Sunday, March 2, 2008

History of MADD

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Mothers Against Drunk Driving (MADD) - a historical perspective

Mothers Against Drunk Driving (MADD) has arguably been one of the most successful public-health grassroots citizen advocacy organizations in the United States in the past century. In 2005, MADD celebrated the 25th anniversary of its founding. Based on a national poll by the Gallup Organization in 2005, MADD is recognized by 94% of citizens. It is generally given credit for changing American attitudes toward drinking and driving. Since MADD’s founding in 1980, alcohol-related traffic deaths in the United States have decreased from an estimated 30,000 to 16,694 in 2004, according to the National Highway Traffic Safety Administration. This article examines the growth of MADD since its founding and attempts to gauge its contribution to the public’s understanding of the impaired-driving problem and to the reductions in alcohol-related highway deaths and injuries that have occurred in the first 25 years of its existence.


IMPAIRED DRIVING (1900–1966)
Motor vehicle crashes became a problem in the beginning of
the 20th century. Alcohol has been associated with this problem
from the beginning, as is indicated by publication of the
first scientific report on the effect of drinking by operators of
“motorized wagons” in 1904 (Editorial, 1904). The federal government
was a late entrant into the drinking-and-driving field
and provided only a minor amount of research funding until the
establishment of the Department of Transportation (DOT) and
passage of the Highway Safety Act in 1966.
By then the basic scientific foundations of the relationship of
alcohol to highway crashes had been established. The classical
work ofWidmark (1932) in Sweden was the first to establish the
basic relationship between alcohol consumption and blood alcohol
concentration (BAC), and Herman Heise (1934) published
the first-known research on the effects of alcohol on driving.
Robert Borkenstein invented the first practical alcohol breathtesting
device in 1954 (Borkenstein & Smith, 1961) and conducted
the classic so-called “Grand Rapids Study” (Borkenstein
et al., 1964) that determined the relationship between BAC and
crash risk a decade later. Despite the scientific progress, the effect
of this knowledge on the public and public policy in the
United States was modest. The primary organization at the national
level concerned with impaired driving was the National
Safety Council’s (NSC’s) Committee on Alcohol, Drugs, and
Received 17 February 2006; accepted 31 March 2006.
Address correspondence to James C. Fell, Pacific Institute for Research and
Evaluation, 11710 Beltsville Dr., Ste 300, Calverton, MD 20705–3102, USA.
E-mail: fell@pire.org
Traffic Safety, which had a strong influence on state legislation.
With the support of the American Medical Association (AMA),
theNSCCommittee promoted laws that established aBACof .15
or greater as presumptive evidence of intoxication and guided
the states through the process of adopting implied consent laws,
which allow officers to require a chemical test of drivers suspected
of driving under the influence (DUI) with an automatic
loss of license if they refused. Despite NSC’s leadership, however,
most of the key laws—illegal per se laws, administrative
license suspension (ALS) laws, zero-tolerance laws for underage
drivers, and lowering illegal BAC limits—that influenced
drunk-driving law enforcement over the next four decades remained
to be enacted by most of the 50 states.
Perhaps as significant for traffic safety as the limited framework
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 (1982) among others noted, during the first half of
the 20th century, crashes were attributed to “driver error.” The
term for such events was “accident,” implying that they were
chance events. The term “accident proneness” was developed
to explain why some individuals were involved in more accidents
than others. 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. Impaired driving attracted little attention
from the media and was overshadowed by popular entertainment
that featured films such as Animal House and Arthur and
comedians who found drunkenness a source of humor.
The publication of Unsafe at Any Speed by Ralph Nader
(1965) helped to correct the popular impression that most fatal
195
196 J. C. FELL AND R. B. VOAS
crashes were the fault of the “nut behind the wheel.” It made clear
that limitations in vehicle design played a significant role in highway
injuries andwas 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 programs
could be developed for each element in three periods of
time—precrash, crash, and postcrash. 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.
EARLY FEDERAL PROGRAMS (1967–1979)
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 (USDOT,
1968) 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 (Levy et al., 1977). Ironically, although the new NHSB
resulted from a movement away from the focus on driver responsibility
to concern with the vehicle/roadway environment,
the first and largest ($88 million) traffic safety demonstration
project ever funded by the federal government focused on the
problem (drinker) driver.
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 (Levy
et al., 1977; Zador, 1977; Johnson et al., 1976); nonetheless,
where any of the local projects succeeded in increasing enforcement
activity, crashes were reduced (Levy et al., 1977). One
enduring legacy from the ASAP effort was the adoption of required
educational programs for DUI offenders as standard court
practice. Under this practice, DUI offenders must attend either a
treatment program or a short educational program as a probation
requirement (Nichols et al., 1978). This procedure was adopted
nationwide, in part because of its low cost to the community, as
the offenders pay for the program.
Following the ASAP program, several smaller demonstration
projects were initiated to evaluate the effectiveness of specific
elements of the DUI criminal justice system, such as the effect
of increasing the number of DUI patrols on weekends (Voas &
Hause, 1987), the potential value of decriminalizing the DUI offense
in order to increase arrests and speed up adjudication, the
prohibition of plea bargaining, and the effectiveness of various
sentencing procedures. Many of the research studies funded by
the NHTSA have been published as governmental reports that
are now out of print. These works are not accessible in the research
literature, but many of them are covered in the reviews of
the literature produced by NHTSA every few years (e.g., Jones
& Lacey, 2002). Out of these projects came several procedures
and devices that enhanced the efficiency of the criminal-justice
system. For example, a list of vehicle maneuvers to alert officers
that the driver was possibly intoxicated was developed, as
was a three-component field sobriety test that could be used at
the roadside and has become the standard field sobriety test nationwide
(Burns & Moskowitz, 1977). Another product of this
period widely used by the courts today is a standardized procedure
for screening DUI drivers to determine the extent of their
alcohol problem (Filkins et al., 1973). Finally, the NHTSA supported
the development of evidential and preliminary breath-test
devices by establishing qualified products lists and providing a
test facility for manufacturers (NHTSA, 1984).
The early work on enforcement, adjudication, and treatment
procedures, as well as the funds flowing to the states through
Section 402 of the Highway Safety Act, has assisted states in
improving their laws and enforcement programs. Evidence of
this is indicated by the increase in DUI arrests that occurred at
the end of the seventies (FBI, 1999). Unfortunately, there was
no concurrent evidence of a reduction in alcohol-related crashes
in the late 1970s. Although the need to evaluate the ASAPs led
to the establishment of the national Fatality Analysis Reporting
System (FARS) in 1975, the current system for estimating the
number of alcohol-related fatalities was not established until
1982 (Rubin et al., 1998). Consequently, there are no comparable
data on alcohol-related crashes for the late 1970s. Total fatal
crashes, however, were increasing at that time, so it is unlikely
that alcohol-related fatalities were decreasing.
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
(Wilde et al., 1971), 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 (Ross, 1992). 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 drinkingand-
driving problem, focusing on the number of people killed
each year.NHTSAalso attempted to support theASAPproblemdrinker
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.
