Evidence to support the asks in our alcohol, drugs and driving consensus statement

Statistics on the harms of alcohol and drugs, including in relation to road harm caused by substance use, highlight the need for policy change, such as those we call for in our consensus statement.

Location: UK
Audience: All doctors
Updated: Friday 5 July 2024
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There is a strong evidence base that supports the measures called for in the consensus statement

Evidence shows that lowering the legal blood alcohol content (BAC) limit for driving saves lives
  • At 80mg/100ml (or 0.08%) England, Wales, and Northern Ireland have the highest BAC limit in all of Europe. Drivers who drink up to this limit are 6 times more likely than experienced drivers to be killed in a collision.
  • Laboratory studies show that impairment in critical driving functions begins at low BAC levels, and most subjects are significantly impaired at 0.05% BAC.
  • Studies from the US have shown that reducing the BAC limit from 0.08% to 0.05% is effective in preventing collisions.
  • Research shows that new drivers are three times more likely to be injured in a crash if they have been drinking alcohol.
  • According to 2010 National Institute for Health and Care Excellence (NICE) estimates, which modelled collisions in England and Wales based on research conducted in Europe and Australia, more than 150 lives a year could be saved by lowering the drink drive limit to 0.05%. At minimum, the Institute of Alcohol Studies estimated in 2020 that 25 lives per year could be saved.
However, a reduction in the BAC limit needs to be accompanied by other measures to ensure success in reducing the levels of drink driving
  • The European Transport Safety Council 2018 report and 2022 report provided examples of progress in reducing drink driving rates across the European Union. Many of the examples highlight that success in reducing drink driving rates combines lowering the BAC limit with other policy measures, such as increasing enforcement and education.
  • There is evidence from a number of countries, including Australia, Brazil, France, Japan, Sweden, Lithuania, Estonia, and Switzerland where a reduction in BAC limit has contributed to a reduction in fatal collisions.
  • Scotland lowered their BAC limit to 0.05% in 2014 without sufficient attention or focus on the wider measures. This resulted in a lack of long-term change in the reduction of drink driving. The experience in Scotland shows us how important it is to implement accompanying measures of enforcement and educating the public of the new limits.
Strong enforcement of any new BAC limits and drug driving limits is crucial to achieve the desired results
  • A Parliamentary Advisory Committee for Transport Safety (PACTS) report from 2020 highlights the importance of road policing in improving road safety and the ‘fatal four’ offences, which includes driving under the influence of alcohol or drugs. Findings show that where enforcement has been increased, compliance with traffic laws has improved and casualties have decreased.
It is also vital to educate the public on the limits, and the dangers of drink and drug driving
  • A 2016 systematic review of studies indicated that under some conditions, and with careful design and good execution, and preferably with a focus on positive messages, mass-media campaigns can successfully contribute to the reduction in alcohol impaired driving.
  • A 2020 PACTS report flags that there is evidence which show that media campaigns, in combination with other policy measures such as increased enforcement, can reduce the number of drink drive casualties and deaths.
  • Evidence shows that untargeted campaigns often fail to resonate with those perpetuating those acts. For example, research found that in the Think! Drink Drive campaign called ‘Personal Consequences’, launched in 2007 and targeted at 17-29 year old males, previous adverts failed to resonate with that group largely because they felt that the messages were targeted at the ‘drunk-drivers’ which they did not associate themselves with.
  • Evidence from THINK! In their Mates for Life campaign shows that media campaigns can be effective in encouraging a target audience - in this case young men - to intervene and prevent drink driving amongst their friends. Their 2022 campaign saw 7 in 10 of their audience reporting taking action after seeing their content, including stopping a friend from drinking before driving.
Sustained investment in alcohol and drug treatment services, as well as national and local health services (including A&E), is a key component of addressing the harms caused by drink and drug driving, and the wider harms of alcohol and drugs
  • Alcohol treatment services have a success rate of around 60%. But not everyone who needs treatment can access it. 82% of dependent drinkers were not in treatment in 2018-2019. And only 23% of people in alcohol treatment services are referred to treatment from health services. This highlights the need for greater investment in training in early identification and brief interventions for healthcare workers – as research showed that healthcare workers assessing patients often fail to spot early signs of problem drinking.
  • Alcohol treatment services benefit not just the individuals who receive treatment but wider society. According to a PHE review (2018), every £1 invested in alcohol treatment yields £3 of social return in England. This increases to £26 over 10 years.
  • In England, increased investment in alcohol and drug treatment in the early twenty-first century, was associated with improved treatment access, reduced waiting times, improved service quality and a reduction in related harm. This is sited by multiple sources including Public Health England.
  • The Public Health Grant in England has been cut by more than a fifth in real terms per person since 2015. Following the Black Review, the government announced an additional £421 million for drug and alcohol services in 2023/24 and 2024/25 in England. This means that total local authority funding for treatment will have increased 40% between 2020/21 and 2024/25, without accounting for inflation or population growth. However welcome this addition is, this funding is short-term and makes it hard to plan for long term investments and strategy.
  • There are also significant shortages of trained staff in addiction treatment services. A 2020 Royal College of Psychiatrists report found that addiction psychiatrists training posts had been decreasing in the last decade, and could be wiped out in the next. Though an issue across the UK, the situation is worse in England. Those in addiction psychiatrist roles only make up 1% of the alcohol and drug treatment workforce in England.
  • The voluntary sector has stepped up to fill the gaps in alcohol and drug treatment services. For example, in England, the voluntary sector makes up about 78% of the WTE alcohol and drug treatment services workforce, with 12% of the whole workforce being unpaid volunteers.
  • Research from 2022 showed that every £1 invested in the NHS generates £4 of economic growth. The study pointed out that investment in the primary care workforce and reduced A&E attendances and urgent admissions would have the greatest effect on the wider economy.
Other preventative measures are also needed in order to reduce the harms caused by drink or drug driving, and the wider harms of substance use in general.

