By then the basic scientific foundations of the relationship of alcohol to highway crashes had been established. The classical work of Widmark in Sweden was the first to establish the basic relationship between alcohol consumption and blood alcohol concentration (BAC), and Herman Heyse published the first-known research on the effects of alcohol on driving.
Perhaps as significant for traffic safety as the limited frame- work for impaired-driving law enforcement was the lack of public understanding of the specific problem presented by drinking and driving and, for that matter, the traffic crash problem in general. As Ross among others noted, during the first half of the 20th century, crashes were attributed to driver error.” Although states, beginning with New York in 1910, had all passed impaired-driving laws, they were generally termed drunk-driving laws,” suggesting that only very heavy drinking was illegal.
The publication of Unsafe at Any Speed by Ralph Nader (1965) helped to correct the popular impression that most fatal crashes were the fault of the nut behind the wheel.” It made clear that limitations in vehicle design played a significant role in high- way injuries and was an important factor in moving the Congress to establish the National Highway Safety Bureau (NHSB, the precursor to the National Highway Traffic Safety Administration NHTSA) as part of the new DOT in 1966. At about the same time, Haddon (1970), a public-health physician active in alcohol research, described a matrix approach to traffic safety that noted three elements involved in crashes—the driver, the vehicle, and the environment (roadway)—and that safety pro- grams could be developed for each element in three periods of time—pre- crash, crash, and post crash.
That formulation not only highlighted the complexity of the crash problem, but also took it out of the realm of chance events and stressed the opportunity for research to produce effective interventions. Haddon’s work had a strong influence on the safety field, though it was unknown to the general public, and he was appointed head of the new federal traffic safety agency when it was established. Although the public and congressional attention was focused on improving the safety of vehicles, the establishment of the NHSB and the appointment of Haddon as its first director led to considerable action directed at impaired drivers.
The 1968 Alcohol and Highway Safety Report to Congress summarized what was known about the relationship of alcohol consumption to crash risk and focused on the problem drinker” as a primary contributor to the problem. This report provided the basis for the initiation of Alcohol Safety Action Projects (ASAPs) in 35 U.S. communities to demonstrate the potential of a comprehensive DUI enforcement and adjudication program.
The ASAP program encountered many of the problems that were exemplified in later Safe Community” programs. There was some controversy over the evaluation of the projects nonetheless, where any of the local projects succeeded in increasing enforcement activity, crashes were reduced.
What was certainly lacking was public concern with the drinking-and-driving problem. For some years, the NSC had been issuing Don’t Drink and Drive” or If You Drive, Don’t Drink” public service announcements (PSAs). Aside from the limited effectiveness of PSAs in promoting safety behavior it was unlikely that in a society in which drinking was a favorite pastime and in which alternative public transportation was generally lacking, public information programs alone would have much impact. The NHTSA, in cooperation with the newly founded National Institute on Alcohol Abuse and Alcoholism (NIAAA), attempted to mount a national campaign to alert the public to the drinking- and-driving problem, focusing on the number of people killed each year. NHTSA also attempted to support the ASAP problem- drinker concept by recruiting Hollywood personalities who had been problem drinkers to participate in PSAs that stressed the risk presented by individuals who cannot control their drinking. There is no evidence that any of these approaches convinced the public that drinking and driving was dangerous.
In the early 1980s the public’s attitude toward drinking and driving was substantially transformed. Citizen activism is generally given credit for this change. On May 3, 1980, Candy Lightner’s 13-year-old daughter, Cari, was struck from behind by a car while walking in the bike lane with her friend. The driver did not stop. Lightner was informed by the California Highway Patrol the day after Cari’s funeral that they had arrested a man and charged him with drunk driving, leaving the scene of an accident, and vehicular manslaughter. She was told that he had been out of jail only two days since being ar- rested for another hit-and-run drunk-driving crash. His driving record reflected three other drunk-driving arrests—two resulted in convictions and one was reduced to reckless driving.
Five days after her daughter’s death Candy Lightner and some friends decided they should start an organization of some kind to fight against drunk drivers. A friend suggested they call it MADD” for Mothers Against Drunk Drivers.
