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DUI Research Update 2008 MEE 080915 indexed by niusheng11

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									                              DUI Research Update 2008

Prepared by: William L. White, MA Senior Research Consultant Chestnut Health
Systems & M. Elizabeth Earleywine, Traffic Safety Resource Prosecutor, Illinois
Department of Transportation, Division of Traffic Safety

Introduction

         Each year new research studies are published that confirm or revise what we
know about alcohol- and other drug-impaired driving. The purpose of this update is to
provide those conducting DUI-related training in Illinois with an update of some of these
latest findings. The period of the update spans January 1, 2007 through July 1, 2008.
The process of selecting the studies for review was as follows. A literature search was
conducted of the all scientific studies published in the English language in peer-reviewed
journals using standard search engines, including PubMed, ScienceDirect, ETOH and
Google Scholar. The search used terms related to alcohol- and drug-impaired driving.
The identified studies were then reviewed for their relevance for DUI trainers. From this
total pool, I extracted or prepared a summary of abstracts from the best studies and then
drafted comments related to the significance of each study. The contact information for
the lead investigator of each study (where it was available) is also included in case you
would like to request additional information. Lead authors usually provide a reprint or an
electronic copy of a requested article.

       The articles reviewed are organized in the following categories:
       1) DUI Trends Abstracts
       2) DUI Profiling Study Abstracts
       3) Evaluations of DUI Intervention Theory and Practice Abstracts
       4) Drugged Driving Abstracts
       5) Treatment/Recovery-related Studies Abstracts
       6) Drug Impairment - Detection
       7) The Standardized Field Sobriety Tests and the Horizontal Gaze Nystagmus
          Test

       The Appendix contains four documents (full papers) that provide a further
synthesis of research studies relevant to those involved in the evaluation, treatment,
sentencing and supervision of DUI offenders.

       •   Changing profile of the drinking/drugged driver, White 2007 publication
       •   Evaluating the “hard core drinking driver,” White & Syrcle 2008 publication.
       •   A new paper on recent alcohol testing: Skipper, DuPont & White 2008
           publication
       •   Executive Summary of a forthcoming Addiction Technology Transfer
           Monograph on managing long-term recovery (includes a substantial amount
           of treatment outcome data) (White, 2008)




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1)     DUI TRENDS

The following studies highlight the most significant trends that have occurred related to
drinking and driving.


H. Gjerde, P. Normann, B. Pettersen, T. Assum, M. Aldrin, U. Johansen, L.
Kristoffersen, E. Oiestad, A. Christophersen, J. Morland (Sept. 2008). Prevalence of
alcohol and drugs among Norwegian motor vehicle drivers: A roadside survey.
 Accid. Analy. & Prev. 40(5):1765-72.

The objective of the study was to determine the prevalence of alcohol, psychoactive
medicinal drugs and illegal drugs among drivers in Norwegian road traffic. Drivers of
motor vehicles were selected from April 2005 to April 2006 in the south-eastern part of
Norway, surrounding, but not including the capital, Oslo. A stratified two-stage cluster
sampling procedure was used. In the first stage, random road sites and time intervals were
selected, and in the second stage, drivers were stopped by random at those sites and time
intervals. Altogether about 12,000 drivers were asked to provide a sample of oral fluid
(saliva) and answer a few questions. Samples of oral fluid were obtained from 88% of the
drivers, of whom 30% were females and 70% males. The prevalence of each drug was
estimated by a weighted average using weights adjusted for under- or over-sampling
compared to traffic statistics. Alcohol or drugs were found in oral fluid samples of 4.5%
of the drivers; alcohol in 0.4%, psychoactive medicinal drugs in 3.4%, and illegal drugs
in 1.0%. Illegal drugs were found more frequently in samples from younger drivers,
while psychoactive medicinal drugs were more frequently found in samples from older
drivers. Psychoactive medicinal drugs were more prevalent among females than males,
among drivers stopped on working days rather than weekends, and among those who
reported annual driving distances less than 16,000 km. The drugs found most frequently
were zopiclone (1.4%), benzodiazepines (1.4%), codeine (0.8%), tetrahydrocannabinol
(0.6%) and amphetamines (0.3%). Two or more drugs were found in 0.6% of the
samples, corresponding to 15% of the drug-positive drivers.


L.A. Kaskutas, W.C. Kerr (July 2008). Accuracy of Photographs to Capture
Respondent-Defined Drink Size. J. Stud. Alcohol Drugs, 69(4):605-10.

OBJECTIVE: Evidence suggests that people misjudge the size of their drinks, calling
into question the validity of data from surveys and screening instruments assessing
alcohol quantity in terms of standard drinks. This article studied the validity of
photographs of glasses to assess drink size.
METHOD: In a U.S. national sample of 323 drinkers, respondents were mailed a
measuring beaker and a set of photographs of wine, beer, and other drinking glasses for
use in a subsequent telephone survey. In the interview, they were asked to pick the glass
most similar to what they use at home and to identify the letter associated with their usual
pour level. Then, a protocol where subjects measured the actual number of ounces in their
typical drink, by pouring water into their usual glass and measuring this volume using the



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measuring beaker, gave a direct measure of home drink volume. We compared drink
sizes using the two approaches.
RESULTS: Photographs worked well for certain groups, including women, young
people, and nonwhites (for wine) and whites (for beer). The greatest magnitude of error
arising from the use of photographs was for wine drinks among those age 50 and older,
those with a 4-year degree, frequent 5 drinkers in general, and heavy-volume wine
drinkers. Average drink size based on the most popular wine and beer glasses in the
photographs were 0.62 oz (18 ml) and 1.62 oz (48 ml) larger than beaker pours,
respectively. Error between actual drinks and photographs was especially high for a large
balloon-shaped wine glass, chosen by only 3% of wine drinkers.
CONCLUSIONS: Whenever possible, researchers and clinicians should incorporate
protocols that allow for some type of direct measurement using the actual vessels from
home. When this is not viable, photographs represent a solution that is practical, shows
promise for beer and wine drinks, and is relevant to any drinking context.


Adams, S. & Cotti, C. (June, 2008). Drunk driving after the passage of smoking bans
in bars. Journal of Public Economics, 92(5-6):1288-1305.

Using geographic variation in local and state smoke-free bar laws in the US, we observe
an increase in fatal accidents involving alcohol following bans on smoking in bars that is
not observed in places without bans. Although an increased accident risk might seem
surprising at first, two strands of literature on consumer behavior suggest potential
explanations — smokers driving longer distances to a bordering jurisdiction that allows
smoking in bars and smokers driving longer distances within their jurisdiction to bars that
still allow smoking, perhaps through non-compliance or outdoor seating. We find
evidence consistent with both explanations. The increased miles driven by drivers
wishing to smoke and drink offsets any reduction in driving from smokers choosing to
stay home following a ban, resulting in increased alcohol-related accidents. This result
proves durable, as we subject it to an extensive battery of robustness checks.

Significance: This is a fascinating study. Given that we know hard-core drinking drivers
are more likely to smoke (and be heavy smokers) and drink outside the home, this finding
is particularly significant. It means that changes in smoking laws place hard-core
drinking drivers and other binge and heavy drinkers on the roads for longer periods of
time—a significant and unanticipated side effect of such legislation. (WLW, June 2008)


Barquín, J., Luna, J.D., & Hernández, A.F. (May 2008). A controlled study of the time-
course of breath alcohol concentration after moderate ingestion of ethanol following
a social drinking session. Forensic Science International, 177(2-3), 140-145.

This paper evaluates breath alcohol concentration (BrAC), nausea (feeling of being
slightly intoxicated) and subjective driving performance after ingesting a moderate dose
of alcohol in the presence of a light meal, which intends to approach a social drinking
setting. 119 healthy individuals (69 males and 50 females, aged 21.7 ± 3.0) ingested three



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glasses of wine (95 mL each) and their BrAC was determined by an Alcotest 7410 at 15,
30, 45, 60, 90 and 120 min post-drinking. 46% of females and no male subjects exceeded
a BrAC of 0.25 mg/L, the legal limit for driving fixed by some Western countries. 53%
of the study population felt nausea during the experimental session and 20% self-reported
impairment of their driving skills. In both cases these subjective effects were more
pronounced in females. The major determinants of mean BrAC were time post-drinking,
gender (male) and body mass index (BMI), all these variables being inversely associated.
Females and individuals with a BMI lower than 22.5 kg/m2 were at an increased risk of
exceeding the legal limit of BrAC. The feeling of nausea was significantly associated
with gender (females), the ingestion of up to 2 drinks on weekdays, and having exceeded
a BrAC of 0.25 mg/L during the experimental study. The main predictor of self-
perception of impaired driving skills was the feeling of nausea, followed by a BrAC in
excess of 0.25 mg/L. In conclusion, both females and subjects with lower BMI are at an
increased risk of exceeding the legal limit of BrAC after moderate alcohol consumption
resembling a social drinking setting.

Significance: This study confirms earlier findings that alcohol impairment can occur at
lower BACs for women and men with lower body mass. (WLW, June 2008).


W. Vanlaar (May 2008). Less is more: The influence of traffic count on drinking and
driving behaviour. Accid. Anal & Prev. 40(3):1018-22
Traffic Injury Research Foundation, 171 Nepean Street, Suite 200, Ottawa, Ontario,
Canada K2P 0B4

Drinking and driving road checks are often organized with either a clear prevention or
repression objective in mind. The objective of a prevention strategy is to make as many
people as possible believe that police officers are enforcing drinking and driving laws and
that drinking drivers will most likely be caught. As such, targeting high traffic count road
sites with high-visibility road checks is a priority because it serves to increase awareness
of the enforcement activity. An alternative to this prevention approach is the “repression”
approach that involves targeting times and places where the highest number of drinking
drivers are to be expected. Rather than attempting to affect the subjective chance of
getting caught, this approach seeks to increase the objective likelihood of getting caught;
the aim is to apprehend as many drinking drivers as possible. Regardless of the chosen
strategy, there is a need to understand how traffic count influences drinking and driving
behaviour as traffic count may play a role in a police officer's choice of sites for a road
check. The objective of this paper is to shed some light on this relationship between
drinking and driving behaviour and traffic count. In this paper, data from a roadside
survey, carried out in British Columbia in 2003, are used. A two-level logistic regression
analysis was carried out with data from 2627 drivers coming from 48 different road sites
to replicate a model that was previously obtained with comparable data from a Belgian
roadside survey, also carried out in 2003. The present study successfully replicated the
findings of the Belgian model, substantiating that the probability for drivers to be
drinking and driving significantly decreases with an increasing level of traffic count. This
supports the suggestion that drinking drivers avoid high traffic count road sites. The



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relevance of these findings with respect to organizing preventive or repressive road
checks and possible confounding variables are discussed at the end of this paper.


J.M. Webster, J.H. Pimentel, D.B. Clark (May 2008). Characteristics of DUI offenders
convicted in wet, dry, and moist counties. Accid. Anal & Prev. 40(3):976-82.
Center on Drug and Alcohol Research, University of Kentucky, 643 Maxwelton Court,
Lexington, KY 40506-0350, USA

Although several studies have examined the effectiveness of local alcohol sales policies
on reducing the incidence of driving under the influence (DUI), less is known about
whether characteristics of DUI offenders convicted in alcohol-restricted areas differ from
those convicted in areas where alcohol is more readily available. A total of 21,647 DUI
assessment records were divided into four groups based on the alcohol sales policy of the
county of conviction and were compared. DUI offenders convicted in counties that limit
or ban the sale of alcohol were more likely to be male, have more drug problems, meet
DSM-IV-TR substance abuse or dependence criteria, and have multiple DUI convictions.
Implications for practitioners and policy makers are discussed.


S. Laapotti; Esko Keskinen (2008) Fatal Drink-Driving Accidents of Young Adult and
Middle-Aged Males—A Risky Driving Style or Risky Lifestyle? Traffic Injury Prev.,
9(3):195-200.

