[Alcohol problems in drinking drivers and clinical management methods]. / Typologie des contrevenants à l'alcoolémie routière et modalités des prises en charge.

BACKGROUND: In order to improve knowledge on the typology of drinking drivers, their clinical management and their outcome in terms of alcohol consumption following treatment, 1086 drinking drivers attending one of the 18 outpatient centres for the care of alcoholics participating to the study were studied; those requiring long-term therapy or those mandated to treatment were followed-up during one year. Most of them (95%) were men with a mean age of 38 years. The drinking-driving offence was recorded during an alcohol spot-check (62%), following a traffic accident (23%) or a traffic offence (15%). For 35%, it was the second offence and 19% have been mandated to treatment. Alcohol consumption before checking were based on spirits in 67% of cases and only wine or beer for the remaining 33%. Severe alcohol problems (i.e. abuse or dependence) were diagnosed in 38%, both in men and women. Mean blood alcohol level was 1.6 g/l, without any difference according to sex; it was significantly increased in those checked following a traffic accident, in those having drank spirits, wine and beer and in those having a severe alcohol problem. Follow-up was organized for those mandated to treatment and for a third of the others, including mainly those second-offenders and those with a severe alcohol problem. Observance to appointments were similar in both groups. At the end of follow-up (350 subjects were concerned), 75% were either non- or moderate drinkers while the 25% remaining were still abuser or dependent; the single parameter independently and significantly associated to an absence of alcohol behaviour improvement was "to be mandated to treatment" (RR=4.4 CI [2.03-9.69], p<0.001). Our results confirm the high prevalence of severe alcohol problems in drinking drivers and demonstrate that women are concerned as much as men. They assess that since increased blood alcohol levels in drivers are observed whatever the type of alcoholic beverages consumed, all these latter without any exception are dangerous when drank in excess before driving. Finally, our results suggest that mandating to treatment a drinking driver should be discussed and its efficacy revisited.

The role of non-governmental organizations.

Non-governmental organizations (NGOs) intervening in the area of alcohol problems are varied and have different histories depending on their political, social and cultural contexts; some are long-established and often bear a heavy heritage, while others have recently arisen from the upheavals in eastern Europe and the developing countries. All of them, however, must solve certain ethical problems if they are to move away from a hygiene-based approach and focus on individual responsibility. The role of NGOs is located between dreaming of a better world and rising up against a market-based system where health and the quality of life take second place to commercial interests. Furthermore, their role is to be found between the impulsive nature of action and the often demotivating process of scientific reasoning and analysis. NGOs can intervene flexibly in all the fields of information, training, advocacy and assistance. They can readily position themselves in the long time-frame required for prevention and in a space freed from burdensome administrative procedures. Their actions often appear to entail criticism of the authorities; in fact, however, they complement the latter, by countering the "hands off" or fatalistic approach of certain communities in the face of the alcohol risk.