THE FIRST 25 YEARS OF MADD 197
THE EMERGENCE OF MADD (1980–1982)
In the early 1980s the public’s attitude toward drinking and
driving was substantially transformed. Citizen activism is generally
given credit for this change. In 1978, Remove Intoxicated
Drivers (RID)—the first citizen activist group dedicated
to fighting drunk driving—was established by Doris Aiken in
New York State. But it was not until 1980 that the victim activist
movement began to garner national attention. 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 arrested
for another hit-and-run drunk-driving crash. His driving
record reflected three other drunk-driving arrests—two resulted
in convictions and onewas 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 (Wilkerson, 2003; Weed,
1987).
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 attempting
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 highprofile
drunk-driving cases occurred (Wilkerson, 2003).
NHTSA’s national office became active in assisting Lightner
and Lamb at press events. In October 1980, Lightner and Lamb
held a national press event along with Congressman Barnes, Senator
Claiborne Pell of Rhode Island, Joan Claybrook (the Administrator
of NHTSA at that time), and Congressman Robert
Matsui from Lightner’s home district. Before the press event,
some MADD activists marched around the White House carrying
placards. Coverage of this protest by the press put MADD
on the nation’s radar screen. By the end of 1980, additional
MADD chapters had been formed in California and Maryland
(Wilkerson, 2003).
MADD was incorporated on September 5, 1980, as a California
corporation. By June of 1981 it had achieved IRS tax-free
status; later in the year, it received more than $100,000 in private
funding and $60,000 from NHTSA to support chapter development.
Articles on the organization appeared in the Los Angeles
Times and Family Circle, and Lightner appeared on national television
as a guest on both the Today Show and the Phil Donahue
Figure 1 Number of News Stories on Drunk Driving, 1979 to 1986 (Volume
of National Newspaper and Periodical Coverage of Drunk Driving by Year.
Newspaper volume based on count of stories in the [National Newspaper Index
includes the New York Times, the Los Angeles Times, the Wall Street Journal,
and The Washington Post]). Periodical volume based on the Magazine Index).
Show. This launchedMADDas the leading national advocate organization
concerned with impaired driving (Wilkerson, 2003).
THE GROWTH OF IMPAIRED-DRIVING PROGRAMS
(1980–1994)
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
(Figure 1), as did the number of DUI laws being considered by
state legislatures (Figure 2). 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.
Figure 2 Number of drunk-driving laws passed by states from 1981 to 1986.
198 J. C. FELL AND R. B. VOAS
In part due to the stimulus provided by the emergence of the
impaired-driving activist movement and by active supporters in
Washington, D.C., such as Sandy Golden and Bill Bronrott, the
U.S. Congress called on the White House to establish a Presidential
Commission on Drunk Driving. In April 1982, President
Reagan took that action by announcing the formation of
the Commission; MADD was invited to participate. By the end
of 1982 there were governor-appointed DUI task forces in 16
states. MADD chapters and particularly MADD state organizations
were active in pushing the introduction of new legislation
and supporting its passage by lobbying state legislators and officials.
Beginning in 1988 with funding from the NHTSA,MADD
conducted a series of state workshops for citizen activists, police
officers, judges, and prosecutors to promote the need for
strengthened DUI laws and more intensive DUI enforcement
(Wilkerson, 2003). A major enforcement issue for NHTSA and
the nationwas “sobriety checkpoints,” which have been shownto
be highly effective in producing general deterrence to impaired
driving (Elder et al., 2002), but were viewed as unconstitutional
by some legal authorities. Their legalitywas affirmed by the U.S.
Supreme Court in the Michigan State Police v Sitz case in 1990,
in which MADD participated by submitting an amicus curiae
brief.
Perhaps most importantly during this period, Congress with
support from the scientific community and MADD and it’s 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 (Toomey et al., 1996). 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’sWorkshop on Drunk
Driving that, for the first time, brought together public health and
traffic-safety scientists and advocates (USDHHS, 1988). 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.
STALLED PROGRESS IN REDUCING ALCOHOL
FATALITIES (1995–2005)
With the great increase in media attention to the impaireddriving
problem and the surge in alcohol legislation in the 1980s,
there was a heartening reduction in alcohol-related fatal crashes
between 1980 and 1995 (NHTSA, 2004). This encouraged the
setting of ambitious goals for alcohol-safety programs. For its
10th anniversary in 1990, MADD produced a “20 by 2000”
plan that set a goal to reduce alcohol-related traffic fatalities
by 20% in the following decade—a goal that actually was met
three years early in 1997. In 1995, Secretary of Transportation
Frederico Pe˜na called a national meeting—“Partners in
Progress”—in which MADD played a very prominent role as
it established many of the agenda items (NHTSA, 1995). The
meeting set an even more ambitious national goal for the reduction
of alcohol-related crashes: reduce alcohol-related fatalities
to 11,000 a year by 2005. Unfortunately, the 17-year decline in
alcohol fatalities came to an end in 1997, and in 2005—the 10th
anniversary of the new national goals—alcohol-related traffic
fatalities remain between 16,000 and 17,000.
Despite the discouraging lack of progress in reducing alcoholrelated
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. This new law was a natural complement to the existing
national MLDA 21 law under which it was illegal for a person
younger than 21 to drink alcohol (Hingson et al., 1994; Voas
et al., 2003). The National Highway System Designation Act
of 1995 (23 USC § 161, 1995) provided sanctions for states
that failed to enact a zero-tolerance law by withholding a portion
of their federal highway construction funds. By June 1998
all states had enacted legislation that complied with the federal
zero-tolerance criteria: 12 states and the District of Columbia
set the limit at .00, two states at .01, and 36 states at .02.
Another of the most significant legislative achievements advancing
alcohol safety during this period was the passage of
legislation lowering the illegal BAC limit from .10 to .08. Beginning
in the 1970s, the DOT used its authority under the Highway
Safety Act of 1966 to encourage states to adopt illegal per
se laws specifying .10 BAC as the legal limit defining impaired
driving. From the outset of the movement to adopt .10 BAC as
the national standard, there were advocates for even lower BAC
levels. In 1986, DOT formally advocated a lower illegal limit
by including a .08 BAC law as one of the regulatory criteria for
a supplemental alcohol traffic safety grant under the program
authorized by the U.S. Congress (23 USC § 408). By 1983, this
movement toward a lower BAC limit had resulted in Oregon and
Utah enacting .08 laws; similar legislation was enacted in Maine
in 1988, California in 1990, and Vermont in 1991.
Beginning in 1992, the growing evidence for impairment at
lower BAC levels (Zador et al., 2000; Moskowitz & Fiorentino,
2000) and for the effectiveness of the .08 limit (Hingson et al.,
1996;Voas et al., 2000a; Hingson et al., 2000; Shults et al., 2001),
as well as MADD’s efforts with state legislators, induced 10 additional
states to adopt .08 BAC per se laws by 1998: Kansas and
North Carolina (1993); Florida, New Hampshire, New Mexico,
andVirginia (1994); Alabama and Hawaii (1995); and Idaho and
Illinois (1997). However, the movement toward a national standard
of .08 BAC was slowed by the strong opposition from the
alcohol and hospitality industries, claiming that the lower limit
THE FIRST 25 YEARS OF MADD 199
would impact social drinking. This led to the introduction of a
bill by Senator Frank Lautenberg of New Jersey and Congressman
Frank Wolf of Virginia that called for the withholding of
a portion of the federal highway construction funds from states
that did not enact .08 legislation.
