Three obstacles in Taiwan’s way to reduce drunk driving

She used to drink day and night, finishing off a large bottle of whiskey or sorghum liquor daily and reached the point where her brain was affected. It wasn’t until two years ago, when she made the decision to quit alcohol that she regained control of her life.

In Taiwan, there are around 700,000 people with alcohol addiction, but very few are willing to seek medical help, like Chang. Most choose to stay at home and harm themselves or worse, lose their self-control and hurt others.

The Ministry of Transportation and Communications (MOTC) and the National Police Agency’s latest statistics show there were nearly 44,000 cases of drunk driving and 230 drunk driving accident deaths during the first 10 months of 2022. As laws in Taiwan are amended to increase the punishment for drunk driving under the “zero tolerance for drunk driving” slogan, the number of drunk driving cases and relevant deaths has decreased by nearly 50% in the past eight years.

What’s worth noting, however, is that from MOTC’s statistics, we can see that the rate for drunk driving recidivism has not decreased and has stayed at nearly 40%. Many medical studies have shown that 70% of repeat offenders struggle with alcohol addiction, which keeps the recidivism rate up. Meanwhile, studies abroad show that over 90% of third- or more-time offenders have an alcohol addiction.

According to Taipei City Hospital Songde Branch Addiction Prevention Department Director Huang Ming-chyi (黃名琪), alcohol addiction is a type of illness relating to the brain. People with alcohol addiction are unable to see future consequences and therefore cannot control their actions, meaning though they know they face fines and imprisonment, the mechanism in their brain prevents them from controlling their actions.

Recidivism rates

“Heavy punishments do nothing. They may still do it after the punishment,” said Huang. It is therefore apparent that laws have a limited effect on reducing drunk driving — this is the first obstacle in Taiwan’s way of finding a solution for the issue.

To help alcohol addicts recover completely, Taipei District Prosecutors Office and the Taipei City Hospital Songde Branch worked together in 2016 to launch a program that combined judicial and medical approaches. It built a mechanism in which prosecutors would defer prosecution for drunk drivers and refer them to hospitals for addiction treatment.

After tracking over 600 cases, Huang observed the recidivism rate within one year of treatment for those who go through with it was 5%. The number was 10% for those who did not finish treatment, and 20-30% for those who never received treatment. This meant that medical intervention does help reduce drunk driving cases.

Yet over the six years since the program’s launch, there were not many referrals. While prosecutors would defer prosecution for 10,000-20,000 drunk drivers every year, they would only order alcohol addiction treatment along with the decision for a few dozen to 200 people.

When even the program’s leading institution, the Taipei City Hospital Songde Branch, only gets 10 deferred prosecution referrals a month at most, it is almost impossible to promote the system in other cities and counties.

‘Serve the ball’

The second obstacle for Taiwan’s drunk driving solution is the legal and practical dilemma posed by the decision between issuing sentences or providing treatment.

“The biggest challenge in execution is that the prosecutors can ignore us. If the prosecutor does not serve the ball, we on the medical end cannot catch it,” said Huang. She added that even though there is data and evidence, prosecutors remain generally skeptical about the effects of alcohol addiction treatment.

Moreover, deferring prosecution means a pileup of cases, which adds pressure to the administration. Prosecutors, therefore, are rarely willing to make referrals.

(Business Today image)

China Medical University Hospital Addiction Medicine Research Center Deputy Director Cheng Wan-ju (鄭婉汝) said that alcoholics who are forced to undergo treatment as part of their deferred prosecution are usually uncooperative.

However, the new carbohydrate-deficient transferring testing technology is unlike sobriety tests in the past, which could only show whether someone had alcohol in the past 24 hours. Today, they show alcohol consumption levels for up to three months.

Cheng added that prosecutors should issue deferred prosecution decisions as they would for category one and two narcotics, and require regular test reports. “Only when it is compulsory will patients cooperate. Otherwise, even if a hospital finds out through a test that a patient consumed alcohol, there is no way to enforce anything.”

On this issue, the medical side expects prosecutors to “serve the ball” and actively refer cases, yet in terms of practicality, prosecutors are faced with a systemic dilemma.

Lin Da (林達), a prosecutor at Taipei District Prosecutors Office, gave an example. A third- or fourth-time drunk driver, in theory, should face heavier punishment, yet instead prosecutors are urged to defer prosecution, issue no punishment, and order treatment.

He asked, “Is it really a good thing to give a light sentence to a case that deserves a heavy one?”

Opposing points of view

Consuming alcohol is not illegal, Lin said. The goal of the judicial system is to ban driving after drinking, yet the goal of medical institutions is to solve people’s drinking issues rather than driving issues. This means the two sides’ intentions are fundamentally different, Lin concluded.