OBJECTIVE: A range of situational and lifestyle-related factors in drink-driving fatal
accidents were studied involving young adult and middle-aged male drivers in Finland.
METHODS: Fatal drink-driving accidents were compared to fatal accidents in which the
driver had been sober. The study included all 18-to 59-year-old male drivers' fatal car and
van accidents investigated by the Road Accident Investigation Teams in Finland between
2000 and 2002 (n = 366 accidents). The variables describing the situation included the
time of the accident, the road condition, the speed, possession of a valid license, seat-belt
usage, and the presence of passengers.
RESULTS: The study found that among young adult males most of the studied
situational factors bore no relation to the state of the driver (sober or drink driver). Only
the time of day, seat-belt, usage, and possession of a valid license were related to the state
of the driver. Among middle-aged male drivers, drink-driving and sober driving accidents
differed more clearly. Further, when the social situation in the car was examined, it was
found that accidents of sober and drink drivers differed from each other within the group
of middle-aged drivers but not within the group of young adult drivers. Heavy alcohol
usage was found to characterize the lifestyle of the studied middle-aged drink drivers.
CONCLUSIONS: It was concluded that for young adult males drink-driving was a part
of a more general risky driving style. Among middle-aged males drink-driving was more
related to a risky lifestyle with drinking problems. Possible countermeasures are
discussed with regard to drink-driving among young adult and middle-aged males.




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O'Brien, M.C., McCoy, T.P., Rhodes, S.D., Wagoner, A. & Wolfson, M. (May 2008).
Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-
related consequences among college students. Acad Emerg Med. 15(5):453-60.
Email: mobrien@wfubmc.edu

OBJECTIVES: The consumption of alcohol mixed with energy drinks (AmED) is
popular on college campuses in the United States. Limited research suggests that energy
drink consumption lessens subjective intoxication in persons who also have consumed
alcohol. This study examines the relationship between energy drink use, high-risk
drinking behavior, and alcohol-related consequences.
METHODS: In Fall 2006, a Web-based survey was conducted in a stratified random
sample of 4,271 college students from 10 universities in North Carolina.
RESULTS: A total of 697 students (24% of past 30-day drinkers) reported consuming
AmED in the past 30 days. Students who were male, white, intramural athletes, fraternity
or sorority members or pledges, and younger were significantly more likely to consume
AmED. In multivariable analyses, consumption of AmED was associated with increased
heavy episodic drinking (6.4 days vs. 3.4 days on average; p < 0.001) and twice as many
episodes of weekly drunkenness (1.4 days/week vs. 0.73 days/week; p < 0.001). Students
who reported consuming AmED had significantly higher prevalence of alcohol-related
consequences, including being taken advantage of sexually, taking advantage of another
sexually, riding with an intoxicated driver, being physically hurt or injured, and requiring
medical treatment (p < 0.05). The effect of consuming AmED on driving while
intoxicated depended on a student's reported typical alcohol consumption (interaction p =
0.027).
CONCLUSIONS: Almost one-quarter of college student current drinkers reported mixing
alcohol with energy drinks. These students are at increased risk for alcohol-related
consequences, even after adjusting for the amount of alcohol consumed. Further research
is necessary to understand this association and to develop targeted interventions to reduce
risk.

Significance: This study offers an interesting historical lesson: any change in non-
alcohol drug trends may exert unexpected and untoward effects on drinking patterns and
related threats to public safety. It will be interesting to see whether the regular use of
caffeinated energy drinks becomes a risk factor for alcohol-related problems and DUI.
This study would support use of this as a risk factor for screening. (WLW, June 2008)


Flowers, N.T., Naimi, T.S., Brewer, R,.D., Elder, R.W., Shults, R.A., & Jiles, R. (April,
2008). Patterns of alcohol consumption and alcohol-impaired driving in the United
States. Alcoholism: Clinical & Experimental Research, 32(4):639-44.
Email: ndf0@cdc.gov

BACKGROUND: Alcohol-related motor vehicle crashes kill approximately 17,000
Americans annually and were associated with more than $51 billion in total costs in
2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI)
drivers in the United States.



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METHODS: 2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed
for alcohol consumption and self-reported AI driving among U.S. adults aged > or =18
years for all states. Alcohol consumption was divided into 4 categories: binge/heavy,
binge/non-heavy, non-binge/heavy, and non-binge/non-heavy. Binge drinking was
defined as > or =5 drinks for men or > or =4 drinks for women on one or more occasions
in the past month, and heavy drinking was defined as average daily consumption of >2
drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined
by drinking pattern and by demographic characteristics. Logistic regression analysis was
used to assess the association between drinking patterns and AI driving.
RESULTS: Five percent of drinkers were engaged in AI driving during the past 30 days.
Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved
binge drinkers. By drinking category, binge/non-heavy drinkers accounted for the largest
percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most
episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI:
16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/non-heavy, and 3.9 (2.4, 6.3) for non-
binge/heavy drinkers, respectively.
CONCLUSIONS: There is a strong association between binge drinking and AI driving.
Most AI drivers and almost half of all AI driving episodes involve persons who are not
heavy drinkers (based on average daily consumption). Implementing effective
interventions to prevent binge drinking could substantially reduce AI driving.

Significance: This is the most methodologically rigorous study yet of alcohol-impaired
drivers. The study provides the latest confirmation that most driving under the influence
(DUI) offenders are binge and heavy drinkers, with only 14% of DUI arrests falling
outside this category. (WLW, June 2008)


Schwartz, J. (April 2008) Gender differences in drunk driving prevalence rates and
trends: A 20-year assessment using multiple sources of evidence. Addictive Behavior,
April, 2008.

This research tracked women's and men's drunk driving rates and the DUI sex ratio in the
United States from 1982-2004 using three diverse sources of evidence. Sex-specific
prevalence estimates and the sex ratio are derived from official arrest statistics from the
Federal Bureau of Investigation, self-reports from the Centers for Disease Control and
Prevention, and traffic fatality data from the National Highway Traffic Safety
Administration. Drunk driving trends were analyzed using Augmented Dickey Fuller
time series techniques. Female DUI arrest rates increased whereas male rates declined
then stabilized, producing a significantly narrower sex ratio. According to self-report and
traffic data, women's and men's drunk driving rates declined and the gender gap was
unchanged. Women's overrepresentation in arrests relative to their share of offending
began in the 1990s and accelerated in 2000. Women's arrest gains, contrasted with no
systematic change in DUI behavior, and the timing of this shift suggest an increased
vulnerability to arrest. More stringent laws and enforcement directed at less intoxicated
offenders may inadvertently target female offending patterns.




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Significance: Studies in the 1970s documented the systematic enabling of female
alcohol-impaired drivers by police officers, resulting in lower arrests rates in relationship
to their prevalence of DUI offending. This study suggests a dramatic reversal of this
trend. This probably reflects the effects of changing values and training of police
officers. Drinking women may very well think that if stopped the police officer will
“give them a break.” This study suggests the odds of getting such a break have
dramatically declined. (WLW, June 2008)


Caetano, R., Ramisetty-Mikler, S. & Rodriguez, L.A. (March 2008). The Hispanic
Americans baseline alcohol survey (HABLAS): DUI rates, birthplace, and
acculturation across Hispanic national groups. J Stud Alcohol Drugs. 69(2):259-65.
Email: Raul.Caetano@UTSouthwestern.edu

OBJECTIVE: This article examines the association between birthplace, acculturation,
and self-reported DUI, 12-month and lifetime DUI arrest rates among Mexican
Americans, Puerto Ricans, Cuban Americans, and South/Central Americans in the U.S.
population.
METHOD: Using a multistage cluster sample design, 5,224 adults (18 years of age or
older) were interviewed from households in five metropolitan areas of the United States:
Miami, New York, Philadelphia, Houston, and Los Angeles.
RESULTS: Birthplace was not associated with DUI, 12-month DUI arrest rates, or
lifetime DUI arrest rates. Mexican Americans in the medium- and high-acculturation
groups were more likely to engage in DUI. A higher proportion of U.S.-born than
foreign-born respondents as well as those in the high-acculturation group, irrespective of
national origin, reported having been stopped by police when driving. U.S.-born Cuban
Americans, Mexican Americans, and South/Central Americans thought they could
consume a higher mean number of drinks before their driving is impaired compared with
those who are foreign born.
CONCLUSIONS: There are considerable differences in DUI-related behavior across
Hispanic national groups. U.S.-born Hispanics and those born abroad, but not those at
different levels of acculturation, have equal risk of involvement with DUI.

Significance: This study confirms the need to conduct culturally nuanced educational
programs on drinking and driving within Hispanic communities. This study also
challenges stereotypes that the Hispanic DUI offender is a recent immigrant unfamiliar
with US drinking and driving laws. (WLW, June 2008)


Jackson, K.M. (March, 2008). Heavy episodic drinking: Determining the predictive
utility of five or more drinks. Psychology of Addictive Behaviors, 22(1) 68-77

Although the heavy episodic drinking (HED) measure of 5+ drinks (sometimes 4+ for
women) is used extensively, there is no empirical basis for the designation of 5 drinks as
the threshold (vs. another threshold that may perform equally). The present study sought
to determine the threshold for HED that maximally predicts proximal and distal adverse-



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drinking-related outcomes. Participants included 115 young adults (57% female; 96%
Caucasian) who partook in an 8-week Internet survey that assessed daily drinking as well
as next-day hangover; 10 months later, adverse outcomes (problem drinking, alcohol-
related problems, maximum number of drinks, and drug use) were surveyed. Thresholds
were computed, with a range from 1+ drinks to 15+ drinks, and outcomes were predicted
from each threshold. Findings for hangover measures showed relatively good
convergence across multiple indicators, with greatest prediction occurring at a threshold
of 10+ drinks per occasion. Different thresholds were observed for long-term outcomes,
with higher thresholds indicative of outcomes with greater severity. Although alternatives
to HED, such as subjective effects and blood alcohol concentration, can indicate risky
drinking, a threshold measure of HED may have advantages in terms of prevention and of
intervention efforts.

Significance: This article typifies the continued struggle and debate over defining binge
and heavy drinking. Like many articles, it concludes that a set threshold definition has
scientific and social value, but that a clear benchmark is difficult to set scientifically.
This article is interesting in that it notes subjective effects of drinking with no reference
to the public safety threats the drinker poses to others and at what level such threats
occur. (WLW, June 2008)


Jones, A.W. (March 2008). Ultra-rapid rate of ethanol elimination from blood in
drunken drivers with extremely high blood-alcohol concentrations. International
Journal of Legal Medicine, 122(2), 129-34.

The rate of alcohol elimination from blood was determined in drunken drivers by taking
two blood samples about one hour apart. These cases were selected because the
individuals concerned had reached an extremely high BAC)when they were apprehended.
This suggests a period of continuous heavy drinking leading to the development of
metabolic tolerance. Use of double blood samples to calculate the elimination rate of
alcohol from blood is valid provided that drunken drivers are in the post-absorptive phase
of the BAC curve, the time between sampling is not too short, and that zero-order
elimination kinetics operates. Evidence in support of this came from other drunken
drivers in which three consecutive blood samples were obtained at hourly intervals. The
mean BAC (N = 21) was .405 (range, .271 –.518l), and the average rate of alcohol
elimination from blood was .033 g /dll−1 h−1 with a range of .020–.062 g/dl−1 h−1. The
possibility of ultra-rapid rates of ethanol elimination from blood in drunken drivers
having extremely high BAC deserves to be considered in forensic casework, e.g., when
retrograde extrapolations and other blood-alcohol calculations are made. The mechanism
accounting for more rapid metabolism is probably related to induction of the microsomal
enzyme (CYP2E1) pathway for ethanol oxidation, as one consequence of continuous
heavy drinking. However, the dose of alcohol and the duration of drinking necessary to
boost the activity of CYP2E1 enzymes in humans have not been established.

Significance: This is the first known study identifying the phenomena of rapid alcohol
metabolism in individuals with very high BACs. This may account for the exceptionally


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high tolerance some heavy drinkers acquire prior to slowed metabolism from liver
impairment. This finding would be particularly important in states with enhanced
penalties for high BACs, e.g., where delays in conducting the breath test may result in an
individual dropping below the BAC level of enhanced sanctions. It also underscores the
importance of getting breath testing completed as soon after apprehension as is possible.
(WLW, June 2008)


Blalock, G., Kadiyali, V. & Simon, D.H. (January 2008). Driving fatalities after 9/11: a
hidden cost of terrorism. Applied Economics, January, 2008.

