SURGEON GENERALS WORKSHOP ON

DRUNK DRIVING

Proceedings

Washington, D.C. o December 1446, 1988

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
             Public Health Service

Offke of the Surgeon General

  5600 Fishers Lane
Rockville, Maryland 20857


ACKNOWLEDGMENTS

The Surgeon General's Workshop on Drunk Driving was supported by the
following organizations:

U.S. Department of Defense
U.S. Department of Education
U.S. Department of Health and Human Services
U.S. Public Health Service
  Alcohol, Drug Abuse and Mental Health Administration
     National Institute on Alcohol Abuse and Alcoholism
     Office for Substance Abuse Prevention
   Centers for Disease Control
   Health Resources and Services Administration
    Bureau of Health Care Delivery and Assistance
     Bureau of Maternal and Child Health and
      Resources Development
   Indian Health Service

U.S. Department of Justice
   Office of Juvenile Justice and Delinquency Prevention
U.S. Department of Transportation
  National Highway Traffic Safety Administration

The report was prepared by Janus Associates under contract 85080-001.

Allmaterial in this volume is in thepublic domain and may be used orreproduced
withoutpennission from the Ofice of the Surgeon General or the authors. Citation
of the source is appreciated.

72e opinions expressed herein are the views of the authors and participants and
do not necessarily reflect the officialposition of the Office of the Surgeon General
or any other sponsoring agency of the U.S. Government.

Printed 1989


Foreword

This Surgeon General's Workshop marks the beginning of a coordinated
campaign to save the 25,000 lives that are lost each year because Americans
persist in drinking and driving. As with smoking, the issues are many and
complicated, and even small steps toward alleviating the problem trigger
emotions and controversy.

Coordination began with having five Federal Departments sponsor the
workshop-Defense, Education, Justice, Health and Human Services, and
Transportation. The experts who participated in the workshop represent the
broad array of specialists who must work together to bring this pervasive
behavior under control. The difficulties they face were immediately apparent
in the number of invited experts who declined to attend.

The participants spent 3 days generating solutions in 11 interrelated areas
and developing recommendations that affect the wide range of people - from
beverage servers to carmakers, from legislators to treatment providers, from
advocates to advertisers-who can play some role in alleviating this problem.
The participants also suggested strategies for implementing the
recommendations and set up timeframes for their accomplishment. They are
included in this volume. Now it is our turn to act to make the Nation safe
from the tragedies precipitated by combining alcohol and motor vehicles.

C. Everett Koop, M.D., Sc.D
Surgeon General

. . .
tn


Workshop Planning Committee

Jerald H. Anderson

Chairperson, Intoxicated Driving Prevention Task Force
OASD (FM&P), ODASD @E&S), S&OHP
U.S. Department of Defense

Loran Archer
Deputy Director

National Institute on Alcohol Abuse and Alcoholism
Alcohol, Drug Abuse and Mental Health Administration
U.S. Department of Health and Human Services

Amy Barkin

Coordinator for the Drunk Driving Workshop
Office of the Surgeon General
U.S. Department of Health and Human Services

Maura Daly

Senior Policy Analyst, Office of the Secretary
U.S. Department of Education

Roberta Dorn

Director, Concentration of Federal Effort Program
Office of Juvenile Justice and Delinquency Prevention
U.S. Department of Justice

Robert W. Denniston

Director, Division of Communication Programs
Office for Substance Abuse Prevention
Alcohol, Drug Abuse and Mental Health Administration
U.S. Department of Health and Human Services

Arthur S. Funke, Ph.D.

Chief Psychologist, Child and Adolescent Branch
Bureau of Maternal and Child Health and Resources Development
Health Resources and Services Administration
U.S. Department of Health and Human Services

V


Mary L. Ganikos, Ph.D.

Program Director, Community Prevention and Late Life Alcohol Abuse
National Institute on Alcohol Abuse and Alcoholism
Alcohol, Drug Abuse and Mental Health Administration
U.S. Department of Health and Human Services

Jan Howard, Ph.D.

Chief, Prevention Research Branch
National Institute on Alcohol Abuse and Alcoholism
Alcohol, Drug Abuse and Mental Health Administration
U.S. Department of Health and Human Services

Michael T. Impelliieri
Chief, Special Programs Division, Offke of Alcohol and State Programs
National Highway Traffic Safety Administration
U.S. Department of Transportation

Steve Moore

Associate Chief of Staff, Office of the Surgeon General
U.S. Department of Health and Human Services

James L. Nichols, Ph.D.
Deputy Director, Scientific and Technical Affairs
National Highway Traffic Safety Administration
U.S. Department of Transportation

Joan White Quinlan

Prevention Program Coordinator, Special Programs Division
Office of Alcohol and State Programs
National Highway Traffic Safety Administration
U.S. Department of Transportation

Richard J. Smith III
Manager, Injury Prevention Program
Indian Health Service
U.S Department of Health and Human Services

vi


Federal Advisory Group on Followup
  Activities for the Workshop

U.S. Department of Defense
  Jerald H. Anderson

   Chairperson, DOD Intoxicated Driving Prevention Task Force
   OASD (FM&P), ODASD @SE&S), S&OHP
   Room 3A272 The Pentagon, Washington, DC 20301-4000
U.S. Department of Education
Maura Daly
   Senior Policy Analyst
   Office of the Secretary, 400 Maryland Avenue, S.W.
   Room 4145, Washington, DC 20202
U.S. Department of Health and Human Services
U.S. Public Health Service
  Robert W. Denniston

Director, Division of Communication Programs
  Office for Substance Abuse Prevention
Alcohol, Drug Abuse and Mental Health Administration
Room 13A-54 Parklawn Building, 5600 Fishers Lane
Rockville, MD 20857
Arthur S. Funke, Ph.D.

Chief Psychologist, Child and Adolescent Branch
Bureau of Maternal and Child Health and Resources Development
Health Resources and Services Administration
Room 9-21 Parklawn Building, 5600 Fishers Lane
Rockville, MD 20857
Mary L. Ganikos, Ph.D.
Program Director
Community Prevention and Late Life Alcohol Abuse
National Institute on Alcohol Abuse and Alcoholism
Alcohol, Drug Abuse and Mental Health Administration
Room XC-03 Parklawn Building, 5600 Fishers Lane
Rockville, MD 20857

vii


Susan J. Lockhart
Program Specialist
Office of the Surgeon General
Office of the Assistant Secretary for Health
Room 18-67 Parklawn Building, 5600 fishers Lane
Rockville, MD 20857
Richard J. Smith III
Manager, Injury Prevention Program
  Indian Health Service
5600 Fishers Lane, Rockville, MD 20857
Bob Vollinger

   Presidential Management Intern
   Office of the Surgeon General
   Office of the Assistant Secretary for Health
   Room 18-67 Parklawn Building, 5600 Fishers Lane
   Rockville, MD 20857
U.S. Department of Justice

John Dawson
Program Manager

   Office of Juvenile Justice and Delinquency Prevention
   Room 758,633 Indiana Avenue, N.W.
   Washington, DC 20531
Donni Hassler, Ed.D.
   Social Science Analyst
   Office of Juvenile Justice and Delinquency Prevention
   Room 742,633 Indiana Avenue, N.W.
   Washington, DC 20531
U.S. Department of Transportation
James L. Nichols, Ph.D.
   Deputy Director
    Scientific and Technical Affairs
   National Highway Traffic Safety Administration
   400 5th Street, S.W. Room 5130, Washington, D.C 20590
  Joan White Quinlan

Prevention Program Coordinator, Special Programs Division
Office of Alcohol and State Programs
National Highway Traffic Safety Administration
400 7th Street, S.W. Room 5130, Washington, DC 20590

*..
VI11


Abbreviations

402 Programs

408 Programs

410 Programs

ABC
ADAMHA
ASAP
ASTHO
BAC
BIA
CDC
CPL
DHHS
DOJ
DOT
DUI
DWI

EMS
FARS
FBI
FCC

23 U.S.C. 402 Highway Safety Programs. These formula grants
to the States for highway safety programs are administered
by the Governors' Representatives for Highway Safety.
23 U.S.C. 408-I incentive grants to States for alcohol traffic
safety programs
23 U.S.C. 410-I incentive grants to States for drunk driving
prevention programs
Alcohol Beverage Control
Alcohol, Drug Abuse and Mental Health Administration
Alcohol Safety Action Projects
Association of State and Territorial Health Officers
Blood Alcohol Concentration
Bureau of Indian Affairs
Centers for Disease Control
Certified products list
Department of Health and Human Services
Department of Justice
Department of Transportation
Driving Under the Influence
Driving While Intoxicated
The terms DWI and DUI are synonymous, meaning either
driving while intoxicated or driving while under the influence.
These are general terms referring to the criminal action of
driving a motor vehicle either (1) while "illegal per se" or (2)
while impaired, under the influence, or intoxicated by alcohol
or other drugs.

Emergency Medical Systems
Fatal Accident Reporting System
Federal Bureau of Investigation
Federal Communications Commission

ix


IACP
IHS
Illegal per se

MADD
MCD

NAB
NAGHSR

NCADD
NCADI
NCIC
NHTSA

NL4AA
NIDA
NSA
OJJDP
OSAP
PHS
PI&E
PSA
RADAR
RPP
RWID

International Association of Chiefs of Police
Indian Health Service

Refers to State laws that make it an offense to operate a motor
vehicle while at or above a specified blood alcohol level.
Mothers Against Drunk Driving
Multiple Cause of Death file taken from death certificate data by
National Center for Health Statistics
National Association of Broadcasters
National Association of Governor's Highway Safety
Representatives
National Commission Against Drunk Driving
National Clearinghouse for Alcohol and Drug Information
National Crime Information Center
National Highway Traffic Safety Administration
National Institute on Alcohol Abuse and Alcoholism
National Institute on Drug Abuse
National Sheriffs Association
Office of Juvenile Justice and Delinquency Prevention
Office for Substance Abuse Prevention
Public Health Service
Public information and education
Public service announcement
Regional Alcohol and Drug Awareness Resource Network
Request for proposals
Riding With Intoxicated Driver

X


Contents

Foreword  ...................................
Workshop Planning Committee   ......................
Federal Advisory Group on Follow-up Activities for the Workshop   . .

Abbreviations   ................................
Opening Remarks  ..............................
C. Everett Koop   .............................
Otis R. Bowen   ..............................
M. George Reagle  ............................

Recommendations  ..............................
Pricing and Availability   .........................
Advertising and Marketing  .......................
Epidemiology and Data Management  .................

Education  .................................
Judicial and Administrative Processes  .................

Law Enforcement   ............................
Transportation and Alcohol Service Policies   .............
Injury Control  ...............................
Youth and Other Special Populations  .................

  Treatment  .................................
CitizenAdvocacy  .............................
Closing Remarks, C. Everett Koop   ....................

List of Participants   .............................

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Opening Remarks

Good afternoon. I am Faye Abdellah, Deputy Surgeon General, U.S.
Public Health Service (USPHS), and am serving as moderator for this
opening session.

First-Welcome to all of you to this historic Surgeon General's
Workshop. The first was initiated by Dr. Koop in 1981.
The Surgeon General's Workshop is a concept, now inveterate, of
convening experts to advise the Surgeon General and to identify the public
health implications of major health problems demanding resolution.
This workshop provides you, the experts, with the opportunity to come
together to advise the Surgeon General, within the constraints of his office,
on how best to approach the problem of drunk driving from the
perspectives of needed education, services, research, and health policy.
Previous workshops have addressed equally complex problems such as
the needs of ventilator/handicapped children, child abuse, elder abuse,
pornography, pediatric AIDS, self-help groups, and, most recently, health
promotion and aging. For example, during the last workshop, one panel
dealt with the problems of alcohol abuse in the elderly-often starting
when they were adolescents. The recommendations of this panel were
incorporated into the research agenda of the National Institute on Alcohol
Abuse and Alcoholism (NIAAA). This is precisely the kind of result that
we would like to see come out of your deliberations.
Soon after the workshop is completed, the workshop proceedings and
background papers will be published and widely disseminated to
appropriate groups at Federal, State, and local levels as well as private
sector groups.

The purpose of this workshop is to develop a comprehensive set of
recommendations that can help the Surgeon General bring drunk driving
under control and eliminate drunk driving as the leading cause of death
among young Americans.

Participants are encouraged to examine each expert panel charge in
light of the following questions:

1.  What do we know about the problem and its extent?

2.  What have we done so far? Have these actions been effective
   or ineffective?

1


2                OPENING REMARKS

3.  What do we need to know?

4. How do we put our knowledge into practice effectively? What
will really work?

This is your mandate.
Let me now introduce this afternoon's speakers.

introduction of Surgeon Genera/ C. Everett Koop

Dr. Koop, the 73th Surgeon Genera/ of the USPHS, has become the
most effective Surgeon Genera/ since the establishment of that
posit/on. Why has he been so effective?

Dr. Koop has paid his dues to the health establishment many times
over. His inimitable courage as a pioneer in pediatric surgery for more
than four decades helped him climb mountains in the pediatric war/d
never before surmounted. His appointment as the U.S. Surgeon
Genera/ in November 1981 presented him with new mountains to
climb; for example, planning and implementing the strategy to achieve
a smoke-free society by the year 2000; introducing regulations to
protect the newborn; protecting the confidentiality of those who are
HIVpositive, yet still seeking new ways of obtaining prospective data
such as volunteer testing of college students; setting new guidelines
for nutrition; and most important, strengthening the PHS
Commissioned Corps to make this cadre of health professionals proud
to serve throughout the United States and in many other parts of the
world.

Not on/y does this Surgeon Genera/ climb mountains that appear to
be insurmountable, but during his college days at Dartmouth, he was
also known to jump off mountains. Does he f/y? - NO. He does nor
have to. His enormous energy propels him on ar /east 16 cylinders!
Ladies and gentlemen, the U.S. Surgeon Genera/ C. Everett Koop.

Opening Remarks

C. Everett Koop. M.D., SC-D.
Surgeon General of the U.S. Public Health Service
U.S. Department of Health and Human Services

Greetings to hosts, guests, and friends.
I want to thank you all for traveling to this workshop from so many parts
of the country. You represent a cross-section of a nation deeply concerned


OPENING REMARKS                 3

about the annual toll of death and disability caused by drunk and drugged
drivers.

You were chosen by a thoughtful, hard-working interagency planning
committee. Its members came from five cabinet-level departments:
Transportation, Justice, Education, Defense, and Health and Human
Services. I'd hardly call it a parochial group, and I'm delighted that they
found the name and address of each one of you.
I also wish to recognize a member of the House of Representatives who
is with us today- Congressman William F. Goodling of Pennsylvania.
Congressman Goodling has been a dedicated and tireless leader in
every major effort by the U.S. Congress to tight the scourge of drunk
driving. The American people are very fortunate to have had him on their
side so far, and we can look ahead to his continued leadership and support
in the 1Olst Congress when it convenes next month. Welcome,
Congressman Goodling, I'm very pleased to have you with us this
afternoon.

All of you, gathered here this week, are respected experts in this field,
but that doesn't mean you all think alike. I'm sure as the workshop sessions
continue, we will become aware of the wide range of opinions and interests
represented here.

I know this is not the best time of year to ask people to leave their
homes and families and spend a few days at a conference. But I believe
that this workshop is different. There's an urgency about the subject: drunk
and drugged driving.

The urgency is almost palpable in the many letters that come in to my
office from State and local officiaIs of every area of the country. The
urgency is also clear in the cards, letters, and telegrams I've received from
surviving family members grieving over the loss of a loved one-someone
killed by a drunk driver.

The urgency is clear from the response we've already had to the
alcoholism and alcohol abuse initiative launched by Secretary Otis R.
Bowen last year and reinforced at a major national meeting in San Diego
this past October.

And it's clear from the sentiment expressed by 99 United States
senators and from a unanimous House of Representatives, who have asked
me to take on this issue and do whatever I can to bring it under control.

Although they are not here today, I do want to recognize two other
individuals who have been of immeasurable help in the United States
Senate-Senator Claiborne Pell of Rhode Island and Senator John W.
Warner of Virginia, the two gentlemen who cosponsored that letter signed
by them and 97 of their colleagues. And, again, Congressman Goodling
can take great credit for the passage of that resolution-House Concurrent
Resolution 276-in the recent 100th Congress.


4               OPENING REMARKS

The Congress knows - as I certainly do, and as most of you know,
also- that the powers of the Surgeon General are carefully circumscribed.
I do not allocate funds, or operate programs, or carry out any specific
legislation. Nor do Ipretend that I do.

On the other hand, the power and authority of my office are heavily
invested inprlbiic education.

My principal assignment, therefore, is to inform the American people of
any threats to their health and to advise them of ways to avoid such threats,
if they are known. I inherited that power and authority when I assumed the
office of Surgeon General more than 7 years ago. And the credit for that
goes to my 12 predecessors, going back for more than a century.
When the time comes for me to take my leave, I hope and pray that I
will have done nothing to compromise the integrity and credibility of this
great office. On the contrary, I hope I also might be remembered as having
done something to further strengthen this office in the eyes of the Nation.
In this matter of drunk driving, the Surgeon General's role is virtually
nothing more-but certainly nothing less-than public education. And by
"the public," I include not only lay citizens but also my colleagues at all
levels of government-Federal, State, and local - and my fellow citizens in
the private sector, both in profit and nonprofit activities.
As Surgeon General, I have a responsibility to speak to them all. And I
do, whether they are comfortable with what I have to say or not.
One of the mechanisms I have used for this purpose is the Surgeon
General's Workshop. The workshop provides, as it were, an umbrella
under which individuals and groups representing many diverse interests
and points of view can assemble and talk out an issue of significance to the
health of the American people.

That umbrella-to be effective -has to be neutral. Hence, let me assure
all of you that I do not come to this workshop with any prearranged
conclusions or recommendations or any preset ideas about what we should
do next.

But let there be no mistake: I am not neutral about the issue of drunk
driving. No sensible person can be neutral about that. Where we differ may
be on the approach that the United States should take, as a civilized
society, to reduce and maybe one day eliminate this terrible thief of health
and life.

I ask you to please adopt this spirit as you take part in the working
sessions tomorrow and Friday. In other words, I ask you to be willing to
share your ideas, but also be willing to listen, and be willing to learn new
things and maybe adjust some of your thinking, if need be.
If we have that kind of participation from everyone, then we may get a
good deal closer to the core of this problem and the essence of its solution.
And that brings me to the announcement that the working sessions


OPENING REMARKS

5

tomorrow and Friday'will not be open to the press. That is consistent with
past practices.

I have conducted nearly a dozen Surgeon General's Workshops during
my two terms in office. The issues have included AIDS, liver
transplantation, the care of handicapped children, family violence,
pornography, and so on.

In each workshop, the main or plenary sessions, like this one, have
always been open to everyone, including the press. But the wonGing sessions
have not been open. They have always been closed to nonparticipants,
again, including the press.

The reason is simple enough. I want all invited participants to go into
these sessions ready to speak their minds, ready to engage in open and
candid give-and-take with colleagues and counterparts, and, yes, in the
course of the debate, ready to change their own minds, if need be.
This approach is not only legal, it's very successful. And I am sure it will
be equally successful for us at this workshop, too. Let me assure you,
however, that, while the actual deliberations of the working sessions will be
closed, the results of those sessions will be made public at the final open
session on Friday. The recommendations will be presented to me by the
persons who lead the sessions. I will take a little time to review them and
then come back to you with my response in the final session, Friday
afternoon.

Now, one more word about these recommendations.
This is the Surgeon General's workshop. And I am the Surgeon General.
But I hope you will look beyond the office of Surgeon General when you
make your recommendations.

As I indicated a moment ago, there's really only one recommendation
for the Surgeon General - to speak out publicly on the issue of drunk
driving. Well, I'm already doing that.

That's why I urge you to set your sights beyond the Surgeon General's
off& and recommend future action for education-State, local, public,
and private-for law enforcement, for the health professions and the
public health community, for the transportation and highway interests, and
for communications, including advertising and broadcasting.
So, with those few ground rules in mind, let us move forward with our
agenda, because time is not on our side. Even as we deliberate here in the
safety of these hotel walls during this otherwise festive season of the year,
alcohol consumption is up and so is the toll of alcohol-related traffic
injuries and deaths.

Hence, we can expect that 1988 -like 1987 and 1986 before it -will be a
year in which 24,000 more Americans will have died on our highways in
alcohol-related accidents.

And many thousands more will have been killed in accidents that are


6                OPENING REMARKS

drug-related, a fact we want to emphasize during this week, which is
National Drunk and Drugged Driving Awareness Week.
During my brief time at this microphone - 20 minutes or so - one of our
citizens will be killed by a drunk driver.
While you were grabbing a quick lunch at noontime, two more were
killed.

And this evening, in the hour when you relax over dinner, three more will
be killed in the same way.

An average of two to three of our fellow citizens are killed on our streets
and highways every hour, around the clock, because they or others had
their judgment and reflexes impaired by alcohol and other drugs.
By this time tomorrow, some 65 Americans will have died on the
highway in alcohol-related accidents.
That's the picture in regard to alcohol-related fatalities. But over a
million alcohol- and drug-related crashes occur every year on our
highways, and most of them do not end in death. But they do result in
injuries-u half-million injuries at a minimum.
When the vehicular wreckage is towed away, the human wreckage is left
behind- the permanent brain damage, the spinal cord injuries, the lost or
permanently deformed limbs, the blindness, and the impotence - the
lifetimes crippled with disability and haunted by recurrent nightmares of
how it all happened.

