As an evaluator for three SPF SIG states that are attempting to reduce alcohol-related traffic crash deaths (ARTCDs), one of the more interesting questions each state and community has faced is who to target to maximize use of prevention resources. One of the most informed answers that I have heard was part of a presentation by my PIRE colleague Bob Voas. He was summarizing findings from a study that he led which assessed whether normative drinkers or heavy drinkers contribute the most to ARTCDs [Voas, R. B., Romano, E. O., Tippetts, A. S., & Furr-Holden, C. D. M. (2006). Drinking status and fatal crashes: Which drinkers contribute most to the problem? Journal of Studies on Alcohol, 67(5), 722-729.]. The following summarizes their findings:

“[T]his study provides pieces of evidence in support of both sides of the debate about the type of drinker who contributes the most to the alcohol-related fatal crash problem. Our results show a positive relationship between heavy abusive drinking… and alcohol-related fatal crashes. When the relationship is adjusted by the number of drivers in each drinking category, however, those who contributed the most to the alcohol-related crash problem are the current normative drinkers, who are much more numerous than symptomatic drinkers. This finding suggests that focusing on the heavy drinker and ignoring the current normative drinker in the design of programs aimed to curb the alcohol-related crash problem could be a mistake.” (p. 728)

In particular, they estimated that about one-quarter of the drinking population could be classified as heavy drinkers based upon either having a diagnosable alcohol disorder or having engaged in binge drinking in the past year. They estimated that this quarter of the drinking population was involved with nearly half of the ARTCDs, and thus concluded that this segment of the population (about 16% of the overall population in the country) was disproportionately responsible for ARTCDs. However, they also estimated that those categorized as normative drinkers (the three-quarters of the drinking population who were not classified as heavy drinkers) were involved with just over half of the ARTCDs and thus were a very important segment of the population to target for prevention (about half of the overall population of the country).

Based on this information, it seems reasonable to recommend that communities prioritize effective and cost-efficient prevention strategies that target heavy drinkers – the population that is disproportionately responsible for ARTCDs. Because this involves identifying ways to influence the choices that these individuals make, it is important to understand their environment – where, when, why, etc. they choose to drink heavily and drive a vehicle. Just behind this in priority, then, would be implementation of effective and cost efficient prevention strategies that target non-heavy drinkers. Because they may make choices to drink and drive in different conditions and for different reasons than heavy drinkers, it seems advisable to assess, and possibly then plan for different prevention activities to target the normative (less heavy) drinkers in the community.