We show that the public's response to terrorist threats can have unintended consequences
that rival the attacks themselves in severity. Driving fatalities increased significantly after
the 11 September 2001 terrorist attacks, events that prompted many travelers to substitute
road transportation for safer air transportation. After controlling for time trends, weather,
road conditions and other factors, we find that travelers' response to 9/11 resulted in 327
driving deaths per month in late 2001. Moreover, while the effect of 9/11 weakened over
time, as many as 2300 driving deaths may be attributable to the attacks.

Significance: This is a fascinating side effect of 9/11. Unfortunately, the authors did not
segregate data for alcohol-related driving fatalities. It would be interesting to note
whether the true consequence of the increased fatalities was increased alcohol
consumption following 9/11 rather than increased driving miles. (WLW, June 2008)


J. Carlisle Maxwell; J. Freeman (December 2007). Gender Differences in DUI
Offenders in Treatment in Texas, Traffic Injury Prev., 9(4):353-60

OBJECTIVE: This is a study of 8,464 adult women and 21,155 adult males who entered
substance abuse treatment in Texas between 2000 and 2005. Participants were either on
probation for driving under the influence (DUI), were referred to treatment by DUI
probation, or had been arrested for DUI in the past year.
METHODS: The female and male clients were compared on demographic
characteristics, substance use patterns, DSM-IV diagnoses, and levels of impairment. T
tests and chi square tests were used to determine significance and multivariate logistic
regression identified predictors of completing treatment and being abstinent at follow-up.
RESULTS: Results. The proportion of females who were sent to treatment as a result of
DUI increased from 27% in 2000 to 32% in 2005. Females were significantly more likely
than males to be White (73% vs. 56%), to have used substances a shorter period of time
(17 vs. 19 years), to be seeking custody to regain their children (11% vs. 2%), to meet the
DSM criteria for drug dependence (32% vs. 23%), to have injected drugs (31% vs. 23%),
to have used substances daily (42% vs. 40%), to have a depressive disorder (16% vs. 7%)
or bipolar disorder (12% vs. 5%), and to be have been in treatment before (60% vs. 49%).
In contrast, males were more likely to be alcohol dependent (49% vs. 44%). Females
were less likely to complete treatment (67% vs. 72%) and reported significantly more
days of problems on the 6 domains of the ASI at both admission and at 60-day follow-up.



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Furthermore, at follow-up, they were more likely to be living with someone who abused
alcohol or used drugs (9% vs.7%).
CONCLUSIONS: Although females comprised only 29% of the DUI treatment
admissions, they were more impaired and experienced more problems than their male
counterparts. The findings indicate that additional resources, including treatment for co-
occurring mental health problems and living in sober households, may be keys to helping
these women achieve abstinence and prevent additional DUI episodes.

H.Z. Khiabani; M.Stokke Opdal; J. M rland (January 2008). Blood Alcohol
Concentrations in Apprehended Drivers of Cars and Boats Suspected to Be
Impaired by the Police, Traffic Injury Prev., 9(1):31-36.

OBJECTIVE: According to the Norwegian Road Traffic Act, car drivers are not
allowed to operate a vehicle with a blood alcohol concentration (BAC) above 0.2 g/kg.
Depending on the size of the boat or ship, boat drivers/captains/first mates are not
allowed to conduct the boat with a BAC above 0.8 g/kg when driving small boats (length
less than 15 m) and above 1.5 g/kg when running larger vessels/ships. The new Sea Act
of June 2005 states that captains/first mates cannot conduct a ship if he/she has a BAC
above 0.2 g/kg. Our aim was to determine the current median BAC in a large population
of car and boat drivers in Norway. Our other aim was to study if median BAC was higher
in boat drivers than in car drivers who were suspected by the police to be impaired.
Furthermore, we wanted to investigate if the BAC levels were differently distributed by
gender or age within and between these two groups.
METHODS: The Norwegian Institute of Public Health analyzes blood samples from all
car/boat drivers suspected of driving under the influence of alcohol and non-alcoholic
drugs. In the present study, samples submitted between 01.05 and 01.09 in 2002-2004
were included. Drivers, who in addition tested positive for drugs or abuse substances
other than ethanol were excluded.
RESULTS: There were 321 boat drivers and 3,061 car drivers who were suspected to be
under the influence of ethanol only. The median BAC in boat drivers (1.76 g/kg [range
0.02-3.54]) was significantly higher compared to that in car drivers (1.54 g/kg [range
0.00-4.27]). In the car driver group, the mean BAC did not differ significantly between
men and women. The median level of BAC was significantly higher in men than in
women in the boat driver group (1.77 g/kg with CI 1.69-1.85 vs. 1.27 g/kg with CI 0.78-
1.76).
CONCLUSIONS: Alcohol impairment of car drivers is known to be considered the most
important contributing cause of car crash injuries. Driving a boat may demand the same
degree of performance skills as driving a car. The median BAC in apprehended boat
drivers was considerably high in the present study. The median BAC was also high in car
drivers despite strict legislation. The population of drivers of cars in our study, however,
is from previous studies known to contain a large proportion of heavy drinkers. Less is
known about the drinking habits in boat drivers, and caution is needed in generalizing
from our results. However, our results indicate the possible need for stricter legislation
and more frequent police control that will hopefully prevent serious accidents caused by
ethanol drinking at sea.




                                                                                         11
A.T. McCartt; K. Blackman; R.B. Voas (December 2007). Implementation of
Washington State's Zero Tolerance Law: Patterns of Arrests, Dispositions, and
Recidivism, Traffic Injury Prev., 8(4):339-45

OBJECTIVES: Zero tolerance (ZT) laws have been effective in reducing alcohol-related
crashes among underage drivers. However, enforcement in some states has not been
rigorous, and ZT offenses may not be viewed as serious offenses. On July 1, 1994, the
state of Washington implemented a ZT law that allowed police to request a test for
alcohol on suspicion of either a ZT or driving-under-the-influence (DUI) offense. The
present study examined effects of the ZT law on arrests and case dispositions among
underage offenders as a function of blood alcohol concentration (BAC) and post-law
patterns of recidivism.
METHODS: Times-series analyses examined the effects of the ZT law on trends in
arrests of underage drivers between 1991 and 1999. Based on arrest records matched with
driver's license records, the effects of the law on dispositions of alcohol-related offenses
among underage drivers were examined, and rates of recidivism among underage
offenders were examined for the period following the ZT law.
RESULTS: There was a substantial increase in arrests of underage drivers beginning
immediately after implementation of the ZT law, especially among drivers with low
BACs. The types of court or administrative dispositions received by underage offenders
changed markedly after the ZT law was implemented. Underage offenders with lower
BACs became far more likely to receive alcohol-related convictions and/or license
suspensions. However, the percentage of underage offenders with higher BACs receiving
DUI convictions declined as some of these offenders received the lesser ZT disposition.
After the ZT law, underage offenders with BACs of 0.10 g/dL or higher were more likely
to recidivate than those with lower BACs, but appreciable proportions of drivers were re-
arrested for another alcohol offense, whatever the BAC and however they were
penalized.
CONCLUSIONS: Implementation of Washington's law indicates that a ZT law can
increase the likelihood that an underage person will be sanctioned for drinking and
driving. However, recidivism remains an issue as more than one in four underage drivers
arrested with low BACs subsequently were re-arrested.


Lynskey, M.T., Bucholz, K.K., Madden, P,A, & Heath, A.C. (November 2007). Early-
onset alcohol-use behaviors and subsequent alcohol-related driving risks in young
women: a twin study. J Stud Alcohol Drugs, 68(6):798-804.
Email: mlynskey@wustl.edu

OBJECTIVE: The purpose of this study was to estimate associations between early-onset
alcohol use/intoxication and subsequent risks of alcohol-related driving risks in young
women after control for familial liability for these behaviors.
METHOD: Self-reported data on alcohol use and associated risks were collected from a
representative sample of 3,786 Missouri-born adolescent female twins. RESULTS: After
statistical control for familial liability to alcohol-related driving risks, alcohol
dependence, and length of exposure to risk (i.e., time between the earlier of age at onset



                                                                                         12
of drinking or age 16 [the minimum legal driving age in Missouri]), young women who
reported early-onset alcohol use/intoxication had odds of alcohol-related driving risks
that were from 1.6 to 2.2 times higher than those with a later onset of alcohol use or
intoxication.
CONCLUSIONS: Young women who commence drinking at an early age are at
heightened risks for subsequent alcohol-related driving risks, and these associations
cannot be explained entirely by familial liability for these behaviors.

Significance: This confirms inclusion of lower age of onset of alcohol or drug use in the
Hard-core Drinking Driving Checklist and adds gender confirmation for its inclusion. It
was long thought that lowered age of onset of drinking was a DUI risk factor because of
its link as a risk factor for adult substance dependence. Studies like the above suggest
that lowered age of onset may constitute an independent risk factor—perhaps as a proxy
for decreased family supervision and subsequent anti-social and risk-taking behavior.
(WLW, June 2008)


B. Hubicka; H. Bergman; H. Laurell (September 2007). Alcohol Problems among
Swedish Drunk Drivers: Differences Related to Mode of Detection and
Geographical Region, Traffic Injury Prev., 8(3):224-31.

OBJECTIVE: To investigate the prevalence of alcohol problems in a representative
sample of Swedish drivers suspected of drunk driving in comparison with control drivers
and the general Swedish population in relation to mode and time of detection. Is the time
of day or night or the detection mode important for the prevalence of alcohol problems
and which are the best predictors for identifying alcohol problems among DUI offenders?
METHODS: Two thousand and one hundred drivers (169 females) suspected of DUI
offence during 1997-2001 who agreed to respond to the AUDIT questionnaire (Alcohol
Use Disorders Identification Test) and 785 control drivers (266 females) not suspected of
DUI recruited at general traffic controls were investigated.
RESULTS: Both mode and time of detection were found to be important. The greatest
impact on the prevalence of alcohol problems emanated from the predictors in the
following order: high BAC; unlicensed driving; detection hours between 12.00 and 18.00,
and age under 26 years. Age over 55 years and detection in general traffic controls were
the two strongest factors negatively correlated to alcohol problems prevalence. The
differences between regions with regard to alcohol problems incidence could only partly
be explained by police routines and resources.
CONCLUSIONS: Mode and time of detection affect the prevalence of DUI offenders
with alcohol problems, and to a lesser degree also BAC level. Both the detection mode
and the time of detection are significant for the proportion of identified DUIs with
alcohol problems. Because the majority of committed DUI offenses are never identified,
it is important to optimize the detection strategies of the police with the purpose of
minimizing public damage and expenses.




                                                                                       13
A.J. Treno, F.W. Johnson, L.G. Remer and P.J. Gruenewald (Sept. 2007). The impact of
outlet densities on alcohol-related crashes: A spatial panel approach Accid. Analy.
& Prev. 39(5):894-901.
Prevention Research Center, 1995 University Avenue, Suite 450, Berkeley, CA 94704,
United States

BACKGROUND: A number of studies using cross-sectional data have demonstrated
that the availability of alcohol, measured by the number and types of alcohol outlets, is
directly related to numerous measures associated with drinking and driving. The current
study contributes the first observation of relationships over time between alcohol outlet
densities on one hand and both automobile crashes and related injuries on the other hand.
METHOD: The study examined longitudinal data from 581 consistently defined zip code
areas represented in the California Index Locations Database, a geographic information
system that coordinates population and ecological data with spatial attributes for areas
across the state. Six years of data were collected on features of local populations (e.g.,
demographics, household size) and places (e.g., retail markets) thought to be related to
two measures of automobile crashes (hospital discharges related to car crash injuries
geocoded to the zip code of patient residence, and police reports associated with car
crashes geocoded to the zip code of crash location). Both crash measures were positively
associated with two outlet types: bars, and off-premise outlets. Additionally, restaurants
appear to provide a protective effect relative to the residence-based measure. Crash rates
were also related to changes in population and place characteristics using random effects
models with controls for spatial autocorrelation (n × t = 3486 observations). Changes in
population and place characteristics of adjacent (spatially lagged) areas were also
considered.
RESULTS: Over time, both local and lagged population and place characteristics were
related to automobile crash-related measures.
CONCLUSION: Controlling for cross-sectional differences between zip code areas,
changes in numbers of licensed alcohol retail establishments, especially bars and off-
premise outlets, affect rates of car crashes and related injuries.