Tens of thousands of deaths, hundreds of thousands of injuries. Those
are numbing statistics. But they are also more than just statistics.
They are real people, real human lives.
Unfortunately, a disproportionate number of highway victims are young
people, young men and women between the ages of 15 and 24. No other
comparable age cohort has such a record of death and injury on the
highway.

And this age group, by itself, accounts for more than 8,000
alcohol-related fatalities, or about a third of all fatalities each year in which
alcohol is implicated.

Fortunately, young people themselves are becoming more and more
sensitive to this issue. That was one of the most encouraging aspects of the
recent report of the public hearings held by the National Commission
Against Drunk Driving.

Young people who testified at those hearings supported the minimum
drinking-age law, seatbelt laws, more public education, and so on.
Also, according to the National Commission, young people themselves,
"with near unanimity, declared that advertising encourages adolescents to
drink," and the Commission went so far as to recommend that "in the
absence of alcohol industry action, legislation should be enacted to
regulate alcohol beverage advertising."


OPENING REMARKS

Young people may not be numerically represented here as they are in
the death and injury statistics each year, but they should be uppermost in
our minds during our deliberations today, tomorrow, and Friday.
And now, a final word. I've been spending some time lately preparing
for the 25th anniversary of the publication of the first Surgeon General's
Report on Smoking and Health. In doing so, I've been looking over that
25year record of progress, and I find it very instructive.
Twenty-five years ago the public health community, with the support of
citizens' groups and members of Congress, embarked upon a systematic
program of research into the relationship between smoking and health.
At the same time, and in a responsible way, they also looked at the
public policy implications of the research results, as those came to light.
From that information they were able to plan ways to help the American
people end their high-risk romance with tobacco. Chief among these ways
was a far-reaching program of public education and instruction.
And so it appears to me that we may now be- in terms of alcohol and
drunk driving-where we were 25 years ago in terms of tobacco and the
fatal diseases caused by smoking.

And that brings me to the particular charge for this workshop, the
specific areas of interest I hope you address in the next 2 days:

o First, let's consider the researclt agenda required for this issue
of drunk and drugged driving. We know quite a bit about the
issue now, but much still remains to be learned. We clearly
need to build a strong scientific base which either confirms
alcohol's role in highway trauma, or refutes the connection
between highway trauma and alcohol and other drugs.

o Next, we need to look at-or anticipate, if possible-the many
policy implications of that research. In other words we may
feel we're justified by experience to have strong opinions
about this and that, but the country needs an objective
assessment of the knowledge base and its implications for
public policy.

o Third- and also on the strength of an ongoing research
program and its policy implications-we need to lay out a
plan with near-tern, and long-term public health objectives. In
other words, what kinds of actions must we take, in both the
public and private sectors, in regard to drunk and drugged
driving? What are our goals and objectives, and how should
we go about reaching them, soon and over the long run?

o And finally, we need to devise an overall strategy for carrying
out such a national plan. In these days of restricted and
limited resources, we must make every person and every


OPENING REMARKS

dollar count. That means not only having a plan, but also
having a coherent and cost-effective approach to the
implementation of that plan.

Those four elements, then, constitute my charge to this workshop:
research, policy, a plan of action, and an implementation strategy for that
plan.

That's a big assignment for a 3-day workshop. But I've found in
workshops past that people tend to work more creatively and at a higher
energy level if time is of the essence.
In any case, this workshop is not an on-the-job training experience for
any of you. You are all seasoned and experienced individuals. Also, I'm not
searching for the ultimate statement on the issue of drugged and drunk
driving. Rather, I'm hoping for a document that will give the country a
strong push in the most fruitful direction.
This may be the first meeting of this kind- and it's an important
one-but I doubt that it will be the last one.
I am sure all of you can think of some people who are missing from this
workshop. Maybe they will be at the next one-and the ones that will
follow. But fust, let's make the very best start we can.
Again, thank you for joining me this week at this workshop. I appreciate
it, and the country will surely benefit from your contribution.
Thank you.

Introduction of Secretary Bowen

Dr. Bowen is the first physician to serve as Secretary of the
Department of Health and Human Services. Having setved iwo highly
successful terms as Governor of Indiana, we are most privileged to
have this physician as Secretary of DHHS.
Secretary Bowen has been able to accomplish what no other
secretary has, name/y, the introduction and successful passage of
legislation related to catastrophic illness. President Reagan publicly
stated that this legislation is the most important of his administration.
Why is it so important that Secretary Bowen be with us at this
workshop? He has accomplished the following related to drunk driving.

  o  He made alcoholism and other alcohol-related problems a
   special priority for the Department of Health and Human
   Services.

o  November 1987, the Department announced a 14-point initiative
to raise public awareness about alcohol-related problems in
America.


OPENING REMARKS

9

o  The Department created a public affairs campaign to help get
the message across.

o  The Department established a National Citizens Commission on
Alcoholism.

Ladies and gentlemen, Secretary Otis R. Bowen.

Opening Remarks

Otis R Bowen, M.D.
Secretary of Health and Human Services

I'm delighted to join such distinguished company in addressing a very real
problem that should be of concern to every single American.
I think this is a very appropriate time of the year to be focusing on this
matter. The holiday season, from Thanksgiving to New Year's,
unfortunately, is the occasion for a general increase in alcohol intake by
the average person. All too often, what ought to be a joyous celebration of
the revival of the human spirit is utterly destroyed by the abuse of alcohol
and the tragedies that follow in its wake.
It's well to remember that, for our purposes, drunk driving is a
misnomer. What we're really talking about is drinking and driving. It isn't
necessary to be intoxicated; just a drink or two can make somebody behind
the wheel a threat to themseIves and to others.
The fact that the holiday season is usually marked by weather that
makes road and highway conditions treacherous simply compounds the
matter.

Now, I don't want to be the grinch that stole Christmas. But I do think
this is as good a time as any to renew our annual plea that conviviality and
good times shouldn't extend to the point of endangering lives and property.
I'll let Dr. Koop terrorize those who want to enjoy a big steak and a
good cigar. Let me just sound the note of caution that's in keeping both
with our purpose and its timing.

I don't think there is anyone who doesn't realize that alcohol abuse and
alcoholism are having a devastating effect o&American society.
And it's going to get worse.              `.
                     `\

Recent studies indicate that the annual cost to the country of alcohol
abuse and alcoholism will reach $136 billion by the end of next year and
will rise to $150 billion by 1995.

The checklist of statistics makes a sad litany indeed.

o  In all, some 18 million American adults are either alcoholics
or have alcohol abuse problems.


10



   o

OPENING REMARKS

Alcohol is a factor in things like teenage pregnancy, poor
scholastic achievement, crime and violence, the gap in health
status between white Americans and Americans from
minority group backgrounds, and general loss of American
productivity.

An estimated 4.6 million adolescents annually- 3 out of every
10 American teenagers- have alcohol problems.
Nearly 9 out of 10 teenage automobile accidents involve
alcohol.

Alcohol is a major disciplinary, vandalism, and crime problem
on most college campuses.

Some 40,000 babies are born each year at increased risk
because of their mother's drinking during pregnancy.
Fetal alcohol syndrome is one of the top three causes of birth
defects and is the only one that's preventable.
Women are the fastest growing component of the alcohol
abuse segment of the population.
Black, Hispanic, and Native American minorities suffer
disproportionately from alcohol-related problems.

In an attempt to do something about this national catastrophe by
increasing public awareness, I launched a 1Cpoint initiative a year ago in
the U.S. Department of Health and Human Services. Since putting alcohol
abuse and alcoholism in the spotlight, we have been able to accomplish a
number of things.

We've established a National Citizens Commission on
Alcoholism.

We've created a special public affairs campaign to inform the
American people of the serious health effects of alcohol.
We've developed a new publication called Alcohol Alert to
expedite the delivery of research findings into the hands of
clinical practitioners.

We've held two national conferences on alcoholism and
alcohol abuse that brought together more than a thousand
clinical practitioners, researchers, and prevention specialists.
And we've joined forces with the American Medical
Association to improve the training of physicians in the
detection and treatment of alcohol problems.

There is, of course, much that still needs to be done. One of the major
alcohol issues that demands our attention is the operation of a motor


OPENING REMARKS                 11

vehicle while under the influence of alcohol. And that's the reason for this
workshop.

Alcohol-related motor vehicle accidents are a very serious national
public health problem. Every year, they inflict lingering spinal cord and
brain injuries and other trauma on half a million people. And they kill
24,000 in this country alone. The toll in human misery is awesome and
intolerable.

Dr. Koop is to be highly commended for organizing this 3-day
workshop. He has enlisted in his cause the Federal Departments of
Defense, Education, Justice, and Transportation.
And from our Department of Health and Human Services, the Centers
for Disease Control, the Health Resources and Services Administration,
the Indian Health Service, and the Alcohol, Drug Abuse, and Mental
Health Administration all work together on this problem.
In the past, there have been honest disagreements on the best ways to
solve this problem of alcohol-impaired driving. This workshop will attempt
to bring together all the public health, academic, government, public
safety, law enforcement, and advocacy points of view. And hopefully, it will
produce the best background research and recommendations on the
problem, from which can come a comprehensive plan to reduce
alcohol-impaired driving and eliminate it as a leading cause of disability
and death among Americans, many of them unacceptably young.
When these findings reach every level of our society, perhaps that
process can begin.

Dr. Koop is going after alcohol-impaired driving the way he has gone
after cigarette smoking. His goal is to save lives. I support his effort.
And even though my stewardship is about to end, the commitment of
the Department of Health and Human Services will not. In fact, planning
has already begun for the third national conference on alcoholism and
alcohol abuse. The second conference, last month in San Diego, was
enormously successful, with more than 1,400 people in attendance. The
next conference promises to be even better.
We aren't the only ones with these concerns. Maybe from others in the
international community we can learn new ways to combat the problem
that brings us together today, and maybe we can teach them something of
what we know.

There may be no magic bullet to end the tragedy of alcohol abuse and
driving, but I think we can begin to develop at this workshop ways and
means of dealing with it that will be just as effective.
I am pleased to see that several members of the Congress are
participating in this workshop. They can play a vital role in anything we
hope to accomplish.

Thank you for coming. I wish you every success in your deliberations.


12              OPENING REMARKS

Introduction of M. George Reagle

Mr. George Reagle is representing Secretary Bumley of the
Department of Transportation. Mr. Reagle is the Associate
Administrator, National Highway Traffic Safety Administration,
Department of Transportation. The Department of Transportation has a
long history of cooperation with the Department of Health and Human
Services and has been working under an interdepartmental agreement
with us for many years in a cooperative fashion on this issue. The
Department of Transportation historical/y has been involved in drunk
driving issues since the 1960s when they implemented alcohol safety
action programs. This is another step in their ongoing efforts to
address this issue of drunk driving.

Ladies and gentlemen - Mr. George Reagle.

Opening Remarks

George Reagle

Associate Administrator for Traffic Safety Programs
National Highway Traffk Safety Administration

Distinguished panel, ladies, and gentlemen.

I want to thank you for the opportunity to address this gathering of
experts on the problem of drunk driving. I sincerely hope that your
deliberations over the next few days can provide us with additional energy
and information to reduce drunk driving and its tragic consequences.

Alcohol Safety Action Projects

During the 197Os, the National Highway Traffic Safety Administration
(NHTSA) placed a great deal of emphasis on the problem of drunk driving
via a national demonstration program involving 35 Alcohol Safety Action
Projects (ASAPs). These 35 projects were designed to reduce drunk
driving at the local level by combining the various elements (e.g.,
enforcement, licensing, adjudication, public information) into a system at
each locality. Prior to this time, persons in these different areas frequently
did not coordinate their efforts to deal with the drunk driving problem.

Evaluation was a major component of these ASAPs, and we were able
to get a reading on how successful we were. By the end of the projects, we
had demonstrated significant reductions in nighttime fatal crashes in 12 of


OPENING REMARKS

13

the 3.5 sites. Still, from 1970 to 1976, we were not able to detect any
significant, national level changes in the problem of drunk driving.

Indepth Demonstration Projects

We then began to look in depth at the various countermeasure elements
to see if we could find ways to improve them and demonstrate their
effectiveness. We conducted a DWI enforcement demonstration project in
Stockton, California that showed that specially trained and motivated
officers were able to significantly increase DWl arrests and to make small
but significant reductions in alcohol-related crashes. We conducted
probation demonstrations in Mississippi and Tennessee and found that
long-term followup with a diagnostic and assessment program called the
"Life Activities Inventory" resulted in significant reductions in recidivism
among convicted drinking drivers. In addition, we conducted a
comprehensive DWI treatment demonstration in Sacramento, California
which showed that intensive treatment and long-term followup could
significantly reduce recidivism among convicted drinking drivers.

Again, however, we detected no changes in the national levels of
drinking and driving or in the fatalities or crashes involving drinking
drivers during this period (1976-80).

1980: A Pivotal Year

By 1980, we had done much groundwork in attempting to find solutions
to the problem of drunk driving. We had conducted and evaluated local
level, comprehensive programs; we had looked in depth at individual
countermeasures, and we had reviewed the results of international efforts
to reduce drunk driving during the past several decades. As a result of our
experiences and those of foreign nations, we began to place significantly
greater emphasis ongeneral deterrence of drunk drivers. This meant that
deterrence activities such as roadside sobriety checkpoints, swift and sure
license actions, jail sentences for multiple offenders, and increased fines
received greater emphasis and more media attention. To convey this new
emphasis to State and local highway safety leaders, in 1980 we initiated a
series of afcolrol-safely workshops to review the results of the past decade
and to convey the latest technology to these leaders.

About the same time, however, a much more important development
emerged. Citizen activist groups, which had begun as early as 1978, became
more visible across the Nation. These groups represented an element that
had been missing in the efforts to reduce drunk driving in the United
States- a concerned public. Recognizing the potential of such groups to
bring about needed changes, we included them in our series of State
workshops and gave them an opportunity to voice their concerns to State
highway safety leaders.


14                OPENING REMARKS

The program we were advocating at that time was a six-point program
involving (1) general deterrence, (2) prevention and intervention, (3)
citizen activist support, (4) emphasis on a total systems approach, (5)
financial self-sufficiency, and (6) a focus on the community level.
Suffice it to say that energy produced by the emergence of citizen
activists, combined with the new emphasis on general deterrence measures,
resulted in the most dramatic progress ever experienced in this Nation in
terms of reducing drunk driving. The activists, and the media attention that
they produced, resulted in dramatic increases in DWI legislation, arrests,
convictions, sanctions, education programs, designated driver programs,
responsible server programs, etc.

Most importantly, the alcohol-related proportion of fatal crashes
decreased nearly every year since 1982. For example:

o  The alcohol-related proportion of fatalities was reduced from
57 percent (in 1982) to 51 percent (in 1987), a reduction of 11
percent from the 1982 level.

o  The proportion of fatalities involving an intoxicated driver was
reduced from 46 percent (in 1982) to 40 percent (in 1987), a
reduction of 13 percent from the 1982 level.

o  The alcohol-related proportion of fatalities among youth
(under age 21) was reduced from 63 percent (in 1982) to 51
percent (in 1987), a 19-percent reduction.

o  The proportion of youth fatalities involving an intoxicated
driver was reduced from 49 percent (in 1982) to 35 percent
(in 1987), a 29-percent reduction.

Never before in the history of this Nation had such reductions been
recorded. They were larger than ever before, and they were documented in
several successive years. Unfortunately, since 1985, these reductions
appear to have slowed or stopped.

Problems Remaining

Unfortunately, we have a long way to go to eliminate or even greatly
reduce the tragedies that result from drunk driving. More than half of all
fatal crashes continue to be alcohol-related. More than 80 percent of these
alcohol-related fatal crashes involve a legally intoxicated driver (i.e., with a
blood alcohol concentration greater than 0.10). Similarly, more than half of
all fatal crashes involving youth continue to be alcohol-related, and
approximately 70 percent of these alcohol-related fatal crashes involve an
intoxicated driver.


OPENING REMARKS

Primary Objectives for Reducing Drunk Driving
To further reduce drunk driving, we must concentrate on specific
program objectives. Some of the most important include the following.

15

Deterring drinking drivers who have not been caught (but
who will contribute to approximately 75 percent of
alcohol-related fatal crashes in the future)
Reducing the impaired driving recidivism of drivers who have
already been arrested and processed through our criminal
justice and/or administrative sanctioning and rehabilitation
processes

Preventing drinking and driving by such means as public
information, education, more responsible serving and hosting
practices, intervention by friends, designated driver programs,
safe ride programs, and preventing the sale of alcoholic
beverages to minors

We can act to reduce this problem in many areas. It is important that we
look at all of them. I am encouraged to see so many topical areas being
addressed at this workshop.

What NHTSA Hopes to Gain From the Workshop

From our perspective at NHTSA, this workshop provides us with an
opportunity to inject new energy into the anti-drunk driving movement.
Clearly, such additional energy and motivation is necessary if we are to
again realize significant reductions in the tragic consequences of this
serious behavior.

The recommendations made by workshop participants will broaden the
activities and number of organizations involved in the efforts to stop drunk
driving. We expect that this workshop will be a major factor in our current
attempts to make drunk driving a public health issue and to enlist the aid
of public health and medical groups in our efforts.

Thank you for taking your time to come here and address this problem.
I wish you success in developing recommendations that can actually make
a difference in reducing this most serious public health problem, drunk
driving.


Recommendations

After meeting and debating for 2 days in closed sessions, the panels
prepared and presented to the workshop participants and the Surgeon
General the following recommendations and strategies for implementing
them.
Note to readers:

On December 14,1988 the National Beer Wholesalers Association filed
a lawsuit in the United States District Court seeking relief under the
Federal Advisory Committee Act to postpone or cancel the Surgeon
General's Workshop on Drunk Driving. Pursuant to the Court's order, the
Surgeon General opened the workshop to members of the public.
Thereafter, the parties resolved the remainder of the lawsuit by entering
into a settlement agreement in which the Surgeon General agreed to
accept and consider comments from interested parties until January 31,
1989. The Surgeon General also agreed that the final recommendations
would not be made before February 28,1989 and that the final
recommendations or report would consider any such written comments.
Since the legal ruling was delivered after the opening plenary session of the
workshop, its stipulations were not reflected in the opening remarks.

Extensive comments were submitted but are not included in these
proceedings because they were not part of the offcal workshop
deliberations and because they were so lengthy. The comments were
considered; however, they did not alter the recommendations published in
this report. The comments will continue to be used in the implementation
of strategies to eliminate alcohol-impaired driving.

16


Panel A

Pricing and Availability

      Chair:  Harold Holder, Ph.D.
Background Paper:  Alexander Wagenaar, Ph.D.
    Recorder:  Mary Ganikos, Ph.D.
Panel Members:  George McCarthy
         Dennis Nalty, Ph.D.
         Michael Jacobson, Ph.D.
         Charles Phelps, Ph.D.
         Sandy Heverly

The Pricing and Availability Panel was charged with discussing matters of
concern and controversy, i.e., the pricing and availability of alcoholic
beverages. A significant portion of American industry is involved in the
production, distribution, and wholesale and retail sale of beer, wine, and
distilled spirits. The panel does not challenge the rights of these industries
or businesses to produce and sell alcoholic beverages. However, the panel
found that by changing pricing and availability of alcoholic beverages,
alcohol-impaired driving injuries and fatalities could be reduced.
The panel prefers the adjective "alcohol-impaired" rather than "drunk"
in reference to driving. This acknowledges the increased risk of crash,
injury, and death for drivers and others when even small amounts of
alcohol are consumed. This is particularly true for young drivers.
The panel's deliberations and recommendations are based on two
sources of information:

o  Scientific research on relationships between alcoholic
beverage price and availability and alcohol-involved driving

o  Experience and expert knowledge of panel members and
  others in the field

17


18               RECOMMENDATIONS

Price

Research evidence shows that an increase in the excise tax could have the
largest long-term effect on alcohol-impaired driving of all policy and
program options available. Since Federal excise taxes differ widely by
beverage type, and the effective tax rates have declined by three-quarters
because of inflation since 1951, the panel makes the following
recommendations to Federal and State Governments.

A-l Recommendations to the Federal Government

A-l .1 Equalization-Equalize Federal excise tax rates by ethanol
(pure alcohol) content across all beverages by raising rates for beer and
wine to that of distilled spirits.

A-l .2 Adjustment for past inflation - Adjust the resulting equalized
excise tax rate to reflect the change in the Consumer Price Index
(CPI-U) since 1970.

A-l .3 Future indexing- Annually adjust the resulting excise tax rate to
reflect changes in the Consumer Price Index (CPI-U) for the previous
year.

A-2 Recommendations to State Governments

A-2.1 Equalization-Equalize excise tax rates by ethanol content
across all beverages by raising rates for beer and wine to that of distilled
spirits.

A-2.2 Adjustment for past inflation -Adjust the resulting equalized
excise tax rate to reflect past inflation.

A-2.3 Future indexing-Annually adjust the resulting excise tax rate to
reflect the change in the Consumer Price Index (CPI-U) for the
previous year.

