Breath testing checkpoints
Law enforcement officers use breath testing checkpoints, also called sobriety checkpoints, to stop drivers and assess their level of alcohol impairment. There are two types of checkpoints: selective breath testing (SBT) where officers request a breath test when they suspect a driver’s impairment; and random breath testing (RBT) where officers test all drivers for blood alcohol levels. SBT is used in some U.S. states; RBT is not used in the U.S. Checkpoints may be publicized through paid or unpaid media coverage, or occur without publicity1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced impaired driving
Reduced alcohol-related crashes
Reduced fatal and non-fatal injuries
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced underage drinking
What does the research say about effectiveness?
There is strong evidence that breath testing checkpoints reduce alcohol-impaired driving, alcohol-related crashes, and associated fatal and non-fatal injuries, especially when checkpoints are highly publicized1, 2, 3. Positive effects have been shown for both random breath testing (RBT)1, 4 and selective breath testing (SBT)1, 3.
States where breath testing checkpoints are legal have lower rates of alcohol-impaired driving, 17% fewer fatal crashes, and 25% fewer driving under the influence (DUI) arrests compared to states where breath testing checkpoints are illegal2. U.S.-based and international studies indicate checkpoints and their enforcement actions may have short-term deterrent effects, with the reduction in alcohol-related crashes and DUI arrests lasting about a week2, 5, 6, 7. States that conduct checks frequently (i.e., at least monthly) have lower rates of alcohol-impaired driving and alcohol-related crashes than states that conduct checks less frequently3, 7. Studies of checkpoints in Australia suggest that testing all drivers may increase the checkpoint’s effectiveness5, and that the checkpoint size, duration, and density do not appear to impact its effectiveness6, 8.
Breath testing checkpoints also have the potential to reduce alcohol consumption among underage youth9. A California-based study finds small and short-term effects on reductions in reported simple and aggravated assaults near checkpoints10. A community initiative in California appears to effectively reduce DUI arrests and public intoxication citations by using a combination of strategies including increasing sobriety checkpoints, adopting a social host liability law, using minor decoy and shoulder tap programs11.
Breath testing checkpoints appear to be implemented more in urban areas; this may be due to differences in resources, enforcement activity priorities, and population densities (i.e., increased density of alcohol establishments in more populated areas)12. A survey of law enforcement agencies shows the frequency of breath testing checkpoints has remained stable or slightly declined from 2010 to 2019, even though they report prioritizing alcohol enforcement higher than before. Breath testing checkpoints may be perceived as too costly or resource-intensive to run despite their potential to reduce health and safety consequences of excessive alcohol use13. Cost-benefit analyses of breath testing checkpoints show a range of benefit to cost ratios from 2:1 to 57:1, highlighting a net benefit to society through the reduction in alcohol-related harms to the general public1. Alternatively, an analysis of states where checkpoints are illegal found it costs states at least $1.9 billion annually in lost life2.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Breath testing checkpoints have the potential to decrease disparities in driving under the influence (DUI), particularly for Black drivers2, 15. Experts suggest that checkpoints, on top of their deterrent effects, may limit racial bias in enforcement actions because their procedures are standardized and more regulated than alternative enforcement actions that rely on officer discretion2. Available evidence suggests that states where sobriety checkpoints are illegal have increases in racial disparities in DUI and marijuana possession arrests, with larger impacts on arrests among Black residents compared to states where sobriety checkpoints are legal2. Furthermore, once arrested for suspicion of DUI, individuals from racialized backgrounds are more likely to be convicted than those who are white15. Experts recommend using data-informed solutions that are responsive to local context in determining when and where to conduct checkpoints, and taking steps to make sure they are not misused to target certain groups by race, ethnicity or income level2, 15.
Evidence consistently demonstrates some groups, particularly Blacks and Latinos, can experience disproportionate personal and social consequences, including alcohol use disorder symptoms and various social problems, at similar levels of alcohol use, compared with other racial and ethnic groups16. Evidence suggests that the combined effects of drinking cultures, historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage in racialized groups contribute to these disparities17.