Bray, R.M. & Hourani, L.L. (July 2007). Substance use trends among active duty
military personnel: findings from the United States Department of Defense Health
Related Behavior Surveys, 1980–2005. Addiction, 102(7):1092-1101.
E-mail: rmb@rti.org

AIMS: This study was designed to assess trends in cigarette, illicit drug, and heavy
alcohol use among active-duty military personnel from 1980 to 2005 and to examine the
influence of socio-demographic changes within the military on patterns of substance use.
DESIGN: Substance use prevalence rates were estimated from cross-sectional data
obtained from nine self-report surveys administered to more than 150,000 active-duty
service members world-wide over a 25-year period. Direct standardization was used to
adjust for socio-demographic changes.
MEASUREMENTS: Measures included self-reported cigarette use, illicit drug use and
heavy alcohol use in the 30 days prior to the survey. Heavy alcohol use was defined as



                                                                                       14
drinking five or more drinks per typical drinking occasion at least once a week in the past
30 days.
FINDINGS: Cigarette and illicit drug use among military personnel declined sharply and
significantly from 1980 to 1998. Heavy alcohol use decreased in the mid-1980s but was
stable from 1988 to 1998. Both cigarette smoking and heavy alcohol use increased
significantly between 1998 and 2002 and remained at those levels in 2005. Illicit drug use
remained low. Logistic regression analyses indicated that trends were influenced by other
factors besides socio-demographic changes across survey years.
CONCLUSIONS: The military has made notable progress in decreasing cigarette
smoking and illicit drug use, but has made less progress in reducing heavy alcohol use.
Additional emphasis should be placed on understanding recent increases in substance use
and on planning effective interventions and prevention programs to reduce use in this
high-risk population.

Significance: This article documents increases in heavy drinking among active US
military personnel—a factor that has influenced DUI rates close to military bases.


M. Ramstedt (July 2007). Alcohol and fatal accidents in the United States—A time
series analysis for 1950–2002. Accid. Anal. & Prev. 40(4):1257-81.
Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University,
Sveaplan, SE-106 91 Stockholm, Sweden

AIMS: To estimate the association between per capita alcohol consumption and fatal
accidents in the United States and to compare the outcome with findings from Europe and
Canada.
DATA & METHOD: Yearly data on fatal accidents by gender and age were analyzed in
relation to per capita alcohol consumption for 1950–2002 using the Box–Jenkins
technique for time series analysis.
FINDINGS: A 1-L increase in per capita consumption was on average followed by 4.4
male deaths per 100,000 inhabitants, but had no significant effect on female accident
mortality. Regarding specific categories of accidents, the effect on fatal motor vehicle
accidents accounted for a large part of the overall effect for men and was also significant
for women. With respect to fatal falling accidents and other accidents, the only
significant effects were found among young males. As concerns women, the association
with per capita consumption in the US was weak in comparison with Canada and Europe.
The US effect estimate for overall male accidents was however equally strong as in
Northern Europe (5.2) or Canada (5.9), and stronger than that found in Central and
Southern Europe (2.1 and 1.6, respectively). With respect to alcohol and fatal motor
vehicle accidents, the association for men of 3.2 was stronger than in Europe and more
similar to the Canadian finding (3.6).
CONCLUSIONS: Per capita alcohol consumption has at least partly been an explanation
for the development of male fatal accidents and particularly motor vehicle accident rates
in the post-war United States. High traffic density and relatively high legal limits for
drunken driving blood alcohol concentration (BAC) are suggested to explain the strong
association found between alcohol and fatal motor vehicle accidents. The results also



                                                                                        15
suggest that a reduction in per capita consumption would have its most preventive impact
on fatal accidents among younger males.


Gonzalez-Wilhelm, Leonardo (June 2007). Prevalence of Alcohol and Illicit Drugs in
Blood Specimens from Drivers Involved in Traffic Law Offenses. Systematic Review
of Cross-Sectional Studies, Traffic Injury Prev., 8(2):189-98.

OBJECTIVE: To determine which is the reported prevalence of alcohol and illicit drugs
in blood specimens from drivers involved in traffic law offenses worldwide.
METHODS: The search was performed by using several international biomedical
databases. In order to reduce publication bias, additional publications were identified
using further sources of information. The present review includes cross-sectional studies
published between 1990 and 2005 in English, Spanish, German, Portuguese, and Italian.
Only studies based on the analysis of blood specimens and chromatographic
quantification of drugs were included.
RESULTS: Forty-nine studies fulfilled the inclusion criteria. Eighteen were excluded
considering practical reasons regarding limitations for a reliable interpretation of their
results. Alcohol appears to be still the predominant substance, with the consideration that
among drivers primarily suspected of DUID, cannabinoids are more prevalent. Among
the illicit drugs, cannabinoids are the most commonly found substance. Certain trends
could be identified, e.g., very low prevalence of cocaine in reports from Nordic countries,
a high prevalence of amphetamines between Norwegian and Swedish studies, and low
rates of THC among Australian studies.
CONCLUSION: The results of this study should be regarded as an attempt to obtain
more reliable data concerning the prevalence of alcohol and illicit drugs among drivers.
To obtain a better assessment of the real current role of alcohol and drugs (illicit and
medications), it seems strongly necessary to update the case-control study conducted by
Borkenstein et al. in 1964, including now blood analyses of the whole spectrum of
substances that can impair drivers.


R.B. Voas; A.S. Tippetts; E. Romano; D.A. Fisher; T. Kelley-Baker (June 2007).
Alcohol Involvement in Fatal Crashes Under Three Crash Exposure Measures,
Traffic Injury Prev., 8(2):107-114.

OBJECTIVE: A common method of normalizing crash fatality data for comparing
subgroups of drivers has been the estimated vehicle miles traveled (VMT).
Unfortunately, the VMT method fails to provide for exposure to risks such as those
related to alcohol consumption (among others). Recently, the “crash incidence ratio”
(CIR) has been introduced to address some of these limitations. The goals of this study
are first, to show that the CIR method is intrinsically similar to an increasingly popular
quasi-induced method: the relative accident involvement ratio (RAIR); second, to
compare the VMT-based, the CIR, and the RAIR methods when applied to the evaluation
of alcohol-related crash fatalities across racial/ethnic groups.
METHODS: We use the 1990-1996 Fatal Accident Reporting System (FARS) with



                                                                                        16
information on the drivers' race/ethnicity and alcohol involvement (BAC). Descriptive
and statistical ratio tests were applied.
RESULTS: The RAIR and CIR are indeed closely related measures that, when used for
comparisons against a reference group, yield exactly the same numerical estimates.
Strikingly different outcomes were obtained depending on using the VMT or the
CIR/RAIR.
CONCLUSION: Choosing one measure over another should depend on the questions to
be answered. The implication of this finding for researchers and policy makers is
discussed.


Yung-Ching Liu ; Shing-Mei Fu (June 2007). Changes in Driving Behavior and
Cognitive Performance with Different Breath Alcohol Concentration Levels, Traffic
Injury Prev., 8(2):153-61.

OBJECTIVE: This study examines the changes in driving behavior and cognitive
performance of drivers with different breath alcohol concentration (BrAC) levels.
METHODS: Eight licensed drivers, aged between 20 and 30 years, with BrAC levels of
0.00, 0.25, 0.4 and 0.5 mg/l performed simulated driving tests under high- and low-load
conditions. Subjects were asked to assess their subjective psychological load at specified
intervals and perform various tasks. The outcome was measured in terms of reaction
times for task completion, accuracy rates, and driver's driving behavior.
RESULTS: The effects of BrAC vary depending on the task. Performance of tasks
involving attention shift, information processing, and short-term memory showed
significant deterioration with increasing BrAC, while dangerous external vehicle driving
behavior occurred only when the BrAC reached 0.4 mg/l and the deterioration was
marked.
CONCLUSION: We can conclude that the cognitive faculty is the first to be impaired by
drinking resulting in deteriorated performance in tasks related to divided attention, short-
term memory, logical reasoning, followed by visual perception. On the other hand,
increasing alcohol dose may not pose an immediate impact on the external vehicle
driving behavior but may negatively affect the driver's motor behavior even at low BrAC
levels. Experience and will power could compensate for the negative influence of alcohol
enabling the drivers to remain in full steering control. This lag between alcohol
consumption and impaired driving performance may mislead the drivers in thinking that
they are still capable of safe steering and cause them to ignore the potential dangers of
drunk driving.


G.M. Ames, C.B. Cunradi, R.S. Moore, P. Stern (May 2007). Military Culture and
Drinking Behavior Among U.S. Navy Careerists. J. Stud. Alcohol Drugs, 68(3):336-
44.

OBJECTIVE: This study builds on research linking work culture and drinking behavior
to examine the influence of the military work environment, especially deployment and
liberty, on heavy and heavy episodic drinking among career enlistees and officers.



                                                                                         17
METHOD: Both quantitative (self-administered cross-sectional survey data collected
from 2,380 respondents) and qualitative (home-base and shipboard observations and
ethnographic interviews with 81 enlisted and officer personnel) methods provided data.
Linear regression analyses were used to examine the relationship between occupational
factors (enforcement of alcohol policy, work problems, work-related stress, and length of
deployment) and positive normative beliefs for heavy drinking during deployment
liberty. Logistic regression analyses were used to examine the relationship between
positive normative beliefs and four drinking-related outcomes (past 12-month DSM-IV,
alcohol abuse and frequent heavy drinking, and heavy drinking and heavy episodic
drinking during most recent deployment liberty).
RESULTS: Occupational factors were significantly related to positive normative beliefs
for heavy drinking during deployment liberty; in turn, positive normative beliefs were
significantly associated with each drinking outcome. Although the prevalence of DSM-
IV alcohol abuse differed significantly between men and women (28.2% vs 15.1%), as
did the prevalence for frequent heavy drinking (13.7% vs 8.9%), no gender differences
were found in the prevalence of heavy episodic drinking or heavy drinking during the
most recent deployment liberty. Ethnographic results provided descriptions of the cultural
context of drinking behavior in relation to ambivalent alcohol policy, relief from work-
related stress, ritual of free-range behavior on deployment liberty, and long-standing
traditions.
CONCLSUIONS: Prevention measures in the military may require policy and
environmental changes.


Poulin, C., Boudreau, B., & Asbridge, M. (April 2007). Adolescent passengers of
drunk drivers: a multi-level exploration into the inequities of risk and safety.
Addiction, 102(1):51-61.
Email: christiane.poulin@dal.ca

AIMS: This study determined the individual-, neighborhood- and provincial-level effects
of rural residence, socio-economic status (SES), substance use and driving behaviors on
adolescents' riding with a drunk driver (RDD).
DESIGN: Multi-level study based on cross-sectional self-reported anonymous data from
the Student Drug Use Survey in the Atlantic Provinces (SDUSAP) and Census Canada
data, merged on the postal code of participating schools. The sample design of the
SDUSAP was a single-stage cluster sample of randomly selected classes stratified by
grade and region.
SETTING: The Atlantic provinces of Canada.
PARTICIPANTS: A total of 12 990 students in junior and senior high schools, with an
average age of 15 years, participated in the 2002 SDUSAP. MEASUREMENTS: The
outcome variable was past-year RDD. The main individual-level independent variables
were SES, rural residence, substance use and driving behaviors. The school-
neighborhood independent variables were the prevalence of heavy episodic drinking,
driving under the influence of alcohol, driver's license, highest level of educational
attainment and low income.




                                                                                       18
FINDINGS: The prevalence of RDD was 23.3% in 2002. Among students in grades 9-12,
lower family SES, rural residence, substance use and driving under the influence were
found to be independent individual-level risk factors for RDD; having a driver's license
was found to be protective. At the provincial and school-neighborhood levels, a high
prevalence of driving under the influence of alcohol and low educational attainment were
found to be independent risk factors for RDD after taking into account individual
characteristics.
CONCLUSIONS: This study provides evidence that inequities exist in the options for
adolescents to be ensured of passenger safety, and that interventions aimed at decreasing
the extent to which adolescents engage in riding with a drunk driver should be based on
conceptual approaches that recognize ecological factors as well as individual-level
susceptibility.

