Upon the release of video game Grand Theft Auto IV (GTAIV) the ESRB is faced with a request from MADD for a stricter rating.

The group Mothers against Drunk Driving (MADD) is calling upon the Entertainment Software Rating Board (ESRB) to look into the matter of this game's rating once again. The GTAIV game includes an option to drive a car on the screen while virtually drunk. In this game, players who drive while intoxicated have to put up with a blurred screen and also note increased difficulty in controlling the car. While this may appear to many people to be totally inappropriate subject matter for a game, MADD has asked the ESRB to change the GTAIV rating from mature rating to adults only.

On 29th April 2008, MADD issued a statement demonstrating the strong feelings and disappointment with regard to the GTAIV game. The statement may be read below.

"Each year nearly 13,500 people die in drunk driving crashes and another half a million are injured in alcohol-related traffic crashes. This is why MADD is extremely disappointed by the decision of the manufacturers of the game Grand Theft Auto IV to include a game module where players can drive drunk. Drunk driving is not a game and it is not a joke. Drunk driving is a choice, a violent crime and it is also 100 percent preventable. MADD is calling on the Entertainment Software Ratings Board to reclassify Grand Theft Auto IV as an Adults Only game, a step up from the current rating of Mature and for the manufacturer to consider a stop in distribution – if not out of responsibility to society then out of respect for the millions of victims/survivors of drunk driving."

In response, it is reported that Rockstar games have acknowledged respect for MADD's mission, but at the same time believe in the mature nature of the game's players to understand the subject matter of the game.