title: Hardcore drinking drivers and other contributors to the alcohol-impaired driving problem: need for a comprehensive approach.
abstract: OBJECTIVE
  Understanding the hardcore drinking driver concept in the context of the alcohol-impaired driving problem.
  
  
  METHODS
  Review of the relevant literature.
  
  
  RESULTS
  As progress against alcohol-impaired driving slowed in the early 1990s, public and political attention turned to "hardcore" drinking drivers, and they have been a priority for the past 15 years. Though intuitive, the hardcore concept has been difficult to conceptualize. Its definition of hard-to-change chronic heavy drinking drivers focuses on a group that is not easily identifiable and ignores many who account for a large portion of alcohol-impaired driving crashes. These include drivers who drink heavily on occasion and drivers who drink at more moderate levels that elevate crash risk. Emphasis on the hardcore has focused attention on the small proportion of drinking drivers who have been detected and arrested, whereas the vast majority of drinking drivers go undetected. Some countermeasures aimed at the hardcore group have been effective in reducing recidivism, but attention and resources also need to be given to general deterrent initiatives (e.g., 0.08 g/dL, sobriety checkpoints, administrative license suspension). There has been no reduction in the overall alcohol-impaired driving problem since the mid-1990s.
  
  
  CONCLUSIONS
  Reductions in the alcohol-impaired driving problem require that attention be focused on all relevant target groups. Some benefits could accrue by recognizing that countermeasures developed for hardcore drinking drivers, such as alcohol ignition interlocks and vehicle or plate impoundment, might also be effective with more numerous first-time offenders. However, such strategies are likely to be most effective against recidivism (specific deterrence). Greater gains could be achieved through general deterrent efforts (increasing the real and perceived risk of arrest and punishment to all drinking drivers), along with application of public health measures designed to reduce overall consumption. Additional ways need to be found to separate drinking and driving, either through cultural changes in drinking and/or driving behavior or, in the future, with the use of technology that can make vehicles inoperable by drivers with illegal blood alcohol concentrations.
authors: Insurance Institute for Highway Safety, Arlington, VA 22201, USA.
authors: Allan F
authors: AF
authors: Williams
authors: Anne T
authors: AT
authors: McCartt
authors: Susan A
authors: SA
authors: Ferguson
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence / Q000517:prevention & control; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000097:blood / Q000331:legislation & jurisprudence*; D000437:Alcoholism; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D001944:Breath Tests; D006291:Health Policy; D006801:Humans; D035846:Law Enforcement; D008004:Licensure