Coincident with those developments on the West Coast, a newspaper reporter named Sandy Golden was calling attention to another drunk-driving victim, Cindi Lamb, who also was at- tempting to combat this problem. Cindi Lamb had been struck by a drunk driver (who was a repeat offender) in 1979 that paralyzed her five-month-old daughter, Laura, from the neck down. With the help of Bill Bronrott, press secretary to Maryland Congressman Michael Barnes, Golden brought Lightner and Lamb together for a news conference with Congressman Barnes. That news event created a good amount of public attention to the impaired-driving problem, and resulted in Cindi Lamb establishing the first chapter of MADD in Maryland. Soon, the media routinely began to contact Ms. Lightner for comments as high- profile drunk-driving cases occurred.
Concurrent with the growth in national attention to the victims of drunk driving and the founding and growth of MADD, media coverage of alcohol safety issues increased substantially, as did the number of DUI laws being considered by state legislatures. During this period state legislatures also increased the severity of the penalties for impaired driving. Key Congressional legislation, sponsored by Congressman Michael Barnes of Maryland and Jim Howard from New Jersey, provided incentive grants for states that adopted proven enforcement strategies and measures that strengthened laws designed to deter impaired driving. These measures included laws that made it illegal per se to drive with a BAC of .10 or greater and ALS laws that provided officers with the authority to confiscate licenses of DUI offenders at the time of arrest. Perhaps most importantly during this period, Congress with support from the scientific community and MADD and its allies in the Congress enacted the national minimum legal drinking age (MLDA) law that required states to pass legislation establishing a prohibition against sale of alcohol to youths aged 20 and younger. In July 1984, President Reagan signed into law the Federal Minimum Legal Drinking Age 21 (MLDA 21) Act. Senator Frank Lautenberg from New Jersey, Congressman Jim Howard from New Jersey, Elizabeth Dole (Secretary of Transportation at that time), Chuck Hurley from the NSC (and currently the Chief Executive Officer for MADD), and Bill Bronrott (from Congressman Michael Barnes staff and currently an elected Maryland Delegate), as well as others, worked closely with Candy Lightner and the MADD activists to build support for this law.
In 1988, based on a Congressional resolution, President Reagan established the U.S. Surgeon General’s Workshop on Drunk Driving that, for the first time, brought together public health and traffic-safety scientists and advocates. This group, in which MADD was an active participant, called attention to the significance of environmental factors, such as alcohol availability and advertising on impaired driving.
Despite the discouraging lack of progress in reducing alcohol- related fatal crashes, the last decade has seen the passage of important new alcohol-safety legislation in which MADD played a significant role through its state offices and congressional education activities. Among the more significant pieces of legislation was the zero-tolerance law that made it illegal for underage drivers to operate a vehicle with any amount of alcohol in their bodies. MADD also played a key role in the adoption of administrative license revocation (ALR) and ALS laws, which have proven to be an effective general deterrent to impaired driving. Throughout the 1990s, MADD officials were key members of the Administrative License Revocation Coalition, which was established to work toward the adoption of ALR and ALS laws in the states. During the 1990s, 17 states adopted ALR/ALS laws to add to the 24 states already with these laws, at least in part due to the efforts by MADD.
The rise of the drinking-and-driving activist movement in the early 1980s led to the formation of several citizen-activist organizations, such as RID, MADD, and Students Against Driving Drunk (SADD), together with the establishment of the Presidential Commission on Drunk Driving and its successor the National Commission Against Drunk Driving (NCADD). All of these organizations played a role in the development of public policy in the impaired-driving area. Over the last 25 years, however, they have followed different organizational paths. The reasons why MADD has emerged as the best known of these entities has interested scholars and activists. MADD was not the first such organization. RID had been founded in 1978, two years before the advent of MADD, and had several community units in the New York State area by the time MADD arrived on the scene.
The Presidential Commission was formed shortly after MADD was founded and had the full support of the federal government during its 18-month action period. It was followed by a succeeding organization (NCADD) sponsored by a broad cross- section of the U.S. industry. All four of these organizations have contributed to traffic safety and are still active today; however, MADD has the largest membership and is the best known to the public (Gallup Organization, 2005). The growth of MADD has attracted the attention of a number of social scientists such as Weed, McCarthy and Crishock and others. Some researchers have attributed the emergence of MADD to the charismatic personality of its founder, Candy Lightner, and certainly she played a prominent role, particularly after NBC produced a movie on her life in 1983.