On June 15, 2000, the Senate passed H.R. 4475 (the DOT
Appropriations Bill for Fiscal Year [FY] 2001) that, through the
threat of sanctions, encouraged states to adopt .08 BAC laws by
FY 2004. The final .08 BAC bill (Section 351) was adopted by
Congress and signed by the President shortly after that (23 CFR
§ 1225, 2000). MADD played a prominent role in pushing the
legislation, including the convening of a “Youth Summit” of 435
young people from every congressional district gathering on the
Capitol steps in Washington, D.C., to visit their representatives
and promote the passage of the .08 limit. Newresearch on the .08
BAClimit has confirmed its effectiveness (Dee, 2001; Eisenberg,
2001; Bernat et al., 2004; Tippetts et al., 2005).
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 (Voas
et al., 2000a). 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.
Increased penalties for repeat DUI offenders also were enacted
during this period. The Transportation Equity Act for the
21st Century (TEA-21) was passed by the Congress in 1998.
MADD played a significant roll in supporting the section of the
act that provided for a minimum license suspension of one year
for second DUI offenders, as well as impoundment of the offender’s
vehicle or installation of an alcohol ignition interlock
on the vehicle. States were required to adopt such legislation or
face a transfer of funds from highway construction to highway
safety programs. Both vehicle impoundment (Voas&DeYoung,
2002) and alcohol interlocks (Willis et al., 2005) have proven to
effectively reduce DUI offender recidivism.
REASONS FOR THE GROWTH OF 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 crosssection
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: Weed (1993), McCarthy and Crishock
(1996), McCarthy and Wolfson (1996), Reinarman (1988), and
Marshall and Oleson (1993). Some researchers have attributed
the emergence of MADD to the charismatic personality of its
founder, Candy Lightner (e.g., Weed, 1993), and certainly she
played a prominent role, particularly after NBC produced a
movie on her life in 1983. MADD did enjoy the advantage of
a very photogenic, outspoken leader who rapidly became proficient
at using the public media to spread MADD’s message
(Weed, 1993; Reinarman, 1988).With this initial leadership and
the support of public-media experts from the broadcast industry
and the federal government, MADD developed a strong capability
to respond effectively to the growing press interest in the
drinking-and-driving problem. The MADD president provided
what had generally been missing in the past—a ready source of
comment for reporters on alcohol-related highway deaths and
a personification of the drunk-driving problem by a prominent
victim.
Other scientists, such as McCarthy and Crishock (1996) and
Reinarman (1988), have suggested that funding and general support
from the hospitality industry played an important role because
they saw MADD’s policies as focused on “killer drunk
drivers” and not on normal social drinkers. Reinarman noted
that the alcohol industry’s interest in blaming the problem on
the deviant driver, to deflect attention away from the full range
of problems related to alcohol consumption, moved them to
support MADD in its early years. Whatever affinity the alcohol
industry felt for the MADD objectives, there is little evidence
that alcohol industry financial support had a significant influence
on the growth of the MADD organization. The only alcohol industry
gift to MADD came from Anheuser-Busch. Reported to
be $175,000, it actually only amounted to $50,000 in cash when
the in-kind components failed to materialize. This support did
not materialize until 1983, well after much larger (more than $1
million) and more crucial contributions were received from insurance
industry leaders andNHTSAin 1981(Wilkerson, 2003).
The issue as to whether MADD profited from indirect support
or lack of opposition from the hospitality industry is difficult to
determine because there are no useful measures of that assistance.
MADD may have initially enjoyed a period during which
it was not strongly opposed by the industry; however, in the
1990s, when it expanded its program to include lowering the
legal limit, it encountered considerable opposition from alcohol
interests that remains to this day.
Reinarman (1988) suggested that the conservative political
climate represented by the Reagan presidency contributed to the
200 J. C. FELL AND R. B. VOAS
rise of MADD because its message stressed the immorality of
drunk driving and the individual’s responsibility for avoiding
that criminal act, which fit well with that administration’s conservative
law-and-order philosophy. This suggestion also is difficult
to evaluate objectively. Clearly, the public’s sympathy for
injured children can be readily aroused and the drinking driver
is an easy target, but it is not clear why that message should
resonate more under conservative governments because liberal
governments are reputed to be more supportive of federal action
in the health and safety area.
Much of the reasoning related to the emergence of MADD is
based on anecdote and opinion because there is relatively little
research evidence directly relating the organizations’ activities
to public knowledge and drinking and driving. 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 before
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.MADDnot 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 trafficsafety
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 considerable
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 support
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, increasing
its name recognition and supporting its fund-raising
efforts.
McCarthy andWolfson (1996) have provided a relatively detailed
analysis of the growth and characteristics of the two best
known drinking-and-driving activist organizations: MADD and
RID. They note that between 1979 and 1985, MADD received
far more national publicity than RID. MADD activists at the
local level had the advantage of approaching communities that
already were aware of MADD and its goals. They characterized
MADD as a top-down organization, noting its stronger
control over membership requirements by the national office
compared to the bottom-up organization of the more loosely affiliated
RID community groups. The MADD chapters tended
to have larger mailing lists and budgets that were five times
higher than their RID counterparts. The authors conclude that
three factors account for the differences between MADD and
RID: (1) the selection effects from MADD’s more stringent criteria
for group chartering; (2) greater interest and enthusiasm
for MADD groups due to the wide popularity and knowledge of
MADD; and (3) the direct chartering of the organization and its
leaders, which motivated individuals to become associated with
a highly prestigious national organization.
Weed (1993, pp. 330–333) has provided a sociological analysis
of the early history of MADD based on the work of
Weber (1964), pointing to the traditional conflict among
founders of reform movements who gain authority from their
victimization experiences. They attract other advocates to an organization
that is not highly structured and where no one has an
office, but all are answering a “call to action.” In such organizations,
the leader has full authority, and the unit is held together
by a common passion for the cause (Weber, 1964, p. 360). The
problem presented by such organizations is that to grow they
must raise funds and deal with the complexities of fund-raising
regulations and taxation. This requires standard business practices
and procedures that may lead to a modification of goals or
the setting of new goals for the organization (McCarthy et al.,
1991). This, in turn, results in recruiting specialists in finance
and administration into the organization who might support the
objectives of the organization but do not share the passion of the
victim’s experience or motivation.
Weed (1993), who had access to MADD staff and records
during the period from 1984 to 1987, applied this social-science
theory to what he saw as the conflict in the early history of
MADD between the National Board of Directors and the charismatic
founder, Candy Lightner. He saw a part of the conflict as
resulting from outside pressures from such organizations as the
Better Business Bureau, but, ultimately, he concluded it was the
inability of charismatic leadership to work with administrative
structures. He gives Lightner a great deal of credit for MADD’s
legislative successes and building the organization, which by
the time she left MADD in 1985, had grown to 360 chapters.