A-2.4 States with relatively low tax levels should increase their rates to
at least the levels in bordering States.


PRICING AND AVAILABILITY

19

Strategy

For Recommendations A-l and A-2, the Surgeon General should
take the following steps by April 1, 1989 to achieve equalization,
adjust for past inflation, and provide indexing for future inflation for
Federal excise taxes on beer, wine, and distilled spirits. The Federal
excise tax increases should be part of the FY 1990 budget.

1.  Write letters to all members of the U.S. Congress concerning
the need to raise taxes as a means of reducing
alcohol-impaired dnving and the Federal budget deficit.

2.  Write similar letters to all State Commissioners of Health
requesting that they urge their State's congressional delegation
to support higher Federal excise taxes. The Surgeon General
should also offer assistance to review State alcohol excise tax
  laws.

3.  Write letters to President Bush, tile Secretaries of Health and
Human Services and Treasury, and the Director of Oflee of
Management and Budget addressing the need for both
increasing alcohol excise tares and end!ng the tax deductibility
of alcoholic beverage purchases.

4.  Urge the National Economic Commission to include Federal
alcoholic beverage excise tax increases in its recommendations.

5.  Convene a meeting with appropriate Congressional leaders in
health and financial matters on the health and budgetary
benefits of raising Federal alcohol excise taxes.

6.  Prepare a position paper OFI the health and fiscal benefits of
raising alcohol excise taxes, addressing alcohol-impaired
driving and other alcohol-related problems as well as
  increased revenues.

7.  Urge organizations and citizens concerned about alcohol-
impaired driving other alcohol problems, and the Nation's
economic and social well-being to urge the President and their
congressional representatives to support higher alcohol taxes.

Preventing Increased Availability

The availability of alcoholic beverages in a community can significantly
affect the extent of alcohol-impaired driving. The effects of small increases
in availability on alcohol-impaired driving are difficult to measure.


20                RECOMMENDATIONS

Nevertheless, the cumulative effect of several such changes can be
substantial.

Therefore, the panel recommends:

A-3 Federal, State, and local governments should not adopt policies that
result in increased availability of alcoholic beverages without careful
analysis, study, and public debate about the potential effects on
alcohol-impaired driving. This applies particularly to bars, restaurants, and
other public facilities, since research shows that the majority of
alcohol-impaired drivers obtain alcohol at such places.

Reducing Availability

To reduce alcohol-impaired driving, State and local governments, and/or
the Federal Government where appropriate, should consider applying the
following measures.

A-4 Adopt or strengthen server/seller liability statutes and policies to
encourage responsible ~xving and selling practices.

A-5 Prohibit "happy hours" and other reduced-price promotions.

A-6 Require training and certification of sellers and servers of alcoholic
beverages.

A-7 Restrict alcohol sales by time and place at sporting, music, and other
public events.

A-8 Adopt open-container laws that prohibit drinking while driving.

A-9 Permit local governments to enact regulations that are more
restrictive than State Alcohol Beverage Control (ABC) laws.

A-10 Strengthen laws concerning hours of sale, characteristics and density
of outlets, and other factors relating to retail availability of alcoholic
beverages.

A-l 1 Increase enforcement of existing State and local Alcohol Beverage
Control regulations and increase resources available for enforcement.


PRICING AND AVAILARILITY

21

A-l 2 Eliminate the tax deductibility of alcoholic beverage purchases for
business purposes.

A-13 Prohibit or discourage serving and selling practices that increase the
level of alcohol-impaired driving.

A-l 4 The Federal Government has a primary responsibility for these
matters in three important settings-military bases, commercial aviation
crews and travelers, and general aviation pilots - and should adopt a strong
leadership role in appropriately controlling pricing, availability, and use of
alcoholic beverages in these settings.

Strategy

For Recommendations A-l thru A-14, the Surgeon General should
take the following steps by November 1, 1989 to reduce
alcohol-impaired driving by limiting and reducing alcohol beverage
availability.

1.  Write letters to a broad range of health and other civic
organizations andparents, asking that they support higher
  Federal and State alcohol tares and other measures that limit
and reduce alcoholic beverage availability.

2.  Convene no later than June 1989 a conference of State
budgetary and health officials to describe and discuss the
health and fiscal benejits of raising alcohol excise taxes. The
Surgeon General should pay special attention to States that
have relatively low excise tares.

3.  White letters to governors, mayors, ABC administrators, and
State and local police leaders to recommend measures they
could take that would reduce alcohol-impaired driving through
better control of alcoholic beverage availability.

4.  Give a national address on alcohol-impaired driving and the
need to increase excise taxes and reduce alcoholic beverage
availability.

5.  Urge owners and managers of stadiums and other such public
facilities to restrict alcoholic beverages as necessary to reduce
alcohol-impaired dn'ving.

6.  Urge sellers and servers of alcoholic beverages, through their
trade associations, to end reducedptice promotions such as
happy hours, eliminate servingpractices that increase risk of


22

RECOMMENDATIONS

alcohol-impaired driving, and implement server and seller
training.

Future Research

Finally, in support of these above recommendations, the following research
should be undertaken.

A-l 5 Evaluate the impact on alcohol-impaired traffic problems as policy
recommendations of this panel are implemented at Federal, State, and
local levels.

A-l 6 Determine the specific price sensitivity of changes in
alcohol-impaired driving by age and gender.

A-17 Document the contribution of location, density, and hours-of-sale of
alcohol outlets to alcohol-impaired driving and resulting injuries and
fatalities.


PRICING AND AVAILABILITY

23

Estimating Effects of Increased Federal Excise Tax
      on Alcoholic Beverages

Charles E. Phelps, Ph.D.*

The Pricing and Availability Panel of the Surgeon General's Workshop on
Drunk Driving proposed a three-step strategy for dealing with Federal
excise taxes (FET) on alcoholic beverages. This note describes the
proposed changes and their consequences.

Increases in the Federal Excise Tax

Equalize all tax rates to that of distilled spirits. Currently, distilled
spirits are taxed at $12.50 per gallon of lOO-proof alcohol. This converts
directly to $2.50 per fifth of NO-proof alcohol, or $2 per fifth of SO proof. A
standard drink of 1.41 oz of %&proof alcohol thus has a Federal excise tax
of $0.11 attached to it.

The equivalent tax on beer is derived by assuming that beer is, on
average, 4.7 percent alcohol (some more, some less). This is 9.4 proof, so to
equalize rates, beer should be taxed at 9.4 percent of the rate for 100-proof
alcohol, or $1.175 per gallon. This equals $0.11 per 12 oz serving of
4.7-percent alcohol, the standard drink of beer.
The equivalent tax on wine is derived for wine with 12 percent alcohol
content, or 24 proof. Thus, a gallon of wine should be taxed at 24 percent
of $12.50, or $3 per gallon, or SO.60 per fifth (25.6 02). Thus, a standard
drink of 4.7 ounces of wine has a tax of $0.11 attached to it after
equalization.

Correct for inflation since 1970. The 1970 distilled spirits tax was $10.50
per proof gallon, or $1.68 per fifth of SO proof. Inflation correction since
1970 provides a multiplying factor of 3, so the equivalent 1989 tax would be
$5.04 per fifth, an increase of $3.04 per fifth from the current tax, or $0.167
per standard drink, to a tax per standard drink of $0.277. This becomes the
1989 standard tax.

The current tax on beer is $0.027 per 12 oz serving, so the equivalent
inflation-corrected tax would increase by $0.25 to $0.277 per 12 oz serving.
The current tax on wine is SO.17 per gallon and $0.034 per fifth. Raising

*Professor of Political Science and Economics and Director, Public Policy Analysis
Program, University of Rochester


24               RECOMMENDATIONS

it to the inflation-corrected distilled spirits tax brings the wine tax to $1.50
per fifth of 1Zpercent wine, (again) $0.277 per drink. This represents an
increase of $1.47 per fifth of wine, or $0.271 per standard drink.

Index for future inflation. This will prevent erosion of the real Federal
excise tax in the future.

Relative Price Changes

The following calculations assume, as would occur in standard competitive
industries, that a tax increase will be added to retail price on a dollar-
for-dollar basis. In a monopoly, the cost-passthrough would be less, using
standard monopoly pricing models.

Distilled spirits. Currently, the average retail price of distilled spirits is
approximately $11.50 per fifth. The added tax of $3.04 per fifth represents
a 26-percent increase in the price of distilled spirits. The relative increase
is smaller for premium brands (and conversely for low-price brands), since
the proposed tax is based on alcohol content, not price.

Beer. Currently, the average price of beer is approximately $0.70 per
can, or $4.20 per six pack. The tax would increase by $0.25 per can,
representing an average increase of 36 percent. Again, the relative change
would be smaller (larger) on relatively high (low) priced beers.
Wine. Currently, a bottle of wine is taxed at $0.036. The current average
price has been estimated at $3.07 for table wines, higher for coolers,
fortified wines, and naturally carbonated wines. On this base, an increase
of $1.47 per bottle represents an increase of 48 percent.

Consumption Changes

The demand elasticity has been estimated for distilled spirits and wine at
about -0.5 to -1. For beer, -0.4 is a reasonably well-established estimate.
Distilled spirits quantity. The quantity response to a 26percent
increase in price would be a decline of 11 to 21 percent, using the assumed
range of elasticities.* With the current apparert consumption at 44 billion
drinks, the decline would range from 4.9 to 9.2 billion drinks, giving a new

*These calculations assume a constant/elasticity demand model. The new
consumption relative to current consumption is found by raising (1 +t) to the power
of the elasticity. For example, if the elasticity is -0.5, and if the tax adds 26 percent to
the current price, then the new consumption is old consumption multiplied by (1.26
raised to the -0.5 power), which equals 0.89. Thus, current consumption would fall by
11 percent.


PRICING AND AVAILABILITY            25

total of 39.2 to 34.8 billion drinks. The midrange of these estimates is a
decline of 7 billion drinks to 37 billion drinks.

Beer quantity. The quantity response to a 36-percent increase in the
price of beer, using an elasticity of -0.4, is a decline of 11.6 percent. The
estimated current volume is 58 billion drinks annually; the projected
decline of 6.7 billion would bring the new annual total to 51.3 billion drinks.

Wine quantity. The response to a 48-percent increase in the price of
wine is as follows. Current consumption is estimated at 13.2 billion drinks.
For a price elasticity of -0.5 to -1, consumption would decline by 18 to 32
percent. The new quantities would be 10.8 billion to 9 biion drinks. The
average of these, 9.9 billion drinks, represents a decline of 3.4 billion.

Implications for Federal Tax Revenue

On the new quantity of 37 billion distilled spirits drinks, the Federal excise
tax would total $10.25 billion. The current FET of $0.11 per drink imposed
on 44 billion drinks produces a current revenue of $4.84 billion, thus the
net increase in FET would be $5.4 billion.

On the new quantity of 51.3 billion beer drinks, the Federal excise tax
would be $14.2 billion. The current tax of $0.027 per drink on 58 billion
drinks produces revenues of $1.57 billion. Thus, the net increase would he
$12.6 billion.

On the new quantity of 9.9 billion wine drinks, the Federal excise tax
would be $2.7 billion. The current tax of $0.006 per drink on 13.2 billion
drinks yields $80 million. Thus, the net increase would he $2.6 billion.
Combining these three sources, the estimated increase in FET would be
$20.6 billion. These estimates rise (fall) as the assumed elasticity is smaller
(larger) than the mid-range estimates used in this calculation.

Lives Saved

The estimates from Saffer and Grossman, from Cook, and from Phelps all
suggest that the elasticity of fatalities with respect to alcohol price is about
4-7 to -1. The current proportions of drinks in the total market are 50
percent for beer, 38 percent for distilled spirits, 12 percent for wine. Thus,
the weighted price change recommended by the Pricing and Availability
Panel is 33.6 percent. The ensuing reductions in highway fatalities would be
19 to 25 percent. On an approximate base of 44,000 highway fatalities in
1988, this represents the avoidance of some 8,400 to 11,000 premature
deaths annually.



26               RECOMMENDATIONS

References

Cook, P.J. The effect of liquor taxes on drinking, cirrhosis and auto
accidents. In: Moore, M.H., and Gerstein, D.R., eds. Alcohol and Public
Policy: Beyond the Shadow ofProhibition. Washington, DC: National
Academy Press, 1981. pp. 255-285.

Saffer, H., and Grossman, M. Beer taxes, the legal drinking age, and youth
motor vehicle fatalities. Journal of Legal Studies 16:351-374,1987.


Panel 8

Advertising and Marketing

       Chair:
Background Paper:
    Recorder:
Panel Members:

Robert Denniston
Charles Atkin, Ph.D.
LCDR Joyanne Murphy
Doris Aiken
Jan Howard, Ph.D.
Lawrence Wallack, Dr. P.H.
Michael Mazis, Ph.D.
James W. Swinehart, Ph.D.
Jean Kilbourne, Ed.D.
Rae Tyson
Beverly Campbell
Mary Beth Robinson

Education about alcohol is a critical first step toward a comprehensive
approach to alcohol problems in our society. Mass communication is one
major source of learning about alcohol use, especially for youth. In
particular, alcohol advertising tends to glamorize alcohol use and to give a
one-sided view without providing information about the consequences of
such use. Hence, more complete and accurate information is needed.
Therefore, the panel makes the following 17 recommendations in six
categories.

Advertising and Promotion

B-1 Match the level of alcohol advertising with equivalent exposure for
effective pro-health and safety messages to provide more complete and
accurate information.

27


RECOMMENDATIONS

Strategy

Assuming continued limitations on public service media availability,
a mandate to government to allocatefinds to purchase time for
altemativelcountetadvertising is necessary. If this goal is not
adequately met within 1 year, a system for mandated
counteradvertising should be implemented.

B-2 Eliminate alcohol advertising and promotion on college campuses
where a high proportion of the audience reached is under the legal
drinking age.

Strategy

1.  l7ze Surgeon General should request that the alcohol industry
  cease advertising and promotion efforts on such college
  campuses by September 1989.

2.  The Surgeon General should

      -  wn'te to such university presidents
     recommending that they disallow advertising
     andpromotion of alcohol and

-  provide guidelines and training sessions to the
  universities.

3.  Alcoholic beverage industry codes should be revised to
incorporate this recommendation.

4.  The public should be informed of the extent and consequences
of alcohol advertising and promotion on college campuses.

5.  Sanctions (legal or economic) should be developed against the
alcohol industry, andpossibly universities, if alcohol
advertising and promotion on such campuses do not cease by
Septem bet 1990.

B-3 Eliminate alcohol advertising, and promotion and sponsorship of
public events (e.g., musical concerts, athletic contests), where the majority
of the anticipated audience is under the legal drinking age.

Strategy

1.  The Surgeon General should request that the alcohol industry
cease advertising and promotional effofis at such public evettts
as well as sponsorship of such public events by September
  1989.


ADVERTISING AND MARKETING

29

2. ZndusLy codes should be revised to incorporate this
  recommendation.

3. A letterfrom the Surgeon General should ask eventpromoters,
sponsors, etc., to disallow advertising and promotion of
  alcohol at such events.

B-4 Eliminate official sponsorship of athletic events (e.g., the Olympics)
by the alcohol beverage industry.

Strategy

1.  7Xe Surgeon General should request that the alcohol industry
cease advertising andpromotion efforts through the
sponsorship of athletic events.

2.  Industy codes should be revised to incorporate this
  recommendation.

B-5 Eliminate alcohol advertising and promotion that portray activities
that can be dangerous when combined with alcohol use.

Strategy

1.  The Surgeon General should request that the alcohol industry
cease advertising and promotion efforts that portray activities
that can be dangerous when combined with alcohol use.

2.  Industry codes should be revised to incorporate this
  recommendation.

B-6 Eliminate the use of celebrities who have a strong appeal to youth in
alcohol advertising and promotion.

Strategy

1.  The Surgeon General should request that the alcohol industry
cease adverlising and promotion efforts through the use of
celebrities with a strong appeal to youth.

2.  Industry codes should be revised to incorporate this
  recommendation.

B-7 Eliminate tax deductions for alcohol advertising and promotion
other than price and product advertising.


30               RECOMMENDATIONS

Strategy
1.  Introduce legislation in the 1Olst Congress to address this
   recommendation.

2.  Introduce legislation in State legislatures to address this
  recommendation.

B-8 Warning labels, now required (as of November 1989) on alcoholic
beverage containers, should also be required, clearly and conspicuously, in
all alcohol advertising.

Strategy

Introduce legislation in the 1Olst Congress to extend the warning
label law to include warning labels on all advertising consistent with
the timetable of the current law.

B-9 Develop and implement training for local community groups
regarding advertising and promotion issues and about voluntary and legal
approaches for addressing this problem.

Entertainment Programming

B-l 0 Encourage the creative community to more fully and accurately
portray the dangers associated with drinking and driving, and to provide
highly visible role models for prevention. We acknowledge and commend
the efforts of the creative community to date.

Strategy

1.  77ie Surgeon General should communicate wirlt appropriate
  individuals through letters.

2.  Workshops should be developed to stimulate increased
   attention to alcohol-related issues.

News Coverage

B-l 1  Encourage comprehensive news reporting of alcohol-related
problems in general, and crashes in particular.

Strategy

1.  i?e Surgeon General should develop and disseminate a fact


ADVERTISING AND MARKETING            31

sheet on alcohol to be distributed to news organizations. 7?lis
fact sheet should include information such as the following.

-  Alcohol is a drug, and beet is the alcoholic
beverage of choice.

-  Alcohol is addictive.

-  The number of alcohol-related deaths
includes approximately 25,000 ttafic fatalities
annually.

2. Encourage inclusion of information about the role of alcohol
in news reporting of local crashes when appropriate.

3. Develop and disseminate twice annually a news release from
the Surgeon Generalproviding the latest available infonnatiort
on drinking and driving.

B-12 Encourage the news media to provide coverage on alcohol issues
commensurate with the nature and scope of the problem.

Public Campaigns

B-l 3 Institute and sustain high visibility public information efforts about
issues related to drinking and driving.

Strategy

I.  Continue to expand andpublicize existingprograms already in
  place, e.g., alcohol awareness week.

2.  Create a coalition ofpublic and private agencies to provide
  focus andpromote coordination of drinkingldriving campaigns.
3.  Increase State and local levels ofpublicfunding, as
  appropriate, mtd encourage private sector involvement.

Regulatory Responsibilities

B-l 4 Consider moving the responsibility for regulation of the alcoholic
beverage industry to the Food and Drug Administration, DHHS.

Research

B-l 5  Fund research to determine -


32               RECOMMENDATIONS

B-l 5.1 The effect of alcohol promotion, advertising, and other media
content on different populations, e.g., underage youth, high-risk
audiences, and juries.

B-15.2 Which specific advertising and entertainment features
contribute to higher versus lower levels of excessive drinking and
alcohol-impaired driving.

B-l 5.3 The most effective media campaign strategies, as part of a
comprehensive intervention effort to reduce drinking and driving.

B-1 5.4 Whether a relationship exists between the amounts of
alcohol-related advertising and editorial content in magazines.

B-15.5 The potential effects of informing audiences about
compensated inclusion of alcohol products in theatrical motion pictures.

B-l 6 Provide a research testing service to measure target audience
reactions to:

- public information campaign messages voluntarily submitted
prior to dissemination; and
- new alcohol advertisements appearing in the mass media.

B-17 Assess the effects of these recommendations, as implemented, on
alcohol problems.

Strategy
1.  Federal and State Government agencies should allocate
  funding for this research.
2.  Private foundations should incteasejimding in tlris area.
3.  Private sector organizations should increase funding in this
    area.


Panel C

Epidemiology and Data
  Management

       Chair:  M.W. Perrine, Ph.D.
Background Paper:  Carl E. Nash
    Recorder:  LCDR Marlene Cole
Panel Members:  Allan Meyers, Ph.D.
         Richard Waxweiller, Ph.D.
         Darryl Bertolucci
         John Donovan, Ph.D.
         Carl Soderstrom, M.D.
           Lawrence A. Greenfeld
         Ted Doege, M.D.

The Panel on Epidemiology and Data Management submits
recommendations regarding drunk driving data collection and data
management and on drugged driving.

In the area of data collection, we recommend the following.

C-l Require State and local police to obtain the blood alcohol
concentrations (BAC) of all drivers and nonmotorists involved in fatal and
serious injury motor vehicle crashes.

C-2 Obtain and record a BAC for all patients of appropriate age
admitted for treatment of acute injury for the purposes of:
- patient diagnosis and clinical management;
   - aiding in the diagnosis of alcohol abuse; and
   - providing data to document the epidemiology of alcohol in all
  types of injury.

33


34               RECOMMENDATIONS

C-3 Develop a research agenda to identify the range of factors that
inhibit the uniform collection of blood alcohol data. There appear to be
institutional, professional, and economic barriers to the collection of blood
alcohol data on people involved in motor vehicle crashes. To carry out the
first set of recommendations, these barriers will have to be understood and
addressed.

Strategy

Implementation of recommendations C-l and C-2 ate addressed in
C-3, the development of a research agenda. The members of the
epidemiology panel ate to prepare a &aft research agenda and
submit to Dr. Pem*ne, Workshop Chairperson, for compilation. This
material will be forwarded to the Surgeon General's office. This
panel requests that the Surgeon General:

1.  define such a research agenda by April 1989,

2.  assign this agenda to one or mote Agencies, and

3.  assign a l-year timeframe for completion of the research.