These include alcohol and drug education programmes:

  • Non-attendees to drink-driving rehabilitation courses are over twice as likely to commit a new drink-driving offence within three years, so by offering high-risk drug-driving offenders the same support, Government hopes to bring down the number of repeat offenders.
  • A systematic review from 2021 showed that some education programmes have the capacity to positively change alcohol-related behaviour, although quality of the programmes affect outcome. Hence, programmes should be designed alongside health education/promotion models and best practice recommendations.

And mandatory labelling of alcohol products:

  • Research has found that all enhanced label designs for alcohol products improved knowledge of the guidelines compared to the standard label, and that the reported motivation to drink was slightly decreased. Though labelling does not necessarily change behaviour, it can inform choices and help provide accurate information and clear advice about the health risks of alcohol.
  • A 2020 Institute of Alcohol Studies review of international evidence shows that introducing health information on alcohol products increases consumer knowledge and awareness of the adverse health impacts of alcohol. The review stressed that a mandatory system is necessary. This is because voluntary labelling schemes, where industry can choose whether to comply and to what extent and quality, are less effective at reaching the standards required to inform and protect consumers where health is concerned.
The public support policy change to reduce alcohol and drug harm, including actions targeted at drug and drink driving

The public supports lowering the BAC limit:

  • Almost 80% of the UK public support lowering the drink-drive limit.

The public supports mandating proper labelling and limiting alcohol advertising:

  • AHA and YouGov research shows that 70% of adults would support health warnings on alcohol products.
  • A European consumer survey revealed that 81% of UK participants believe that alcohol labels do not provide sufficient health-related information.
  • A 2023 survey found that 54% of the British public would support not allowing alcohol advertising in public spaces. The most popular measure was including a health warning on all alcohol advertising to communicate the risks associated with drinking alcohol, supported by 66 percent of respondents.

The public supports investment into national and local health services:

  • The Health Foundation and Ipsos partnered to deliver research that found that 77% of the public believe that the NHS is crucial and everything must be done for it to be maintained, and 71% would support additional government spending and investments.

