1. Introduction

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Recent figures show the number of drink drivers involved in accidents has risen in the UK for the first time in a decade. In 2015, 3,450 drivers failed a breath test after an accident, up from 3,227 in 2014.[1]Figures from the Department of Transport reveal 1,380 people were killed or seriously injured in alcohol related accidents during 2015 – up five per cent on the previous year. According to the latest figures from the Institute of Alcohol Studies, every year drink driving causes 240 deaths and more than 8,000 casualties in the UK. 60% of those who are killed or injured are people other than the driver, such as passengers, pedestrians and cyclists. The cost to the country has been estimated at £800 million a year[2].

The level of 80mg/100ml was set in the UK over 50 years ago, England along with Wales and Northern Ireland continue to have one of the highest drink drive limits in the world. In fact, the UK is the only country of the 53 member states of WHO European region not to have reduced the legal limit to 50 mg/100ml3. Nine of the European Union (EU) member state countries have gone as far as legislating for a zero tolerance level on the basis that any alcohol concentration in the blood increases the risk of a crash. Novice drivers and Professional /com - mercial drivers particularly need to be targeted and the WHO strategy is to supplement enforcement of the lower drink drive limit with more random breath tests and more punitive personal punishment[3].

After Scotland lowered its limit to 50 mg/100ml in December 2014, police figures showed a 12.5% decrease in drink driving offences in the first nine months. Statistics released by Transport Scotland revealed 168 deaths in 2015, down from 203 the previous year and a drop in the total number of casualties, which fell by 3% from 11,307 to 10,968 – the lowest number since records were started[4].

Many factors in addition to the level of alcohol in the blood influence the extent of impairment in driving skills including weight, age, sex and metabolism.[5] Newer patterns of alcohol consumption such as the fashion to mix alcohol with other drugs and energy drinks have been shown to have a profound influence on accident causation. Energy drinks lessen subjective intoxication in persons who have also consumed alcohol and cause a significantly higher frequency of alcohol related consequences, even after adjusting for the amount of alcohol consumed. Almost one-quarter of college students report mixing alcohol with energy drinks.[6] Drug use – marijuana, narcotics, stimulants and depressants is also associated with significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol.[7] The binge drinking pattern is known to have increased considerably over the past ten years in the UK and binge drinkers have been found to be more likely to drive while impaired by alcohol compared with non-binge drinkers.[8] After an evening bout of binge drinking, concentrations of alcohol will still be present the following morning sufficient to fail breath test analysis[9].

Certain age groups appear to be particularly vulnerable. A Freedom of Information (FoI) request published in 2016 revealed that 27-year- old men and 26-year-old women were the most common drink-driving offenders at 8,886 and 1,620 respectively, and that thirty year-old men had 95 per cent more offences at 8,258 compared to the 258 of 18-year-old male drivers. Older age groups also have a high risk of offending, with 80-year-olds being nearly twice as likely to be caught drink-driving compared to 17-year-olds.[10]

The potential benefit of lowering the maximum drink drive limit to 50mg/100ml will need to be combined with effective deterrent penalties. In addition, improved awareness campaigns for the age groups identified along with insightful targeting of other vulnerable groups including the often resistant daily drinkers will be essential.[11] The establishment of zero tolerance level needs to be considered further particularly for the groups described as being at most risk and when alcohol intake is combined with other addictive drugs.[7,12] With just 10mg/100ml concentration in blood, these subjects have an increased likelihood of being involved in a fatal accident. The current reluctance of Government to impose more fiscal and regulatory measures to reduce overall alcohol consumption in this country may not apply to the same extent to drink driving limits.[13] Indeed Government have stated that reduction in drink driving remains a priority. There is also strong public support for lowering the limit, with the British Social Attitude Survey recently reporting that three quarters of the public (77%) support lowering the drink driving limit.[14]