What is the relevant historical background?
Alcohol is deeply rooted in American life and history. Prior to the American Revolution, alcohol was perceived as an invigorating and restorative beverage that did not spoil easily and was safer than water18. Its taxation provided a major source of revenue for colonial governments18. After the American Revolution, the temperance and women’s rights movements shifted societal perspectives of alcohol and led efforts for its banishment. These efforts led to the adoption of the 18th Amendment in 1920, which banned the manufacture, sale, and transport of alcohol across the U.S., also known as Prohibition19. Prohibition ended in 1933 in large part because of the need to generate tax revenue and stimulate job growth during the Great Depression and gave states authority to regulate alcohol; each have approached regulation differently18. Today, the federal government has limited authority to impose national-level rules and regulations, which continues to be a patchwork of alcohol regulations that vary by state. Some state legislatures have preempted local government from implementing certain regulations and laws20.
Throughout history, alcohol misuse was seen as a personal failing. This evolved over the 19th century as the addictive properties of alcohol were understood18. Alcohol use disorder is now seen as a chronic disease that is influenced by genetics, neighborhood disadvantage, stress, access to alcohol, drinking cultures and contexts, and alcohol-industry influences21, 22.
The use of breath testing checkpoints in the U.S. began in the 1980s, however the approach has faced continued debates and legal challenges against the use on the grounds that it violates fourth Amendment rights against unjustified search2. In 1990, the U.S. Supreme Court handed down a ruling wherein the potential benefits of sobriety checkpoints in reducing fatal crashes were seen to outweigh their potential interference with liberty. The ruling allowed individual states to retain the right to operate checkpoints as long as the programs pre-selected checkpoint sites, were well-publicized, and adhered to specific procedure regarding which drivers were stopped (i.e. every driver, every fourth driver, etc.)2.
Equity Considerations
- Do local law enforcement agencies have the necessary resources and staff to implement checkpoints safely and in a standardized manner? Who can you partner with to secure the necessary funding and staffing to implement checkpoints?
- Do local law enforcement agencies have standardized protocols to support decision-making on where to implement checkpoints? Do these protocols prevent targeting specific groups of people or minoritized neighborhoods? How can you help advocate for improvement in the regulation of checkpoints and their implementation?
- Are checkpoints conducted at times when alcohol-impaired drivers are most likely to be on the roads, such as weekend evenings or after large community events (i.e. concerts, sporting events), and during safe weather conditions?
Implementation Examples
As of 2022, 38 states and Washington, D.C. permit law enforcement officers to conduct publicized random breath testing checkpoints by law; frequency and other specifics vary. Twelve states prohibit or do not authorize checkpoints14.
Implementation Resources
‡ Resources with a focus on equity.
NHTSA-Kirley 2023 - Kirley BB, Robison KL, Goodwin AH, et al. Countermeasures that work: A highway safety countermeasure guide for State Highway Safety Offices. 11th edition. Washington, D. C.: National Highway Traffic Safety Administration (NHTSA); 2023.
Footnotes
* Journal subscription may be required for access.
1 CG-Motor vehicle injury - The Guide to Community Preventive Services (The Community Guide). Motor vehicle injury prevention.
2 Jones 2022c - Jones LE, Morin CB. Sobriety checkpoint laws, fatal car crashes and arrests. Drug Enforcement and Policy Center: The Ohio State University Moritz College of Law. 2022: Working Paper.
3 Lenk 2016 - Lenk KM, Nelson TF, Toomey TL, et al. Sobriety checkpoint and open container laws in the United States: Associations with drinking-driving. Traffic Injury Prevention. 2016;17(8):782-787.
4 IAS-Anderson 2006 - Anderson P, Baumberg B. Alcohol in Europe: A public health perspective. London, UK: Institute of Alcohol Studies (IAS); 2006.
5 Erke 2009 - Erke A, Goldenbeld C, Vaa T. The effects of drink-driving checkpoints on crashes - A meta-analysis. Accident Analysis & Prevention. 2009;41(5):914-23.
