Rockstar Games' controversial Grand Theft Auto IV has come under fire again, this time from Mothers Against Drunk Driving (Madd).

The protest group said in a statement that it is "extremely disappointed" by the inclusion of a game module in GTA IV in which players can drive when drunk.

"Drunk driving is not a game and it is not a joke. Drunk driving is a choice, a violent crime and 100 per cent preventable," said Madd.

The organisation has called on the US Entertainment Software Ratings Board to bump up GTA IV's rating from 'Mature' to 'Adults Only' and for the manufacturer to consider a stop in distribution.

GTA publisher Take-Two Interactive has not officially responded to Madd's call to have the rating changed.

However, it is unlikely that Take-Two will acquiesce as 'Adults Only' games are not carried by most major retailers in the US. This can have a major negative impact on sales.

Some observers have pointed that the drunk driving sequences in GTA IV may even help Madd's campaign.

Controlling the vehicle becomes very difficult and gets the player noticed by the police quickly, thereby highlighting the dangers of, rather than glorifying, drunk driving.

Nearly 13,500 people die, and a further 500,000 are injured, in alcohol-related traffic crashes in the US each year, according to Madd.