Nonetheless, he leaves the picture of an organization bereft of
its engine, with some threat to its continued existence.
Unfortunately, Weed’s analysis ended at that point and thus
failed to follow the full development of the MADD organization
beyond 1985. MADD ultimately developed into a large,
highly organized national entity while preserving much of its
THE FIRST 25 YEARS OF MADD 201
charismatic element. The organization that evolved in the years
immediately following Lightner’s resignation established a governing
board of directors. Initially, most of the directors were
drawn from the business world and were not localMADDmembers;
however, following Lightner’s departure, chapter members
became the majority on the board. As is the case for most large,
nonprofit organizations, MADD employs an executive director
who manages the central office staff with specialists divided into
several departments (e.g., field issues, programs, public policy)
and reports to the Chairman of the Board. Recently, the new
executive director of MADD has been given the title of Chief
Executive Officer, further distinguishing that position from the
national president, who is the chief spokesperson for MADD.
The central office staff supports local chapters and conducts national
programs. A key feature of MADD’s public-media program
is the president, who is always a victim member of the
organization. The president fills the role of chief spokesperson
for MADD and management of the central office is left to the
executive director. This preserves the authority and passion of
the public face of the organization without placing the burden
of managing a large national staff on a victim volunteer.
A part of this organizational growth and transformation, not
recorded byWeed, was the development of a strong support program
for the victims of impaired drivers.Aunique 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 service
to more than 27,000 victims, and in 2004 served more than
31,000 victims of alcohol-related crashes.
Aside from developing a very professional model for assisting
impaired-driving crash survivors and victim families, the organization
promoted victims’-rights legislation to ensure that state
victim-compensation laws included victims of drunk drivers.
MADD also has supported a National Victim Rights Amendment
to the Constitution. 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 withVictim Impact Panels (VIPs) in 190 communities.
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. Although Shinar
and Compton (1995) found some evidence for the effectiveness
of VIPs, other studies did not support their results (e.g., Polacsek
et al., 2001). These results, however, do not reduce the potential
importance of VIPs to the recovery of the victim.
Also not recorded by Weed—because it occurred somewhat
after his study—was the integration of researchers into the development
of MADD’s public-policy program. As noted in the
Figure 3 Cumulative growth in the number ofMADDchapters, 1980 to 2004.
beginning of this article, alcohol safety is a complex field requiring
programs that deal with alcohol availability and consumption,
as well as drinking and driving itself. To establish a broad
base of national support, it was necessary for MADD to develop
public policies beyond the focus of increasing sanctions for impaired
drivers. This program expansion, which included not only
underage drinking but also support for responsible beverage service
and sales practices and safety belt legislation, was considered
essential to MADD accomplishing its mission to eliminate
impaired driving. However, this expansion had to be accomplished
without it appearing to the public that MADD was diluting
its primary mission and without diminishing the support
of the volunteer members. MADD achieved this transition by
inviting researchers to serve on the national board, establishing
the position of vice president for public policy, and adopting the
position that no policy action would be supported unless there
was scientific evidence for its effectiveness.
Thus, 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
(Wilkerson, 2003). McCarthy and Wolfson (1996) attributed
much of MADD’s success to its organizational ability and its effectiveness
in attracting members and funds. The resulting rapid
expansion in the number of chapters is shown in Figure 3 and the
increased revenues are shown in Figure 4. This growth was in
Figure 4 Growth in total MADD revenue, 1984–2004.
202 J. C. FELL AND R. B. VOAS
contrast to the RID organization (www.rid-usa.org) that was the
principal alternative victims’ organization to MADD. RID, although
making important contributions to the impaired-driving
effort, remained an affiliation of more local, autonomous entities
under the leadership of the founding members with a limited
number of local chapters and limited national visibility.
The McCarthy and Wolfson study provides an interesting
comparison between an organization that retained its initial,
purely volunteer character and its original charismatic leader
(RID) and one that went through a considerable transformation
(MADD). MADD established a strong central administration,
encompassing policies not in its original charter while taking
steps to preserve the passion exhibited by its founder, Lightner,
who was no longer with the organization. Despite some financial
crises along theway and premature obituary announcements
(Marshall & Oleson, 1993), MADD has become a unique organization
that other activist groups might profit from emulating.
The management of the organization is vested in the board, comprised
of a majority ofMADDmembers from local chapters and
a professional executive director who manages the central office
staff. The MADD president is relieved of administrative duties
and thus is freed to act as a full-time spokesperson for the organization.
The absence of its charismatic founder has allowed
other victim members of MADD to represent the organization
to the nation. This experience has demonstrated the power of the
message—the personal stories of loss and grief—in obtaining
legislative action and public support. In 2005, for the first time,
a male victim was elected to the presidency of MADD.
MADD POLICY DEVELOPMENT
During its 25-year history,MADDhas dealt with many issues
central to highway-safety policy while developing its own program.
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. Unfortunately,
most of this activity is undocumented. However, both the
authors have served on the MADD National Board in different
periods of time beginning in 1982 to the present, covering most
of the organization’s existence, and can provide some observations
based on that experience. A brief review of some major
issues will assist both in understanding theway in whichMADD
grew into its present status and in evaluating its achievements.
A few of the developmental issues encountered over the 25-year
history of the organization can be described.
Individual Versus Systems Approach
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) andWagenaar
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 underage
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.
Position on Drinking Versus Drinking and Driving
From its inception, MADD was faced with the conflict between
measures to control drinking and driving and policies and programs
to control alcohol consumption. This problem was a part
of the individual versus systems approach just discussed. There
is substantial evidence that alcohol availability, particularly to
youth, is related to the frequency of impaired-driving crashes
(Wagenaar&Holder, 1991, 1995). It was inevitable thatMADD
would be challenged to take positions on such issues as underage
drinking, alcohol taxation, and alcohol advertising. Moreover,
even if such issues could have been entirely avoided, purely
traffic-safety policies, such as lowering the illegal BAC limit
to .08, brought MADD into conflict with most of the alcohol
and hospitality industries. Some representatives of the alcohol
industry saw that as an attack on their core clientele of “social
drinkers” (Pe˜na, 2003). MADD has attempted to maintain the
distinction between its opposition to drunk driving and advocacy
of the responsible use of alcohol by adults. It is often difficult to
maintain such a separation in public statements when research
suggests that any measurable amount of alcohol affects performance
(Moskowitz et al., 1985, 2000). Thus, the “best practice”
is no driving after any drinking, a message that provokes a response
that the speaker is a neoprohibitionist (Pe˜na, 2003).