Recent statistics of the harms caused by drink and drug driving are concerning

Alcohol use and the harm this causes to road users, society, and our services, has significant consequences
  • In Great Britain, around 5% of all reported road traffic collisions in 2021 involved at least one driver or rider over the legal alcohol limit – a rate that has seen no improvement since 1990.
  • There has been no sustained decrease in the number of those killed or seriously injured (KSI) drink drive casualties between 2013-2021. There was a sharp decline in 2020 (due to the Covid-19 pandemic), but in 2021 that number increased to pre-2020 average levels. The percentage as a proportion of KSI casualties has increased since 2014 (from 5% to 7%).
  • Great Britain had 260 drink drive fatalities in 2021, an 11% increase from 2013, and the highest number since 2009.
  • 17% of all road deaths in Great Britain occurred where a drink driver was involved in the collision. Analysis conducted in 2014 estimates that 60% of those killed or injured in drink-drive collisions are those other than the driver.
  • A 2021 PACTS report stated that 17% of drink drive offences are committed by a reoffender, and a significant number of reoffenders have alcohol and mental health issues.

Drink driving causes an avoidable strain on the NHS and ambulance services and the wider economy

  • The latest available data estimated that drink driving costs Great Britain £23.5 million in medical and ambulance costs.
  • The latest available data estimated that, in total, drink driving costs Great Britain £800 million each year.
Drug driving is on the rise and causes significant and worsening harm to society
  • Drug-driving has been on the increase in recent decades in Great Britain. According to the Department for Transport, the number of deceased drivers with drugs detected in fatal collisions has increased by over 60% from 2014 to 2019. Whilst this could reflect changes to testing abilities and record keeping, the increase is broadly in line with that for the ‘impaired by drugs’ contributory factor recorded in STATS19*.
  • In 2021, the Department for Transport statistics showed that the number of casualties in relation to drug-driving was 2,500. This is a surge of 260% since 2012. Between 2014 and 2021, 64% of casualties in collisions where an impairment drug was detected were fatalities. 91% of those fatalities were drivers with drugs in their system, showing that those most affected were the drug drivers themselves.
  • A 2021 Parliamentary Advisory Committee for Transport Safety report on drug driving found that nearly half (44%) of drug drive offences are committed by a reoffender.
  • Illegal drugs played the largest role in drug-driving cases in all age groups. The 5 most common detected drugs in general police drug driving tests were cocaine, benzoylecgonine, cannabis, morphine, and ketamine. Only drivers over the age of 70 had medicinal drugs detected more than illegal drugs.

* Statistics on road safety in Great Britain are mostly based on personal-injury collisions reported to the police in the STATS19 data collection.

Current road traffic officer enforcement powers and practices are inadequate to appropriately enforce drink and drug driving limits
  • A 2021 PACTS report on drink driving showed that levels of police enforcement on the road in the UK have decreased by 63% since 2009.
  • The police may randomly stop a vehicle in order to ascertain whether or not the driver has alcohol or drugs in their system, but they cannot randomly require a driver to comply with any tests. This does not include preliminary roadside alcohol breath tests, as those can be administered as a matter of routine if they reasonably believe a person was drinking at the time of a collision on the road or public spaces.
  • The police can test for cannabis and cocaine at the roadside, but can only screen for other drugs at a police station. The 2021 PACTS report on drug driving flagged that blood samples had to be taken by a healthcare practitioner and a healthcare practitioner in charge of the case had to approve the specimen being taken. Police officers reported that, in cases where there was no force healthcare professional at the station, this system could ‘require taking people arrested on suspicion of drug driving to A&E where, under the triage systems most hospitals operate, they will be allocated a doctor but it can be some time before the doctor is able to see the patient.’ Hence, also adding to the burden on A&E services.
  • Enforcement of drug driving laws varies dramatically across the UK, with some police forces convicting 10 times more drug drivers than others. Additionally, some police forces have as many convictions for drug driving as drink driving, while in other forces patrols are rationed to a single drug testing kit which results in officers only testing where there is clear evidence of drug use. They also raise significant concerns about the amount of time taken for laboratories to process blood tests and the length of the court process in general.
  • An added complication in the case of a collision attended by ambulance or paramedics is the need to determine which drugs found in the body were administered by paramedics on scene, rather than taken by the user before a collision.