Significance: This study confirms the prevalence with which adolescents ride in an
automobile with an intoxicated driver. Ironically, having a driver’s license actually
reduces this risk. This suggests the need for special educational programs targeting teens
between the ages of 13-16. (WLW, August 2007)


G.P. McMillan, T.E. Hanson & S.C. Lapham (March 2007). Geographic variability in
alcohol-related crashes in response to legalized Sunday packaged alcohol sales in
New Mexico. Accid. Analy. & Prev. 39(2):252-7.
Behavioral Health Research Center of the Southwest, 612 Encino Pl NE, Albuquerque,
NM 87102

On July 1, 1995 the state of New Mexico lifted its ban on Sunday packaged alcohol sales.
Legislation lifting the ban included a local option allowing individual communities
within the state to hold an election to reinstitute the ban on Sunday packaged alcohol
sales. Previous research has shown a clear statewide increase in alcohol-related crash and
crash fatality rates after the ban was lifted. The goal of this study is to measure county-
level variability in changes in alcohol-related crash rates while adjusting for county
socio-demographic characteristics, spatial patterns in crash rates and temporal trends in
alcohol-related crash rates. Bayesian hierarchical binomial regression models were fit to
the observed quarterly crash counts for all counties between July 1, 1990 and June 30,
2000. Results show marked variability in the impact of legalized Sunday packaged
alcohol sales on alcohol-related crash rates. Relative risks of an alcohol-related crash for
the post-repeal versus pre-repeal period vary across counties from 1.04 to 1.90. Counties
with older population suffered a greater negative impact of legalized Sunday packaged
alcohol sales. Counties with communities that quickly passed the local option to re-ban
packaged sales on Sundays were able to mitigate most of the deleterious impact of
increased alcohol availability that was observed across the state.




                                                                                         19
E.A. Fleming, G. Gmel, P. Bady, B. Yyersin, J.C. Givel, D. Brown, J.B Daeppen (Jan.
2007). At-Risk Drinking and Drug Use Among Patients Seeking Care in an
Emergency Department. J. Stud. Alcohol Drugs, 68(1):28-35.

OBJECTIVE: This study reports the frequency of alcohol use and associated tobacco and
drug use among emergency department (ED) patients, in order to increase physician
awareness and treatment of women and men seeking care in ED settings.
METHOD: All adults seen in the ED at the University Hospital in Lausanne,
Switzerland, between 11 AM and 11 PM were screened by direct interview for at-risk
drinking, tobacco use, drug use, and depression during an 18-month period.
RESULTS: A total of 8,599 patients (4,006 women and 4,593 men) participated in the
screening procedure and provided full data on the variables in our analysis. The mean age
was 51.9 years for women and 45.0 years for men; 57.5% (n = 2,304) of women and
58.5% (n = 2,688) of men were being treated for trauma. Based on guidelines of the
National Institute on Alcohol Abuse and Alcoholism, 13.1% (n = 523) of the women
were at-risk drinkers, 57.3% (n = 2,301) were low-risk drinkers, and 29.6% (n = 1,182)
were abstinent. Among men, 32.8% (n = 1,507) met criteria for at-risk drinking, 51.8% (n
= 2,380) met criteria for low-risk drinking, and 15.4% (n = 706) were abstinent. Younger
individuals (ages 18-30) had significantly higher rates of episodic heavy drinking
episodes, whereas at-risk older patients were more likely to drink on a daily basis. A
binary model found that women and men who drank at at-risk levels are more likely to
use tobacco (odds ratio [OR] = 2.48, 95% confidence interval [CI]: 2.0-3.08) and illicit
drugs (OR = 5.91, CI: 3.32- 10.54) compared with abstinent and low-risk drinkers.
CCONCLSUIONS: This study supports systematic alcohol screening of women and men
seen in EDs and suggests that patterns of alcohol and drug use vary by age and gender.


M.T. Gómez-Talegón & F.J. Alvarez (Jan. 2006). Road traffic accidents among
alcohol-dependent patients: The effect of treatment. Accid Anal. & Prev. 38(1):201-
07.
Institute for Alcohol and Drug Studies, Faculty of Medicine, University of Valladolid,
47005 Valladolid, Spain
It is well known that driving under the influence of alcohol increases the risk of traffic
accidents. Alcohol-dependent patients are responsible for two-thirds of motor vehicle
crashes involving alcohol. Studies carried out on the general population have shown a
relation between alcohol dependence and traffic accidents. The aim of the study is to
analyze the effect on traffic accidents of treatment of patients with alcohol-related
problems. To do so, the prevalence of traffic problems in a sample of patients with a
diagnosed dependence on alcohol was assessed for three periods: during their lifetime, in
the year preceding the start of treatment and over the year of treatment. A prospective
study was carried out of 176 patients (147 males, 29 females; mean age 42.9 years)
diagnosed as alcohol dependent according to the DSM-IV criteria in three alcoholic
treatment centers in Castilla y León, Spain. 36.9% of the alcohol-dependent patients had
had some kind of traffic problem during their life and 8.5% in the year prior to starting
treatment. The most frequent problem was positive breath tests, followed by accidents
with damage to the vehicle. Sixty-nine of the 176 patients were still receiving treatment



                                                                                        20
after a year. The prevalence of traffic problems among those patients who followed
treatment for 1 year (4.3%) was lower than in the year before treatment (15.9%).
The study showed that the treatment is also effective in reducing traffic problems.




                                                                                      21
2)     DUI Profiling Studies

The following studies focused on profile characteristics associated with DUI or DUI
recidivism.

M. Rakauskas, N. Ward, E. Boer, E. Bernat, M. Cadwallader, C. Patrick (Sept. 2008).
Combined effects of alcohol and distraction on driving performance. Accid. Analy. &
Prev. 40(5):1742-49.
HumanFIRST Program, ITS Institute, University of Minnesota, 111 Church Street SE,
Minneapolis, MN 55455, USA

Although alcohol and distraction are often cited as significant risk factors for traffic
crashes, most research has considered them in isolation. It is therefore necessary to
consider the interactions between alcohol and distraction impairment sources, especially
when examining the relationship between behavior and crash risk. In a driving simulator,
the primary goal was to maintain a safe headway to a lead vehicle and the secondary goal
was to maintain stable lane position. All participants engaged in distractions that
represented different levels of resource competition and half of the participants consumed
alcohol (target BAC 0.08 g/dl). Specific comparisons were made between sober driving
while distracted and driving intoxicated without distraction. Distraction tasks produced
more changes in driving behavior than did alcohol for both longitudinal (primary) and
lateral (secondary) driving goals. Alcohol impairment was evident only in relation to
lateral driving performance, however, there was an amplification of impairment when
alcohol and distraction conditions were combined. Distraction resulted in a general level
of impairment across all driving goals, whereas participants with alcohol appeared to
shed secondary driving goals to “protect” primary driving goals. Drivers’ strategies to
cope with alcohol (and distraction) may not be sufficient to offset the increased crash
risk.


G. Stoduto, P. Dill, R.E. Mann, E. Wells-Parker, T. Toneatto, R. Shuggi (Sept. 2008).
Examining the Link Between Drinking-Driving and Depressed Mood. J. Stud.
Alcohol Drugs 69(5):777-80.

OBJECTIVE: Because both alcohol and depressed mood exert deleterious effects on
psychomotor performance, the possibility that people with depressed mood may be more
likely to drive after drinking may have important implications for traffic safety. In this
work, we examine the association between depressed mood and self-reported driving
after drinking in a large representative sample of adults in Ontario.
METHOD: Data are based on the 2001-2004 Centre for Addiction and Mental Health
Monitor, an ongoing cross-sectional telephone survey of Ontario adults ages 18 and older
(N = 3,979). Logistic regression analysis was performed to identify the risk of driving
after drinking two or more drinks in the previous hour within the past 12 months
associated with scores on a screening measure of depressed mood (depression-anxiety
and social functioning subscales of the 12-item General Health Questionnaire), while




                                                                                        22
controlling for alcohol-use measures (weekly volume and frequency of heavy drinking),
driving exposure, and demographic factors.
RESULTS: Logistic regression analysis revealed that the odds of reporting driving after
drinking within the past year increase significantly as depressed mood (specifically,
depression-anxiety scores) increases.
CONCLUSIONS: Additional research on the nature of the link between depressed mood
and impaired driving should be undertaken, including assessing whether there exists any
synergistic effects of depressed mood and alcohol on collision risk and considering the
implications of this relationship for prevention and remedial activities.


J. Fell, D. Fisher, R. Voas, K. Blackman, A.S. Tippetts (July 2008). The relationship of
underage drinking laws to reductions in drinking drivers in fatal crashes in the
United States. Accid. Anal. & Prev. 40(4): 1430-40.
Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900,
Calverton, MD 20705-3111

This study reports on an effort to evaluate and interrelate the existence and strength of
two core laws and 14 expanded laws designed to (a) control the sales of alcohol, (b)
prevent possession and consumption of alcohol, and (c) prevent alcohol impaired driving
by youth aged 20 and younger. Our first analysis determined if the enactment of the
possession and purchase laws (the two core minimum legal drinking age laws) was
associated with a reduction in the ratio of drinking to nondrinking drivers aged 20 and
younger who were involved in fatal crashes controlling for as many variables as possible.
The ANOVA results suggest that in the presence of numerous covariates, the possession
and purchase laws account for an 11.2% (p = 0.041) reduction in the ratio measure. Our
second analysis determined whether the existence and strength of any of the 16 underage
drinking laws was associated with a reduction in the percentage of drivers aged 20 and
younger involved in fatal crashes who were drinking. In the regression analyses, making
it illegal to use a false identification to purchase alcohol was significant. From state to
state, a unit difference (increase) in the strength of the False ID Use law was associated
with a 7.3% smaller outcome measure (p = 0.034).


Jewell, J.D., Hupp, S.D.A, & Segrist, D.J. (July 2008). Assessing DUI risk:
Examination of the Behaviors & Attitudes Drinking & Driving Scale (BADDS),
Addictive Behaviors, 33(7):853-65.
Southern Illinois University Edwardsville, Department of Psychology, Box 1121,
Edwardsville, IL 62026

Despite research findings indicating attitudinal differences among drivers with and
without a history of DUI offenses, there are no well-established instruments specifically
designed to clinically assess drinking and driving attitudes and behaviors among adults.
The purpose of this current series of three studies was to investigate the psychometric
properties of the Behaviors & Attitudes Drinking & Driving Scale (BADDS). The
BADDS was developed in previous studies by the authors and assesses respondents'



                                                                                         23
rationalizations for drinking and driving, likelihood of future drinking and driving,
drinking and driving behaviors, and riding with a drinking driver behavior in the previous
month. Study 1 (N = 179) and Study 2 (N = 338) assessed college participants, while
Study 3 gathered data from adult DUI offenders (N = 160) and non-DUI offenders
(N = 166). Results indicate good to excellent test–retest reliability and internal
consistency estimates for the BADDS scores. Support for the construct validity as well as
concurrent and predictive criterion validity of the BADDS scores was also demonstrated.
Potential applications for the measure, as well as need for future research are described.

Significance: Another instrument worth investigating.


M.B Johnson, R.B. Voas, T. Kelley-Baker, C.D.M. Furr-Holden (July 2008). The
Consequences of Providing Drinkers With Blood Alcohol Concentration
Information on Assessments of Alcohol Impairment and Drunk-Driving Risk. J.
Stud. Alcohol Drug,s 69(4):539-49.

OBJECTIVE: We examined the effect of providing drinkers with blood alcohol
concentration (BAC) information on subjective assessments of alcohol impairment and
drunk-driving risk.
METHOD: We sampled 959 drinking participants from a natural drinking environment
and asked them to self-administer a personal saliva-based alcohol test. Participants then
were asked to rate their alcohol impairment and to indicate whether they could drive
legally under one of four BAC feedback conditions (assigned at random): (1) control
condition (no BAC feedback provided before the ratings); (2) categorical BAC
information (low, high, and highest risk) from the saliva test; (3) categorical BAC
information corroborated by a calibrated police breath alcohol analyzer; and (4) precise
(three-digit) BAC information from the breath alcohol analyzer.
RESULTS: Both control participants and participants who received precise BAC
feedback gave subjective impairment ratings that correlated with actual BACs. For
participants who received categorical BAC information from the saliva test, subjective
impairment did not correlate with the actual BAC. Providing drinkers with BAC
information, however, did help them predict more accurately if their BAC was higher
than the legal BAC driving limit.
CONCLUSIONS: Although BAC information can influence drinkers assessments of
alcohol impairment and drunk-driving risk, there is no strong evidence that personal
saliva-based alcohol tests are particularly useful.