This issue of MADD’s position on drinking, as opposed to
impaired driving, became a focus of the political controversy
THE FIRST 25 YEARS OF MADD 203
over the reduction of the legal limit from .10 to .08 in the period
leading up to action by the U.S. Congress in 2000. Using
a BAC prediction system (NHTSA, 1994) to estimate the BAC
of a small woman and large servings of wine consumed rapidly
on an empty stomach, spokespersons from the alcohol industry
claimed that two glasses of wine could result in an .08 offense
(Pe˜na, 2003). The alcohol industry, and particularly the Century
Council, also promoted the concept of the “hard core drinking
driver” from Simpson, Mayhew, and Beirness (1996), which
suggested that the emphasis in drinking-and-driving programs
should be placed on drivers with high BACs in the .15 or higher
range rather than those with low or moderate BACs. Thus, they
claimed that MADD was focusing on social drinkers rather than
the problem drinkers at highest risk for crash involvement. The
issuewas further sensitized by theAMAcalling for lowering the
illegal BAC to .05. This supported the alcohol industry’s contention
that the .08 limit was just the first step in the direction
of lowering the legal BAC to .05 (the current level in most of
Europe) or even to .02 (the current level in Sweden). Although
MADD spokespersons have never advocated moving to the .05
level, some representing the alcohol industry pushed the view
that “The road to neo-Prohibition proceeds along two lines of attack.
First, anti-drunk-driving advocates aim to steadily decrease
the amount of alcohol a motorist can consume before becoming
a criminal. Second, the movement works to ever expand the
settings where any drinking of alcohol beverages is verboten”
(Pe˜na, 2003, p. 7). Although MADD succeeded in promoting
the passage of a Congressional mandate to the states to adopt
.08 per se laws and all 50 states and DC now have such laws, the
problem of fending off claims that it is “prohibitionist” remains.
Punitive Versus Remedial Measures for Drunk Drivers
When their loved ones have been seriously injured or killed, the
victims naturally demand severe sanctions for the offenders. An
early goal of MADD public policy was to demand jail terms for
first offenders as well as multiple DUI offenders. In the 1960s
and 1970s sanctioning of DUI offenders by the courts was relatively
lenient, even to the extent of avoiding license suspension
in many cases. Appropriately, MADD supported more substantial
penalties to strengthen general deterrence and to prevent
convicted offenders from immediately getting back on the road.
Thus, MADD played an important role in encouraging states to
lengthen the periods of license suspension and to adopt ALS
laws.
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 longterm
“educational” component (Andenaes, 1974) 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 offenders
by Kinkade and Leone (1992). Although there is some evidence
(Zador et al., 1988) that jail is effective in producing general
deterrence, that evidence is compromised by the fact that most
state laws mandating incarceration provide for the substitution
of community service due to the lack of jail space. Further, there
is no evidence that serving jail time reduces future recidivism
(Voas, 1985). 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. Despite
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 (Wells-Parker et al.,
1995).
Participation in Safety-Belt Campaigns
The prevention of impaired driving and the use of safety belts
are two of the three most important driver-behavior issues related
to crash injury (along with excessive speed). Early in its
history, MADD’s effort to keep on message was challenged by
the issue of supporting safety-belt messages and particularly
safety-belt laws. Many national organizations adopted safety
belt laws as a central element of their programs and the NHTSA
initiated programs to encourage states to adopt primary enforcement
safety belt laws, so there was not a direct need for MADD
to be involved. Even so, there are a number of possibilities for
combined enforcement campaigns such as checking safety-belt
use at sobriety checkpoints and detecting impaired drivers during
nighttime safety-belt usage enforcement activities. Initially,
some were concerned that this would dilute MADD’s drinkingand-
driving message, but, ultimately, these concerns were resolved
by promoting safety belts as the best protection for potential
victims against the drunk driver. This ability to assume
other key safety measures within the MADD mission was probably
an important factor in keeping the organization within the
mainstream of the highway-safety movement.
Integration of Youth Programs into MADD Activities
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 controlling
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.
A national organization of youth called “Students Against
Driving Drunk” developed independently. In the early nineties,
the two organizations entered into discussions of the possibility
of an amalgamation (Wilkerson, 2003). This did not occur for
a number of reasons, but clearly a central issue was that the
SADD leadership was uncomfortable with strongly supporting
204 J. C. FELL AND R. B. VOAS
theMLDA21 and zero-tolerance laws.SADDwent on to change
its name to “Students Against Destructive Decisions,” and its
focus is primarily on peer-to-peer education programs.
Consequently, theMADDleadership still needed to develop a
system for mobilizing underage youths concerned with impaired
driving. Its approach was to develop an outreach program—
Youth in Action (YIA)—to youths. This program established
youth groups (principally at the high-school level) sponsored by
localMADDchapters. The YIA program partners young people
with adult leaders in the community to work toward “environmental”
prevention strategies. Projects focus on strengthening
enforcement of underage drinking laws and policy change. YIA
teams have been trained in more than 40 communities across the
country. These young activists have proved to be particularly effective
in drawing the attention of the press and community
members to the underage drinking problem. Their partnerships
with local law enforcement agencies, schools, and community
leaders have helped to promote local enforcement programs and
support key underage-drinking legislation (Fell, 2004).
The power of young activists also was mobilized at the national
level through a NationalYouth 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” (Wilkerson, 2003).
Coordinating Policy with Research
A large number of policies and programs can influence impaired
driving. Several of these policies (such as ALS laws, .08 laws,
andMLDA21 laws) have been evaluated, and their effectiveness
has been well documented. Other measures have not been evaluated
or have been poorly assessed. In the rapidly developing
technological area dealing with impaired driving, new devices
and measures touted to be effective in preventing or reducing
injuries appear regularly. Only recently has the Centers for Disease
Control and Prevention (CDC) initiated a coordinated effort
to assess major countermeasure programs (Shults et al., 2001).
As with other organizations, MADD has been repeatedly faced
with decisions about which programs to support and the level of
effort that should be devoted to their promotion.
Such issues arrived early for the MADD leadership. Some
of the policies growing out of the victims’ concern with strong
penalties for drunk driving, such as jail terms, were difficult
to implement and not as well supported by research as other
policies, such as ALS and MLDA 21. To meet the need for
expert advice on program priorities, MADD leaned heavily on
the NHTSA’s research and program staff and a few outside scientists.
In 1990, MADD Public Policy Committee Chairman,
Beckie Brown, convened an advisory group of scientists to develop
recommendations for action over the next decade titled
“20 by 2000.” This group provided a set of priorities based on
the best research available at the time and provided consulting
services on program issues as they arose (Brown et al., 2004).
The general success of that program led to the national board
adopting the principle of only supporting laws and policies for
which there was scientific evidence of effectiveness. The reliance
on scientific information to guide policy and program
planningwas further institutionalized by providing two positions
on the national board for research specialists. In recognition of
MADD’s efforts to coordinate policy based upon scientific research,
the International Council on Alcohol, Drugs and Traffic
Safety (ICADTS) presented the MADD organization the prestigious
Widmark Institutional Award in 1995. In recognition
of Ms. Brown’s individual efforts, she was given the Haddon
Award in 2004 by ICADTS for advocating “scientifically-based
changes in public policy which have reduced the adverse effects
of alcohol or other drugs on traffic safety.”
Increasing Membership Diversity
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 provided
to the victims of alcohol-related traffic crashes, and because
this activity had to be highly sensitive to the stress that the
families of crash victims were under, itwas 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
led to the development of a permanent position on the national
office staff for a Diversity Coordinator. In 1999, in conjunction
with the NHTSA,MADDsponsored a National Diversity Forum
in Florida, to which the leaders of the nation’s major minority
organizations were invited. 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 (Voas et al., 1998, 2000b).
