One for the Road: Drunk Driving since 1900 (review)

The first history of drunken driving in the United States has been written by an eminent medical historian, Barron H. Lerner. His narrative, as one would expect, is well researched in primary and archival sources as well as the literature on the scientific and social history of alcohol use and abuse and the history of public health and accidents. He writes with great authority and with full awareness of the difficult and complex moral, social, political, and epidemiological questions involved in a phenomenon that takes the lives of at least eleven- to fifteen-thousand Americans a year and destroys the quality of life for untold more.

Lerner writes clearly, accessibly, and quotably. This book deserves a wide reading among public health, public policy, and compassionate, conscience-driven people. Lerner's narrative is straightforward. As Americans employed more technology, drinking became less of a moral question per se, and more a social question, as those in automobiles became a hazard to themselves and others. In the early twentieth century, the number of cars on the road increased. As speed became a desirable attribute, the dangerousness of a person who was inebriated was intensified. The problem moderated during the Prohibition years, but with repeal in 1933, it became acute. In Los Angeles, for example, by 1934, there was a fourfold increase in drunk driving deaths (p. 21). The post-repeal increase was parallel to reported cirrhosis rates and other health indicators.

For two decades, opinion leaders in the United States normalized the act of drinking. The alcoholic beverage industry named it "social drinking" or "moderate drinking"—without, of course, any hard definitions. Anything beyond that, however, was alcoholism, which was classified as an illness. These standards were endorsed by the National Safety Council and the American Automobile Association. As devices appeared in the 1930s to measure levels of alcohol in a person's blood, their use was opposed by the AAA as well as the alcoholic beverage industry.

In the 1950s and 1960s, there was a major shift as the drunk driving toll rose to twenty-five thousand per year. Alcoholic beverage consumption became a public health issue, especially for younger people, to the point that a National Institutes of Health institute was created. In the 1970s and 1980s, toleration of drinking before driving began to wear thin among some experts. And then around 1980, "the political and cultural climate [became] conducive to the angry, moralistic, and media-driven campaign that would, for a brief time, make drunk driving one of the country's preeminent social issues" (p. 64). Mothers Against Drunk Driving (MADD) came on the scene. Yet MADD, like the industry, at first treated the problem as one concerning individual behavior.

In 1983, there was a presidential commission. In 1984, federal law managed to move the states to a uniform drinking age. Activists followed the cigarette model and advocated taxes, labeling, and safety advertising, especially to the prime market, young people. Meanwhile, because law enforcement was only temporarily effective in cutting the death rate, designing cars to make them safer looked like an effective way to reduce the statistics. After all, there was now evidence that alcoholism was in part based on genetics.

In the 1990s, there was a powerful backlash and active opposition, led by "lawyers, libertarians, and the liquor lobby" (p. 123). Were drunk drivers truly criminals? And "the shock value of images of dead teenagers and smashed cars had begun to wear off" (p. 151). Modern Drunkard Magazine began publication. Moreover, the research and epidemiological evidence had problems. In 2004, the .08 percent standard for driving was reached in all states, an achievement, Lerner points out, that was so great that pressure to impose the logical .05 percent level got lost. Indeed, Lerner's most telling evidence is what other countries were able to achieve.

Lerner discusses the grave questions of what and who is responsible in American culture as well as questions...