Driving under alcohol influence and road-traffic safety: to punish or to treat alcohol non-dependent and dependent drivers?

Background: The mobility facilitated by road transport enables many people to enjoy a lifestyle characterized by flexibility and independence. However, it comes at a price of many deaths and injuries. Alcohol is by far the most prevalent psychoactive substance that affects drivers. Basic ideas about neurobiology of alcohol dependency are presented to underline the pathological nature of dependency and to differentiate between non-dependent and alcohol dependent drivers. Offenders drinking drivers can be sentenced to mandatory participation in some form of short psychotherapeutic intervention. Screening and assessment are needed to refer the offender to the most appropriate intervention and/or treatment according to their dependency or non-dependency status. Conclusion: Combining short psychotherapeutic interventions (treatment) outside medical system with non-treatment sanctions that prevent offenders from drinking and driving (license revocation, alcohol ignition interlocks) reduces the public's risk while non-dependent offenders are given support for a more stable change of behavior. The best treatment strategies include motivation enhancement and a combination of group cognitive-behavioral techniques with some education. Alcohol dependent drivers cannot benefit from short psychotherapeutic intervention programs for non-dependent offenders because of pathologically changed neurobiology and should be referred to alcohol addiction treatment in designated healthcare institutions.