He added that he supports leveraging the power of judicial enforcement to have alcoholics undergo treatment, but in the meantime, illegal driving must also be punished.

“The key issue is that the current Criminal Code is stiff when it comes to methodology. Prosecutors can only defer prosecution to encourage alcoholics to seek treatment, meaning they must give up charging drunk drivers for their criminal liability. This is why things appear to veer from justice.”

Lin said that countries including Germany, the U.S., or Japan have developed a range of court orders. In addition to prison sentences, the court may add rehabilitative measures such as designating a time frame for addiction treatment before or after an individual serves a sentence.

In Taiwan’s Criminal Code, though Article 89 specifies “compulsory cure” as a rehabilitative measure for those who commit offenses while intoxicated, the article does not provide clear definitions, nor specify the types of establishments, treatment, and fees applicable, making it difficult to enforce. Lin believes the Criminal Code must be thoroughly reviewed and amended, because with deferring prosecution as the only choice currently available to prosecutors, they would be too concerned for the system of referring cases to medical institutions to solidify.

Money matters

Alcoholic patients who are referred to medical institutions with their prosecution deferred must cover all medical expenses themselves. Even when they receive treatment voluntarily, the government does not allocate enough subsidies, funds, and resources to alcohol addiction treatment — which is the third obstacle for Taiwan.

The Ministry of Health and Welfare (MOHW) used to have an annual budget of just NT$6 million (US$197,200) to subsidize alcohol addiction treatment expenses including for outpatient visits, medication, and hospitalization. In 2021, the budget was increased to NT$17 million, and with a subsidy cap of NT$40,000 per person, Cheng Wan-ju said that from her experience, “It’s still not quite enough. Patients go through the money within about six months.”

China Medical University Hospital Psychiatry Case Manager Lin Hsin-chieh (林心婕), estimated that if a patient is never hospitalized and has weekly outpatient appointments while on medium-priced medication, he or she will spend NT$65,000 a year. With the addition of a bi-weekly psychological treatment session, which costs around NT$37,500 a year, the total expense would surpass NT$100,000 a year.

If a patient has a more severe case of alcoholism and must be hospitalized, a single day will cost NT$2,000-4,000, which is quite a high price.

Usually, hospitals suggest alcoholic patients should receive treatment for at least six months to a year to ensure their condition is stable. Lin’s estimate confirms the current NT$40,000 subsidy would not last individuals for six months.

Having to pay for all the remaining expenses out of pocket reduces the willingness of patients to continue receiving treatment, Lin said. Once they stop their treatment, many tend to start drinking again, creating a vicious cycle.

Department of Mental Health Director-General Chen Li-chung (諶立中) said that compared to issues such as drugs and smoking, alcoholism gets much less attention, making it hard for discussion to form around relevant policies. Since taking office in 2015, he has promoted treatment for alcohol addiction, but it has been hard to get funding and he has had to work to move budgets over from elsewhere.

Alcohol surcharge

In 2022, although the budget for alcohol addiction treatment was NT$17 million, the actual expenditure neared NT$30 million, benefitting over 3,000 alcoholics. This showed how much more money is needed in addition to the budget.

Chen said an effective way to get funding for the cause would be to pass a law that requires an “alcohol surcharge,” though this would affect alcohol businesses’ profit and be met with social opposition. Therefore, the MOHW can only do its best to prepare by cultivating professionals specializing in alcohol addiction treatment and enlisting hospitals that are willing to join the program before the right time comes for the program to be further promoted.

Considering that Taiwan produces and imports 7 billion liters of alcohol, Huang Ming-chyi agrees with Chen’s view about needing an alcohol surcharge. She said when it comes to preventing tobacco and narcotic hazards, the government gives out large budgets, but leaves out alcohol hazards.

As alcohol causes so many social problems, businesses profiting from it should be liable for the social responsibility, she said. If an “Alcohol Hazards Prevention Act” can come into existence, the alcohol surcharge can be done in the same way as a tobacco surcharge, so that every time someone buys alcohol, part of the price is donated to causes such as alcohol addiction treatment and hazard prevention.

Huang said only legislation can regulate alcohol sales and advertising while ensuring there is funding for relevant causes, which addresses the problem at its root.

The Ministry of Justice has already established that drunk driving prevention policies would focus on two things, namely heavy criminal punishment and medical intervention.

Aside from constantly amending the law to increase punishments, in terms of alcohol addiction treatment, whether various government departments are able to work more closely together and develop supporting measures, whether funding is available, and whether rigid laws can be changed are all key factors that decide the effectiveness of policies.

The government must not wait for major social incidents to happen before it corrects its oversight. It must begin working on problems immediately.