C-4 A voluntary standards organization should establish a consensus
committee to set standards for definitions, questions, data elements, and
methodologies used in research and data collection relating to
drunk/drugged driving.

Strategy

Thepanel advises the Surgeon General to invite an organization to
establish a consensus committee charged with the task of assembling
an initial set of definitions within a year.

To obtain improved exposure data, the panel recommends the following.

C-5 Change policies to facilitate periodic roadside surveys to collect valid
and complete data on the BAC of an appropriate sample of all drivers
using public roads.

C-6 Conduct roadside surveys at enforcement checkpoints and other
sites to collect data on BAC at all levels starting at zero.

C-7 Develop policies and procedures to ensure that accurate alcohol


EPIDEMIOLOGY AND DATA MANAGEMENT        35

data are obtained for commercial motor vehicle operators using the
highways.

C-8 Encourage development and testing of a valid, cost-effective
surrogate for roadside surveys.

Strategy

1. A policy needs to be generated to encourage and facilitate the
  toadride surveys that receive the endorsement of the Surgeon
   General.

2. A change in State and localpolicies is needed to facilitate the
collection of data, which include zero BAC.

3.  Commercial motor vehicle operators should undergo drug
testing during toaciside data collection when feasible.

C-9 Determine more accurately the characteristics of drunk drivers and
identify the contributions of those characteristics to the risk of serious
motor vehicle crashes.

Strategy

Focus should be placed on those characteristics of drunk drivers
amenable to intervention.

A major purpose of collecting epidemiologic data is to indicate possible
points of intervention. Therefore-

C-10 Evaluate all drunk driving countermeasures-whether they apply to
people, vehicles, or environment - for effectiveness, safety, acceptability,
and cost.

In the area of data managemeti, we recommend the following.

C-l 1 Develop standards and procedures for keeping and linking records
relating to drunk/drugged driving and related offenses, from arrest through
prosecution, conviction, and disposition. These should be adopted by all
jurisdictions in the country.

C-12 Convene a study committee to:

   - inventory existing routinely collected data bases,


36                RECOMMENDATIONS

- inventory data bases that have the potential to provide useful
information,

- assess the validity, completeness, and comparability of these
data bases and the ability to access and link them, and

- identify needs for additional data that should be routinely
collected.

C-l 3 Develop a central locus for assembling relevant drunk driving data
bases and describing their contents to potential users. The panel on
epidemiology finds that the resources applied to data collection and
analysis on alcohol and motor vehicle crashes is minuscule compared to
losses from crashes involving alcohol. To achieve a significant improvement
in motor vehicle safety will require substantially more and better
information, and the commitment of substantially more resources to
epidemiologic research on drinking and driving.

Strategy

The Surgeon General should ensure that this study committee be
assembled with government and nongovernment representation. The
optimum size o, this ad hoc committee would be 12 members. This
committee would be in existence within 1 year and receive finding
on a prorated basis from the Federal Agencies sponsoring this
workshop. The committee wouldprovide a written report on the
tasks outlined in C-12 and C-13 to the Surgeon General and the
Agencies involved in this workshop.

Considerably less is known about drugged driving that about drunk driving.
Therefore -

C-l 4 Define a research and data collection agenda to determine the
nature and magnitude of the drugged driving problem.

Strategy

The Surgeon General should convene a workshop on drugged
driving in 1989.


Education

       Chair:
Background Paper:
    Recorder:
Panel Members:

Patricia Waller, Ph.D.
Bruce Simons-Morton, Ed.D., M.P.H.
Joan White Quinlan
Katherine Armstrong, Ph.D.
Michael Goodstadt, Ph.D.
Elizabeth A. Weaver
Delores Delaney
John Harvey
Alvera Stern, Ph.D.
David Sleet, Ph.D.
David Anderson, Ph.D.

The Education Panel recognizes that driving while intoxicated (DWI) is a
leading cause of death and disability and the leading cause of death among
young people. A variety of efforts are needed to address this problem, and
education plays an important role.

The private and public sectors have a shared responsibility to educate
and protect the public against impaired driving. Health, alcohol, and traffic
safety communities must work together in designing and implementing
effective education and behavior-change programs.
Educational efforts should be designed to help overcome DWI social
acceptability and reduce myths surrounding DWI. DWI information
should be factual and current. It should help the public, professionals, and
decisionmakers understand what they can do to help change DWI policy
and practices.

Education leading to effective policy development at Federal, State, and
community levels is a critical step in this process.
Education does not occur in a vacuum. It must be part of a
comprehensive public health approach to DWI that includes social and
environmental action.

37


38              RECOMMENDATIONS

Properly designed and implemented educational efforts can influence
knowledge, attitudes, and practices and are cumulative and additive in
their effects.

The goal of education programs for those under 21 years of age should
be to promote no use of alcohol (or other drugs). For those 21 and over,
educational efforts should promote the concept of low-risk
choices - choosing not to drink in high-risk situations.
Educational interventions must be undertaken within worksites, the
family and community, health care agencies, and schools. Within these
settings, targets include the general public, at-risk individuals, and
decisionmakers.

Most DWI educational programs are insufficiently based in theory and
should reflect current knowledge in the fields of social psychology, mass
communication, and organizational change.
Research should be ongoing and should help to identify effective
education and promotion strategies needed to reduce DWI in specific
community settings. Once identified, these strategies should be widely
disseminated.

0 bjectives

The Education Panel offers the following objectives for all drinking and
driving education programs.

o To decrease the frequency of drinking in association with
driving

o To reduce the frequency of drinking in other traffic-related
situations (motorcycles, bicycles, boats, snowmobiles, etc.)

o To reduce the average blood alcohol concentration among
drinking drivers to less than 0.05 percent, and promote zero
tolerance as the standard for the public

o To decrease the frequency of riding with drinking drivers

o To promote social norms that do not tolerate drinking and
driving

o To promote personal responsibility for discouraging drinking
and driving among friends and acquaintances

o To promote support by the general public and actions by
decisionmakers for public policy, environmental control, and
environmental protection and programs regarding drinking
and driving


EDUCATION

General Recommendations

The Education Panel offers the following general recommendations.

39

Drinking and driving education should be considered an
essential component of a comprehensive public health
approach to DWI reduction.

Drinking and driving education should be integrated into all
health promotion/risk reduction programs.
Drinking and driving information should be included in health
professional training.

All drinking and driving public information and education
programs should be based on sound learning theories, as well
as social marketing and communication strategies.
All decisionmakers should be educated about the
development and implementation of effective policies to
prevent drinking and driving.

The impact of alcohol beverage advertising should be
balanced with fair time counteradvertising.

Specific Recommendations

Policy Education

D-l Develop model policies for worksite, school, health care, community,
and recreational settings regarding alcohol.

Strategy

Ser up an advisory group to review existingpolicies and to identify,
currentpromisingpolicies. Convene a consensus panel to select
policies for each setting.

D-2 Develop a decisionmaker's guide to drinking and driving policy
development.

Strategy

Using the policies selected by the consensus panel, develop and
publish a manual. Subsequently, conduct trainingfor local, city, and
State decisionmakers.


40               RECOMMENDATIONS

D-3 Develop guidelines for training education, health care, and other
professionals.

Strategy

Provide small grants to professional organizations to develop
training manuals for their membership to reduce drinking and
driving and consider this training as part of the requirements for
maintaining their certification.

D-4 Develop guidelines for the sponsorship, promotion, use, and sale of
alcoholic beverages in relation to lifetime leisure activities (recreation,
sports, drinking establishments).

Strategy

Develop a guide for communities on environmental and social
policy including responsible recreational events; make camera-ready
copies available and develop a distribution list and mechanism for
distribution.

Encourage State and local governments to implement environmental
controls, such as eliminating happy hour promotions, banning
alcohol advertising on billboards and at fairs, and posting warning
labels where alcoholic beverages are sold.

D-5 Educate decisionmakers about how to implement incentives
regarding the parental supervisory role.

Strategy

Conduct research to determine if analytical skills are permanently
impaired by preadolescent and adolescent drinking.

Have parents educate and encourage otherparents to teach their
children not to drink and drive, as well as inform decisionmakers
about the important role parents can play.

D-6 Increase revenues for drinking and driving programs by raising taxes
on alcoholic beverages and/or increasing fines for a DWI offense.

Strategy

Develop model legislation for use by legislators and track legislation
as it is beingpassed.


EDUCATION

41

Have exhibit booths at annual conferences of mayors, governors,
and city managers. Educate these target groups by making
information available.

D-7 Expand warning labels on alcoholic beverages.

Strategy

Provide research findings to citizen activist coalitions on the wide
range of health eflects from alcohol consumption and encourage
them to work toward more comprehensive warning labels.

D-8 Encourage stronger law enforcement and adjudication of existing
drinking and driving laws.

Strategy

Establish a monitoring system to identify areas having exemplary, as
well aspoor, enforcement and adjudication of drinking and dn'ving
laws. Regularly publish the names of those cities and counties having
the "best" enforcement and adjudication rates, as well as the 10 `hot
spots. ))

Develop a guide for State Attorneys General identifying liability
issues, encouraging dram shop liability andprovidingguidance on
responsible business practices.

Professional and Provider Education

For health care providers, schools, worksites and communities (law
enforcement, elected officials, parents, clergy, media, etc.) -

D-9 Increase the level of knowledge and awareness about drinking and
driving prevention.

Strategy

Distribute copies of the recommendations to a wide variety of
national groups and organizations in the following areas: education,
highway safety, judicial and law enforcement, driver licensing, public
health, and medical. Ensure that associations not represented at this
workshop receive copies of the recommendations. Khen the
recommendations are distributed, include a list of recipients.


RECOMMENDATIONS

Encourage these groups and organizations to use the
recommendations to (1) create a State Task Force on Impaired
Driving or (2) motivate .&sting State Task Forces.

Include a diversity of State and local groups and organizations in
implementing these recommendations.

Provide accurate information on drinking and driving to science and
health editors and writers, as well as free-lance write?& for inclusion
in health and scientific journals.

D-l 0 Increase the number of professionals who receive education about
drinking and driving prevention as well as the importance of modeling and
how their behavior affects the public.

Strategy

Provide small grants to professional organizations to develop
training manuals for their membership to reduce tinking and
driving and consider this training as part of the requirements for
maintaining their certification.

Work with textbook editors andpublishers to ensure that accurate
information is included and updated regularly.

Request that relevant groups and organizations monitor alcohol
education materials for accuracy and messages.

Work with curriculum developers in health programs to include and
update materials on impaired driving, including the nature of
alcohol advertising and marketing.

Provide information on how to access health promotion fun& that
could be used for reducing impaired driving.

D-l 1 Include training in professional practices for professionals and
providers.

Strategy

Provide small grants to professional organizations to develop
training manuals for their membership to reduce drinking and
driving and consider this training as part of the requirements for
maintaining their certification.


EDUCATION                   43

D-l 2 Educate on how to overcome barriers to implementing policies and
programs.

Strategy

Publish a guide on how communities can overcome barrier Co
policy changes.

D-l 3 Provide education and training in support of community coalition
development to citizens, traffic safety, public health, and medical
professionals.

Strategy

Give widespread recognition and utilization to @ems-based
community development approaches, i.e., the Centers for Disease
Control's program entitled PATCH - Planned Approach to
Community Health.

Expand the scope of ewisting coalitions to include impaired driving
issues and strategies, i.e., Trafic Safety Now and fhe Safe Kids
Campaign.

Have NIAAA's Chief Executive OfJicer Task Force form a
subcommittee on drinking and driving to qlore ways corporations
can reduce drinking and dn*ving.

D-l 4 Provide incentives to increase and recognize those professionals and
providers who develop and implement effective and innovative programs.

Strategy

Create a well-recognized awardprogram in Ihe Departments of
Transpottarion and HeallIt and Human Services to recognize
effective and creative impaired-dn'vingprograms conducted by
private/public sectorparinerships.

Public Education

D-l 5 Increase the quality and quantity of exposure of the public to how
they can reduce drinking and driving by:
- affecting policy
   - reducing tolerance for drinking and driving
   - advocating for legislative changes


44               RECOMMENDATIONS

- perceiving how their behavior affects those around them

Strategy

Prepare a Surgeon General's letter on impaired driving myths and
facts. Facts would include: problem of crash involvement, the
difference between impaired and drunk driving, gender/individual
differences, genetic and biological vulnerability, the effects of alcohol
consumption on sexuality and weight, the temporary effects of
alcohol consumption (i.e., "hangover effect"), the risks for impaired
pedestrians, and the concept of "`low-risk"choices. Myths would
include: even though alcohol consumption is legal for adults, it is not
necessatily safe; drivingperformance is not improved by consuming
alcohol; beer is an intoxicating beverage; it is dangerous to be able to
`hold your liquor'> and a 12 oz wine cooler contains more alcohol
than a can of beer.

Prepare a strong statement for the Surgeon General to issue on
encouraging the nonuse of alcohol by those under age 21. The
message should include the association with health problems,
especially when combining alcohol with other drugs.

Develop a plan for disseminating the workshop recommendations.
Document current Federal drinking and driving activities.

Have the Surgeon General hold a press conference to disseminate
the above information to the public.

Use motivational techniques to help people maintain a commitment
to not drink and drive and to encourage communities to maintain a
long-term commitment to reduce the problem.

Ensure that information on drinking and driving is included on
electronic bulletin boards for use by the media, educators, science
writers, etc., in informing the public.

Print the names and BACs of convicted drinking drivers.

Work with television programmers and writers to include messages in
the electronic media on drinking and driving.

Provide the automobile industry (manufacturers, dealers, etc.) with
information they can provide to customers.

D-16 Base public information campaigns on effective social marketing
theories.


EDUCATION

45

Strategy

Conduct research on the knowledge, attitudes, andpractices of the
American public and develop materials and messages accordingly.

Market drinking and driving messages, theories, and strategies irt an
easy-to-read manner. Provide materials that contain graphics and
are written for appropriate reading levels. Request support from the
private sector in developing these materials.

Have NL4AA and other relevant Institutes compile a review of their
most recent research and grant findings. Provide this information to
science writers and other writers to use in developingpublic
information articles.

D-17 Educate the public (1) concerning the effects of marketing and
advertising by the alcohol beverage industry regarding alcohol
consumption and (2) about the relationship between increased taxes on
alcohol beverages and reduction in drinking and driving crashes.

Strategy

Provide small incentive grants to associations to have the public
identify ways to overcome the alcohol beverage industry's advertising
and marketing practices.

Use findings from NLAAA-sponsored studies and grants on the
relationship between increased taxes and a decrease in motor vehicle
crashes to inform the public.

D-l 8 Educate the public about the impairing effects of low levels of
alcohol on driving performance.

Strategy

Conduct research to detennine the length of time that low, moderate,
and high doses of alcohol affect performance of adolescents, young
adults, adults, and older individuals.

Research Needs

D-19 Conduct research on the relationship between media messages and
"traditional" classroom instruction.


46               RECOMMENDATIONS

D-20 Test and replicate social marketing strategies with targeted
audiences.

D-21 Conduct ongoing systematic evaluation of the alcohol beverage
industry's advertising marketing and promotion efforts and their
relationship to alcohol consumption and drunk driving; explore the
relevance of these efforts to educational initiatives.

D-22 Conduct research on effective community approaches to drinking
and driving prevention.

D-23 Reexamine drinking and driving education to improve its
effectiveness.

D-24 Translate research findings for practitioners and determine the most
effective means for disseminating this information.

D-25 Determine the most effective combination of approaches for a
community program to reduce impaired driving.

D-26 On an ongoing basis, expand and maintain existing national data
bases on knowledge, attitudes, and practices regarding drinking and
driving.

D-27 Monitor and assess implementation of these recommendations.

Strategy

Coordinate the research plans for agencies such as NUAA,
NHTSA, CDC, and NIDA, in particular, CDC's Injury Prevention
Research Centers.

Request that the Transportation Research Board study these
recommendations and develop its own research implementation
plan.
Expand funding for research from exkting sources, e.g., request that
Congress include drinking and driving research in the Omnibus Drug
Bill.


Panel E

Judicial and Administrative

Processes

       Chair:  The Honorable James D. Rogers
Background Paper:  James Nichols, Ph.D.
         H. Laurence Ross, Ph.D.
    Recorder:  CDR Gloria Ames
Panel Members:  William Hayes
         Ray Larson
           Joel Watne
            Paul Kamenar
         Kay Chopard

The judicial, prosecutorial, and administrative functions play a very
important role in dealing with the subject of this workshop, but cannot be
the total solution. Responsible action is needed from citizen support
groups, community leaders, the hospitality industry, manufacturers of
alcoholic beverages, and automobile manufacturers.

The judicial, prosecutorial, and administrative functions should act to
change the behavior of those who are apprehended for drunk driving and
those who are not apprehended.

The panel makes the following recommendations.

E-l Apply "hard" driver's license revocation (i.e., no exceptions for
hardship, occupation, treatment, or other reasons) for a minimum of 90
days for first offenders. The time of revocation should be substantially
increased for repeat offenders.
Most jurisdictions have some form of "Limited Driver's License"
process. This nullifies the beneficial results of the loss of the driving
privilege.

In jurisdictions with "hard" license revocation, it has been found that

47


4x3               RECOMMENDATIONS

very few people have lost their jobs, and none have been unable to attend
treatment or aftercare programs.

E-2 Increase emphasis on reducing driving without a valid driver's license
due to driving while under the influence or other alcohol-related charges,
as this is an intentional offense. The panel recommends singly or in
combination:

-  License plate confiscation (License plate confiscation
should be used by judges as a condition of pretrial
release. Administrative hearing officers should also use
license plate confiscation. The judge may consider the
issuance of special plates.)

-  Incarceration of the violator

-  Impoundment of the vehicle used in the violation

E-3 Do not reinstate driver's licenses lost for an alcohol-related offense
without the offender providing proof of compliance with an alcohol
assessment and any court order.

E-4 Make the following sanctions mandatory in addition to "hard" license
revocation.

-  Fines. The monies should be used to fund educational
programs on the use of alcohol and driving and to
compensate victims.

-  Jail. This may be stayed for first-time offenders on
compliance with court-imposed conditions. The stay
should be for at least 2 years.

E-5 Discourage plea negotiations. All negotiations shall be placed on the
record, and all proceedings shall be in open court.

E-6 Make driving illegal per se at 0.08 blood alcohol concentration. All
presumptions of not being under the influence of an alcoholic beverage or
nonintoxication should be repealed.

This still recognizes that driving with any alcohol concentration presents
an increased hazard to the driver and the public.

E-7 Encourage States and the District of Columbia to regularly review
their existing implied consent laws to determine if they are meeting their
desired goals. The penalties associated with such laws should be
sufliciently more severe than penalties associated with failure of a chemical


JUDICIAL AND ADMINISTRATIVE PROCESSES       49

test or of an alcohol-related conviction to provide an incentive to submit to
a chemical test.

E-8 Adopt administrative per se driver's license laws. In this type of a
procedure, the offender's driving privileges can be revoked for driving with
a blood alcohol concentration at or above a set level.

E-9 Give prosecution and defense the same rights of appeal. (In some
jurisdictions, the prosecution has no right of appeal.)

E-l 0 Have an alcohol assessment, by a competent certified person,
selected by the court, made available to the judge prior to sentencing of all
defendants in alcohol-related driving offenses.

E-l 1 Provide sufficient funding for judges, prosecutors, and
administrative hearing officers for continuing education in alcohol and
related driving offenses. This funding should not only allow for training
within the State but out of State at such locations as the National Judicial
College.

E-l 2 Recognize the rights and roles of victims and adopt the Slatemertl of
Recommended Judicial Practices which were adopted December 2,1983, by
102 judges- two from every State and the District of Columbia - at a
Conference at the National Judicial College. *

"Giving victims the right of allocution at sentencing hearings has not
resulted in any noteworthy change in the workloads of either the courts,
probation departments, district attorneys' offices or victim witness
programs." * *

E-l 3 Admit evidence from the criminal proceedings in any resulting or
related civil proceedings.

E-14 Establish a uniform State and national record system for all moving
traffic violations.

-  Reporting to both State and national systems shall be
mandatory with sanctions for noncompliance.

*Copies of the Statement of Recommended Judicial Practices may be secured from
National Institute of Justice/NClRS, Box 6000, Rockville, Maryland, 20850.

**National Institute of Justice, Executive Summary, victim Appearances Under the
California V%ims' Bill of Rights. Page 59.


RECOMMENDATIONS

-  Each State and the District of Columbia shall
participate in the national system.
-  Each State and the District of Columbia shall regularly
audit and review their systems for compliance.
-  The national system shall be regularly reviewed for
compliance and uniformity.

E-l 5 Apply judicial, prosecutorial, and administrative penalties to parties,
other than the driver, who contribute to the offense, such as the legal or
illegal providers of the alcoholic beverages.

E-l 6 Develop self-sufficient systems and programs for prosecution,
adjudication, sanctioning, and treatment of alcohol-related driving
offenders. (Use fines, fees, and alcohol consumption taxes.)