Recent statistics of the wider harms of alcohol and drug use paint a bleak picture

Alcohol use is detrimental for the nation’s health, and deaths and sickness caused by alcohol are the highest they’ve been in decades.
  • The most recent data for the UK from 2022 saw the highest number of deaths from alcohol specific causes on record (10,048 deaths or 16.6 per 100,000) people. This is 4.2% higher than the number of deaths in 2021 (9641 deaths or 14.8 per 100,000 people), which in turn was 76.2% higher than 2001 when records began (5701 deaths or 10.6 per 100,000 people).
There are significant health inequalities related to alcohol harm
  • An Institute of Alcohol Studies report from 2020 showed that those in the most socioeconomically deprived decile have 2.23 times the rate of alcohol-specific mortality (i) and 1.53 times the rate of alcohol-related mortality (ii) compared to the least deprived decile despite similar or lower average alcohol consumption. This is known as the alcohol harm paradox.
  • The rate of alcohol-specific hospital admissions in the most deprived tenth of lower tier local authorities in England is significantly higher than the rate in the least deprived tenth. The same can be said for alcohol-related admissions, both broad (iii) and narrow (iv). A similar disparity between those living in most deprived compared to least deprived areas could be seen in Northern Ireland, Wales and Scotland.

i Deaths from conditions wholly caused by alcohol. This definition is also used by the ONS in their annual UK data release published in parallel with this OHID release.

ii Deaths from conditions which are wholly or partially caused by alcohol. For partially attributable conditions, a fraction of the deaths are included based on the latest academic evidence about the contribution alcohol makes to the condition.

iii A measure of hospital admissions where either the primary diagnosis (main reason for admission) or one of the secondary (contributory) diagnoses is an alcohol-related condition (partially or wholly caused by alcohol). This represents a broad measure of alcohol-related admissions but is sensitive to changes in coding practice over time.

iv A measure of hospital admissions where the primary diagnosis (main reason for admission) is an alcohol-related condition. This represents a narrower measure. Since every hospital admission must have a primary diagnosis it is less sensitive to coding practices but may also understate the part alcohol plays in the admission.

The strain that alcohol use has on police and emergency services and capacity is significant

Police services are forced to spend a considerable amount of time and resource to address incidents related to alcohol use.

  • In 2015, the Institute of Alcohol Studies reported that alcohol-related incidents accounted for 53% of police time.
  • Data from 2019/20 indicate that 42% of violent incidents are alcohol-related.
  • 2024 estimates from the Institute of Alcohol Studies find that there is a £14.58 billion cost due to alcohol-related crime and disorder, with £4,470 million associated to costs specifically to the police and the criminal justice system.

The same can be said for ambulance services and health services, who address the avoidable health burden that alcohol use brings.

