensoo et al., 2005]. This result showed that police referred drunk driving separately quite well and drunk drivers with alcohol-related problems.

During the follow-up period in our study only men got fines for drunk driving. It is not surprising, because it is known that men take risks more often than women [Cestac et al., 2011; ]. It has been shown that the proportion of fatal accidents with positive blood alcohol concentration is significantly higher in male drivers than in female drivers [Tsai et al., 2008], but the percentage of young female drunk drivers in fatal accidents showed a greater increase than that of young male drunk drivers at the age of 19–24 years [Tsai et al., 2010]. Women’s socialization decreases differences between female and male adolescents [Brown and Tappan, 2008]. Also in drinking patterns the differences between female and male adolescents have decreased [Wilsnack and Vogeltanz, 2000]. Therefore activities preventing risk-taking and drunk driving should nevertheless be carried out for both genders.

The study groups did not differ significantly in respect to education and income. About 10% of the subjects had university education. According to the distribution of the income we can say that about 10% of the subjects had a higher income and after deduction of the taxes it was over 15 000 EEK (958.7 EUR) per month. The minimum wage in Estonia in 2007 was 230.08 EUR [Eurostat], it is income with taxes. Minimum wage without taxes was somewhat less than 3000 EEK (191,7 EUR). About one third of the subjects had an income lower than 3000 EEK. Such people may be students or young people with low income and may have studied at the driving school supported by their parents or friends. Driving a car means additional costs. We do not know how many of the subjects actually drove a car during the following period. It might be one limitation of our study. But supposing that at the beginning of the study the study groups were not significantly different in respect to their socio-economic background, it could be similar during the following period and also for car driving.

The survival analysis revealed that the subjects in the intervention group were less likely drunk drivers than the subjects in the control group. The result is quite unique, as the intervention was brief and a persistent result is evident after almost three years. In other school-based short interventions preventing drunk driving there is insufficient evidence to determine the effectiveness of these interventions on drunk driving outcomes, at the same time they have been effective in reducing sharing the car with drunk drivers among students [Elder et al., 2005]. The effectiveness of this brief intervention might also be explained by the following circumstances: in driving school students have similar learning objectives, they are all applying for a driver’s license, they all have been interested in knowledge necessary for driving and for passing the driver’s license exam, and probably most of them are highly motivated to become good drivers. Therefore such an intervention would be more suitable to be carried out in a driving school than in a regular school.

According to the theory of planned behavior, an individual’s intention to perform behavior could be predicted by the individual’s attitudes toward the behavior, by their subjective norms (the individual’s perception of social pressures to perform a behavior), and by perceived behavioral control (the individual’s perception of control over the behavior) [Ajzen, 1991]. Marcil et al. (2001) showed that young males’ intention to drink and drive is predicted by their attitudes, their perceived behavioral control, and to a lesser degree, by subjective norms. The authors highlighted that drunk driving prevention work should aim at reducing this perception to a more realistic level. During our psychological intervention it was explored and discussed why drivers take higher risks and have driven drunk, and how it would be possible to strengthen self-control over one’s decision not to drink and drive. It could also be possible that the subjects of the intervention group may after drinking have perceived lower control over their own driving ability due to obtained knowledge from the intervention and have not driven drunk so often as controls.

Our study was carried out at the time of the national traffic safety program. Topics of traffic safety, including drunk driving, were highlighted in the media. Every year a traffic safety campaign against drunk driving is organized around the midsummer day celebration. Therefore the general attitude against drunk driving might be negative in the population. Nevertheless among groups where risk-taking behavior is more prevalent the situation might be different. Our study revealed that in the case of higher scores in Fast decision-making, Thoughtlessness, Disinhibition, Excitement seeking and also adjusting by age in the case of higher scores in BIS-11 short psychological intervention was not sufficient for preventing drunk driving.