E-17 Use existing special programs and further devise others for juvenile
drinking drivers. They must use both education and comprehensive actions
of the court centered around their driving privilege.

E-18 Develop programs for the 18- to 26-year-old group for both
education and sentencing procedures. This age group is involved in a
disproportionate number of alcohol-related driving offenses.

The panel realizes that some recommendations may work well in all
jurisdictions and others may be less effective in some. Certainly, no
jurisdiction has solved the problem, and no jurisdiction should sit back and
be complacent. Each jurisdiction should regularly reexamine its own
methods and also look at those used by others. All too often the statement
is made that "We have the toughest laws in the country." This may be true,
but tough laws are meaningless if they are not enforced and implemented
by the courts, prosecutors, administrative hearing officers, and law
enforcement agencies.



Panel F

Law Enforcement

       Chair:  Maury Hannigan
Background Paper:  John Lacy, Ph.D.
         Robert Voas, Ph.D.
    Recorder:  LTJG Dorothy Stephens
Panel Members:  Peter O'Rourke
           Dean Gerstein
         Ralph Hingson, Sc.D.
         Johnny Mack Brown
            John Mouloen
           Howard P. Patinkin
            James P. Donovan

Driving Under the Influence (DUI) enforcement is a short-term control
over a much more fundamental problem - public attitudes toward alcohol
abuse. This public health problem must be addressed in the long range by
effective education programs beginning in our primary schools and
extending to adult programs, mass media, advertising, and regulation. This
will require a concerted and cooperative effort among agencies concerned
with health, education, transportation, commerce, and the administration
of justice. Enforcement can contribute to this longer range process through
well-publicized programs enforcing community standards regarding
drinking and driving.

We recommend six high-priority measures that would make DUI
enforcement more efficient and effective in the apprehension of DUI
offenders. The goal of enforcement is deterrence. The recommended
measures are likely to increase the volume of DUI arrestees and thus affect
other components of the DUI control system-notably the courts,
corrections, and licensing agencies.
The Law Enforcement Panel of the U.S. Surgeon General's Workshop
on Drunk Driving makes the following recommendations.

51


RECOMMENDATIONS

F-l Develop a comprehensive DUI training program for chief executives
of law enforcement agencies. The graduates of the program should-

- Understand the specific nature and extent of the DUI
problem;

- Understand state-of-the-art strategies and technologies of
DUI enforcement;

- Be able to implement and use DUI data systems in their
jurisdiction; and

- Be able to identify and effectively draw on relevant
organizations and resources at the local, State, and national
level.

Strategy

An executive trainingprogram should be developed by NHTSA, in
conjuncrion with the InternationalAssociation of Chiefs of Police
(IACP) and the National Sheriffs Associarion (NSA). This training
program should be disseminated nationwide To all chief law
enforcement execulives through the auspices of L4CP and NSA.

a  Timeframe: development ofprogram in 1989

o  Timeframe: implementation ofprogram in 1990 and beyond

F-2 Apply innovative techniques of DUI enforcement such as passive
sensors, preliminary breath testing (PBT) devices, BATmobiles (mobile
breath alcohol testing units), drug recognition experts, and horizontal gaze
nystagmus. Adopt appropriate enabling legislation where needed and train
field officers and court personnel in appropriate evidentiary use and
interpretation of these techniques.

Strategy :

A program should be established by NHTSA in conjunction with rhe
National Bureau of Standards and the UCP to cetiifipassive breath
sensors for DUI enforcement.

Such a program shall include minimum standards for these devices,
a quanGfication test, the development of a certijiedproducts list
(CPL), and a quality-control samplingprocedure. This program
should be established in consulration with the NSA.

o  Emeframe: develop standards and CPL by January 1990.


a  Tinteframe: establish quality-control procedures by January 1991


LAW ENFORCEMENT

53

NHTSA, UCP, and NSA should educate law enforcement
personnel in the use of devices (passive sensors, PBTs) and
techniques (drug recognition experts, horizontal gaze nystagmus) and
encourage their application and wide utilization.

o  Timeframe: begin implementation by calendar year 1989 and
beyond as necessary

NHTSA should also continue to evaluate devices and techniques
through appropriate research.
0 Timeframe: ongoing

F-3 Implement DUI checkpoints in those jurisdictions currently not using
this technique, and expand their use in jurisdictions currently using them.
To enhance the efficiency and effectiveness of checkpoints, we advocate
the use of BATmobiles, passive sensors, and/or PBT devices and the
adoption of legislation to permit sobriety checkpoints where necessary.
These techniques should be used in accordance with the standards set
forth by the United States Supreme Court and/or respective State Courts.
Also, research data on the effectiveness of checkpoints should be broadly
disseminated.

Strategy

The IACP and NSA should conduct leadership workshops on the
conduct of single and multiple agency checkpoints during their 1989
annual conferences, to be followed by a series of workshops across
the country to disseminate this information to line supervisors, with
the assistance of each State's Governor's High way Safety
representative.

o  Timeframe: Calendaryear 1989 and continue thereafter
Where checkpoints are currently not being used consult with the
attorney general of that State for the purpose of meeting the
constitutional requirements of that State, relative to the application
of checkpoints or drafting necessary constitutionalllegislative
amendments to allow their application.

o Emeframe: immediate

F-4 Make blood alcohol concentration testing mandatory for all drivers
involved in fatal and serious injury traffic collisions, both for data
collection and prosecution, as appropriate.


54              RECOMMENDATIONS

srrutegy

NHTSA should develop and disseminate model legislation for
application by the states.

o  Timeframe: during calendaryear 1989

F-5 Adopt administrative Iicense suspension and revocation procedures
for DUI that are designed to keep to a minimum the time required for field
officers to carry out their testifying functions.

Strategy

The Surgeon General should write a letter to the governors of those
States that currently have no administrative license suspension
legislation (administration per se) to encourage such legislation.

o Timeframe: immediate

F-6 Maximize public perception of the risk of arrest and punishment for
driving under the influence through law enforcement public information
and education efforts. These efforts are essential to the deterrent
effectiveness of DUI enforcement.

Strategy

To deter drunk driving through enforcement, public information and
education (PI&E) efforts must be tailored to the specific activities of
the enforcement agency and thus must be developed at the local
level. NHTSA should develop and disseminate basic PI&E
resources and materials for training in their adaptation Qnd use at
the local level. NHTSA should work with the Governor's Highway
Safety Representatives (NAGHSA), IACP, and NSA to conduct
training to foster the use of these materials at training sessions
sponsored by these organizations.

o  Timeframe: no later than 1989, annual IACP, NSA, and
NAGHSR conferences, and ongoing


Panel G

Transportation and Alcohol Service

Policies

      Chair:  Joseph Gusfield, Ph.D.
Background Paper:  Robert Saltz, Ph.D.
         Robert Apsler, Ph.D.
    Recorder:  Michael Impellizzeri
Panel Members:  William Scott
         Perla NiguiduIa
            James Peters
         Terry Pence

The Transportation and Alcohol Service Policies Panel was charged with
reviewing the role of alternative forms of transportation, such as taxis and
designated driver programs, and their ability to reduce the problem of
drinking-driving. The panelists were further charged with reviewing and
recommending policies that might also have a direct bearing on the
drinking-driving event, such as drinking establishment patterns, server
education, and employee assistance programs.

The panel focused its attention on the environment of transportation
opportunities and on social and commercial practices for serving alcohol.
One element common to both concerns was the aim of disengaging
prevention of the driving act from the drinking act. We recognize that
policies to affect transportation and server practices have received scant
attention in public health circles. Among alternative forms of
transportation, the support of and information about designated driver,
safe ride, and employee assistance programs are important adjuncts to
public transportation and private commercial transportation.

No less important are the practices of beverage service establishments
in the prevention of drinking-driving. Training servers and other beverage
service personnel to monitor and recognize patrons at risk should be a
significant aspect of beverage service enterprises. The panel further

55


56               RECOMMENDATIONS

recognized that commercial beverage serving establishments have an
obligation to be concerned about safe transportation for patrons whose
drinking creates a risk to themselves, passengers, and/or pedestrians. The
role of such enterprises, as well as social hosts, is vital to a successful
program to curb drinking-driving.

The panel was also convinced that the cogency and feasibility of such
service programs and alternative transportation forms depend on
particular local conditions of servicing agencies and transportation
facilities. They also require the cooperation and support of community
agencies and groups. The need for implementing programs at the local and
communal level was stressed. The purpose of the special community task
force recommended below is to create community standards for serving
practices by social hosts and commercial establishments so as to prevent
drinking-driving and ensure compliance with existing local rules and
regulations. In addition, the task force would examine and encourage
improvements in alternate systems of transportation. Such task groups are
important since, in the past, transportation and server practices have been
overlooked in public health prevention efforts.

The panel recognizes the possible danger that programs to provide safe
transportation for drinkers may encourage drinking and risk exacerbating
other alcohol problems. Servers and others should be aware of these risks
and not view the recommendations here as encouraging any lessening of
other actions to prevent problems related to the use of alcohol.

Community Focus

G-l Each community should form or expand a task group to review and
implement, in a systematic way, interacting policies and priorities as to
alcohol service and alternative transportation. Such groups should include,
but not be limited to, representatives of public transportation, taxi
associations, alcohol and drug abuse authorities, traffic safety
professionals, hospitality industry associations, zoning authorities, licensing
agencies, citizen support groups, insurance companies, alcohol beverage
authorities, educational institutions, and other public and private sector
groups.

The agenda for this community effort includes the recommendations in
the three broad areas of transportation, server practices, and
implementation strategies.

Transportation

Alternative transportation plans enable impaired drinkers to reach their
destinations without risking harm to themselves or others.


TRANSPORTATION AND ALCOHOL SERVICE POLICIES

57

G-2 The designated driver program should be a community-wide
approach addressing all types of drinking situations at all hours and
involving drinkers, commercial establishments, social hosts, transportation
alternatives, and special events, including sports events. Servers and social
hosts must not allow guests or patrons to become intoxicated and thus
become a danger to themselves and others, not only through
drinking-driving but in other dangerous situations as well. Designated
driver programs should incorporate these features:

- The designated driver does not drink any alcoholic beverages.
- Establishments or social hosts provide easy availability of and
promote food and alcohol-free beverages.

G-3 Information describing the relationship among alcohol consumption,
blood alcohol level, and risk of injury or death should be provided to all
individuals obtaining a new or renewal license for operating any type of
motor vehicle.

G-4 The hours of drinking establishments should be consistent with the
hours of alternative transportation.

G-5 Improving the effectiveness of taxi cabs and other similar forms of
transportation as alternatives to drinking and driving should be explored
with representatives of the taxi and other pertinent industries.

G-6 The automotive industry and the National Highway Traffic Safety
Administration should continue to explore the viability of ignition
interlocks and their incorporation in future vehicle design.

G-7 As a condition of obtaining a license to serve alcohol, including "one
day" or special permits, an organization must develop and implement a
specific plan to provide transportation for individuals who are impaired.
Social hosts should do the same.

G-8 Programs to promote safe or alternative transportation (designated
driver, safe rides, etc.) should keep in mind that problems related to
impairment are not limited to driving automobiles, but also include
operating motorcycles, bicycles, boats, snowmobiles, and airplanes;
horseback riding; skiing; and even being an impaired pedestrian.

Beverage Service Policies and Practices

Alcohol service training and intervention refer to a broad set of strategies


58              RECOMMENDATIONS

that address environmental reforms at two basic levels: the legal
environment and the specific environment of the licensed establishment.
The following policy considerations are recommended in order to achieve
a consistent and effective prevention plan.

G-9 Crowd management: Licensees must maintain an adequate ratio of
staff to patrons in order to monitor beverage sales, consumption, and
patron behavior.

G-l 0 Promotions: Licensees should not encourage drinking as a focus of
activity through promotions such as free drinks, drinking contests,
discounted drinks, or multiple drink purchases (e.g., happy hours).

G-l 1 Training: Training appropriate to the type of facility should be
made available to all managers and servers of alcoholic beverages,
consonant with policies recommended here.

G-12 Written policies: Written policies must be posted and made
available to all employees. These should be included and made a part of
alcohol service training.

G-l 3 Food options: Food should be offered and available during all hours
of operation.

G-l 4 Alcohol-free beverages: Alcohol-free beverages of all types should
be promoted, offered, and made available where alcoholic beverages are
sold.

G-15 Alternative transportation: Alternative transportation options must
be made available wherever and whenever alcoholic beverages are served.

G-16 Serving sizes: All alcoholic beverage drinks should be served in
single- serving standard sizes (e.g., 12 oz beer, 5 oz wine, or 1 `/4 oz
80-proof liquor).

G-17 Drinking on the job: Managers and staff are required to be
alcohol-free while on duty.

G-l 8 Age identification: All patrons must produce a valid identification
when a server is in doubt as to legal drinking age. Two forms of
identification, one with a photo such as government identification or
drivers license, are recommended.


TRANSPORTATION AND ALCOHOL SERVICE POLICIES    59

G-19 Intoxicated patrons: Service to intoxicated patrons is prohibited.

G-20 Employee assistance programs: All alcohol service employees must
have access to an employee assistance program.

Implementation and Incentives

It is recognized that responsible beverage service policies will be followed
only in a legal, economic, and social environment that encourages them.
The following specific recommendations serve to foster that environment.

G-21 Server practices require vigilant enforcement by regulatory
agencies. Those agencies must be adequately funded to carry out that task.
In addition, State regulatory agencies (Alcohol Beverage Control boards)
should be reviewed to determine current practices, conflicts of interests,
scope of authority, and enforcement of existing statutes. State legislatures
should review the structure of their Alcohol Beverage Control agencies to
emphasize their place in the promotion of public health.

G-22 State licensing regulations should be adopted to provide incentives,
such as adjustment of licensing fees, for compliance with responsible server
practices as recommended.

G-23 State legislatures should review and reform their dram shop (liquor)
liability laws to maximize their preventive impact and to encourage
business to adopt responsible serving practices. (The 1985 Dram Shop Act,
Western State Law Review 12:417-517,1985, can serve as a reference.)

G-24 States should review and certify server and manager training
programs to assure that they accomplish prevention goals, and that the
implementation of monitoring and certification of trainees is consistent
with other vocational and educational programs in the State.

G-25 State insurance commissioners should review the rate-setting
practices of liability insurance companies to ensure incentives for
implementing risk management practices that minimize drinking-driving.

G-26 Adequate records of the site of the last drink should be kept in all
cases of all officially reported alcohol-related incidents.

G-27 A representative from each of the 11 panels from this workshop


60               RECOMMENDATIONS

should be selected to serve on the advisory board of the governmental
interagency implementation group.

G-28 The final report of this workshop should be widely disseminated to a
broad range of agencies and enterprises in public and private sectors,
including regulatory agencies, insurance companies, trade associations,
and local workshops and conferences such as Responsible Service Forums
and Life Savers. Dissemination might include representatives from the
implementing groups or from the workshop panels.


Panel H

Injury Control

      Chair:
Background Paper:
    Recorder:
Panel Members:

Injury control in drunk driving crashes requires examination of all
components covering precrash, crash, and postcrash phases. These phases
are not isolated but are intimately linked and interrelated. Injury
prevention, injury control, and rehabilitation are inseparable parts of the
treatment of alcohol abuse as a disease.

Specific concrete recommendations concerning injury control require
direct and indirect approaches. Direct approaches concern prevention
and treatment programs directed at the drinking driver as a perpetrator of
injury. Indirect approaches concern programs directed at generic injury
control, such as improved environment and behavior modification. Specific
agencies and groups should be designated to help in the implementation of
these approaches.

Injury Control in the Precrash Phase


H-l Establish a program to integrate at the national, State, and local level

                   61

John M. Templeton, Jr., M.D.
Julian Waller, M.D.
CDR Richard J. Smith III
Martin R. Eichelberger, M.D.
George L. Reagle
Lawrence Schneider
Clark Watts, M.D.
Stephen Teret, J.D.
Katherine McCarter
Susan McLaughlin, M.S.N., R.N.
Chief Ricky Davidson


62               RECOMMENDATIONS

highway safety personnel, highway engineers, maintenance personnel, and
Federal and State Departments of Transportation. The program should -
- Stress injury prevention; and

- Foster technology transfer and implementation.

H-2 State governors: Develop a State-sponsored injury control coalition
in each State comprising components from public health, education, traffic
safety, judiciary, alcohol beverage control, communications, alcohol and
drug abuse, and others, including balanced representation from grassroots
citizen groups. The goals of the coalition should be to-
   - Develop scientifically based education in injury prevention;
   - Evaluate the program to measure the impact of education;
   - Develop expertise in the correlation of injury severity scores
   on crash analyses;

- Identify high-risk roadway and environmental conditions, and
to implement programs to correct these hazards; and

- Propose legislative initiatives designed to implement injury
control.

H-3 State governors: Establish a Fatal Crash Review Panel in each State
to include broad government and lay community representation. Its goals
would be to -

- Produce better epidemiological reporting of the crash event
by police and other authorities;
- Analyze causation, including multiple components of
causation; and

- Recommend changes in action programs and environmental
improvements such as signs, guard rails, etc.

H-4 Federal Department of Transportation: Establish a national safety
feature checklist to be displayed on all new cars, highlighting objective
scores concerning rollover potential, front end yielding, intrusion
protection, fields of vision, etc. Mandated standards should include -

- A defined numerical range for each feature;
- The vehicle's specific score for each feature; and
- Consumer education programs for the public.

H-5 FCC and Congress: Develop and implement national policies and
programs to lessen the use of alcohol seen in TV programs and feature
movies.


INJURY CONTROL

63

H-6 FCC and Congress: Develop and implement national policies and
programs for television that encourage positive lifestyle decisions such as
routine buckling up, refusing to drive after drinking, and refusing to ride
with a driver under the influence.

H-7 FCC and Congress: Establish national policies requiring equal time
on television for public service announcements to advise the public of the
hazards of alcohol.

H-8 NHTSA and State and local authorities: Develop demonstration
programs to study the use of an interlock mechanism for the vehicle of
anyone convicted of a DUI offense, and encourage the use of interlock
mechanisms where proven effective.

Injury Control in the Crash Phase

H-9 Federal DOT: Promote enactment in every State of effective
mandatory seatbelt laws to include "primary" enforcement with an
adequate line.

H-l 0 Federal DOT: Promote enactment of laws requiring airbags for
drivers and front seat passengers as standard equipment.

H-l 1 Federal DOT: Promote the proper use of seatbelts and child safety
seats in both cars and trucks. Stress -
- 3-point harness devices and improved technology for the
  protection of young children and low birth weight infants;

- Use of seatbelts even in vehicles with airbags; and

- Use of seatbelts in front and back seat.

H-12 Federal DOT, HHS, and Justice: Promote Federal policies that
foster passage and maintenance of laws regarding mandatory helmet usage
for all motorcycle riders.

H-l 3 NHTSA: Encourage industry and consumer programs to retrofit
used vehicles with appropriate standard restraint devices and air bags.

H-l 4 Federal DOT, HHS, and Justice: Foster policies for mandatory
fitting of large trucks with devices to prevent "underride."


64              RECOMMENDATIONS

Injury Control in the Postcrash Phase

H-l 5 Regionalize emergency medical service systems for the care of
injured patients throughout the Nation.
   - Establish guidelines for the care of injured patients in the
  prehospital, inhospital, and rehabilitation phases of care.
   - Define regionalization guidelines for urban and rural areas.
   - Develop "self-sufficiency" funding mechanisms such as a
  surcharge on DUI and other traffic violations.
   - Develop new approaches to the financing of inhospital and
  rehabilitation care of indigent patients.

- Encourage public education in the structure and function of
emergency medical systems.

H-l 6 DHHS and medical care professional groups: Develop and
implement comprehensive rehabilitation programs for -
- Physical rehabilitation;
- Psychosocial intervention for the drinking driver; and
   - Psychosocial rehabilitation of the victims and the family of the
   victim.

H-17 DHHS: Require BAC testing of all age-appropriate trauma victims
of traffic-related injuries as a component of their medical care and
management.

H-18 DHHS interacting with professional education organizations:
Encourage the teaching of alcohol abuse and injury control as a public
health issue in the curricula for health care providers.

H-19 States: Establish State trauma registries as an important part of a
system to provide epidemiological data on death, disabilities, and costs to
government and private resources.

Stru tqy

1.  The Surgeon General should speak to the National Governor's
Conference on what each goventor can do to be a catalyst for
administrative and legislative action on drinking and driving within
each State.

-  Stress that injury is a preventibie disease that
requires a comprehensive approach to reduce


INJURY CONTROL

65

2.

the human andfinancial cost of alcohol
abuse and traflc-related injuries.

-  Provide specific recommendations regarding
improved vehicle safety, environmental safety,
and injury prevention behavior.