  • In 2015, the Institute of Alcohol Studies reported that alcohol-related incidents accounted for 37% of ambulance time.
  • In 2019, more than 16% of ambulance callouts in Scotland were alcohol-related.
  • 2024 estimates for alcohol-related ambulance call out costs in England are at £857million.
  • In 2021, the PHE estimated that cost to the NHS in England from alcohol harm was around £4.2 billion. Recent research published in 2024 from the Institute of Alcohol Studies found that the economic burden on the NHS in England now stands at £4.9 billion.
  • Alcohol-related hospital admissions in England increased by 2% between 2018/19 and 2019/2020 - an 8% increase since 2016/17.
  • From 2021 to 2022, there were 342,725 hospital admissions wholly due to alcohol (alcohol-specific) in England, and the number of admissions in men was double the figure for women. This is a 7.6% increase from 2020, where there were 318,595 alcohol-specific admissions in England.
  • From 2019/20 to 2022, Public Health Wales highlighted a 5.5% increase in hospitalisations due to alcohol-specific conditions in Wales.
  • Although hospital admissions due to alcohol-related issues in Scotland in 2020/2021 were the lowest it has been since 2006, hospitalisations were still much higher in 2020/21 than they were in 1981.
  • In Northern Ireland, treatment solely for alcohol related issues fell from 67% out of all those in treatment in 2007 to 38.6% in 2022-23, indicating that a higher percentage of patients in treatment may be for poly-use of alcohol and drugs.
The economy is also severely impacted by alcohol use
  • New research from the Institute of Alcohol Studies published in 2024 has found that alcohol harm costs England £27.4 billion a year. This is a 40% increase in the cost of harm from alcohol since 2003. Additionally, tax revenue from alcohol only raises around £12.5 billion each year, hence it is dwarfed by the financial cost of harm.
  • Figures on alcohol harm costs for the devolved nations are more dated, with estimates ranging between £5.1 to £8.1 billion total.
The harm that drug use causes to UK society and society’s health is growing year on year
The same health inequalities also exist with drug use.
  • The drug harm paradox is similar to the alcohol harm paradox. It is in most deprived areas that the health harms associated with drug use are felt greater, across the UK.
  • In England in 2019/20, those who are from the most deprived areas have rates of 470 admissions per 100,000 of the population with a primary or secondary diagnosis of drug-related mental and behaviour disorder. Their counterparts in the least deprived areas have rates of 55 admissions.
  • In Wales, those who are from the most deprived areas are 5.9 times more likely than those living in least deprived areas to be admitted to hospital for illicit drug use.
  • In Scotland in 2020, people living in the most deprived areas were found to be 18 times more likely to die from drug related death.
The strain that drug use has on police and emergency services and capacity is also significant

Drug related crime drains police resources.

  • Costs of drug related crime in 2017/2018 were up to £680 million a year in enforcement costs, including staffing, training, and more.

Ambulances are regularly called out on emergencies due to drug use.

And national health services are dealing with higher levels of drug related illnesses than in previous decades.

Drug use also has a detrimental effect on the UK society and the economy.
  • Drug related deaths through misuse reported in the UK rose from 4,517 in 2020 to 4,564 in 2021. Scotland continues to have the highest numbers of drug related deaths through misuse, 245 deaths per million.
  • Drug use, drug seizures and drug offences continue to increase within the UK with a total annual cost to society of over £21 billion in 2021.

There is evidence to support the need to implement wider policy mechanisms that limit the price, marketing and availability of alcohol products

Success on limiting alcohol advertising
  • A 2022 World Health Organisation report highlighted how alcohol advertising targets young people and heavy drinkers, and calls for the need for more effective national regulations and international collaboration.
  • A 2009 review of seven cohort studies that followed more than 13,000 young people aged 10 to 26 years old found that exposure to alcohol advertising or promotional activity led to an increase in subsequence alcohol consumption in young people. Therefore, limiting or banning advertising would bring that effect back to baseline.
  • A 2006 economic analysis in the USA that assessed the effects of alcohol advertising on youth behaviour concluded that a complete ban on alcohol advertising could lower monthly youth drinking by 24% and youth binge drinking by about 42%.
Minimum Unit Pricing (MUP)
  • An independent evaluation of Scotland’s Minimum Unit Pricing policy concluded that in the 2.5 years of operation, MUP has prevented hundreds of avoidable deaths and reduced health inequalities linked to alcohol consumption.
  • Research showed an immediate reduction in alcohol sales in shops after MUP was introduced in Wales.

Other measures that could be effective in reducing drink-driving

Alcohol interlocks

An effective way to reduce alcohol related collisions.

  • A review of 15 studies of interlock effectiveness found that offenders who had interlocks installed in their vehicles had arrest recidivism rates that were 75% lower than drivers who did not have interlocks installed. Studies have also showed that interlocks reduce alcohol-related collisions and fatalities while they are installed in vehicles.

As well as its effectiveness, it is also something the public would support.

  • A 2020 YouGov survey has revealed that 82% of respondents support the mandatory fitting of interlock devices to buses and coaches. The technology is designed to tackle the growing problem of drink driving in the UK by preventing a driver who is under the influence from taking control of a vehicle. 83% of survey respondents supported the use of such devices by repeat drink drive offenders.

Alcohol, drugs and driving consensus statement