In 2004, of the 15,346 new victims served by MADD—where
the ethnicity of the victim was known—15% were Black, 13%
were Hispanic, and 69% were White (MADD, personal communication
from the MADD National Office, Irving, Texas, 2005).
At the present time, theMADDnational president is an African-
American male.
Influencing State Programs
Funds for state traffic-safety programs are managed through the
state offices of highway safety and are under the control of the
Governor’s Highway Safety Representative. In the early days
of the Highway Safety Act, NHTSA regional administrators
exercised considerable influence over state expenditures under
their authority to review and approve the annual safety plans
THE FIRST 25 YEARS OF MADD 205
submitted by the state directors. Over time, resistance by some
state officials to submitting the plans for review and approval resulted
in the abolishment of that requirement in favor of requiring
the state to go through a prescribed planning process without the
detailed approval process. This resulted in less federal influence
on state safety programs. NHTSA might have strengthened its
influence by establishing some national performance criteria for
rating state programs, but the agency apparently determined that
thiswas not practical given the political sensitivities surrounding
the distribution of highway safety funds.
The MADD leadership became concerned that, as a result
of the weakening of federal influence over state highway-safety
expenditures, support for alcohol-related countermeasure programs
was decreasing. Consequently, MADD began to provide
regular appraisals of the adequacy of state highway-safety programs.
This involved considerable political risk, as low assessments
were likely to antagonize state officials and the failure to
be critical risked a lack of credibility. The availability of the core
group of researchers and highway-safety specialists brought together
by Brown to develop the “20 by 2000” plan provided the
basis for designing a comprehensive survey of state impaireddriving
countermeasure programs. The survey was conducted
by the state MADD chairman or public-policy specialist by contacting
state officials and gathering information on state laws,
programs, and traffic statistics.
In 1991, MADD launched its “Rating the States” (RTS) program,
which became a continuing series of reports (MADD,
1991–2005) that provided a letter-grade score in nine impaireddriving
program areas: DUI laws, DUI enforcement, DUI sanctions,
underage-drinking programs, victims’ issues, political
leadership, state traffic-records systems, regulation and control
of alcohol sales, and alcohol-related fatality trends. Each report
was released at a national news conference that garnered extensive
coverage by the news media. Individual state press events
also were held. As expected, some state officials were outraged
when their state programs received low grades. Nonetheless, in
several states, the news coverage stimulated action by the governor
or the state legislature to adopt much needed legislation
(Russell et al., 1995).
Much of the information that went into the RTS program
was qualitative, thus making it less usable for program evaluation.
Despite this limitation, Shults et al. (2002) found that
the RTS grades that the states received were associated with
self-reported impaired driving in those states. This association
betweenMADDstate grades and a measure of alcohol-impaired
driving was calculated using multiple logistic regression analyses
on the Behavioral Risk Factor Surveillance System (BRFSS)
survey data from each state. Those living in states with aMADD
grade of “D” were 60% more likely to report driving after drinking
too much than those living in states that received an “A”
grade from MADD. The association was for both men and
women. These findings suggest that stronger state-level DUI
laws, enforcement, and programs are associated with reductions
in alcohol-impaired driving (Elder et al., 2002).
These policy adaptations to the ongoing federal and state program
activities appear to have helped MADD broaden its base
while still maintaining its identity as the premier victims’ organization
concerned with impaired driving. Had the organization
not been able to incorporate the broader objectives growing out
of traffic safety and public-health research, itwould have had difficulty
obtaining the support of government agencies and other
related safety organizations.
EVIDENCE FOR THE EFFECTIVENESS OF MADD
Press reports and statements by governmental officials and
safety activists provide a vast amount of qualitative evidence for
MADD’s effect on the impaired-driving problem in the United
States (Gladwell, 2001). However, crashes are a function of a
complex set of factors that makes the evaluation of any intervention
effort difficult. Attempting to assess the effect of the
wide variety of programs and policies sponsored or promoted
by MADD over 25 years using objective data is clearly difficult
to accomplish with any precision. This is particularly true
as many organizations (NHTSA, NSC, RID, state and local officials,
and individual industries) are working toward the same
goals, so teasing out the relative contribution of each organization
is clearly not possible. Perhaps the best analysis can be made
by considering the factors that enter into the general model for
predicting crash involvement. There is general acceptance of the
relationship between laws, their enforcement, and public education
on driver perceptions of the risk of being caught for DUI and
punished which affect public attitudes toward impaired driving.
These perceptions and attitudes are, in turn, related to crash involvements.
Thus, the causal model (Figure 5) may be useful in
analyzing the potential effect of MADD’s programs on crashes.
Legislation
MADD played a major role in the strong growth of impaireddriving
legislation shown in Figure 2. Merki and Lingg (1987)
concluded that MADD had been a major force behind the adoption
by the states and communities of eight effective impaireddriving
strategies. Perhaps the six most important pieces of alcohol
safety legislation in state legislatures in the last quarter
century were (1) MLDA 21 laws, (2) zero tolerance for youth
laws, (3) .08BAClimit laws, (4)ALSlaws, (5) illegal per se laws,
and (6) increased sanctions for repeat DUI offenders. MADD
played a central role at both the national and the state levels in
obtaining the passage of the first three laws, as was indicated
by the MADD president being invited to speak at the formal
signing of each of the bills. MLDA 21, zero-tolerance, and .08
laws were the only pieces of safety legislation for which the
Congress authorized the withholding of highway safety funds
from states that did not enact the legislation. MADD’s role
in the other three legislative areas also was substantial. The
movement of the states to illegal per se laws was already underway
before MADD was founded, but MADD support hastened
the adoption of the legislation during the 1980s and 1990s.
Figure 5 Model of major elements in law enforcement programs to reduce
alcohol-related crashes.
206 J. C. FELL AND R. B. VOAS
MADD played a direct role in the drafting of the TEA-21 legislation
that strengthened the sanctions for repeat DUI offenders.
MADD’s role in the adoption of ALS laws was previously
discussed.
Enforcement
At the community level,MADDchapters have supported policeenforcement
activities by demanding strong DUI enforcement
and acknowledging police efforts through annual awards to the
officers who make the most DUI arrests. At both the local and
national levels, MADD has supported sobriety checkpoints. At
the national level they have supported special incentive funding
for checkpoints under Section 410 of the Highway Safety
Act. They also submitted an amicus curiae brief in support of
checkpoints when the U.S. Supreme Court reviewed the issue
in the Sitz case. FBI crime-record data (Figure 6) 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.