  -  Support regionalization of injury care systems.
The Surgeon General and his office should also address the
issue of drinking and driving through -

     -  TVprograms to educate thepublic (as done
     with AIDS);
     -  A speech to the National Governor's
    Conference; and
     -  A formal congressional hearing on the issue of
    drinking and driving.
3. The expertise and assistance of the following specific agencies
andgroups, as listed with the individual recommendations
made by the injury controlpanel, should be enlisted:

-  Departntent of Transportation (NHTSA)
-  Federal Communications Commission

-  Department of Justice
-  Depatiment of Health and Human Services
  WC)
- U.S. Congress
-  State Departments of Transportation
- State governors
-  State regal authorities
-  National Association of State Enteqqemy
  Medical Services Directors

-  Medical care professional groups
-  Professional education organizations


Panel I

Youth and Other Special Populations

       Chair:  Galen Davis
Background Paper:  Michael Klitzner, Ph.D.
        Philip May, Ph.D.
         Elsie Taylor
    Recorder:  CDR Phillip Smith, M.D.
Panel Members:  Allan F. Williams, Ph.D.
         Anthony J. Heckemeyer
         Judy Zundel
         Raul Caetano, M.D., Ph.D.

The several recommendations coming out of this Surgeon General's
workshop may be effective in the general population. However, their
effectiveness in ethnic minority groups will depend on the extent to which
those interventions are tailored to the social and cultural identity of the
specific ethnic group. Educational efforts, for instance, need to take into
account the best media for dissemination of information as well as sensitive
use of meaningful cultural symbols and images.

Drunk driving as a major public health problem affects youth and ethnic
minority groups disproportionately. Specifically targeted interventions are
needed. However, drinking and driving occur in the context of social
norms, and cultural and regional trends are influenced by a multitude of
other factors.

Drinking and driving among youth are frequently determined by their
adult role models. Action at the school level should include more than just
classroom prevention programs; a restructuring of the schools to improve
student commitment to education and other social values is also needed.
Concerted efforts should be aimed at improving self-concept, coping skills,
and psychological adjustment.

The panel finds it difficult to provide specific recommendations for the
special populations as distinct entities given the lack of data on the extent

66


YOU-l-H AND OTHER SPECIAL POPULATIONS

67

and correlates of the problems within each group. Therefore, the panel
addresses those issues which the various ethnic groups have in common
while highlighting the specific needs of certain ethnic groups. The
following recommendations are based on this premise.

Relative to drinking and driving, we recommend the following
programs, policies, and countermeasures.

I-1 Increase local, State,and Federal taxation on alcoholic beverages.

l-2 Increase justice system training.

1-3 Increase health care system training (i.e., cross-train disciplines where
possible).

l-4 Increase the precision and consistency of present data collection
systems (i.e., the Fatal Accident Reporting System (FARS), Multiple
Cause of Death (MCD) file, death certificates) to collect and record data
on drinking and driving among youth and at-risk minority groups.

Strategy

Research finds should be allocated from NLAAA, probably the
epidemiology branch. The request forproposals (RFP)
announcement should include provisions for evakation of data
collection measures. Results should be realized within 2 years of
implementation.

o  Timeframe: 3 months for RFP
       9 months to go through review and award system

I-5 Renew governmental regulatory guidelines on motor vehicle design
and road safety.

l-6 Support community involvement through proven strategies and
programs.

l-7 Restrict Federal highway funds if States do not institute administrative
drivers license revocation for DUI.

l-8 Ensure swift and sure sanctions including making the sanctions reflect
the magnitude of the problem.


68              RECOMMENDATIONS

l-9 Support enactment and enforcement of the 1987 National Commission
Against Drunk Driving (NCADD) checklist of countermeasures.

Strategy

The National Highway Traffic Safety Administration should include
the 19 countermeasures of the 1987 NCADD Checklist of
Countermeasures in their 408 or 410 D?W countermeasure incentive
programs. States must attain 80pement of the countentleasures to be
eligible for the incentivegrantjimdr in thefirstyearand 9Opercenl to
be eligible for the second and subsequent years. Special grant
incentives should be set up for lOO- percent attainment.

o This program should be implemented during the 1990 Federal
jiscal year.

I-1 0 Encourage comprehensive school-based K-12 alcohol and other drug
abuse education and educator training programs of proven efficacy.

Strategy

By the end of 1990, NL4AA in conjunction with NHTSA should
award a series of 5-year contracts to evaluate txisling andlor
innovative educational strategies and teacher-training efforts in terms
of student behavioral outcomes, including age ofjirst use, drinking
patterns, D?VURWD, and other alcohol-related problems.

Teacher Paining should be evaluated in terms of increased leacher
awareness and knowledge, increased comfort with addressing
alcohol-related issues, increased skill in implementing alcohol
education, and increased skill in action planning of prevention for
the school and communi@

These conlracts should be restricted to individuals and institurions
who have notparticipated in the development of the programs and
who have no financial interest in the dissemination of theprograms.

I-1 1 Add funds for States to develop and evaluate innovative programs to
prevent and reduce drinking and driving.

I-1 2 Encourage civil liability for intentionally providing, directly or
indirectly, alcohol to minors.


YOUTH AND OTHER SPECIAL. POPULATIONS

69

I-1 3 Institute night driving curfews for beginning drivers under 18 years of
age.

Strategy

o NHTSA and the Office of Juvenile Justice and Delinquency
Prevention (OJJDP) should develop model curfew and 0.02
legislarion by the end of 1990.

o Stares failing to adopt legislation conforming to these models by
the end of 1992 should forfeit lOpercent of their Federal
highwayfunk

o By the end of 1992, NHTSA and OJJDP should have developed
a training curriculum for local law enforcement officers in
metho& for identifying youth driving with low BACs.

o By the end of 1992, training of trainers conferences of the above
curriculum should be held in all NHTSA program regions.

o By the end of 1992, NHTSA should award a 3-year contract to
study rhe implementation of curfew and 0.02 legislation in all
  States.

I-1 4 Increase the effectiveness of minimum alcohol purchase age laws.

l-15 Support mandatory seatbelt and motorcycle helmet laws and tie them
to Federal highway funds.

l-l 6 Endorse the following recommendations of the National Commission
on Drunk Driving report on youth:

- Administrative per se license suspensions should be
statutorily permitted.

- Open container laws should be promulgated.
- Strict sanctions should exist for the sale or transfer of
alcoholic beverages to youths under the legal drinking age.

Appropriate State agencies and State legislatures should consider
legislation in the following areas.

I-1 7 Make classroom instruction on alcohol use, other drug use, and
impaired driving mandatory for grades K-12; develop curriculum
guidelines for each grade level.


70                RECOMMENDATIONS

Strategy

By the end of 1990, based on current knowledge, NUAA in
conjunction with NHTSA and Depattment of Education should
develop guidelines for the selection and development of curricula
and reacher-training methods by local school districts. This effort
should be overseen by a nationalpanel of expefis who do not have a
financial interest in any such programs.

NOTE: The Department of Education recendy did this for a'rug
education (including alcohol and tobacco), but there is little (if any)
traffic safety thnrst in their materials.

I-1 8 Encourage insurance rebates for drivers who take an approved
driving risk-reduction course and have a clean driving record.

I-1 9 Include a mandatory component on alcohol use and impaired driving
in driver education courses.

l-20 Discourage and/or limit beverage advertising and promotion that is
directed at youth and minorities.

Strategy

Implementation should follow guidelines set up by the Advertising
and Marketing Panel.

l-21 Endorse 0.08 BAC for DWI for all the population 21 years of age and
older.

l-22 Endorse additional penalties over and above standard liquor law
violations for those under age 21 with an 0.02 BAC or above.

l-23 Increase the enforcement of DUI laws relative to youth.

l-24 Increase professional and public information and education with
regard to youth and other special populations. Proven strategies for
prevention and remediation should be utilized. Emphasis should be placed
on providing education to:

- Criminal justice personnel
- Health care professionals
- Educators


YOUTH AND OTHER SPECLAL POPULATIONS        71

- Media professionals
- Other policymakers
- Other community leaders
- General public

Prevention media communications should take into account the
appropriate culture and ethnic values when delivering their message.

l-25 Provide broad-based education of Indian tribal leaders and tribal
members on policy options pertaining to alcohol.

Strategy

Require the Federal Agencies, in consultation with tribal
communities, to develop strategies andplans forproviding training
on tribal specific and appropriate alcohol policy, e.g., to include
personnel plans and policies, law and order codes and ordinances,
school criteria and guidelines for education, diagnosis and treatment
protocols in clinics and hospitals, and quality assurance plans for all
treatment and rehabilitation programs.

The lead Agencies should be the Bureau of Indian Aflairs (BIA), the
Indian Health Service ( IHS), NLAAA, NHTSA, etc.
o Timeframe: By December 1990

l-26 Increase Indian tribal law enforcement resources.

l-27 Expand traffic safety initiatives among Indian tribes.

l-28 Better utilize all sources of funding for education, recreation, and
economic development. In particular, improve the socioeconomic status of
the American Indian.

i-29 Support Federal/tribal/State cooperation for the establishment of
detention and treatment centers for American Indians.

I-30 Improve social and cultural relevance in all programming and
countermeasures.

l-31 For American Indians and Alaska Natives, seek support of tribal
governments in the development of tribal resolutions for establishing policy
actions on alcohol and operation of motor vehicles while under the
influence of alcohol or other drugs.


72

RECOMMENDATIONS

Strategy

Amend P.L. 99-570, the Anti-DrugAbuse Act of 1986, to include
incentives for tribal governments to formulate, execute, and enforce
tribal-specific drinking-driving policies. Lead agencies: Bureau of
Indian Affairs, Indian Health Service

a  Timeframe: December 1989for amended legislation

l-32 Develop and implement educational efforts to increase Hispanics'
awareness of the risks associated with drinking and driving and to minimize
drinking practices that lead to the consumption of higher volumes of
alcohol per occasion. The target groups should be youth and males aged
21-39 years.

Strategy

A campaign should be developed nationwide with sponsorship from
the Ofice for Substance Abuse Prevention (OSAP). Proposals
should include carefully laid outplans for evaluations of campaign
effectiveness.

o  Timeframe: 3 months to request proposals
       4 months to proposal deadline
       2 months for review
         3 months for funding

l-33 Encourage special training of law enforcement officers to ensure
nondiscriminatory DUI law enforcement.

l-34 Increase community recreational resources for black (and American
Indian and Hispanic) youth.

Strategy

Funa? may be allocated from State block grants or from OSAP for
demonstration projects to set up neighborhood afterschool programs
(e.g., music, drama programs; physical rehabilitation programs;
occupational therapy programs; RAP and counselingprograms).

o  Timeframe: 1 year for implementation ofprogram
       1 year for evaluation of success of programs
      look for results in 1992


YOUTH AND OTHER SPECIAL POPULATIONS

73

l-35 Increase education of religious and other black community leaders
about alcohol abuse and drunk driving.

Strategy

Include an appeal to religious leaders in their rerigous training
programs.

Institute training curricula in ministerial schools.
Encourage black community leaders to set up neighborhood RAP
sessions andprograms.

Funds may be allocated from the Of&e for Substance Abuse
Prevention or the National Highway Traffic Safety Administration.

o  Timeframe: One year setup time to implement programs; one
additional year to see how or if the program works and produces
  results.

l-36 Increase religious and community programs on alcohol and other
drug abuse for blacks.

Research

In the area of research, the panel recognizes the extreme lack of data on
specific minority populations with regard to drinking and driving.
Descriptive data are needed on the following topics.

l-37 Describe effective alcohol and other drug abuse assessment tools for
youth.

l-38 Identify effective support groups for youth and ethnic minorities
returning from treatment.

l-39 Develop more precise and consistent measures to collect and record
data on drinking and driving among youth and ethnic minority groups.

I-40 Determine the extent of drinking and driving among ethnic groups
and the major demographic characteristics of individual members of the
group who engage in such behavior.

l-41 Study the relationships among drinking patterns such as volume
consumption per occasion and drinking and driving.


74                RECOMMENDATIONS

l-42 Investigate the attitudes toward drinking and driving among blacks/
Hispanics/American Indians and how deviance is defined in the specific
group*

l-43 Track arrest patterns to assess the question of the validity of high
prevalence of DUI arrest among Hispanics as it relates to law enforcement
practices.

l-44 Assess the effectiveness of frrst and multiple offender rehabilitation
programs for youth and ethnic minorities.

l-45 Assess the effectiveness of driver's license sanctions associated with
DUI convictions.

l-46 Assess the effectiveness of State laws that apply special license
sanctions to youth for alcohol-related violations.

i-47 Evaluate the effect of liquor advertisements on the use of alcohol by
minors.

1-48 The panel endorses the research questions listed in Dr. Perrine's
background paper for the Epidemiology Panel as they relate to the
different age groups in the minority population. (See background papers in
separate volume.)

In specifically addressing the recognized research priority needs among
American Indians, the panel makes the following additional
recommendations.

l-49 In the area of epidemiology, research is needed on the following
issues relevant to American Indians:

- Motor vehicle accidents based on geographic location, i.e.,
reservation/off-reservation, urban or rural sites
- Adult prevalence studies
- Survey of tribal alcohol policies
- Prevalence and level of impairment due to drinking and
driving related motor vehicle accidents

I-50 In the area of social-psychological research, the following topics are
of major importance to American Indians:
   - Social-psychological studies of accident victims


YOUTH AND OTHER SPECIAL POPULATIONS

7.5

- Attitudinal values and trends on drinking and driving

Strategy

Sponsorship for this research should come from the National
Institute on Alcohol Abuse and Alcoholism. The mechanism for
funding would be the basic ROl grant finding of the extramural
research program.

o Timeframe: February 1, 1989 Receive proposals
        June 1989     Initial review
        October 1989    Council review
        December 1989  Funding awarded

l-51 Organize Federal coordination efforts to provide technical assistance
to tribes regarding legislation implementation.

Strategy

Lead agencies: Bureau of Indian Affairs, Indian Health Service,
NHTSA, NLAAA, etc.

a Timeframe: December 2990

l-52 Evaluate the effectiveness of policy execution by:

   - Process evaluation- the stages of passing and implementing
  new policy; and

- Outcome measures - maintain accident (e.g., pregnancy,
morbidity and mortality) data and alcohol (e.g.,
alcohol-related problems) data on a longitudinal database.

Strategy

Lead agencies: Indian Health Service, NIAAA, and private sector
agen ties.

l-53 Identify potential State, Federal, tribal, and private funding resources
to implement tribal policy.

Strategy

Lead agencies: IHS, BU, NL4AA
o Timeframe: ongoing



76              RECOMMENDATIONS

l-54 Develop interagency plans for prioritizing funding needs and
technical assistance to meet tribal priorities such as:
- Public health planning
- Legal aid

- Media and information services

- Plans for dissemination of knowledge and sharing experience
among local communities.

Strategy
Lead agencies:  BL4, IHS, tribal governments

o  Timeframe: PIans by December 1990
       Implementation:  ongoing as process evolves


Panel J

Treatment

      Chair:
Background Paper:

   Recorder:

Panel Members:

Robert Niven, M.D.
Vernon Ellingstad, Ph.D.
Kathryn Stewart
CAPT Frank Hamilton, M.D.
Loran Archer
Harvey Siegel, Ph.D.
Mark Goldman, Ph.D.
Chauncey Veatch III
James A, Farrow, M.D.
John Allen, Ph.D.
Jeri Shaw

Drinking and driving is a serious social and public health problem. Because
of the enormous human and economic costs of drinking and driving on our
society, the Panel on Treatment unanimously agrees that prevention and
deterrence from drinking and driving are beneficial to all our society.
To improve traffic safety in the United States, the panel advocates the
position that the safest blood alcohol level is 0.0 percent while driving and
strongly recommends that the public service message should clearly state:

"If you are going to drive, don't drink."

The panel further advises that contrary or different messages, including
"Know your limit" messages, should not be used.
From a public health perspective, all of the following recommendations
are important. The panel opts to prioritize and rank order these
recommendations according to which are most pressing and would
enhance an effective response to this problem.

77


78

RECOMMENDATIONS

Prevention

Rehabilitative countermeasures, even if lOO-percent successful, can
have only a limited impact on traffic safety. The main approach to
eliminating alcohol/drug-related injuries or fatalities must be focused on
prevention.

J-l Prevention measures, including both general and specific deterrence
aimed at eliminating the behavior of driving while under the influence, are
essential if major declines in mortality and morbidity are to be achieved.
Prevention measures to be considered include traditional educational
approaches and also public policy, enforcement, legal sanctions, and
treatment measures. All messages, verbal and behavioral, should be clear,
concise, noncontradictory, and focused on eliminating the joint activities of
drinking and driving.

Strategy

7he Surgeon General should immediately begin to promote a single
public health message concerning drinking. This message should be
"Don't drink and drive. "Any contrary messages to this should be
discouraged including "Know your limits " messages.

The Surgeon General should ensure that all Federal Government
promotional materials about drinking and driving be revised to
reflect this position by the National Drunk and Drugged Driving
Awareness Week in 1989 and should ask all voluntary agencies
concerned with drunk driving to adopt an identical message and to
discourage contrary messages.

The Surgeon General should convene a multidisciplinary task force
to develop mechanisms to coordinate and increase prevention efforts
and the reCOF?InleFIdatiOnS frOFn this and other task forces involved in
the Surgeon General's Workshop on Drunk Driving.

E'te Surgeon General, acting through the Public Health Service,
should create a variety of educational materials on drunk driving
which should be widely distributed (including through chemical
dependency and other health care facilities and organizations) and
incorporated in health care training didactic and clinical
cum'culums. IThe creation and dissemination of these materials
should be completed by the National Drunk and Drugged Driving
Awareness Week in 1989, or as soon as possible.


TREATMENT

79

Treatment

J-2 Treatment should not routinely be used as a substitute for legal
sanctions, but rather as an important component of a comprehensive traffic
safety program.

Driving under the influence of alcohol or other drugs is a multifaceted
problem for which there is no single effective treatment of any type
(medical, legal, or punitive).

Treatment programs reduce driving related alcohol/drug incidents in
those alcohol/drug dependent persons successfully treated, both those with
and those without prior DUI offenses. Such programs are also a resource
(as are other components of the health care delivery system) to further the
dissemination of prevention materials.

A systematic approach to offenders using qualified personnel,
appropriate standards, with oversight and quality assurance controls and
without conflict of interest, is necessary to assess those persons who may
benefit from one or a combination of treatment approaches. Such a
systematic approach also needs ongoing evaluation to develop answers to
relevant questions and enhance cost-effectiveness.

The traditional short-term, low-intensity educational programs that are
broadly applied have been of limited effectiveness, and more intensive,
longer term treatment options may be more beneficial (albeit more costly)
and perhaps applicable to a selected population of offenders.

Strategy

Since a significant body of research supports the role of legal
sanctions, in panicular licensing sanctions, in reducing DUI
recidivism, the Surgeon General should encourage Federal, State,
and localgovemments to adopt andpromulgate policies and
practices that offer treatment in combination with licensingpenalties
and other sanctions proven to be effective and to discourage offering
treatment in lieu of other known, effective sanctions.

Because of the wide variations in the structure and quality of
assessment and treatmentprograms from State to State, the Surgeon
General sitouldpromote and encourage States to develop
mechanisms for high-quality diagnostic and referral procedures for
DUI offenders and specifically, should encourage the use of unifomt
diagnostic ctiteria and assessment instmments and treatment
approaches, since this would greatly facilitate reseamh studies on the
eflectiveness and cost-effectiveness of treatment.


80              RECOMMENDATIONS

Research

J-3 Develop a precise data base on the incidence and prevalence of
driving under the influence in different population groups. Since drunk
drivers comprise a heterogeneous population, specific demographic
identifiers among this population need to be defmed. Special populations
(i.e., youth, minorities, and women) should be targeted in obtaining these
data.

J-4 Intensively investigate the neuroscientific basis of high-risk, impulsive
behavior and recidivism in this population.

J-5 Develop a scientific evaluation of treatment modalities and the
combination of various treatment options for the heterogeneous group that
makes up the drunk-driving population.

J-6 Evaluate the effectiveness of new, short-term low-intensity programs
that have an impact on behavior from both an outcome and a process
perspective.

J-7 Develop and evaluate newer treatment modalities in high-risk
populations.

Strategy

The Surgeon General should encourage and foster research and the
coordination of research activities of various U.S. Government
Agencies involved in this field to increase the quantity and quality of
research focused on the drunk dn'ving issues identified by the task
force. A priority in this area, which requires an immediate increase in
research, is the assessment of subpopulations who are already
underrepresented in existing knowledge bases.

The Surgeon General should encourage States and local government
agencies to develop uniform data collection, assessment, and
treatment methodologies, since such information would provide an
invaluable basis for the further development ofpublic policy
initiatives aimed at minimizing the enormous adverse impact of
drunk driving.


TREATMENT

Resources

81

Significant increases in fiscal and personnel resources will be required
for success, but this is not seen as the sole responsibility of the Federal or
State Governments.

J-8 Since DUI has significant economic impact, funds should be used
judiciously at all levels of State, local, and Federal Government. In
allocating resources to address this issue of traffic safety, funds earmarked
for public education should be given the highest priority. Evaluation and
reevaluation of current treatment programs that are most cost effective and
provide the most efficient treatment are encouraged.

J-9 Coordination and leadership, at the highest levels of government and
in the private sector, are also necessary if impaired driving is to be
eliminated. Involvement of health, judicial, law enforcement,
transportation, and education departments, in an intense and truly
cooperative effort, will facilitate the involvement of universities, business,
and private groups in developing, implementing, and testing strategies to
eliminate this national tragedy.

