Adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992
Revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General ssembky, Taipei, Taiwan, October 2016
Deaths and injuries resulting from road crashes and collisions are a major public health problem. The World Health Organization’s 2015 Global status report on road safety indicates that the total number of road traffic deaths per year has reached 1.25 million worldwide, with the highest road traffic fatality rates in low-income countries.
Driving while under the influence of alcohol has caused a large number of the deaths and injuries resulting from road crashes. The prevalence of drinking and driving is increasing worldwide each year.
A change in the behaviour of road users with regard to alcohol consumption would appear to be the most promising approach to preventing traffic deaths and injuries. Measures forbidding driving while under the influence of alcohol will lead to a considerable improvement in road safety and an appreciable reduction in the number of dead and injured.
CONSEQUENCES OF DRINKING AND DRIVING
Driving a vehicle implies the acceptance of a certain number of risks. The careful driver will always be aware of the risks but also ensure that the level of risk never rises to an unacceptable level. Alcohol not only impairs one’s ability to drive, but it also alters a driver’s subjective assessment of risk so that he or she drives more recklessly.
Irrespective of the amount of alcohol consumed, the maximum concentration of alcohol in the body is reached:After half an hour when taken
- on an empty stomach;
- After an hour when taken with a meal.
On the other hand, it takes the body a long time to eliminate alcohol. An individual in good health eliminates alcohol at a rate that reduces blood alcohol concentration by 0.1 to 0.15 gram/litre/hour. Thus, one’s driving ability remains impaired long after he or she has stopped drinking.
Alcohol abuse has both short- and long-term neurological and psychiatric consequences that can endanger road safety.
Certain drugs interact negatively with alcohol, and in particular some combinations are known to reduce alertness. When drugs, whether legal or illegal, are taken with alcohol, the effect of the latter is intensified. This mixture can trigger mental dysfunctions that are extremely dangerous for road users. Physicians should be educated and informed about these pharmacological facts.
1. The WMA reaffirms its commitments to work for reducing excessive alcohol consumption and for fostering harm-reduction policies and other measures (WMA Declaration on Alcohol, October 2015.)
2. Physicians and National Medical Associations should play an active role in promoting and advocating for the development of evidence-based government policies to reduce alcohol use and driving:
3. At the present time, permitted blood alcohol levels while driving vary from country to country. Even small amounts of alcohol have a direct effect on the brain, with disturbances noted at levels as low as 0.3 grams per litre. Therefore, it would be desirable to lower the maximum permissible level of blood alcohol to a minimum, but not above 0.5 grams per litre, which is low enough to allow the average driver to retain the ability to assess risk.
4. The especially high prevalence in certain countries of driving while under the influence of alcohol may justify more coercive policies, which physicians and National Medical Associations should play an active role in supporting. For example, the driver may be declared unfit to drive for a period of time sufficient to ensure he or she will no longer be a threat to road safety in the future.
5. Government officials should consider implementing restrictions on the sale or affordability of alcohol, perhaps through taxation, licensing systems, and/or limits on the days and hours of sale. Restrictions on the promotion of alcoholic beverages, including advertising and event sponsorship, should also be considered.
6. A minimum legal age for alcohol purchase and consumption should be adopted in each country. Government officials should consider implementing a separate, lower or zero blood alcohol content law for young drivers.
7. There should be strict consequences to selling alcoholic beverages to individuals under the age to purchase and consume alcohol. These laws should be properly enforced.
8. Any driver who has been in a road traffic crash must undergo a blood alcohol concentration test or a breath test.
9. The practice of random driver testing for breath alcohol levels should become more widespread, and there should be further research into other ways to test urine, breath and saliva to identify impaired drivers and prevent subsequent operation of motor vehicles.
10. Devices that prevent individuals with an unauthorised level of blood alcohol from starting the engine of or operating the vehicle should be developed and experimented with.
12. Educational interventions should promote moderation and responsibility in the consumption of alcohol and seek to reduce the likelihood that someone will consume alcohol and drive afterwards.
13. The information dispensed by physicians and other health professionals should be aimed at making everyone aware of the dangers of driving under the influence of alcohol. When physicians and other health professionals issue fitness-to-drive certificates, they can use this opportunity to educate road users and pass on a message of prevention and personal responsibility.
14. In most countries, road crashes linked to alcohol consumption affect adolescents and young adults to a disproportionately high degree, and every available resource should be mobilised to reduce their consumption of alcohol. The problem of alcohol consumption in adolescents and young adults and its relation to road safety should be addressed in the school curricula so that a responsible attitude becomes the norm.
Clinical and rehabilitative interventions
15. Physicians should also be involved in reducing the likelihood of impaired driving by participating in the detoxification and rehabilitation of drunk drivers. These initiatives should be based on a detailed analysis of the problem as it manifests itself within each country or culture. Generally speaking, however, alcoholism is a medical condition with concomitant psychological or social and interpersonal difficulties that affect the family, work or social environment.
16. Alcoholic subjects should be given access to rehabilitation services. When drivers are found to have excess alcohol in their blood (or their breath), other factors linked to their excessive drinking should be examined and included in a rehabilitation programme. These rehabilitation programmes should be publicly funded.
17. Road crashes linked to the consumption of alcohol can be considered as possible predictors of other addictive and violent behaviours. This should be taken into consideration in the medical treatment of the patient.
18. Strategies should be developed by relevant stakeholders to ensure safe transportation home in situations where alcohol consumption occurs.
19. Eliminating alcohol from the workplace and in situations where consumers must drive should be a goal of organizational policies. The promotion of non-alcoholic drinks is an important tool to facilitate these policies.