In novice drivers both Fast decision-making and Excitement seeking that describe the adaptive side of impulsivity and only Thoughtlessness, one measure that describes the maladaptive side of impulsivity have significantly been associated with drunk-driving. In our earlier study with male car drivers (mean age of drunk drivers 33±11 years and in controls 36±12 years) it appeared that drunk driving was associated with Disinhibition and Thoughtlessness, which both describe the maladaptive side of impulsivity [Eensoo et al., 2004; Paaver et al., 2006], and have been characterized as an inability to plan and think through one’s actions, thus leading to negative consequences [Dickman, 1990]. In earlier studies it has been found that in younger subjects Sensation seeking (18-years college students) [Zakletskaia et al., 2009] and Excitement seeking (drunk-drivers recorded in the police records who have been reported driving drunk sometimes or often per year, mean age 28 years) [Eensoo et al., 2005] have significantly been associated with drunk-driving.

Our results show that subjects with higher scores in impulsivity need an additional intervention for preventing drunk driving. It is known that personality traits including also impulsivity measures are normally distributed in population, therefore this psychological intervention might be more effective in subjects with low or mean level of impulsivity rather than in subjects with high impulsivity. On average, certain types of impulsive behavior decrease with age, but generally impulsivity is a persistent personality tendency [Evenden, 1999].

It is possible to develop self-regulation abilities and learn to control impulsive tendencies. For drivers with higher impulsivity it might be useful to develop a prevention program focusing on coping strategies [Kulick and Rosenberg, 2000]. For example according to the adapted Marlatt’s cognitive-behavioral model an individual may obtain coping skills to avoid a high-risk situation (e.g. walking to the drinking location). Coping results in increased self-efficacy (belief in one’s ability to resist driving after drinking) and decreased likelihood of driving after drinking in the future [Kulick and Rosenberg, 2000].

Our intervention has a significant effect on drunk driving in the case of higher scores in Mild social deviance, but not in the case of higher scores in TWEAK. Additional interventions and rehabilitation programs for drunk driving offenders should pay attention also to the alcohol problems. It has been shown that drunk driving offenders and especially relapsed drunk driving offenders are a very heterogeneous group. For example relapsed drunk driving offenders are more likely to have been involved in collisions, they have more traffic violations and crimes other than drunk driving, heavier drinking patterns, prior treatment for alcohol or other drug problems, they are less likely to have college education, more likely to be unemployed, and have lower household incomes than the first-time drunk driving offenders [Nichajski and Stasiewicz, 2006].

CONCLUSION

After the three-year follow-up period it was evident that in the control group and in the “lost” group there was a significantly higher proportion of drunk drivers than in the intervention group. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving. Compared to the intervention group the control group had a higher risk for drunk driving also in the case of higher scores in Mild social deviance or alcohol-related problems. In the case of higher scores in impulsivity measures the impact of short psychological intervention is not sufficient for preventing drunk driving. On the basis of these results we can conclude that a brief psychological intervention focusing on the topic of impulsive behavior in traffic is suitable to be carried out in driving schools as a primary prevention activity against drunk driving.

Acknowledgments

This research was supported by the Estonian Road Administration, and the Estonian Ministry of Education and Research (no. 0180027 and 0180060).

APPENDIX

Table 1.

Basic characteristics of the study groups

Control group Intervention group “Lost” group
N % N % N %
Gender
  Male 239 46.2 453 41.8 126 43.6
  Female 278 53.8 630 58.2 163 56.4
Education
  Elementary to high-school 467 90.5 927 87.9 259 90.2
  University 49 9.5 128 12.1 28 9.8
Income
  Up to 3000 EEK 172 36 318 33.2 72 26.8
  3001 to 15 000 EEK 268 56.1 560 58.5 168 62.4
  over 15 000 EEK 38 7.9 80 8.3 29 10.8
Drunk driving
  Yes 17 3.3 16 1.5* 10 3.5
  No 500 96.7 1067 98.5 279 96.5
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*

p<0.05, significantly different from control and “lost” groups

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