J-10 The cost of treatment should be borne as much as possible by
individuals convicted of DUI, based on their ability to pay. If the individual
is unable to pay, the individual's high-risk group (those convicted of DUI)
should bear the cost.

Resources for supporting this prevention and rehabilitative endeavor
would be derived from revenue from fees, penalties, and other appropriate
sources.

Strategy

In view of scientific data indicating the limited effectiveness of
short-tern, low-intensity educationalprograms, which are the most
common approach to DUI offenders, the Surgeon General should
encourage States and local governments to reassess the use of
resources currently devoted to such programs and to consider
retargeting resources to other treatment orprevention strategies.


Panel K

Citizen Advocacy

       Chair:  Howard F&ton, M.D.
Background Paper:  John McCarthy, Ph.D.
     Recorder:  CAPT Patricia D. Mail
Panel Members:  Mickey Sadoff
           Rebecca Brown
            Ann Esch
         Nancy Ricci
           Ritchie Aanderud
           Marsha Woodward
          Harold Brandt, M.D.
          Wes Roy
           Sue Rusche

Citizen advocacy represents a broad focus of concern that cuts across the
more specifically defined issues associated with driving while intoxicated
(DWI). Having its roots in the towns and communities of the Nation where
the problem of DWI is most omnipresent, the citizen advocate's concerns
encompass all aspects of DWI from advertising and marketing through
enforcement, judicial and administrative issues, and treatment. But the
greatest concentration of effort is in education, for it is through education
of the judiciary, legislature, and citizenry that the dramatic efforts to
reduce and eliminate DWI are concentrated. Only continued community
awareness can bring about the type of behavioral and attitudinal changes
necessary to ensure the safety of the Nation's highways from impaired
operators of motor vehicles.

The Citizen Advocacy Panel was charged with addressing a range of
issues, many of which are being addressed by other panels in the workshop.
After wrestling with these charges, it became apparent that continued
deliberations would only serve to duplicate the recommendations of the
other panels. Each of the charges represented a vital and important issue,

82


CITIZEN ADVOCACY                83

and there was insufficient time to address each in the detail required. The
panel members are concerned that citizen advocates were not empaneled
as members of each of the other panels, for only in that fashion could the
citizen advocates voice their unique concerns.

The citizen advocate is able to represent the perspectives and issues that
cut across jurisdictional lines; represent victim viewpoints; challenge
inaccuracies and inconsistencies in the law, its enforcement, and
disposition; and speak out as a conscience for necessary action.

The panel proceeded to address several issues that were of particular
and continued concern to advocacy groups. The panel also went on record
as supporting and endorsing the recommendations of the Presidential
Commission on Drunk Driving (1983) and the Youth Driving Whout
Impairment Report of the National Commission Against Drunk Driving
(1988). In addition, the panel addressed the special roles and
responsibilities of citizen advocates and supported the mandate provided
by their inclusion in this workshop that citizen advocacy groups continue to
give the issue of DWI the full force of concern in our society which this
grave problem deserves.

The panel makes the following recommendations to the Surgeon
General.

Recommendations for Advocacy Groups

K-l Develop a coalition of national and local advocacy groups for the
purpose of coordination, exchange of information, and strategic planning.

Strategy

An agency should be identified, such as the National Highway
Traffic Safety Administration (NHTSA), under whose sponsorship a
meeting of advocacy groups could be convened to initiate coalition
building. This conference could occur in conjunction with the next
Lifesavers Conference, April 1989.

The NHTSA grant programs should provide finding for regional
workshops on drinking and dnving to facilitate coalition building on
a regional basis. Because of the already established networks of
NHTSA, the Surgeon General should encourage the Congress to
increase appropriations for NHTSA's grant programs. If
coordination with Lifesavers is not feasible, then other sources of
support for a coalition-building conference should be sought and a
preliminary meeting held during 1989,


84             RECOMMENDATIONS

K-2 Establish a national clearinghouse of information about impaired
driving issues and advocacy activities as a resource for advocates and the
general public.

Strategy

73e Surgeon General should provide the leadership to coordinate
appropriate agencies b identi' funding and establish a National
Impaired Driving Prevention Information Clea@house to help
advocacy groups and other interested parties.

o This should be initiated by the end ofjkcalyear 1989.

K-3 Advocacy groups should educate themselves with regard to all
aspects and issues of impaired driving to ensure that they have the most
accurate and up-to-date knowledge about the problems.

Strategy

The National Impaired Driving Prevention Information
Clearinghouse ,vould serve as a major sounze of infonnation and
training materials for advocacy groups and individuals interested in
becoming advocates. Advocates who interact with the press or the
legislators must know current laws and legislative initiatives for
improving them.

K-4 Of all the activities in which advocates are involved, the major efforts
should be directed toward four primary activities that are not emphasized
by any other group:
- Court monitoring
  - Victim assistance

- Influencing public policy and legislation
- Ongoing awareness and public education

Strategy

The National Clearinghouse would be a resource for information to
support these activities, provide training matenbl, serve as a
reposirorv for model legislaCion, and provide assistance with the
development of appropriale materials. However, nothing will be
accomplished withour energetic and vigilant efforts by local
advocates.


RECOMMENDATlONS                 85

K-5 Advocacy groups should continue to expand their volunteer base,
drawing on both victims and potential victims.

K-6 It is important for advocacy groups to keep their volunteers happy
and productive. Volunteers require training in order to be well prepared
and comfortabIe with their tasks. A variety of activities should exist that
challenge and utilize the broad range of volunteer skills and talents that the
individual members bring with their commitment.

Strategy

Advocate participants need to take back to their organizations the
recommendations presented at the workshop and to seek ways to
both implement and encourage support for the recommendations,
giving them wide publicity and assuring the widestpossible
distribution of the subsequent report.
The Proceedings of the Surgeon General's Workshop on Drunk
Driving should be sent to all of the following:
   - State governors
   - State legislators

-  State Attorneys General
-  Members of the U.S. Congress
-  National advocacy groups
-  Federal Judges and members of the U.S.
Supreme Court

-  Members of the Presidential Commission on
Drunk Driving

      -  Advocacy group officers
       -  Members of the citizen advocacy panel.
In addition, copies should be made available to the National
Clearinghouse for Alcohol and Drug Information for distribution to
advocacy group chapters nationally through NCADl's Regional
Alcohol and DrugAwareness Resource (RADAR) Network and the
National Institute of Justice Clearinghouse.

Copies should also be sent to the national officers and all State
presidents of the League of Women Voterx

K-7 Advocacy groups must continually seek a variety of resources within
their communities to support their activities, in&ding help from
corporations, foundations, individuals, and governmental entities.


86             RECOMMENDATIONS

K-8 Advocates should seek opportunities to recognize and reward those
individuals whose behavior and actions are necessary and appropriate to
the task of removing impaired drivers from the streets and streams of
America. Appropriate behavior should be reinforced and recognized,
whether through the services of volunteers or from administrators, law
enforcement officers, judges, probation officers, legislators, or other
professionals.

Strategy

When a national clearinghouse is established one service might be
the development and dissemination of a newsletter that would
feature volunteers and professionals and recognize their important
contributions to getting impaired dn'vers off the Nation's highways.

K-9 Advocates must be on the alert to identify the unaddressed potential
situations in their communities that create a climate for excessive alcohol
consumption. Excessive drinking at sporting events or festivals should be
discouraged. Those individuals responsible for the planning of public
events should be encouraged to seek ways to reduce and control the ready
availability of alcohol and to actively discourage DWI while promoting
alternatives.

Strategy

This activity is a major responsibility of local advocacy groups.
Distribution of the workshop proceedings will help to disseminate
this information.

K-10 Advocates must be constantly on the alert for attempts within their
community or State to revoke and/or weaken established laws and policies
by appending revocation language onto otherwise unrelated bills.

Strategy

A clearinghouse would help make such attempts wide& known, and
tlte tactics in one State would be qposed for all to learn from and
guard against in their own States.

Additional Recommendations

In addition to recommendations specific to citizen advocates, the panel
also wishes to go on record regarding issues that are of great concern to
citizen advocates.


CITIZEN ADVOCACY                87

K-l 1 Emphasize that DWI is a national catastrophe (crisis) representing a
most serious threat to the public health and deserving of extensive and
continuous attention at all levels of government and society.

K-12 State clearly that Driving Under the Influence (DUI) or Driving
While Intoxicated (DWI) is a crime and deserving of criminal sanctions,
even for the first offense. Use a twofold attack consisting of administrative
license revocation per se combined with criminal sanctions. Although some
leniency in punishment and emphasis on education toward behavior
modification are appropriate for first offenders not involved in crashes
resulting in injury or death, the importance of establishing a record of this
first offense as a crime cannot be overstated, for it then becomes the basis
for more punitive sanctions for the multiple offender.

Strategy

This needs to be stated and restated, not only by the Surgeon
General, but by the U.S. Attorney General and Federal and State
attorneys.

To help publicize tJle magnitude of this issue and to give prominence
to thepewasiveness of DWl in the country, reports of DW7 and
related criminal activities, such as hit-and-run, should be regularly
incorporated in the FBI's Uniform Crime Report.

o  Incorporation of such reporting to be initiated by October 1989.

K-13 Increase national attention on DWI and the events leading up to this
act. To accomplish this, use of properiy descriptive language must be
strongly encouraged. This includes the fact that alcohol-related crashes
and injuries are not "accidents."

Strategy

The Surgeon General should encourage all major medical
organizations and the Centers for Disease Control to define
alcohol-related episodes as crashes, with resultant injun'es where
appropriate, and to cease using the word "accident." The CDC
should commence regularly reporting alcohol-related crash injuries
and deaths. These deaths and injuries due to DWl should be
regularly tracked and reported in the Center for Disease Control's
Morbidity and Mortality Weekly Report. The latter will help to raise
health professional awareness about the magnitude of the problem.

o  This should be initiated by October 1, 1989.


88             RECOMMENDATIONS

K-l 4 Increase the use of sobriety checkpoints on the Nation's roads and
highways and reinstate them in those States that have declared them
unconstitutional.

Strategy

The U.S. Attorney General shouldpromulgate the model standards
for setting up such checkpoints. A summary of the issues relating to
this recommendation may be found in the Impaired Driving Issues
Compendium (1989),prepared by Mothers Against Drunk Driving:
  The NationalAssociation of Chiefs of Police, other law enforce-
ment associations, the Justice Department, and NHT&I should all
strong4 urge the use of check@&. NH%4 should encourage State
Attorneys General to review their locai laws and make changes as
needed to implement checkpoints, as well as to provide guidelines to
their members and the various states on the legal implementation of
such checkpoints.

Advocates need to inform themselves about this issue and deter-
mine what their local and State policies are regarding checkpoints.
Wth volunteer legal consultation, conduct a review of local laws to
determine where modification may be needed to implement or
reinstitute checkpoints.

a All of the above with preliminary implementation by December
31, 1990.

K-15 Significantly lower the per se BAC of 0.10 and apply this lowered
standard to the general public consistently throughout the United States.
Standards should be consistent with either the recommendations of the
American Medical Association (.05) or those currently being applied to
commercial transportation operators (.04). The permissible BAC for
drivers under the age of 21 should be established at 0.00 nationally.

Strategy

The U.S. Public Health Service should charge its appropriate
Agencies to begin a review of all relevant research immediately to
determine appropriate BAC levels to safe& operate motor vehicles,
and issue a report on their findings not later than December 30, 1990.

when this determination is made, the infomtation should be
forwarded to NHTSA and the Depattments of Justice, Education,
and Defense for the widest possible promulgation. In addirion, the
PHS should forward a recommendation to the appropriate


CITIZEN ADVOCACY

89

Congressional Committees to consider development of legislation to
establish this level nationally.

Advocacy groups should urge the adoption of the level on a
State-by-State basis.

If all legislative avenues to establish a physiologically relevant
standard fair, then the Congress should consider withholding
Federal highway trust finds from States, as part of a total package of
mandating model standards for the public health and safety.

o Effective legi.sIation and enforcement could be in place by 1992.
The PHS can probably conduct a review of research and make a
recommendation by the end ojFY 1990.

K-16 Adopt uniform graduated penalties for DWI in the States and
territories, with special focus on multiple offenders, especially those
individuals driving with revoked licenses.

Strategy

The Surgeon General should ask NHTSA to work with advocacy
groups, law enforcement officials, and appropriate judiciary
organizations to develop such models and suppoti've educational
material.

The resources of NHTSA should be directed to convening an eqert
working group to establish standard graduated sanctions, with
particular emphasis on multiple offenses, driving under license
revocation, andpenalties for those who knowingly lend a vehicle to
an individual wlto has a revoked license.

K-17 Establish a national computer registry of DWI offenders in which
the recognition of DWI in any State has reciprocity and recognition in all
other States. This should be available to licensing bureaus and all
enforcement officers through a network like the Federal Bureau of
Investigation's National Crime Information Center (NCIC).

Strategy

The Congress is urged to appropriatefunds to implement the I988
Drunk Driving Prevention Act, and advocacy groups nationally
should also urge passage of the provisions of this law in their
individual States.

In addition, the Surgeon General should request participation of the


90

RECOMMENDATIONS

Justice Department and other appropriate law enforcement agencies
and institutions to review and recommend the most qeaYent
manner for creation of this data base.

o Review and recommendations regarding feasibility and cost
could be completed by the end of FY 1990 and the Registry be
bnplemented by the end of FY 1992.

K-18 All States should incorporate into their driver qualification tests
questions on the effects of drinking and driving and the penalties for
violations.

Strategy

Advocacy groups should urge incorporation through their legislators
and licensing bodies.

o  To begin immediately

K-l 9 Testing for BAC should be mandatory as evidence in any crash,
injury, or death in which a motorized vehicle is involved (including boats,
snowmobiles, and other all-terrain and off-road vehicles).

Strategy

The U.S. Attorney General should restate the requirements of the
Uniform Vehicle Code as they pertain to mandatory testing, and
testing should be applied in all trafjic crashes resulting in fatalities or
bodily injury.

o  This emphasis needs to be promulgated immediately and
consistently, certainly as soon as possible after the new Attorney
General takes ofice January 24 1989.

K-20 Require all medical personnel in trauma centers and emergency
rooms to conduct BAC testing and report suspected DWI offenders to the
proper authorities. These laws would be similar to the child abuse laws in
which clinicians are protected against prosecution for compliance, but
compliance is mandatory.

Strategy

The U.S. Attorney General should recommend legislation to provide
protection from prosecution of medical personnel and request that
this requirement be inserted into appropriate legislation.


CITIZEN ADVOCACY                91

Advocates should work with their local medical societies, State
medical associations, and the Attorney General to &aft legislation to
implement and enfome this reporting.

o Mandatory reporting to be passed by at Ieast five States by
December 1992.

K-21 Establish programs of victim assistance for the injured as well as the
dead. These programs should provide help not only with court
proceedings, but with compensation and treatment, both physical and
psychological,

Strategy

Advocacy groups, working with the Department ofJustice and
NHTSA, should establish a Kctims Bill ofRights, to be
incorporated into newly drafted highway safety legislation that is
designed to fill the gaps in the current drunk driving legislation.

The Department of Justice should promote the Etims Bill of
Rights, including the admissibility of Victim Impact Statements for
adoption into law.

o By December 1, 1990.

A model law needs to be developed to address the issue ofnonfatal
injuries incurred in an alcohol-related crash. This must include
restitution/compensation for any degree of injury that occurs. This
model law needs to be incorporated as a statute in new legislation.
Such legislation should be developed during a consensus conference
sponsored by NHTSA.

o By December 31, 1991.

K-22 The Department of Justice and other interested parties should file
amicus briefs before the next session (and, if necessary, in any future
sessions) of the Supreme Court (e.g., South Carolina vs. Gathers 88-305 or
others) in an effort to reverse the high court's decision on Booth vs.
Maryland (107 S.Ct, 2529 [1987]) regarding the admissibility of Victim
Impact Statements.

Strategy

The U.S. Attorney General should submit an amicus brief to the
court in support of the admissibility of victim Impact Statements.

o  By April 1,1989.


92              RECOMMENDATIONS

K-23 Focus increased attention on the issue of alcoholic or codependent
denial and its insidious influence on those who are charged with the public
responsibility of addressing and dealing effectively with impaired driver
issues at all levels. This includes impaired or addicted individuals in
education, the criminal justice system, the medical care system, and private
citizens whose own ilhress may negatively impact their ability to behave in
an appropriate and lawful manner.

Strategy

The U.S. Public Health Service, through appropriate agencies,
should facilitate increased awareness of addiction and the attributes
of an impaired individual, with strong encouragement for the
increased availability of employee assistance programs and other
detection and treatment measures. This education should be
conducted cooperatively with NHTSA and the Departments of
Defense and Education.

o Preliminary information on denial and codependency should be
provided to professional preparation institutions, both law and
medicine, by December 31, 1989.

o  Supervisors in all major Federal Agencies should receive
information on impairment and the availability of employee
assistance programs in theirAgencies by October 1, 1990.

The PHS, through the educational resources of the CDC, should
develop counteradvertising messages for youth to illustrate the
negative consequences of alcohol abuse and to foster a climate of
nonalcoholic sociability.

o Public service announcements should be pilot tested and
available by June 30, 1990.

The panel reiterates that the most important single element in addressing
all the issues of drunk driving is education. Continual community
awareness about the severity and seriousness of DWI must be the
responsibility of all individuals who wish to protect themselves, their
property, and their lives from serious injury or death.

The members of the Citizen Advocacy Panel wish to thank Surgeon
General C. Everett Koop for his concern and his willingness to put the full
weight of his office and the attention of the U.S. Public Health Service on
the issue of drunk driving.

NOTE: The Citizen Advocacy Panel recommends to all concerned
readers the MADD Impaired Drivers Issues Compendium, which provides
detailed information about many of the issues discussed at the workshop.


Closing Remarks

C. Everett Koop, M.D., Sc.D.
Surgeon Genera1 of the U.S. Public Health Service
U.S. Department of Health and Human Services

I'm certain there are no reasonable people who believe that drunk driving
should be tolerated. Yet people shy away from any discussion deeper than
"isn't it terrible." Leadership is hard to come by, because it is a lonely
position. Although this workshop had the enthusiastic representation of five
cabinet departments in planning, only one cabinet secretary-Dr. Otis
Bowen - appeared at this meeting.

It is never an easy assignment to respond to workshop recommendations
because the time is short, the number of recommendations great, and the
Surgeon General has neither budget nor power, save the power of moral
suasion.

It has been my custom to keep the participants and other interested
individuals and organizations apprised of initiatives undertaken and other
activities 6 months and 1 year after publication of the booklet. On selected
subjects in former workshops, annual progress reports have also been
provided to participants.

I am pleased that Jeffrey Miller and Loran Archer have been able to
respond to your deliberations and, believe me, I am grateful to them. They
have indicated a willingness to work with us, and you have heard what a
resource they are for you.

I find myself in the cleanup position, and since the other respondents and
I have already conferred, I will try not to be repetitious. Since the subjects of
many of the panels are crosscutting, generic remarks covering all panels
seem appropriate. Obviously, I will properly refer recommendations with a
narrow focus to appropriate agencies. And when recommendations are sent,
ail will be sent because of the overlaps and crosscutting of some issues and
panels.

The advertising and marketing recommendations remind me of the first,
and at times faltering, steps taken 25 years ago in reference to tobacco
advertising. I'm not being critical; that's a compliment.

93


CLOSING REMARKS

In reference to the research recommendations, you have already heard
from Mr. Archer. I will discuss them with Mr. Archer and Dr. Gordis of
NIAAA, and with Dr. Fred Goodwin, Administrator of ADAMHA, as well
as getting them exposure in appropriate media catering to the academic
community.

I will present the epidemiology panel's recommendations to Dr. James
Mason, Director of the Centers for Disease Control (CDC), for a critique for
feasibility on the part of the Federal Government and request that he report
on current and future plans of the CDC that may address specific
recommendations. I will also ask for the cooperation of the CDC in wide
dissemination of the panel's findings.
Education is probably where I can be most effective, and I pledge myself
to this effort both now as your Surgeon General and later when I leave this
office for the private sector.

I will seek appropriate counsel regarding the broad dissemination of the
judicial and administrative enforcement recommendations to those agencies
most likely to have responsibility and/or the ability to act.
I will undertake to deliver to organized medicine by appropriate
means-personal and by transmittal- concerns and recommendations of the
injury control and treatment panels. I will be contacting these organizations
early on:

  o  American Medical Association-especially the student sector

  o  National Medical Association - for some of the ethnic
   considerations

o  American Academy of Pediatrics

o  American College of Surgeons

o  American College of Preventive Medicine

o  American Academy of Family Physicians

o  American Trauma Society and others that will come to mind or
be suggested by you.

Appropriate contact will also be made with the following groups to
expedite the recommendations on youth and other special populations.
o National PTA

o  National School Board Association


o  The various associations of school principals

o  The National Education Association.


CLOSING REMARKS                 95

My work with these groups over the past few years regarding AIDS gives
me easy access and ready credibility.

But also: Boy Scouts, Girl Scouts, Camp Fire Girls, 4-H Clubs, and others.
I note the crosscutting nature of the concerns of the citizen advocacy
panel. I will convene a group (and welcome suggestions from the panel) to
consider the formation of a nonprofit corporation of the 5Ol(c)3 type to act
as an umbrella for a coalition to be supported by dues - to set its own
agenda. I will provide funds to pay legal fees and other expenses to get this
off the ground.

