Decision Strategies While Intoxicated Relate to Alcohol-Impaired Driving Attitudes and Intentions

Objective: Approximately 28 million individuals engage in alcohol-impaired driving (AID) every year. This study investigated individuals' AID decision making strategies under intoxication, their variability across the breath alcohol concentration (BrAC) curve, and the association between strategy and AID attitudes, intentions, and behavior. Method: Seventy-nine adults (mean 23.9 years, 57% female) who drank alcohol ≥2 days per week and lived >2 miles away from their typical drinking locations completed an alcohol administration protocol and AID decision making task. AID attitudes, intentions, and behaviors were assessed repeatedly across the BrAC curve. Bayesian cognitive modeling identified decision strategies used by individuals on the AID decision making task, revealing whether alcohol consumption level and/or ride service cost factored into individuals' decisions to drive while impaired or obtain a ride. Additional analyses tested whether AID attitudes and intentions were related to individuals' decision strategies. Results: Two decision strategies were examined on the ascending and descending limbs of the BrAC curve: compensatory (both consumption level and ride service cost factored into AID decisions) and non-compensatory (only consumption level factored into AID decisions). Switching to a compensatory strategy on the descending limb was associated with lower perceived intoxication, perceiving AID as less dangerous, and being willing to drive above the legal BrAC limit. Conclusions: Results suggest that risk for engaging in AID is higher for those using a cost-sensitive, compensatory strategy when making AID decisions under intoxication. Future research is needed to test whether AID countermeasures (e.g., subsidized ride services) are differentially effective according to decision strategy type. Public Health Significance Statement This study indicates that being cost-sensitive to ride service prices later in a drinking episode is a riskier decision strategy and is related to riskier alcohol-impaired driving attitudes and intentions.