References

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1. http://www.telegraph.co.uk/news/2016/09/30/n umber-of-drunk-drivers-involved-in-accidents-rises-for-first-ti/ (Accessed 30/10/17) a. By Lexi Finnigan - Number of drunk drivers involved in accidents rises for first time in a decade. The Telegraph, 30 Sept 2016.
2. http://www.ias.org.uk/uploads/pdf/IAS%20sum mary%20briefings/lowerlimitbriefing.pdf
   a. By Institute of Alcohol Studies, 5th September 2016. (Accessed 30/10/17)
3. http://www.euro.who.int/__data/assets/pdf_file/0007/244897/Drinkdriving-policies-and
   -countermeasures.pdf?ua=1 (Accessed 30/10/17) a. European status report on alcohol and health 2014. Drink-driving policies and countermeasures. World Health Organisation Regional Office for Europe.
4. https://www.sundaypost.com/news/scottish-news/road-accident-deaths-17-year-drink-drive-limit-lowered/ (Accessed 30/10/17) a. By Lucinda Cameron – Road accident deaths down 17% in 2015 during year after drink drive limit lowered. Press Association, 19th October 2016 – Sunday Post. © DC Thomson Co Ltd 2017.
5. Marks P, Williams R. Alcohol-related road traffic accidents: promoting a lower alcohol strategy. Clin Med (Lond). 2007 Aug;7(4):348-50.
6. O'Brien MC, McCoy TP, Rhodes SD, Wagoner A, Wolfson M. Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med. 2008: May; 15(5):453-60.
7. Li G, Brady JE, Chen Q. Drug use and fatal motor vehicle crashes: a case-control study. Accid Anal Prev. 2013 Nov; 60:205-10.
8. Marks P, Williams R. Escalation of Binge Drinking Pattern and Its Consequences. J Alcohol Drug Depend SubstAbus. 2015; 1: 001.
9. https://www.thesun.co.uk/motors/3524266/drin k-drive-deaths-rise-as-one-in-eight-fail-roadside-breath-test-50-years-after-limit-is-first-introduced/ (Accessed 30/10/17) a. By Joe Finnerty - Drunk at the wheel. The Sun, 10th May 2017.
10. http://www.dailymail.co.uk/news/article-3552947/Women-30s-40s-19-times-likely-caught-drink-driving-teenage-motorists.html (Accessed 30/10/17) a. By Daily Mail Reporter - A Freedom of Information (FoI) request to the Driver and Vehicle Licensing Agency (DVLA) into drink-driving offences from January 2011 to January 2016, published on Monday, Apr 22nd 2016.
11. https://academic.oup.com/eurpub/article/23/sup pl_1/ckt126.151/2838015 (Accessed 30/10/17) a. By Schulze H. Recommendations of EU-project DRUID (Driving under influence of drugs, Alcohol and Medicines). European J of Public Health, 23(Suppl 1); 2013: 66.
12. Sewell RA, Poling J, Sofuoglu M. The effect of cannabis compared with alcohol on driving. Am J Addict. 2009 May-Jun;18(3):185-93.
13. Williams R, Alexander G, Aspinall R, Bosanquet J, Camps-Walsh G, Cramp M, Day N, Dhawan A, Dillon J, Dyson J, Ferguson J, Foster G, Gardner R, Gilmore SI, Hardman L, Hudson M, Kelly D, Langford A, Liversedge S, Moriarty K, Newsome P, O'Grady J, Pryke R, Rolfe L, Rutter H, Ryder S, Samyn M, Sheron N, Taylor A, Thompson J, Verne J, Yeoman A. New metrics for the Lancet Standing Commission on Liver Disease in the UK. Lancet. 2017 May 20;389(10083):2053-2080.
14. http://www.alcoholpolicy.net/2016/09/social-survey-attitudes-2015-is-support-for-minimum-pricing-growing.html (Accessed 30/10/17) a. Alcohol Policy UK – news and analysis for the alcohol harm reduction field.