I will seek to put this new organization in touch with possible ongoing
sources of funding. Believe me, this is an effective and productive tool,
judging from our post-workshop experiences with organ procurement for
transplants, child abuse, resource location for handicapped children,
self-help, and so on. I will see that these recommendations reach the widest
possible audience, because we all must be advocates.
And now for some comments that apply to all panels-I will:

Use my relationship with organized medicine to give the final
product of this workshop the broadest applications.
See that a copy of the final document goes to each Senator and
each Congressman with an appropriate covering letter from me.
Do the same for the chiefs of staff of the various congressional
committees that could have a legislative interest in these
recommendations.

Present these findings in detail and with additional comments to
the Association of State and Territorial Health Officers at their
annual meeting in the spring.

Seek an appropriate opportunity to address municipal and
county health officers in the same manner.
Personally sit down with the new Secretary of the Department
of Health and Human Services soon and with the new Surgeon
General eventually and solicit their personal involvement
because of the gravity of the situation and the need for action,
and

Wherever possible, I will lay the burden on government
agencies, private agencies, and academia and seek cooperation
at every level.

When the new administration is underway, I will see that the governors of
each State and territory receive the complete set of documents with a
covering letter from me.


96               CLOSING REMARKS

Now for a final word. Strange as it may seem, there are a few people and
organizations who would have preferred that we not meet on this subject this
week - or maybe ever.

I guess by now everyone knows of my correspondence with Mr. Edward
0. Fritts, President of the National Association of Broadcasters (NAB)
inasmuch as the press had his letter to me when I received my copy. His is a
key organization, I won't deny that. I wanted him and the NAB to be here
with us. I wanted everyone to hear the NAB's point of view not only because
broadcasters are very influential - as we all know-but because they also
have so much at stake in this issue. Hence, they certainly have a right to be
here.

That's why I invited Mr. Edward Fritts. And that's why I also invited Mr.
John O'Toole, the Executive Vice-President of the American Association of
Advertising Agencies (the `Y-A's"), and Mr. Dewitt Helm, the President of
the Association of National Advertisers, the people who are the clients of
the 4-A's.

But all three declined. Mr. O'Toole and Mr. Helm suggested that our
workshop lacked "good balance." They also said they had very little time to
prepare for the discussion that would no doubt take place here. And each
person suggested I cancel the workshop.
I was sorry to get their replies. But, if I may say so, I think their complaints
and suggestions are quite unfair. Now, it is true that one message that might
be heard at this workshop is this one: alcohol contributes to injury and
premature death.

That's a troubling message, to be sure, and one's instincts might well be,
figuratively speaking, to "kill the messenger"- in this case, discredit this
workshop or have it cancelled. If so, then Mr. O'Toole's and Mr. Helm's
strategy didn't work.

However, the letter to me from Mr. Fritts of the NAB was a bit more
unsettling because it contained this observation:
    At best, this workshop is designed to politicize the
    emotional tragedy of drunk driving. At worst, it is a total
    abuse of the policy-setting process.
In addition to being surprised at that unfortunate choice of words, I was
taken aback by that observation, since over the past 7 years I have personally
convened and conducted a dozen workshops, several at the request of
President Reagan, dealing with such difficult issues as -
o Organ transplantation;
o Domestic violence;

o The needs of handicapped children and their families; and


CLOSING REIvfARKS                 97

  . The role of the self-help movement in public health.
And I've conducted workshops on child pornography and public health
and on the care of children who are born with AIDS, and so on. None of
these workshops was called to "politicize an emotional tragedy," and all
these workshops contributed significantly to the policymaking process of this
administration. AS till this one, I am sure.
I don't wish to dwell on the NAB's criticism because it may be nothing
more than an early and predictable phase in the industry's learning process.
That's been the immediate response from the broadcasting and the
advertising industries. We obviously must wait for them to offer something
more helpful. But what are the chances that will happen? If history is any
guide, the chances might be slim.

I hope that's not the case, because the history of smoking and health is not
encouraging. I've reviewed the way the tobacco, broadcasting, and
advertising industries behaved around the time my predecessor, the late Dr.
Luther Terry, released the first Smoking and Health Report 25 years ago.
From that review I can see that, even at this early stage of discussion, there
are already similarities of behavior.

And that's a shame. I think we'd all prefer that these industries-and their
chosen leaders-would heed the oft-quoted wisdom of George Santayana,
who wrote

Those who cannot remember the past are condemned to
repeat it.

I can tell you that I, for one, would rather not repeat the difficult times we
had in the past. I do not think the confrontations were always necessary or
fruitful.

But some aspects of the past are worth noting and worth emulating. For
example, 25 years ago the public health community, with the support of many
citizens' groups and a substantial number of members of Congress,
embarked upon a systematic program of research into the relationship
between smoking and health.

At the same time, and in a responsible way, we also began to look at the
public policy implications of the research results, as they came to light. From
that information we were able to plan ways to help the American people cast
off this high-risk health behavior: smoking. And that meant principally a
long-range and unremitting program of public education and instruction.
That's what happened regarding the issue of smoking and health. And
certainly drinking and driving is high-risk behavior amenable to education
and instruction.

1 respectfully suggest that Mr. Fritts, Mr. O'Toole, and Mr. Helm- and


98                CLOSING REMARKS

their colleagues -review that history as I did, because the American people
may now be - in terms of alcohol-where we were 25 years ago in terms of
tobacco.

The relationship of the National Commission Against Drunk Driving and
this workshop provides a puzzle not easy to solve. That we-the Commission
and this workshop-have the same presumed goal should be obvious. That
we should stand together makes sense.

Yet Mr. Adduci, Chairman of the Commission, cleverly suggested to me
in a letter of November 28,198& that "you may be considering the following
along with other options." One option was to "disregard the views and
position of the National Association of Broadcasters." Another was to
postpone this meeting, and a third was to "notify all panelists that (my) office
had overlooked or was unaware of the fact that DOT had given the National
Commission a $100,000 grant to do a 16-month assessment of its initiatives."

After further correspondence with me and conversations with my staff, it
was agreed that Mr. Adduci and I would let no light be seen between us as
we stood side by side in this effort to reduce the carnage on our highways and
streets. And that either Mr. Aducci or his program director, Dr. Grant,
would speak at the opening plenary session.

This seemed very appropriate in view of the published report of the
commission on "youth driving without impairment," excerpts of which both
Dr. Bowen and I read the day before yesterday at the plenary and
commented upon favorably.

Yet when the confirmatory letter was faxed to me on the 13th-the day
before this workshop opened-there was a quid pro quo. In return for that
speech, we would not release conclusions or recommendations of two of our
panels until the commission had completed its assessment project-a
minimum of 16 months from whenever they start.

I thought that would be unacceptable to you and, therefore, the
Commission refused to speak at the opening plenary session. I thought the
proposed delay - 16 months -was particularly inappropriate in view of the
fact that the National Beer Wholesalers Association and the National
Association of Broadcasters, with participating legal counsel, in the most
intense discussions Wednesday, Thursday, and today, requested only a
45day comment period followed by a 30-day delay before final publication.

As for me, I intend to ignore those who would lynch or execute a first
offender in drunk driving, just as I would ignore those who say that it has not
yet been proven that alcohol is responsible for impaired driving. I intend to
assume what leadership role I may between these two extremes and, as I have
with other issues, transmit what energy, enthusiasm, and credibility I have to
this war against impaired driving.


CLOSING REMARKS                 99

I will think of lots more and keep you posted.
Thanks to Amy Barkin, Steve Moore, and many others who have brought
US this far with the workshop and thank you, Susan Lockhart, for all you will
do with me as we face this problem in the new year.
And thank all of you for coming. Have a blessed holiday season and all
that's good in the new year.



List of Participants

Ritchie Aanderud. President, Remove Intoxicated Drivers, Washington
State, Puyallup, WA.

Doris A&en. President, Remove Intoxicated Drivers, Schenectady, NY.
John Allen, PhD. Chief, Treatment Research Branch, National Institute on
Alcohol Abuse and Alcoholism, Alcohol, Drug Abuse and Mental
Health Administration, U.S. Public Health Service, Rockville, MD.
Gloria Ames, CDR. Immigration and Naturalization Service, Health Care
Program, Washington, DC.

David Anderson, PhD. Substance Abuse Specialist, Arlington, VA.
Robert Apsler, PhD. Harold Russell Associates, Inc., Winchester, MA.
Loran Archer. Deputy Director, National Institute on Alcohol Abuse and
Alcoholism, Alcohol, Drug Abuse and Mental Health Administration,
U.S. Public Health Service, Rockville, MD.
Katherine Armstrong, PhD. Coordinator, Children and School Programs,
Office of Disease Prevention and Health Promotion, U.S. Public
Health Service, Washington, DC.
Charles Atkin, PhD. Professor, Department of Communications, Michigan
State University, East Lansing, MI.
Darryl Bertolucci. Mathematical Statistician, Division of Biometry and
Epidemology, National Institute on Alcohol Abuse and Alcoholism,
Alcohol, Drug Abuse, and Mental Health Administration, Rockville,
  MD.

Harold Brandt, MD. Mothers Against Drunk Driving, Baton Rouge, LA.
Rebecca Brown. National Legislation Chairman, Mothers Against Drunk
Driving, Hudson, FL.

Johnny Mack Brown. Sheriff, Greenville County Sheriffs Office,
Greenville, SC.

Raul Caetano, MD, PhD. Alcohol Research Group, Berkeley, CA.
Beverly Campbell. Church of Jesus Christ of Latter Day Saints,
Washington, DC.

Kay Chopard. Staff Attorney, Prosecuting Attorneys' Training Council, Des
Moines, IA.

101


102

PARTICIPANTS

Marlene Cole, LCDR. Veterinary Resources Branch, Division of Research
Services, National Institutes of Health, U.S. Public Health Service,
Bethesda, MD.

Ricky Davidson. Chief, Emergency Medical Services Committee,
International Association of Fiiechiefs, Shreveport, LA.
Galen Davis. Special Assistant to the Governor, Topeka, KS.
Delores Delaney. Member, National PTA, Committee on Health, Virginia
Beach, VA.

Robert W. Denniston. Director, Division of Communication Programs,
Office for Substance Abuse Prevention, Alcohol, Drug Abuse and
Mental Health Administration, U.S. Public Health Service, Rockville,
  MD.

Ted Doege, MD. American Medical Association, Chicago, IL.
John Donovan, PhD. Research Associate, Institute of Behavioral Sciences,
University of Colorado, Boulder, CO.
James P. Donovan. Chief, Division of Law Enforcement Services, Bureau of
Indian Affairs, Washington, DC.

Martin R. Eichelberger, MD. Director, Emergency Trauma Service,
Children's Hospital, National Medical Center, Washington, DC.
Vernon Ellingstad, PhD. Department of Psychology, University of South
Dakota, Vermillion, SD.

Ann Esch. North Carolinians Against Intoxicated Drivers, Winston-Salem,
  NC.

James A. Farrow, MD. Director, Division of Adolescent Medicine,
Director, Reduce Adolescent Drinking and Driving Project,
Department of Pediatrics, University of Washington, Seattle, WA.
Howard F&ton, MD. Duke University Medical Center, Durham, NC.
Mary L. Ganikos, PhD. Program Director, Late Life Alcohol Abuse,
Prevention Research Branch, National Institute on Alcohol Abuse and
Alcoholism, Alcohol, Drug Abuse, Mental Health Administration, U.S.
Public Health Service, Rockville, MD.
Dean Gerstein. Study Director, National Academy of Sciences,
Washington, DC.

Mark Goldman, PhD. Professor of Psychology, Director, Clinical Program,
University of South Florida, Tampa, FL.
Michael Goodstadt, PhD. Director, Division of Prevention, Rutgers Center
for Alcohol Studies, Rutgers University, Piscataway, NJ.
Lawrence A. Greenfeld. Deputy Associate Director, Bureau of Justice
Statistics, Department of Justice, Washington, DC.


PARTICIPANTS

103

Joseph Gusfield, PhD. Professor, Department of Sociology, University of
California at San Diego, La Jolla, CA.
Frank Hamilton, MD, CAPT. National Institutes of Health, U.S. Public
Health Service, Bethesda, MD.

Maury Hannigan. Deputy Commissioner, California Highway Patrol,
Sacramento, CA.

John Harvey. Elementary and Traffic Safety Education Consultant, State
Department of Education, Montpelier, VT.
William Hayes. Manager, New Jersey Highway Safety Office, Trenton, NJ.
Anthony J. Heckemeyer. Presiding Circuit Judge, 33rd Judicial District,
  Benton, MS.

Sandy Heverly. Mothers Against Drunk Driving, Las Vegas, NV.
Ralph Hingson, ScD. Professor, Chief of Social and Behavioral Sciences,
School of Public Health/College of Medicine, Boston University,
Boston, MA.

Harold Holder, PhD. Director, Prevention Research Center, Berkeley, CA.
Jan Howard, PhD. Chief, Research Prevention Branch, National Institute
on Alcohol Abuse and Alcoholism, Alcohol, Drug Abuse, and Mental
Health Administration, U.S. Public Health Service, Rockville, MD.
Michael Impellizzeri. Chief, Special Programs Division, National Highway
Traffic Safety Administration, Washington, DC.
Michael Jacobson, PhD. Director, Center for Science in the Public Interest,
Washington, DC.

Paul Kamenar. Executive Legal Director, Washington Legal Foundation,
Washington, DC.

Jean Kilbourne, EdD. Board Member, National Council on Alcoholism,
West Newton, MA.

Michael Klitzner, PhD. Pacific Institute of Research and Evaluation,
Bethesda, MD.

John Lacy, PhD. Director for Alcohol Studies, The University of North
Carolina, Highway Safety Research Center, Chapel Hill, NC.
Ray Larson, Commonwealth's Attorney, Lexington, KY.
Patricia D. Mail, CAPT. Division of AIDS Programs, U.S. Public Health
Service, Rockville, MD.

Philip May, PhD. Professor, Department of Sociology, University of New
Mexico, Albuquerque, NM.

Michael Mazis, PhD. Professor and Chair, Department of Marketing,
American University, Washington, DC.
Katherine McCarter. Associate Executive Director, American Public
Health Association, Washington, DC.


104              PARTICIPANTS

John McCarthy, PhD. Department of Sociology, Catholic University,
Washington, DC.

George McCarthy. Chairman, Alcoholic Beverage Control Commission,
Boston, MA.

Susan McLaughlin, MSN, RN. Senior Staff Specialist, Center for Nursing
Practices, American Nurses Association, Kansas City, MO.
Allan Meyers, PhD. Associate Dean, College of Liberal Arts, Boston
University, Boston, MA.

John Moulden. National Transportation Safety Board, Washington, DC.
Joyanne Murphy, LCDR. National Institutes of Health, U.S. Public Health
Service, Bethesda, MD.

Dennis Nalty, PhD. Director, Office of Policy Analysis and Development,
South Carolina Commission on Alcohol and Drug Abuse, Columbia,
  SC.

Carl E. Nash. Chief, Accident Investigations Division, National Center for
Statistics and Analysis, National Highway Traffic Safety
Administration, Washington, DC.

James Nichols, PhD. Deputy Director, Scientific and Technical Affairs,
National Highway Traffic Safety Administration, Department of
Transportation, Washington, DC.

Perla Niguidula. Club Operations Specialist, Recreation Services
Department, Naval Military Personnel Command, Arlington, VA.
Robert Niven, MD. Harper Hospital, Department of Psychiatry, Detroit,
  MI.

Peter O'Rourke. Director, Office of Traffic Safety, Business and
Transportation Agency, Sacramento, CA.

Howard P. Patinkin. Assistant Deputy Superintendent, Chicago Police
Department, Traffic Division Administration, Chicago, IL.

Terry Pence. Traffic Safety Section, State Department of Highways and
Public Transportation, Austin, TX.

M.W. Perrine, PhD. Director, Vermont Alcohol Research Center,
Burlington, VT.

James Peters. Responsible Hospitality Institute, Springfield, MA.
Charles Phelps, PhD. Professor of Economic and Political Science,
Director, Public Policy Analysis Program, University of Rochester,
Rochester, NY.

Joan White Quinlan. Coordinator, Prevention Program, Special Programs
Division, National Highway Traffic Safety Administration, Department
of Transportation, Washington, DC.


PARTICIPANTS

105

George L. Reagle. Associate Administrator for Traffic Safety Programs,
National Highway Traffic Safety Administration, Washington, DC.
Nancy Ricci. President, Remove Intoxicated Drivers, Connecticut,
Wallingford, CT.

Mary Beth Robinson. Director of Public Relations, National Automobile
Dealers' Association, McLean, VA.
James D. Rogers, Judge. Fourth Judicial District Court, Minneapolis, MN.
H. Laurence Ross, PhD. National Institute of Alcohol Abuse and
Alcoholism, Alcohol, Drug Abuse and Mental Health Administration,
U.S. Public Health Service, Rockville, MD.
Wes Roy. Representative, City of Radcliff, Radcliff, KY.
Sue Rusche. National Drug Information Center of Families in Action,
Atlanta, GA.

Mickey Sadoff. President, Mothers Against Drunk Driving, Hurst, TX.
Robert Sal&, PhD. Assistant Director, Prevention Research Center,
Berkeley, CA.

Lawrence Schneider. Health Services and Facilities Consultant, Office of
Emergency Medical Services, Department of Health and Rehabilitative
Services, Tallahassee, FL.

William Scott. Director, Office of Alcohol and State Programs, National
Highway Traffic Safety Administration, Washington, DC.
Jeri Shaw. Johnson, Bassin and Shaw, Inc., Silver Spring, MD.
Harvey Siegel, PhD. Professor and Director, Wright State Substance Abuse
Intervention Programs, School of Medicine, Wright State University,
Dayton, OH.

Bruce Simons-Morton, EdD, MPH. Associate Professor, Center for Health
Promotion Research and Development, University of Texas, Health
Science Center at Houston, Houston, TX.
David A. Sleet, PhD. Professor, Department of Health Science, Graduate
School of Public Health, San Diego State University, San Diego, CA.
Phillip Smith, MD, CDR. Indian Health Service, U.S. Public Health
Service, Rockville, MD.

Richard J. Smith III, CDR. Manager, Injury Prevention Program, Indian
Health Service, U.S. Public Health Service, Rockville, MD.
Carl Soderstrom, MD. Assistant Professor of Surgery, Associate Director
of Physician Education, University of Maryland, Maryland Institute for
Emergency Medical Services Systems, Baltimore, MD.
Dorothy Stephens, LTJG. Health Resources and Services Administration,
U.S. Public Health Service, Rockville, MD.


106              PARTICIPANTS

Alvera Stern, PhD. Administrator, Division of Prevention and Education,
Illinois Department of Alcoholism and Substance Abuse, Chicago, IL.
Kathryn Stewart. Pacific Institute for Research and Evaluation, Vienna, VA.
James W. Swinehart, PhD. President, Public Communication Resources,
Inc., Pelham Manor, NY.

Elsie Taylor. Public Health Advisor, Prevention Research Branch, National
Institute on Alcohol Abuse and Alcoholism, Rockville, MD.
John M. Templeton, Jr., MD. Childrens Hospital of Philadelphia,
Philadelphia, PA.

Stephen Teret, JD, MPH. Director, Johns Hopkins Injury Prevention
Research Center, Johns Hopkins University School of Hygiene and
Public Health, Baltimore, MD.

Rae Tyson. USA Today, Arlington, VA.
Chauncey Veatch, III. President, National Association of State Alcohol and
Drug Abuse Directors, Department of Alcohol and Drug Programs,
  Sacramento, CA.

Robert Voas, PhD. Pyramid Planning, Bethesda, MD.
Alexander Wagenaar, PhD. Associate Research Scientist, University of
Michigan, Transportation Research Institute, AM Arbor, MI.
Lawrence Wallack, Dr.P.H. Associate Professor, School of Public Health,
University of California, Berkeley, CA.
Julian Waller, MD, MPH. Professor, Department of Medicine, University
of Vermont, Burlington, VT.

Patricia Waller, PhD. Associate Director for Driver Studies, Highway
Safety Research Center, University of North Carolina, Chapel Hill, NC.
Joel Watne. Special Assistant, Attorney General, State of Minnesota,
Roseville, MN.

Clark Watts, MD, MPH. Professor of Neurosurgery, University of
Missouri, Arlington, VA.

Richard Waxweiller, PhD. Chief, Epidemiology Branch, Division of Injury
Epidemiology and Control, Center for Environmental Health, Centers
for Disease Control, U.S. Public Health Service, Atlanta, GA.
Elizabeth A. Weaver. Director of Education, Motorcycle Safety
Foundation, Irvine, CA.

Allan F. Williams, PhD. Senior Researcher, Insurance Institute for
Highway Safety, Washington, DC.
Marsha Woodward. President, Remove Intoxicated Drivers, Allen County,
Scottsville, KY.

Judy Zundel. Special Assistant to the Deputy Assistant Secretary, Indian
Affairs (Trust and Economic Development), Bureau of Indian Affairs,
Washington, DC.

Q U.S.GOVERNMEM P!+lNllNGCfFCE 1999 2344.92