Christoffersen , K . Soothill , B. & Francis, M. (June 2008). Risk factors for a first-
time drink-driving conviction among young men: A birth cohort study of all men
born in Denmark in 1966, Journal of Substance Abuse Treatment, 34(4), 415 - 425.

Using a complete birth cohort of all young men born in 1966 in Denmark (N = 43,403),
the prevalence of a first-time drink-driving conviction among young men is estimated.
More than 7% of the total male birth cohort was so convicted before the age of 27 years.



                                                                                          24
In an examination of risk factors for a first-time drink-driving conviction, young adults
coming from potentially vulnerable groups have an increased risk. Earlier criminal
convictions of various types were also significant predictors of drink driving. Situational
pressures also play a part and are controlled for, with the risk of a drink-driving
conviction increased substantially in rural areas compared to metropolitan areas. The
study concludes that disadvantages during adolescence, including parental substance
abuse, having a teenage mother, and domestic violence, are associated with a first-time
drink-driving conviction.

Significance: Interesting comparison to US studies. No known US studies have looked
at having a teenage mother or being exposed to domestic violence as a child as a risk
factor for DUI or DUI recidivism, although there is a related study published in Finland
(see 2001 article authored by Anu, below). (WLW, June 2008).


McMillan, G.P., Timken, D.S., Lapidus, J., C'de Baca, J., Lapham, S.C. & McNeal, M.
(April 2008). Underdiagnosis of comorbid mental illness in repeat DUI offenders
mandated to treatment. J Subst Abuse Treat, 34(3):320-5.
Email: gmcmillan@bhrcs.org

Repeat offenders for DUI are routinely mandated to undergo alcohol treatment. These
individuals have been shown to have high rates of co-occurring psychiatric disorders,
which can be important for the conduct and outcomes of alcohol treatment. The extent to
which treatment providers are aware of these disorders and modify treatment accordingly
is unknown. As part of a larger study to investigate the impact of sanction conditions on
probation outcomes, we screened 233 patients for psychiatric conditions and compared
the findings with the psychiatric conditions identified during mandatory treatment by
independent treatment providers. Adjusted rates of under-diagnosis were commonly high:
97.2% of bipolar disorder cases, 67.5% of major depression cases, 100% of obsessive-
compulsive disorder cases, and 37.3% of drug use disorder cases remained undiagnosed
during treatment. Rates of over-diagnosis were low for all disorders, with the exception
of drug use disorders. These rates of under-diagnosis represent missed opportunities to
improve treatment outcomes among repeat DUI offenders.

Significance: This is the first definitive study of the rate of under-diagnosis of
psychiatric illness among DUI recidivists. The addiction treatment field must
independently develop expertise to assess and treat such conditions among DUI
recidivists or develop integrated assessment and treatment procedures in collaboration
with mental health specialists. In the interim, concurrent court referral for mental health
evaluations would be indicated for DUI recidivists with past histories of failure in
addiction treatment. See further evidence from the 2006 (Lapham) and 2007 (Shaffer)
studies in this section, below. (WLW, June 2008).




                                                                                          25
Brown, T.G., Ouimet, M.C., Nadeau, L., Lepage, M., Tremblay, J., Dongier, M. & Kin,
N.M.. (March 2008). DUI offenders who delay relicensing: a quantitative and
qualitative investigation. Traffic Inj Prev. 9(2),109-18.
E-mail: thomas.brown@mcgill.ca

OBJECTIVES: As in many jurisdictions, individuals convicted of DUI in the province of
Quebec are mandated to re-licensing programs, which include obligatory participation in
intervention programs. However, prolonged delay in re-licensing is widespread,
potentially contributing to unlicensed driving, untreated substance misuse problems, and
drink-driving risk. Information about the characteristics of DUI offenders who delay re-
licensing (DR) is sparse. This investigation compares the characteristics of DR offenders
with those offenders who do not delay (NoDR). In addition, the rationales of DR
offenders for delaying re-licensing are explored qualitatively.
METHODS: Two studies were conducted to explore the characteristics of DR offenders.
In Study 1, DR offenders (n = 46) were compared to NoDR offenders (n = 74) on
multidimensional measures of psychosocial functioning, driving behavior, substance use,
and psychological and neurocognitive characteristics. In Study 2, a qualitative
examination of 20 DR offenders' reasons underlying delayed re-licensing was
undertaken, with verbatims content analyzed to identify major themes. A questionnaire,
based upon this preliminary analysis, was then administered to another sample of DR
participants (N = 37) to appraise and confirm thematic comprehensiveness.
RESULTS: The main findings of Study 1 were that, compared to NoDR offenders, DR
offenders had more past DUI convictions, were at greater risk for drink driving per
kilometer (km) driven, were more likely to have received substance abuse treatment, and
exhibited indices of poorer neurocognitive performance in visual memory and behavioral
inhibition domains. No group differences were uncovered on substance use measures.
The findings of Study 2 revealed that the expense of participation, availability of alternate
transportation, lack of interest, and no access to a vehicle were the most frequent
explanations for delayed re-licensing.
CONCLUSIONS: Overall, these findings suggest that both individual and contextual
factors influence timely fulfillment of re-licensing requirements. While the cost of re-
licensing may succeed in removing some offenders from the road, it may also be a barrier
for others at risk for drink driving, preventing exposure to needed intervention programs.
Reducing this barrier may need to be weighted against the risks of re-licensing more DUI
offenders. Neurocognitive factors may need to be taken into account to not only decrease
delay in re-licensing but also increase the benefits from participation in interventions that
are part of current re-licensing programs.

Significance: No known US study has looked at this issue. Delays in seeking re-
licensure may constitute a risk factor on its own or simply be a proxy for knowledge of
policies that will decline re-licensure for those with know high past problems severity.




                                                                                           26
Hettema, J.E., Miller, W.R., Tonigan, J.S. & Delaney, H.D. (March 2008). The test-
retest reliability of the Form 90-DWI: an instrument for assessing intoxicated
driving. Psychol Addict Behav, 22(1):117-21.
Email: jennifer.hettema@ucsf.edu

Although driving while intoxicated (DWI) is a pervasive problem, reliable measures of
this behavior have been elusive. In the present study, the Form 90, a widely utilized
alcohol and substance use instrument, was adapted for measurement of DWI and related
behaviors. Levels of reliability for the adapted instrument, the Form 90-DWI, were tested
among a university sample of 60 undergraduate students who had consumed alcohol
during the past 90 days. The authors administered the instrument once during an intake
interview and again, 7-30 days later, to determine levels of test-retest reliability. Overall,
the Form 90-DWI demonstrated high levels of reliability for many general drinking and
DWI behaviors. Levels of reliability were lower for riding with an intoxicated driver and
for variables involving several behavioral conjunctions, such as seat belt use and the
presence of passengers when driving with a blood alcohol concentration above .08.
Overall, the Form 90-DWI shows promise as a reliable measure of DWI behavior in
research on treatment outcome and prevention.

Significance: This is another instrument that states will be looking at to adopt for future
use. (WLW, June 2008)


Hingson, R.W., Heeren, T & Edwards, E.M. (March 2008). Age at drinking onset,
alcohol dependence, and their relation to drug use and dependence, driving under
the influence of drugs, and motor-vehicle crash involvement because of drugs. J
Stud Alcohol Drugs. 69(2):192-201.
Email: rhingson@mail.nih.gov

OBJECTIVE: We explored among people who ever consumed alcohol whether early age
oft drinking onset and alcohol dependence predicted drug use and dependence. We also
examined among drinkers who have used drugs whether they also predict driving under
the influence of drugs and motor-vehicle crash involvement because of drugs.
METHOD: A U.S. national sample of 42,867 persons age 18 and older was surveyed in
1991-1992 (response rate = 90%). Logistic regression examined these potential
associations among 27,616 respondents who ever drank alcohol, controlling for numerous
demographic and personal characteristics.
RESULTS: Among "ever" drinkers, 22% used drugs, 10% had driven under the influence
of drugs, and nearly 1% was in a motor-vehicle crash because of drug use, the equivalent
of 1 million people. The younger the age of respondents when they first began drinking
and whether they ever experienced alcohol dependence were independently associated
with greater odds of ever using drugs and experiencing drug dependence. Among persons
who consumed alcohol and drugs, having ever experienced drug dependence was the
strongest predictor of driving under the influence of drugs and motor-vehicle crash
involvement because of drug use. After controlling for drug dependence and age at first




                                                                                           27
drug use, having experienced alcohol dependence was also independently associated with
both outcomes.
CONCLUSIONS: Efforts to prevent drug-related crashes should include drug use
prevention and treatment, as well as prevention of early alcohol use and treatment of
alcohol dependence.

Significance: In the hard-core drinking driver checklist, we included early age of onset
of AOD use as a risk factor because of studies linking early AOD use to adult
dependence which is in turn linked to DUI recidivism. This is the latest confirmation of
this risk factor. (WLW, July 2008)


LaPlante, D.A., Nelson, S.E., Odegaard, S.S., LaBrie, R.A. & Shaffer, H.J.. (March
2008). Substance and psychiatric disorders among men and women repeat driving
under the influence offenders who accept a treatment-sentencing option. J Stud
Alcohol Drugs, 69(2):209-17
Email: debi_laplante@hms.harvard.edu

OBJECTIVE: DUI continues to be a serious public health concern in the United States.
Research suggests that the substance use/abuse and psychiatric histories of repeat
offenders might contribute to the persistence of this phenomenon. Because psychiatric
histories could be important to recovery and likely differ substantially between men and
women, the present study examined psychiatric and substance-use histories of male and
female DUI repeat offenders in treatment.
METHOD: Seven hundred twenty-nine residents at the Middlesex Driving Under the
Influence of Liquor program in Tewksbury, MA, a licensed residential facility providing
treatment and education to repeat DUI offenders, participated in the current study during
the course of 12 months. These participants completed a standardized diagnostic
interview-12 modules of the Composite International Diagnostic Interview-as part of
their intake interview.
RESULTS: Female repeat offenders in this study were substantially different from male
repeat offenders in lifetime and past-year psychiatric comorbidity patterns. Women had
more extensive histories of psychiatric morbidity (i.e., psychiatric disorder in addition to
substance abuse/dependence, alcohol abuse/dependence, and pathological gambling) and
were more likely than men to report a history of multiple morbidities (i.e., multiple
psychiatric disorders in addition to substance-related or gambling disorders).
CONCLUSIONS: Both male and female repeat DUI offenders have extensive but
different psychiatric histories that might play a significant role in DUI recidivism. These
differences in psychiatric and substance-use histories among men and women could have
important implications for treatment and prevention of DUI

Significance: This study has several critical findings: 1) there is a high prevalence of
psychiatric disorders among DUI offenders, 2) this prevalence rate is higher for women
than men, and 3) women DUI offenders have different psychiatric profiles than male DUI
offenders, e.g., increased rates of bipolar disorder, generalized anxiety disorder, and
posttraumatic stress disorder. These findings support the move toward global assessment



                                                                                          28
that we have pursued in IL and call for more gender-specific treatment and integrated
mental health and addiction treatment. (WLW, June, 2008) See same finding in the
McMillan study, cited in this section, above.


