Alcohol-impaired driving is a prime cause of road traffic accidents (RTAs), and its consequences. Many countries use blood alcohol concentration (BAC) to examine the level of alcohol intoxication for legal purposes. However, for different countries, the legal BAC limit varies, which leads to differences in road safety outcomes. This review examines the relationship between BAC, alcohol influenced driving, and legal BAC limit using the peer-reviewed studies, international reports, and policy documents across different regions of the world. Further, this review study aims to provide current findings on alcohol pharmacokinetics, effects of BAC on body, global legislation, and prevention strategies used by law enforcement agencies. The literature reviewed from different countries show that alcohol affects driving even below the legal BAC limits. It is also observed that the countries implementing low BAC limits along with strict enforcement measures such as frequent breath testing and awareness campaigns generally have fewer alcohol-related road accidents and fatalities. On the other hand, driving under the influence of alcohol is still a major challenge for low and middle-income countries where drink-driving laws are often inconsistent. Overall, the data show that effective legislation, consistent enforcement, reliable forensic practices, and continued public awareness can help reduce alcohol-related RTAs.