Although Ross and Voas (Ross, 1982; Ross & Voas, 1990)
noted that the probability of apprehension is the most important
factor in producing deterrence, the severity of the sanction
and the speed with which it follows the arrest also are important
factors in deterrence. At the beginning of the 1980s, DUI
offenders were frequently given relatively light sentences. The
driver involved in the death of Candy Lightner’s daughter was a
three-time offender. Thus, from the beginning of the movement
there was active concern with court-sentencing practices. Consequently,
MADDdeveloped an active court-monitoring process
that Compton (1988) credited as having a positive effect on the
adjudication of DUI offenders. Additionally, MADD actively
supported efforts at the state level to pass ALS laws, which have
been shown to be associated with crash-injury reductions (Zador
et al., 1988; Voas et al., 2000a) and gave such legislation high
priority in its RTS program.
Figure 6 Estimated DWI arrests in the United States (1978 to 2003).
Publicity
Figure 1 clearly shows a major increase in media coverage
of the drunk-driving issue beginning in 1980. Most observers
(McCarthy et al., 1987) 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.
Deterrence
Surveys shortly after MADD’s founding indicated a reduction in
reported drinking and driving. The Harris polling organization
reported that its annual national survey of U.S. adults showed an
increase in respondents who said they never drink or never drove
after drinking from68%in 1983 to74%in 1986 (Howland, 1988,
p. 169). The CDC also reported reductions in reported impaired
driving in its state behavioral risk surveys. The percentage of
respondents who reported “driving after drinking too much”
decreased from 5.5% in 1984 to 4.5 % in 1986/1987 (CDC,
1986a, 1986b, 1987).
More recent surveys have shown a continuing public awareness
of the drinking-and-driving problem. Unfortunately, there
have been no completely comparable drinking-and-driving surveys
that cover the period from 1980 to the present. NHTSA
has conducted biannual national surveys since 1990. These surveys
indicate little change during the 1990s in the percentage
of U.S. residents who report driving within two hours of drinking
in the past year (Royal, 2000), despite the change in trend
in alcohol-related fatal crashes (Figure 7). The role of MADD
in producing deterrence to drinking and driving is difficult to
determine. However, two national Gallup surveys conducted in
the early 1990s indicated that 71% of the public recognized
MADD’s name unaided and, when the term MADD was recognized,
95% perceived that it was effective in reducing drunk
driving (Gallup, 1993, 2000, 2005). This suggests that, at least
Figure 7 Percentage of reduction in fatally injured drinking drivers and
pedestrians and per capita alcohol consumption in the U.S. from 1982 baseline
year.
THE FIRST 25 YEARS OF MADD 207
Figure 8 Percentage of weekend nighttime drivers with positive BACs on
U.S. roads.
by the second decade after its founding, MADD was having an
impact on the public’s view of impaired driving.
Impaired Driving
National surveys of weekend nighttime drivers on U.S. roads
were conducted in each of the last three decades of the 20th
century. The results of these surveys (Figure 8) provide strong
evidence of a substantial reduction in impaired driving in the
United States between 1973 and 1996 (Voas et al., 1998). The
point at which the downward trend from 36.1% of drivers with
positive BACs in 1973 to the 25.9% in 1986 cannot be determined,
so the role of MADD in this change is unclear, though
it is likely based on the trends in publicity and DUI laws, much
of which occurred after 1980. The reduction between 1986 and
1996 clearly occurred during the period in which MADD had
established itself as the leading advocate organization with chapters
throughout the country. The decade from 1986 to 1996 corresponds
to a period after which much of the early surge in legislation
peaked (see Figure 2) and was in place in many states,
presumably having an effect on impaired driving.
Alcohol-related Crashes
One study (McCarthy & Ziliak, 1990) 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.
A more qualitative estimate of the impact of MADD on
crashes can be deduced from the trend in alcohol-related fatal
crashes. The FARS is a census of all fatal crashes on U.S.
roadways since 1975, but the current system for estimating
alcohol-related fatalities was not initiated until 1982. Based on
the NHTSA imputation system (Subramanian, 2002), alcohol-
Figure 9 Total U.S. highway fatalities 1975 to 1985.
related traffic fatalities have declined from 26,173 in 1982 to
16,694 in 2004, a 36% decrease, whereas non-alcohol-related
traffic fatalities have gradually increased from 17,772 in 1982 to
25,942 in 2004, a 46% increase. Similar percentages for 1975 to
1982 are not available, but as shown in Figure 9, the total annual
number of traffic fatalities during that period increased during
the last half of the 1970s, peaked in 1979 and 1980, but declined
in 1981 and 1982. Thus, there is no indication of a significant
reduction in alcohol-related fatalities before 1981. Beginning in
1982, the percentage of all fatally injured drivers and all fatally
injured pedestrians who had had been drinking (with positive
BACs) declined from 1982 through 1995 and then leveled off
for the next decade (Figure 7). The reduction in the percentage
of fatally injured drivers who were drinking was substantially
greater than that experienced for fatally injured pedestrians. The
percentage reduction in fatally injured drivers with alcohol also
was greater than the percentage reduction in per capita alcohol
consumption. This suggests that the change in national alcohol
consumption that might have produced much of the reduction in
fatally injured drinking pedestrians did not account for the larger
reduction in impaired driver deaths. Because MADD targeted
drivers, not pedestrians or drinking in general, this difference
supports the hypothesis that it had an effect on drinking-driver
deaths and injuries beyond that which might be accounted for
by the observed reduction in alcohol consumption.
The reduction in alcohol-related fatalities following the emergence
of victim-activist groups supports the hypothesis that they
had an important affect on highway safety in the 1980s. The
continuation of substantial reductions into the early 1990s when
MADDemerged as the primary victim-activist organization suggests
that it had the primary influence on the observed reduction.
It is estimated that more than 300,000 lives have been saved due
to the reduction of alcohol involvement in fatal crashes from
60% in 1982 to 39% in 2004 (Table I).
However, to accept the hypothesis that MADD was partially
responsible for the observed reductions requires a comparison
set of data not influenced by a victim-activist organization. Because
alcohol-related fatalities in other industrialized countries
also were reduced during the 1980s (Sweedler et al., 2004),
the interpretation of the relationship of MADD to the reduction
in alcohol-related fatalities in the United States must be
guarded.