J.R. Miller, T.J. Pikora (March 2008). Alcohol consumption among recreational
boaters: Factors for intervention. Accid. Anal. & Prev. 40(2): 496-501.
School of Population Health, M431 University of Western Australia, 35 Stirling
Highway, Crawley, WA 6009, Australia

Recreational boating is a popular leisure time activity in many countries. It is estimated
that, in Australia, boating incidents cause more harm than rail and air crashes combined
and, in terms of transport, are second only to motor vehicle crashes as a cause of serious
injury. The consumption of alcohol among recreational boaters is considered an
important risk factor for fatalities and injuries among both operators and passengers.
Using a database of all recreational vessels registered in Western Australia (WA), a
sample of 500 adult boaters was recruited to participate in a telephone survey. The effects
of demographic variables and boating characteristics upon the use of alcohol among
recreational boaters on their last trip were explored using logistic regression. The odds of
not having a drink were associated, after adjusting for age, with having completed a
boating education course and with carrying children less than 12 years on board. The use
of alcohol was not found to be prevalent among WA recreational boat owners. Based on
these findings, it is recommended that efforts to decrease boating-related incidents, such
as through education and legislation measures, be monitored over time to determine the
effects of these strategies upon safety behaviors.


Willemsen, J., Dula, C.S., Declercq, F. & Verhaeghe, P. (March 2008). The Dula
Dangerous Driving Index: an investigation of reliability and validity across cultures.
Accid Anal Prev. 40(2), 798-806.

The aim of this study is to further establish the validity and reliability of the Dula
Dangerous Driving Index (DDDI). The reliability and validity of the instrument was
investigated by comparing data from a US university sample, a US community sample,
and a sample of Belgian traffic offenders. Exploratory and confirmatory factor analysis
supported the presence of a four-factor structure with items for Drunk Driving forming a
separate scale apart from items for Risky Driving, Negative Cognitive/Emotional Driving
and Aggressive Driving. A multi-group confirmatory factor analysis with model
constraints supported the validity of the DDDI. Inter-correlations revealed that the DDDI
subscales are closely interrelated and uni-dimensionality of the measure was found in all
three samples. This suggests the DDDI Total score can be used as a composite measure
for dangerous driving. However, the validity of the subscales was demonstrated in the
Belgian sample, as specific traffic offender groups (convicted for drunk driving,
aggressive driving, speeding) scored higher on corresponding scales (Drunk Driving,
Aggressive Driving, and Risky Driving, respectively), indicating that it is clinically
meaningful to differentiate the subscales.



                                                                                         29
Significance: This article is included this article because the DDDI is not an instrument
Illinois identified in our national survey. It is one of the few instruments other than the
DRI that views DUI as imbedded in a larger pattern of riskier and aggressive driving.
(WLW, June 2008)


Durant, .R.H, McCoy, T.P., Champion, H., Parries, M.T., Mitra, A,. Martin, B.A.,
Newman, J. & Rhodes, S.D. (January 2008). Party behaviors and characteristics and
serial drunkenness among college students. J Stud Alcohol Drugs, 69(1):91-9.

OBJECTIVE: This study examined the relationships between party behaviors and social
contextual factors for the largest party attended by college students and serial
drunkenness by students over the 3 traditional weekend party days (Thursday-Saturday).
METHOD: On two separate 3-day party time periods in the spring of 2006, a random
sample of 3,600 students from two large public universities completed a Web-based
survey. The survey was administered on a Sunday evening and assessed alcohol
consumption, party behaviors and observations, and other social contextual factors
occurring during the 3 previous days. Serial drunkenness was measured as having gotten
drunk on 0-3 days for the specified 3-day period for students who had attended one or
more parties.
RESULTS: Multivariate analysis indicated that serial drunkenness was associated with
being white, being single without a partner, having ridden with a drinking driver over the
weekend, drunken behaviors by other students at the largest party attended, the number of
drinks the student consumed before attending the party, the number of drinks consumed
at the largest party, and the number of friends that attended the party with the student. A
lower frequency of serial drunkenness was associated with the perception that alcohol
was difficult to obtain.
CONCLUSIONS: The availability of alcohol before and at the largest party attended over
the weekend, attending the party with a larger number of friends, and drunken behaviors
by other students at the party, plus riding with a drinking driver after the party, were
associated with serial drunkenness over the 3-day period by the students at these two
universities.

Significance: A growing number of studies of binge drinking are identifying factors that
include areas Illinois already includes on the ASUDS-RI and the Hard-core Drinking
Driver Checklist. For future revisions of these instruments, we may want to review the
binge drinking studies for items we may have missed, particularly if Illinois ever pursues
a special instrument for DUI offenders under age 25. (WLW, June 2008).




                                                                                          30
Moss, H.B., Chen, C.M. & Yi, H.Y. (December 2007). Subtypes of alcohol dependence
in a nationally representative sample. Drug Alcohol Depend., 91(2-3):149-58.
Email: mossh@mail.nih.gov

OBJECTIVE: The authors sought to empirically derive alcohol dependence (AD)
subtypes based on clinical characteristics using data from a nationally representative
epidemiological survey.
METHOD: A sample of 1484 respondents to the National Epidemiological Survey on
Alcohol and Related Conditions (NESARC) with past year AD was subjected to latent
class analysis in order to identify homogeneous subtypes.
RESULTS: The best-fitting model was a five-cluster solution. The largest cluster (Cluster
1: approximately 31%) was comprised of young adults, who rarely sought help for
drinking, had moderately high levels of periodic heavy drinking, relatively low rates of
comorbidity, and the lowest rate of multigenerational AD (approximately 22%). In
contrast, Clusters 4 and 5 (approximately 21% and 9%, respectively) had substantial rates
of multigenerational AD (53% and 77%, respectively), had the most severe AD criteria
profile, were associated with both comorbid psychiatric and other drug use disorders,
lower levels of psychosocial functioning, and had engaged in significant help-seeking.
Clusters 2 and 3 (approximately 19% each) had the latest onset, the lowest rates of
periodic heavy drinking, medium/low levels of comorbidity, moderate levels of help-
seeking, and higher psychosocial functioning.
CONCLUSION: Five distinct subtypes of AD were derived, distinguishable on the basis
of family history, age of AD onset, endorsement of DSM-IV AUD criteria, and the
presence of comorbid psychiatric and substance use disorders. These clinically relevant
subtypes, derived from the general population, may enhance our understanding of the
etiology, treatment, natural history, and prevention of AD and inform the DSM-V
research agenda.

Significance: This article represents one of the latest studies confirming the existence of
multiple subtypes of severe alcohol problems. (WLW, June 2008)


J.L. Muilenburg, W.D. Johnson, S.L. Usdan, L. Annang & D.L. Clayton (Nov. 2007).
Prevalence of impaired driving behaviors in a diverse, rural, southern middle
school. Accid. Anal & Prev. 39(6):1080-87.
University of Georgia, Department of Health Promotion and Behavior, 311 Ramsey
Center, Athens, GA 30602,
Little research has been reported on the risky behaviors of pre-driving adolescents
revolving around alcohol use, in particular impaired driving behaviors, which in general
have been shown to be higher in rural areas. This study investigated the prevalence of
drinking while driving and riding with a drinking driver among 290 middle school
students in a Mississippi Delta area middle school. Just under half (45.3%) responded
that at least once in the past 30 days they had ridden with a drinking driver and 17%
indicated they had driven an automobile after drinking alcohol. The prevalence of
underage drinking, driving under the influence of alcohol, and riding with a drinking
driver among our sample of middle school students is alarming. This study shows



                                                                                         31
alcohol-related driving behaviors are not solely performed by those who are legally
licensed to drive, but simply by those who have access to vehicles. The authors
recommend that prevention programs focusing on reducing the incidence of impaired
driving should start in early adolescence.


Shaffer, H.J., Nelson, S.E., LaPlante, D.A., LaBrie, R.A., Albanese, M., & Caro, G.
(October 2007). The epidemiology of psychiatric disorders among repeat DUI
offenders accepting a treatment-sentencing option. J Consult Clin Psychol.,
75(5):795-804.
Email: Howard_shaffer@hms.harvard.edu

Psychiatric comorbidity likely contributes to DUI among repeat offenders. This study
presents one of the first descriptions of the prevalence and comorbidity of psychiatric
disorders among repeat DUI offenders in treatment. Participants included all consenting
eligible admissions (N = 729) to a 2-week inpatient treatment facility for court-sentenced
repeat DUI offenders (i.e., offenders electing treatment in place of prison time) from
April 17, 2005, to April 23, 2006. Participants completed the Composite International
Diagnostic Interview, which assessed the following disorders using criteria from the
Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric
Association, 1994): alcohol use and drug use, bipolar, generalized anxiety, posttraumatic
stress, intermittent explosive, conduct, attention deficit, nicotine dependence,
pathological gambling, and major depressive. Repeat DUI offenders evidenced higher
lifetime and 12-month prevalence of alcohol use and drug use disorders, conduct
disorder, posttraumatic stress disorder, generalized anxiety disorder, and bipolar disorder
compared with the general population. Almost half qualified for lifetime diagnoses of
both addiction (i.e., alcohol, drug, nicotine, and/or gambling) and a psychiatric disorder.
Lifetime and past-year comorbidity rates were higher among participants than in the
general population. These results suggest that clinicians should consider multimorbidity
within DUI treatment protocols.


Bortolotti, F., Trettene, M., Gottardo, R., Bernini, M., Ricossa, M.C. & Tagliaro, F.
(August 2007). Carbohydrate-deficient transferrin (CDT): a reliable indicator of the
risk of driving under the influence of alcohol when determined by capillary
electrophoresis. Forensic Sci Int., 170(2-3), 175-8.
Email: federica.bortolotti@medicina.univr.it

Carbohydrate-deficient transferrin (CDT) is a marker of chronic alcohol abuse, which has
recently been introduced to evaluate the physical fitness for obtaining a driving license.
The aim of the present study was to evaluate the prevalence of elevated CDT levels in
subjects stopped while driving under the influence of alcohol by using a validated method
based on capillary electrophoresis. The study was carried out on a group of 40 drunken
drivers (group A) and on a control group (n=51) of subjects chosen from the general
population (group B). CDT was directly determined by capillary electrophoresis in free
solution and UV detection at 200 nm. CDT results from both groups were classified as



                                                                                         32
"negative" or "positive" on the basis of the cut-off set at 2.00% (CDT index). The
subjects classified as "positive" in group A were 24 (60%), whereas in group B were 2.
The subjects classified as "negative" in group A were 16 (40%), whereas in group B was
49 (96.1%). The comparison of the observed percentages, evaluated with the chi(2)-test,
was highly significant (p<0.001). The present study confirms the high prevalence of
chronic alcohol abusers among drunken drivers and the usefulness of CDT as a predictor
of the risk of drunk driving.


Dill, P.L., Wells-Parker, E., Cross, G.W., Williams, M., Mann, R.E., Stoduto, G. &
Shuggi. R.(August 2007). The relationship between depressed mood, self-efficacy
and affective states during the drinking driving sequence. Addict Behav. 32(8):1714-
8.

Relationships between depressed mood, abstinence confidence and temptation, and
experienced emotions just before and during recent drinking driving sequences (drinking
driving emotional states: DDES) were examined in a sample of DUI offenders.
Depressed mood offenders (41% of sample) reported lower abstinence confidence, higher
temptation, and higher DDES, especially in association with negative affective states.
Implications for interventions with depressed mood DUI offenders are discussed.

Significance: This study adds to other studies that have documented the high incidence
of depression in DUI offenders. What has not yet been determined is the extent to which
acuity of depressive episode plays a role in DUI recidivism events. The use of
depression/recovery checkups might play a positive role in reducing recidivism in this
group. (WLW, June 2007)


White, W. & Gasperin, D. (July 2007) The “hard core drinking driver”:
Identification, treatment and community management. Alcoholism Treatment
Quarterly, 25(3), 113-132.

Overall cultural attitudes and behaviors related to drinking and driving have changed
dramatically in the past forty years, but left in its wake a core of individuals who, despite
education, threats, and punishments, continue to frequently drive with high blood alcohol
concentrations. It is important that addiction counselors, law enforcement officers,
prosecutors, judges, probation officers, and administrative hearing officers recognize this
“hard core drinking driver” and structure interventions that can both enhance personal
recovery and protect public safety. This article profiles hard core drinking drivers and
offers guidelines for their treatment and management.

Significance: This is the best summary of the work have done in Illinois to identify those
DUI offenders at greatest risk of recidivism—defined as most likely to be re-arrested for
DUI or to be involved in future alcohol/drug-related crashes involving injuries of
fatalities.