Four conjectures can be offered for MADD’s emergence as the leading grassroots organization in the impaired-driving area:
• The placing of a face on the traffic injury problem.” As noted, media campaigns directed at the alcohol safety problem be- fore 1980 had failed to move the public to action. Reports of thousands of victims were just statistics and were ineffective because numbers are too impersonal to convey the toll on victims’ lives and their families. Appeals to avoid drinking and driving without the public first accepting that there was a problem were, for the most part, ignored. MADD not only personalized the traffic-crash victim, but also focused attention on the most appealing of the victims—children—that caught the attention of the media and the public.
• Governmental assistance. In the early 1980s, NHTSA’s special effort to promote community involvement in the traffic- safety problem included providing staff to support the emerging citizen-activist movement. NHTSA provided technical assistance on alcohol-safety laws and research and provided introductions to members of Congress, existing safety organizations, and the press that MADD leadership could exploit more successfully than other emerging groups at that time.
• Recruitment of national experts. Although it caused consider- able tension and stress within the organization and contributed to the loss of its founder, MADD was ultimately successful in bringing onto its national board and into its national office experts in citizen-activist organization, traffic safety, legislation, lobbying, media, and fundraising, while maintaining a strong role for victims in the governance of the organization.
• Effective victim services. MADD appears to have been particularly successful in developing a strong victim-services organization as evidenced by its continuing substantial sup- port from the Department of Justice, Office for Victims of Crime. This served as an important recruiting base for its membership. In addition, the MADD leadership was effective in bringing forward the families of victims to present their stories, which received wide coverage in the press, in- creasing its name recognition and supporting its fund-raising efforts.
MADD moved rapidly from a small local group with no formal structure in 1980 to a highly structured national organization with revenues of almost $50 million by 1990. A part of this organizational growth and transformation, not recorded by Weed, was the development of a strong support pro- gram for the victims of impaired drivers. A unique 21-hour training program was developed to assist members in supporting victims and helping them deal with the courts and with their physical and psychological injuries. Currently, MADD has 1,200 victim advocates trained under that program, 1,100 of whom are volunteers (100 are paid by MADD). Though less well known to the public than its campaign for stronger DUI laws, it was MADD’s service to victims that helped ensure a growing membership. McCarthy and Wolfson (1996) found that victim services are strongly related to membership. In 2003, MADD provided ser- vice to more than 27,000 victims, and in 2004 served more than 31,000 victims of alcohol-related crashes. MADD was the first organization to develop a formal program that used victims in an intervention effort with individuals convicted of crime. The organization is currently involved with Victim Impact Panels (VIPs) in 190 com- munities. VIPs are designed as a therapeutic experience for the victims and an opportunity for convicted DUI drivers, most of which have not yet been in a crash, to understand the injuries that their behavior can inflict on other road users.
During its 25-year history, MADD has dealt with many issues central to highway-safety policy while developing its own pro- gram. An understanding of its efforts as a victims’ organization in dealing with the wide rage of critical and controversial issues in the traffic-safety and public-health fields can be instructive to similar organizations and to public-health researchers.
The attention of victims is naturally drawn to the drunk driver and his or her conviction and sanctions. Therefore, MADD policies naturally and necessarily focused on the criminal drunk driver when it was first established. However, this emphasis is reminiscent of the nut behind the wheel” approach to traffic safety in the first half of the 20th century. That impaired drivers cause crashes is not doubted. Alcohol-related incidents, however, are influenced by a multiplicity of factors: those in the criminal justice system, such as safety campaigns, driver licensing, traffic-law enforcement; those in the alcohol regulatory system, such as alcohol sales taxes and beverage-service practices; and those in the drinking-and-driving environment, such as alcohol advertising and alternative transportation strategies. Public-health researchers, such as Holder (1987) and Wagenaar and Farrell (1989), and criminologists, such as Ross (1992), have focused on environmental factors central to the long-term challenge of reducing alcohol problems including drinking and driving. To encompass the broader field of environmental prevention it was important to avoid a limited focus on the killer drunk” (Gusfield, 1981).
