05 Apr Development of alcohol testing in Sweden
Sweden is culturally intolerant to drink driving. Since 1990, the illegal blood alcohol concentration (BAC) limit in Sweden has been 0.02% (or 0.10 milligrams of alcohol per litre of exhaled air). The Vision Zero was conceived in 1994 and written into Swedish Law in the Road Traffic Safety Bill In 1997, with the ultimate goal of zero deaths or serious injuries in traffic. Sweden has since modelled its road safety reform strategy on the Vision Zero approach. This includes a wide variety of initiatives ranging from the design of traffic infrastructure to education and enforcement with speed controls and random roadside alcohol breath testing controls (at a frequency of 287 per 1,000 population in 2010) 1.
Increasingly widespread implementation of alcohol ignition interlocks (alcolocks) is one strand of this policy and this was first studied in a national demonstration trial in 1999 (the first EU pilot program). In December 2004, seven Swedish authorities mandated installation of alcolocks in their own and contractors’ vehicles. From 2005, many more buyers have started to require alcolocks in transportation contracts and it is often mandated by government agencies. A 2012 report estimated the total number of alcohol interlocks in use in Swedish professional transport was around 75,0002. By 2015 94% of all buses had alcolocks installed3. Adoption continues to spread and with a population of less than 10 million, proportionately Sweden is one of the world’s leading alcolock markets. As part of the zero vision policy the BAC limit of 0.02% is used in all traffic situations, whether private or professional.
Use of alcolocks in Swedish taxi’s, buses, trucks and trains has spread over the last 10 years and it is now normal to mandate 100% alcohol screening in some form in new contracts.
With any alcohol testing policy, the balance between personal freedoms and safety is crucial. Previous legal challenges in Sweden have clarified that daily alcohol testing is in general acceptable for safety sensitive employees (e.g. drivers and jobs with an obvious link to public safety) but it must be conducted in a manner that avoids unnecessary infringement of an individual’s freedom. Thus when daily alcohol testing is required a thorough consultative process is essential to ensure a comprehensive policy is in place to handle all aspects of the procedure.
The role of labour unions is central in any employee welfare issues and they have very significant influence on the details of testing policies. In Sweden the unions relationship with management is often much more collaborative than in some other countries.
Random versus 100% testing?
Alcohol testing with traditional devices using mouthpieces can be a time-consuming process, so testing very large numbers of employees on a regular basis is normally not practical. Where testing volume needs to be limited, a truly random testing procedure is widely accepted as the best solution. However occasional testing can make individuals feel “singled out”, there can be a lack of trust regarding how random the selection process is and significant tension can arise.
In this setting the recent implementation of a nationwide, networked, alcohol check-in system for all train drivers at the main train operator (SJ), can be seen as a natural development. The system is quick and easy enough to allow automated daily screening of all safety-sensitive staff. Various steps have been taken to protect the personal integrity of staff and the whole process becomes very routine and undramatic.
Future Developments: daily testing of non-safety-sensitive staff?
The option of expanding testing beyond core safety-sensitive staff is potentially controversial as it is primarily an occupational health issue rather than a safety issue. The main justification is to identify alcohol dependent colleagues to ensure they could receive targeted intervention to help manage their dependency.
Many alcohol dependent individuals remain in employment, with no formal recognition of the problem. A recent study found 4.2% of the Swedish population were alcohol dependent and a further 1.7% had a misuse of alcohol4. Many die prematurely due to alcohol misuse, with 1950 deaths registered in Sweden in 2014 with an alcohol-related diagnosis (an annual rate of 31.4 men and 9.5 women per 100,000 population)5. If daily alcohol screening identified individuals at risk and was linked to active support programs, it could trigger a life-saving change in behavior in at least some cases. The potential benefits in terms of decreased mortality and morbidity have to be weighed against the potential intrusion into employees’ right to privacy. Alcohol dependence is recognized as an illness so employers and trade unions have a strong combined obligation to provide as much support as is practically possible. The positive collaborative approach and well established, simple automatic screening system could help bring alcohol dependency out of the shadows for the benefit of all.