208 J. C. FELL AND R. B. VOAS
Table I Lives saved due to the reduction of alcohol involvement in fatal traffic crashes from 1982–2004, source: Fell (1995)
Estimated Total
Alcohol-Related Non-Alcohol- Fatalities if Lives Saved due
Total Fatalities Related Fatalities Alcohol-Related to Reduction in
Traffic had Remained at Alcohol in Fatal
Year Fatalities % Number % Number 1980 Level Crashes
1982 43,945 60% 26,173 40% 17,772 43,945 —
1983 42,589 58% 24,635 42% 17,954 44,395 1,806
1984 44,257 56% 24,762 44% 19,495 48,205 3,948
1985 43,825 53% 23,167 47% 20,658 51,081 7,256
1986 46,087 54% 25,017 46% 21,070 52,100 6,013
1987 46,390 52% 24,094 48% 22,296 55,132 8,742
1988 47,087 51% 23,833 49% 23,254 57,500 10,413
1989 45,582 49% 22,424 51% 23,158 57,263 11,681
1990 44,599 51% 22,587 49% 22,012 54,429 9,830
1991 41,508 49% 20,159 51% 21,349 52,790 11,282
1992 39,250 47% 18,290 53% 20,960 51,828 12,578
1993 40,150 45% 17,908 55% 22,242 54,998 14,848
1994 40,716 43% 17,308 57% 23,408 57,881 17,165
1995 41,817 42% 17,732 58% 24,085 59,555 17,738
1996 42,065 42% 17,749 58% 24,316 60,126 18,061
1997 42,013 40% 16,711 60% 25,302 62,564 20,551
1998 41,501 40% 16,673 60% 24,828 61,392 19,891
1999 41,717 40% 16,572 60% 25,145 62,176 20,459
2000 41,945 41% 17,380 59% 24,565 60,742 18,797
2001 42,196 41% 17,400 59% 24,796 61,313 18,881
2002 43,005 41% 17,524 59% 25,481 63,007 20,002
2003 42,884 40% 17,105 60% 25,779 63,744 20,860
2004 42,636 39% 16,694 61% 25,942 64,147 21,511
TOTAL LIVES SAVED 312,549
If the proportion of alcohol-related fatalities had stayed the same as 1980–1982, lives saved per year could be calculated by converting the 40% non-alcohol-related
to decimal .4044147 and dividing the non-alcohol-related fatalities each year by this decimal. As in 1983, non-alcohol-related fatalities were 17,954. If divided by
the decimal .4044147, the estimated total fatalities if the proportion had remained the same would be 44,395. Taking the 44,395 and deducting the actual 1983
fatalities of 42,589 would result in a figure of 1,806 lives saved. This same formula would be used for each year. Alcohol-related fatalities from 1982–2004 are
from the new FARS Imputation Method.
The relationship of MADD activities to news coverage, state
DUI legislation, the reductions in impaired drivers on the road,
and the alcohol-related fatalities described herein have generally
persuaded researchers that MADD should receive substantial
credit for the reductions in alcohol-related highway injuries in
the United States. Aside from the McCarthy and Ziliak (1990)
study that found a measurable relationship between the presence
of a MADD chapter and a reduction in DUI-related injury
crashes, Merki and Lingg (1987) concluded that MADD
has been a major force behind whether states and communities
adopted eight effective impaired-driving strategies. Marshall and
Oleson (1996) described the beneficial effects of MADD’s victim
services, and McCarthy andWolfson (1996) concluded that
an affiliation with MADD appears to energize local leaders in
countering drunk driving. Compton (1988) found a preliminary
effect of the adjudication of DWI offenders due to MADD’s
court-monitoring program.
Although the focus of most evaluations of MADD have been
on the extent of its impact on alcohol-related crashes, ironically,
its most important impact may have been on the public’s attitude
about drinking itself. MADD played an important role
in the passage of the national MLDA 21 law. O’Malley and
Wagenaar (1991) demonstrated that youths growing up in states
with such laws drank less once they came of age than did youths
from states where the drinking age was lower than 21. By making
impaired-driving socially unacceptable MADD created a
standard for consumption and a credible basis for those who
choose not to drink to provide the socially condoned excuse that
“I am driving.” Although publicizing the impaired-driving problem
has not resulted in drivers avoiding drinking, it has placed
pressure on those that might otherwise consume more heavily. It
is possible that the campaign against drinking and driving, with
greater enforcement and more severe sanctions for offenders, has
had an impact on alcohol consumption. Data from youths leaving
heavy-drinking locations (Lange et al., 2006) have demonstrated
that, relative to passengers, patrons who are drivers have lower
BACs.
Apotentially unintended negative consequence of the success
of the anti-drunk-driving campaign, compared to other public
health educational efforts, is that, although the public recognizes
the driving risks involved in heavy drinking, they have failed to
appreciate other alcohol-related health risks, such as nontraffic
injuries, violence, and risky sexual behavior. This is manifested
in parents who preside at teen beer parties under the impression
that as long as they confiscate the car keys and keep the youths
from driving, the young people are safe (e.g., Balko, 2005).
THE FIRST 25 YEARS OF MADD 209
LOOKING TO THE FUTURE
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 lowor 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.
Impaired-Driving Goal
MADDhas responded to the lack of progress over the last decade
by setting a goal to reduce the percentage of drunk drivers in
fatal crashes by 25% over the next three years (2006–2008).
In 2003 (the last year of available detailed data when MADD
established this goal) 42,509 people were killed in traffic crashes
in the United States. Drivers who were legally drunk (i.e., BACs
of .08 or greater, the limit in every state) were involved in 31%
of those fatal crashes, resulting in 13,045 fatalities. By focusing
on five key strategies MADD believes that rate can be cut by
25% from 31% to 23% over the next three years. If the 25%
reduction goal can be achieved, 3,261 lives would have been
saved in 2003, for example.
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 impaired
driving byDUIoffenders; (4)working to improve theDUI
criminal-justice system performance and accountability, including
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.
Underage-Drinking Goal
It is a mark of the growth of MADD since its origin in 1980
that, in addition to an impaired-driving goal, it has set a goal for
reducing underage binge drinking (five or more drinks in a row
for men and four or more for women in the past month). The
objective is to reduce by five percentage points the 31% of 16
to 20 year olds who report binge drinking (SAMHSA, 2004).
Although MADD supports all of the recommendations from
the Institute of Medicine report on underage drinking (Bonnie
and O’Connell, 2003), MADD plans to focus on two strategies:
(1) work with police departments to strengthen the enforcement
of MLDA 21 laws and (2) support and ensure adequate
resources for a national media campaign on underage drinking
focused on the adults. Most alcohol obtained by underage
drinkers is through adults older than 21 and, in many instances,
the parents.
To be successful in this endeavor, MADD plans to build on
recent research funded by the NIAAA (Grant & Dawson, 1997;
Hingson, Heeren, Zakocs, Winter, & Wechsler, 2003) demonstrating
the impact of early onset of drinking on adult drinking
and driving-and-drinking problems.
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.
Victim Services Goal
As indicated earlier, a major source of strength for MADD is
its highly developed program of service to the victims of drunk
drivers. Its Victim Assistance Program had more than 1,200
trained victim advocates and, in 2004, assisted more than 31,000
victims and survivors of impaired-driving crashes nationwide, a
15% increase from 2003. Marshall and Oleson (1996, p. 6) have
recognized the program as “filling a cultural void and providing a
way for people to manage and channel their grief inways that are
psychologically healthy and socially constructive.”Weed (1987)
noted that victim activists gain status and experience that facilitates
their playing leadership roles—leadership that MADD has
harnessed in building its local chapters (McCarthy & Wolfson,
1996). MADD has set a goal of increasing the number of victims
served by at least 20% a year through 2008, an important
objective to its continued growth.
210 J. C. FELL AND R. B. VOAS
CONCLUSION
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 landmark
federal legislation (MLDA21, 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. Because
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.
ACKNOWLEDEGMENTS
Some of the information on the history of MADD was summarized from
a document written by Dean Wilkerson, former Executive Director of MADD.
Information coming from that unpublished document is acknowledged by reference
to it in the article. We recognize Dean’s hard work and dedication to
MADD during his tenure. Partial support for this article was provided by a grant
from the NIAAA (K05 AA014260).

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