Abstract
People mixing driving motor vehicles with consuming alcohol increases deaths and injuries on the roads, as was established irrefutably in the mid-1960s. This commentary discusses how society across Europe has responded since then to this burden by managing drink driving in the interests of road safety. The principal response has been to set, communicate and enforce limits on the level of alcohol in the blood above which it is illegal to drive and to deal in various ways with drivers found to be exceeding the limits. Achieving reduction in drink-related road deaths has benefitted public health, though the aim to change behaviour of drinking drivers has been a challenge to the profession. Other achievements have included changes in public attitude to drink driving, and reduction in reoffending by convicted offenders through rehabilitation courses and use of the alcohol interlock, which prevents starting of a vehicle by a driver who has drunk too much. There is scope for improved recording of road deaths identified as drink-related, greater understanding of effectiveness in enforcement of the legal limit and improved availability of the alcohol interlock. Relevance of experience with drink driving to management of other drug driving and prospects for building on the achievements so far are discussed.