A critical concern of any organization is to maintain its identity and stay on target. Early in its history, MADD was faced with a focus on the individual offender versus the environmental prevention issue when it became involved in the movement to raise the drinking age to 21. This issue clearly falls into the realm of alcohol regulation, but also is definitely related to un- derage impaired-driving crashes (Wagenaar ; Wolfson, 1994; Shults et al., 2001). Lightner recognized this relationship and, although this threatened a dilution of the MADD mission of focusing on drunk drivers, led the organization to strongly support the measure. Over time, MADD broadened its support to other alcohol-safety issues, such as zero-tolerance laws for youth and .08 per se laws, as well as programs related to alcohol sales. This broadening of the MADD agenda was institutionalized when in 1985 the name was changed from Mothers Against Drunk Drivers to Mothers Against Drunk Driving.
From its inception, MADD was faced with the conflict between measures to control drinking and driving and policies and pro- grams to control alcohol consumption. This problem was a part of the individual versus systems approach just discussed. The call for jail for first offenders and increased jail time for multiple offenders was more controversial. The jail sanction can be seen as having what Ross (1984) has called a short-term general deterrence” impact on potential drunk drivers and a long- term educational” component for society as a whole that characterizes impaired driving as a crime. Thus, jail had a potential role to play in combating the public disregard of the drinking-and-driving problem before 1980. However, jail space is limited and the cost of confinement to the community and the criminal-justice system is high, as noted in a study of the California legislation requiring jail sentences for first offender by Kinkade and Leone. Consequently, MADD has accepted the limitations of jail for first offenders; although, it continues to support longer license suspension periods. However, MADD’s position on jail sentences for multiple offenders remains unchanged. De- spite its initial punitive focus, MADD also has come to support improved treatment programs for offenders as it has accepted the evidence that offenders, particularly multiple offenders, exhibit drinking problems (Wells-Parker & Williams, 2002) and that court treatment programs are effective.
Early support for the MLDA 21 law represented MADD’s first major step toward broadening its original focus on the criminal drunk driver. This commitment was carried forward in its strong support for the national zero-tolerance law. This law established a legal base for reducing the availability of alcohol and control- ling underage impaired driving and also presented a challenge to MADD for the inclusion of youth in its activities, particularly in the areas of alcohol safety and enforcement of underage drinking-and-driving laws. The power of young activists also was mobilized at the national level through a National Youth Summit conducted in 2000. The summit had a potentially significant effect on the congressional passage of the .08 BAC limit. This effort to recruit youth involvement culminated in the establishment of a youth position on MADD’s National Board in 1998 and in 1999 and the modification of MADD’s mission statement The mission of Mothers Against Drunk Driving is to stop drunk driving and support the victims of this violent crime” to include the words and prevent underage drinking”. The founders of the drunk-driving activist movement initially tended to be White and, for the most part, early chapters were formed by White middle-class victims. Because a major source of new members for MADD was the service that members pro- vided to the victims of alcohol-related traffic crashes, and be- cause this activity had to be highly sensitive to the stress that the families of crash victims were under, it was natural that members could bond best with individuals most like themselves. Consequently, MADD grew into a predominantly White organization and experienced some difficulty in providing victim services to minorities. The MADD National Board recognized this limitation and in 1997 established a diversity task force with the objective of strengthening the minority membership of MADD. This movement toward diversity is critical to MADD’s continued growth, because research indicates that certain minorities, such as Hispanics, are more involved in drinking and driving and alcohol-related crashes and minority involvement in this problem will grow as they become a larger part of the driving population.
At the community level, MADD chapters have supported police- enforcement activities by demanding strong DUI enforcement and acknowledging police efforts through annual awards to the officers who make the most DUI arrests. FBI crime-record data indicate that DUI arrests began to rise in 1978, before the advent of MADD, indicating that the effort of the NHTSA to provide new tools for the police and to finance DUI enforcement programs through the Highway Safety Act was beginning to pay off. However, DUI arrests reached their peak between 1982 and 1992, the years in which MADD was most visible and politically active, so it is probable that MADD was important in sustaining this rise in enforcement activity.
Most observers have given credit to victim activist groups, particularly MADD, for this sudden increase in press coverage. As noted, MADD has maintained a public-relations capability to respond rapidly to print and electronic media inquiries through statements and interviews with its president. Although media coverage has declined since the early 1980s, MADD still has kept the issue before the public, particularly in connection with holiday periods and highly publicized crash events and by responding to attacks on MADD supported programs by some of their critics.