6 Morrison 2021a - Morrison CN, Kwizera M, Chen Q, et al. The geography of sobriety checkpoints and alcohol-impaired driving. Addiction. 2021;117(5):1450-1457.
7 Morrison 2019 - Morrison CN, Ferris J, Wiebe DJ, Peek-Asa C, Branas CC. Sobriety checkpoints and alcohol-involved motor vehicle crashes at different temporal scales. American Journal of Preventive Medicine. 2019;56(6):795-802.
8 Morrison 2021 - Morrison CN, Kwizera M, Chen Q, et al. Alcohol-involved motor vehicle crashes and the size and duration of random breath testing checkpoints. Alcoholism: Clinical and Experimental Research. 2021;45(4):784-792.
9 RAND-Imm 2007 - Imm P, Chinman M, Wandersman A, et al. Preventing underage drinking: Using Getting To Outcomes™ with the SAMHSA strategic prevention framework to achieve results. Santa Monica: RAND Corporation; 2007: Technical Report 403.
10 Seifarth 2023 - Seifarth J, Ferris J, Peek-Asa C, et al. Unintended reductions in assaults near sobriety checkpoints: A longitudinal spatial analysis. Spatial and Spatio-temporal Epidemiology. 2023;44:100567.
11 Fell 2018 - Fell JC, Tanenbaum E, Chelluri D. Evaluation of a combination of community initiatives to reduce driving while intoxicated and other alcohol-related harms. Traffic Injury Prevention. 2018;19:S176-S179.
12 Calvert 2020 - Calvert C, Toomey T, Lenk K, et al. Variation in alcohol policy enforcement across urban and nonurban communities. Journal of Rural Health. 2020;36(2):240-246.
13 Lenk 2023 - Lenk KM, Scholz N, Erickson DJ, et al. Alcohol enforcement in the United States from 2010 to 2019. Journal of Studies on Alcohol and Drugs. 2023;84(3):416-423.
14 NHTSA-Kirley 2023 - Kirley BB, Robison KL, Goodwin AH, et al. Countermeasures that work: A highway safety countermeasure guide for State Highway Safety Offices. 11th edition. Washington, D. C.: National Highway Traffic Safety Administration (NHTSA); 2023.
15 Kagawa 2021 - Kagawa RMC, McCort CD, Schleimer J, et al. Racial bias and DUI enforcement: Comparing conviction rates with frequency of behavior. Criminology and Public Policy. 2021;20(4):645-663.
16 Mulia 2017 - Mulia N, Karriker-Jaffe KJ, Witbrodt J, et al. Racial/ethnic differences in 30-year trajectories of heavy drinking in a nationally representative U.S. sample. Drug and Alcohol Dependence. 2017;170:133-141.
17 Vaeth 2017 - Vaeth PAC, Wang-Schweig M, Caetano R. Drinking, alcohol use disorder, and treatment access and utilization among U.S. racial/ethnic groups. Alcoholism: Clinical and Experimental Research. 2017;41(1):6-19.
18 Olson 1985 - Olson S, Gerstein DR. Alcohol in America: Taking action to prevent abuse. Washington, D.C.: The National Academies Press; 1985.
19 Aaron 1981 - Aaron P, Musto D. Temperance and prohibition in America: A historical overview. In: Alcohol and public policy: Beyond the shadow of prohibition. Moore MH, Gerstein DR eds. Washington, D.C.: The National Academies Press; 1981.
20 APIS-State Preemption - Alcohol Policy Information System (APIS). About alcohol policy.
21 Zapolski 2014 - Zapolski TCB, Pedersen SL, McCarthy DM, Smith GT. Less drinking, yet more problems: Understanding African American drinking and related problems. Psychological Bulletin. 2014;140(1).
22 Sudhinaraset 2016 - Sudhinaraset M, Wigglesworth C, Takeuchi DT. Social and cultural contexts of alcohol use: Influences in a social–ecological framework. Alcohol Research: Current Reviews. 2016;38(1):35-45.
Related What Works for Health Strategies
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