Don’t Drink and Drive.
A very simple message at first glance. But then caveats crept in. You can have one drink, maybe two. Various websites suggest anything up to four units of alcohol, that’s 2 pints, can safely be drunk and an individual can legally drive.
This statement contains so many contradictions. The first is that alcohol ingested has an equivalent impact on everyone. The concentration of alcohol in blood depends on various factors, including weight, age, gender and medications that interfere with the enzymes responsible for metabolising most drugs, including alcohol.
Far more pertinent is the use of the word “safely” next to the “legal limit” referring to alcohol and driving. England, Wales and Northern Ireland currently have the highest legal limits to drive in Europe at 80mg of alcohol per 100ml of blood. In most of Europe, including Scotland, the blood alcohol limit is 50mg/100ml, and in many countries it’s even lower. For example, in Sweden, the legal limit is 20mg/100ml for all drivers – effectively zero tolerance – while Hungary, Romania, Slovakia and the Czech Republic don’t allow drivers to drink any alcohol at all.
Even the European average of 50mg/100ml trebles the risk of a fatal road traffic accidents compared to not drinking at all. The UK legal limit of 80mg/100mls further doubles the risk compared to the European average limit, which means there is a 6-fold increase in the likelihood of being involved in a fatal crash, compared to not drinking at all. Just having 10mg/100mls – less than half a glass of wine - increases the risk of being at fault in a collision by 46%.
Everyone reacts differently to alcohol so there is no failsafe way to tell how much alcohol puts an individual over the legal limit and even small amounts of alcohol can increase the risks of an accident so, if you are driving, the safest amount to drink is nothing.
So why is this message not getting through?
Alcohol is an integral part of British culture. “A beer after work”, “Is it Gin o’clock yet?”, “one for the road” are phrases that have permeated the language. To change this does require a cultural shift - which can be aided by increasing public awareness - but arguably, not by much. There’s widespread recognition that the existing drink driving limits are too high, with 77% supporting lowering the drink-drive limit.
Government must follow public opinion for this policy change and reduce the legal drink driving limit. In addition, to ensure this change is effective in reducing the harms of drink driving, it is also important for a focus on increased enforcement of it and for the government to introduce accompanying policies to reduce alcohol-related harm including public education campaigns and greater treatment and support services for those who need it.
Of course, alcohol is not the only substance that impairs driving ability and can lead to significant harm.
Drug-driving accidents are on the rise – with an 260% increase from 2012 to 2021. Both illegal and legal drugs can impair driving. There is a zero-tolerance policy for driving under the influence of 8 illegal drugs in England, Scotland and Wales, and different threshold limits for 9 drugs most associated with medicinal uses.
However, the high rate of drug-driving accidents clearly shows that much more needs to be done to reduce drug-driving and the harms it causes. Some prescription medicines can also cause driving impairment on their own or when combined with alcohol. Doctors and other healthcare professionals can play an important role in raising awareness of these effects with their patients.
Alcohol and drug-related harm impacts those directly affected, including the victims of road traffic accidents caused by impaired driving, and the wider society, and costs the NHS billions.
This remains a significant problem that needs to be tackled over the longer term. Hence, the BMA is calling to lower the legal drink-drive limit to the European average as an important first step. This policy change will come up against significant financial and political lobbying, from an industry that has a vested interest in minimising the impact of alcohol-related harm. And, while crucial on its own, this change won’t address the wider impact of drugs and alcohol on our society.
This is why the BMA is also calling for other evidence-based policies including increased funding for drug and alcohol treatment services (reversing a decade of significant cuts) and a widespread public education campaign on the harms from alcohol and drugs. These points are also highlighted by the chair of the BMA’s Public Health Medicine Committee, who explores the disproportionate impact of alcohol harm more broadly on people living in the most deprived communities.
As healthcare professionals, we can help convey a very simple message.
Alcohol, drugs and driving don’t mix.
David Strain is chair of the BMA board of science