One study that has attempted to directly measure the MADD contribution to crash reduction was limited to the state of California during the years from 1982 to 1985. Using data from state crash files and the number of MADD chapters, the authors concluded that the incidence of DUI crashes in a locality increases the probability that a MADD chapter will be established in the community and that the presence of a MADD chapter significantly reduces the number of DUI injury crashes. McCarthy and Ziliak also confirmed the expectation that a higher level of enforcement activity reduced alcohol-related injury crashes.
MADD’s 25th anniversary came approximately 40 years after the initiation of federal efforts in the field of alcohol safety with the establishment of the NHTSA. During that time alcohol-related fatalities have decreased by at least 35%. That is a substantial success, but the failure over the last decade to make substantial progress is disappointing. Given the relatively strong criminal-justice framework constructed over the last four decades, a critical question for the future is What remains to be done?” In the1980s when MADD was founded, the alcohol safety infrastructure at the state level was incomplete. Many states lacked the basic foundations of an alcohol-safety legislative system, including illegal per se laws, ALS, MLDA 21 laws, and zero-tolerance laws. Most states had established relatively high BAC limits for driving at .10 or .15, and the sanctions for DUI offenders were low or compromised by plea bargaining and unregulated diversion programs. Currently, all states have age 21 MLDA, zero tolerance, and .08 laws, and most states have the other elements of a comprehensive alcohol traffic safety legal system. A key problem currently is the lack of effective enforcement of these laws. It has proved to be easier for organizations such as MADD to encourage states to pass laws than to motivate state and local governments to provide the resources to support their enforcement.
MADD, with its partners, has proposed five strategies to meet that goal: (1) working with law enforcement to promote highly publicized, frequent sobriety checkpoints or similar enforcement methods in each state; (2) working to achieve high levels of safety belt use in each state, including the enactment of primary safety belt laws in the 26 states that do not have such laws; (3) supporting the development and use of effective technology, such as alcohol ignition interlocks on vehicles to prevent im- paired driving by DUI offenders; (4) working to improve the DUI criminal-justice system performance and accountability, includ- ing the reinstitution of court monitoring by MADD volunteers; and (5) promoting effective alternative transportation programs to prevent drunk driving. It remains to be seen whether these strategies will have an effect on the problem.
More difficult still will be the reduction of binge drinking on the college level. Despite substantial efforts to reduce college drinking problems, Hingson and colleagues (2005) estimated that each year 1,400 college students between the ages of 18 and 24 die and 500,000 are injured from alcohol-related causes. In a more recent article, Hingson and colleagues (2005) reported that alcohol-related injury deaths increased from 1,400 to 1,700 between 1998 and 2001, indicating that high-risk drinking at colleges and universities is increasing. Consequently, there is still pressure from some college administrators and the media to repeal the age 21 drinking limit (Seaman, 2005). Bills to repeal age 21 laws have been introduced in the legislatures of Vermont, Wisconsin, and Louisiana. MADD may find that a substantial effort will be needed to keep the Congress from rolling back the minimum drinking age. The organization that, when founded, was focused on the criminal drunk driver, has moved to make the reduction of underage drinking—the spawning ground for the problem—into one of its’ major objectives for the future. Thus, MADD may be taking on a problem more difficult than impaired driving.
There is considerable evidence that MADD has made a difference in the United States regarding alcohol-impaired driving. MADD has contributed to the public’s view that drunk driving is socially unacceptable. MADD has played an important role in encouraging state legislatures to enact more effective impaired-driving laws and has been a prominent player in land- mark federal legislation (MLDA 21, zero tolerance, .08 BAC per se). Because of these accomplishments, there are now official MADD affiliations in Guam, Puerto Rico, Canada, Sweden, and Japan.
MADD’s best-kept secret is its service to victims. More than 31,000 victims were served by MADD in 2004 with emotional support, victim assistance, and court accompaniment. Currently, 41,000 of MADD’s 67,000 active members, and an unknown number of contributors, are alcohol-related crash victims. Be- cause the source of their motivation for the cause is direct experience, and not the varying waves of public opinion, they form the bedrock of the organization for the future.
Since 1999, when it added preventing underage drinking to its mission statement, MADD has provided strong support for the enforcement of drinking-age laws, which unfortunately are in a very similar stage as was drunk driving in this country in the 1960s and 1970s—illegal but tolerated. That must change if long-term progress is to be made in reducing impaired-driving and other alcohol-related problems. MADD is attempting to meet this challenge, just as it did the impaired-driving problem 25 years ago