                                                                                           33
Labrie, R.A., Kidman, R.C., Albanese, M., Peller, A.J. & Shaffer, H.J. (July 2007).
Criminality and continued DUI offense: criminal typologies and recidivism among
repeat offenders. Behav Sci Law. 25(4); 603-614.

We examined over 20,000 arraignment records to define criminal typologies and post-
treatment DUI convictions for a select cohort of 1,281 repeat DUI offenders who were
offered and elected treatment as an alternative to incarceration; we compared this
information with a similar data analysis collected 20 years previously. Analyses of 8,600
prior-to-treatment convictions defined four basic crime profiles: only DUI and other
substance-related offenses (60%), plus crimes against property (18%), plus crimes against
people (8%), plus crimes against both property and people (13%). During the six years
after inpatient treatment, 15.5% of the cohort was convicted of another DUI. The
recidivism rate was significantly different across criminal types and was not related to the
time post treatment years at risk. The findings show there has been no significant
improvement in treatment outcome over the last 20 years. New and innovative DUI
offender policies and practices are needed to better engage the heterogeneous offender
population, and reduce the incidence of repeat DUI.

Significance: This study offers a potentially important typology of criminal profiles of
DUI recidivists that might be helpful to judges, probation officers and treatment
professionals. The overall conclusion also supports the development of a specialized
treatment for the DUI recidivist. (WLW, August 2007).


Medina-Mora, M.E. (July 2007). Mexicans and Alcohol: Patterns, problems and
policies. Addiction, 102(7);1041-1045. (No abstract with this article.)

Significance: This article notes several factors that may contribute to drinking and
driving among Mexican Americans: 1) the loss of alcohol control rituals following the
Spanish colonization of Mexico, 2) a cultural norm that makes it permissible for males to
drink and become intoxicated, 3) a pattern of “fiesta drinking”—low frequency of
drinking but high volume of drinking per drinking occasion, 4) a preference for drinking
outside the home, and 5) weak alcohol control policies in Mexico, e.g., low alcohol
taxation policies. (WLW, August 2007).


Ouimet, M.C., Brown, T.G., Nadeau, L., Lepage, M., Pelletier, M., Couture, S.,
Tremblay, J., Legault, L., Dongier, M., Gianoulakis, C., & Ng Ying Kin, N.M.. (July
2007). Neurocognitive characteristics of DUI recidivists. Accid Anal Prev. 39(4):743-
750.

Individuals who drive under the influence of alcohol may be at greater risk for
neurocognitive impairment because of their exposure to multiple sources of neurological
risk. This could contribute to the persistence of DUI behavior and influence the
effectiveness of remedial interventions. The objectives of this study were to clarify the
neurocognitive characteristics of DUI recidivists and the nature of potential impairments,



                                                                                           34
and to explore relationships between these characteristics and the frequency of past DUI
convictions. One hundred male recidivists were evaluated for visuospatial constructional
abilities and visual memory, verbal fluency, attention skills, cognitive flexibility, spatial
planning, and verbal and movement inhibition. Results indicated that a majority of
recidivists showed signs of neurocognitive impairment on several dimensions.
Impairment was most marked on visuospatial constructional abilities and visual memory.
In contrast to previous studies, no participants were found to have impulse control
problems. Measures of memory and cognitive efficiency were significantly associated
with the frequency of past convictions. Finally, exploratory analyses of two potential
sources of impairment, alcohol exposure and head trauma, suggested the role of excessive
alcohol use as the most obvious associated factor. Overall, the findings indicate that
neurocognitive impairments are a common feature in recidivists and may contribute to
DUI persistence. Development of a DUI-specific neurocognitive assessment and greater
understanding of how neurocognitive status influences DUI risk could lead to
remediation strategies better adapted to the individual characteristics of recidivists.

Significance: This is the first study of its kind focused specifically on DUI recidivists,
and suggests that recidivists may have marked neurological impairment compared to the
non-recidivists. With replication, this finding could lead to specific tests that add
additional predictive power to the identification of the hard core drinking driver. This
finding also has considerable implications to the treatment of the DUI recidivists and may
offer clues as to how traditional treatment could be improved for the DUI recidivist
(WLW August 2007).


Martinez , J.A., Rutledge, P.C., & Sher, K.J. (June 2007). Fake ID ownership and
heavy drinking in underage college students: prospective findings. Psychol Addict
Behav., 21(2):226-32.
Email: jamf22@mizzou.edu

The authors examined the ownership of false identification (fake ID) for the purpose of
obtaining alcohol and the relation of fake ID ownership to heavy drinking in a
longitudinal sample of college students under 21 years of age. A sample of 3,720
undergraduates was assessed the summer prior to college entrance and during the 4
semesters comprising freshman and sophomore years. Regression analyses were used to
estimate bidirectional relations between consumption and fake ID ownership. Sex, Greek
membership, and prior drinking were controlled. Results showed that fake ID ownership
increased over time (12.5% pre-college to 32.2% fourth semester) and that Greek
members were more likely than others to own fake IDs. Fake ID ownership predicted
concurrent and next-semester heavy drinking with increasing strength over time. Also,
the acquisition (onset) of fake ID ownership at each time point was predicted by
previous-semester consumption. When traditional, robust risk factors of consumption are
controlled, fake ID ownership meaningfully relates to heavy drinking in college. It thus
presents a significant public health problem, addressable through training for alcohol
servers and retailers, punitive measures toward fake ID owners, and other possible
interventions.



                                                                                          35
Significance: College students are one of the most difficult populations to evaluate
related to DUI. This study offers an interesting potential “tell” that could be used to help
identify those students at greater risk of problem severity and possible recidivism.
(WLW, June 2008).


Ryb, G.E., Dischinger, P., Kufera, J. & Soderstrom, C. (May 2007). Smoking is a
marker of risky behaviors independent of substance abuse in injured drivers. Traffic
Inj Prev. 8(3):248-52.
E-mail: gabyryb@pol.net

OBJECTIVE: Smoking has been linked to disease and injury. The purpose of this study
is to investigate the smoking habits of motor vehicular driver trauma center patients and
their association with previous injury history and risky behaviors.
METHODS: The studied population included 323 motor vehicular driver injury patients
(123 smokers and 200 non-smokers) interviewed as part of a larger study of psychoactive
substance use disorders at an adult Level I trauma center. Patients with head injuries,
hospital stays of less than two days, and diminished cognition were excluded. Interviews
included demographics (age, gender, race, marital status), SES; income, education,
employment), risky behaviors (seatbelt non-use, drinking and driving, riding with drunk
driver, binge drinking), and trauma history information (vehicular, assault, and other
injuries). Substance abuse (alcohol and drug dependence) was evaluated in depth using
DSM III-R criteria. Smokers and non-smokers were compared in relation to control and
dependent variables using student's t test and chi-square (alpha = 0.05). Outcome
variables included previous trauma history and risky behaviors. Multiple logistic
regression models using step-down selection methods (alpha = 0.05) were constructed
with risky behaviors and trauma history as dependent variables including demographics,
SES and substance as independent variables.
RESULTS: Smokers represented 38 % of the 323 patients studied. Smokers (n = 123)
were younger (34 vs. 43 years), more likely to be male (72 % vs. 50 %), not married
(72% vs. 56 %), and had higher rates of alcohol (29 % vs. 9 %) and drug dependence
(14% vs. 3%) than non-smokers (n = 200). Educational achievement (20% vs. 15% less
than high school) and income level (24% vs. 23% with less than $15,000 of yearly
income) were not different between smokers and non-smokers. Smokers were more likely
than non-smokers to have a history of prior vehicular trauma (48% vs. 26%), assault
(25% vs. 9%), or other injury (50% vs. 37%). The following injury-prone behaviors were
also more common among the smokers than non-smokers: seatbelt non-use (49% vs.
29%), drinking and driving (38% vs. 15%), riding with drunk driver (38% vs. 13%), and
binge drinking (68% vs. 26%). In multiple logistic regression models adjusting for
demographics, SES, and substance abuse, smoking revealed significantly higher odds
ratios (OR) for the following dependent variables: seatbelt non-use (OR = 2.9), riding
with drunk driver (OR = 2.2), binge drinking (OR = 2.4), previous vehicular (OR = 2.0),
and assault injuries (OR = 2.5).
CONCLUSION: Smoking is independently associated with risky behaviors and repeated
history of vehicular or assault injury within the vehicular trauma population.



                                                                                          36
Significance: The Conclusion says it all: Another study identifying smoking as an
identifiable risk factor in DUI. (WLW, June 2008)


Bingham, C.R., Elliott, M.R. & Shope, J.T. (April 2007). Social and behavioral
characteristics of young adult drink/drivers adjusted for level of alcohol use. Alcohol
Clin Exp Res., 31(4):655-64.
Email: rbingham@umich.edu

BACKGROUND: Alcohol consumption and drink/driving are positively correlated and
many predictors of alcohol use also predict drink/driving. Past research has not fully
distinguished the contributions of personal risk factors from the level of alcohol use in the
prediction of drink/driving. As a result, the extent to which predictors are specific to
drink/driving, versus due to a mutual association to alcohol use, is unclear.
METHODS: This study examined the unique and shared risk factors for drink/driving
and alcohol use, and examined the attributable risk (AR) associated with predictors of
drink/driving while adjusting for alcohol use. Study data were from a telephone survey of
3,480 Michigan-licensed young adults who were drinkers. Four groups of drink/drivers
were formed based on the prior 12-month maximum severity of drink/driving: (1) never
drink/driving; (2) driving at least once within an hour of 1 or 2 drinks; (3) driving within
an hour of 3 or more drinks or while feeling the effects of alcohol; and (4) drinking while
driving.
RESULTS: Lower perceived risk of drink/driving, greater social support for drinking and
drink/driving, greater aggression and delinquency, more cigarette smoking, and more
risky driving behaviors uniquely predicted drink/driving severity in models adjusted for
alcohol use. The largest ARs were associated with social support for drinking and
drink/driving and perceived risk of drink/driving.
CONCLUSIONS: These results confirm that alcohol use and drink/driving share risk
factors, but also indicate that part of the variation in these factors is specific to
drink/driving. Implications for interventions to reduce drink/driving are discussed.

Significance: This study supports the risk factors included in the Illinois Hard-Core
Drinking Driver Checklist.


Cavaiola, A.A., Strohmetz, D.B. & Abreo, S.D. (April 2007). Characteristics of DUI
recidivists: a 12-year follow-up study of first time DUI offenders. Addict Behavior,
32(4):855-61.
Email: acavaiol@monmouth.edu

77 individuals convicted of a DUI offense were screened for recidivism approximately 12
years following their first offense. At the time of the initial DUI conviction, participants
were administered the MAST and the MMPI-2. Participants' drinking history and driving
history and arrest at the time of screening and at a 12-year follow-up were also reviewed.
The results indicate that, among DUI recidivists, on average 6 years elapsed between



                                                                                          37
their first and second DUI offenses. Driving history prior to the first DUI offense was
predictive of later recidivism. The only significant finding from the MAST and MMPI
results was that repeat offenders tended to have higher scores on the L and K validity
scales of the MMPI. These results are discussed in the context of Jessor's Problem-
Behavior Theory and as well their clinical implications for screening and treatment
decisions involving first time DUI offenders.

Significance: This study supports our use of overall driving history and
characterological factors in determining risk for DUI recidivism. (WLW, June 2008).


Williams, A.F., McCartt, A.T., & Ferguson, S.A.. (March 2007). Hardcore drinking
drivers and other contributors to the alcohol-impaired driving problem: need for a
comprehensive approach. Traffic Inj Prev. 8(1):1-10. .

OBJECTIVE: Understanding the hardcore drinking driver concept in the context of the
alcohol-impaired driving problem.
METHOD: Review of the relevant literature.
RESULTS: As progress against alcohol-impaired driving slowed in the early 1990s,
public and political attention turned to "hardcore" drinking drivers, and they have been a
priority for the past 15 years. Though intuitive, the hardcore concept has been difficult to
conceptualize. Its definition of hard-to-change chronic heavy drinking drivers focuses on
a group that is not easily identifiable and ignores many who account for a large portion of
alcohol-impaired driving crashes. These include drivers who drink heavily on occasion
and drivers who drink at more moderate levels that elevate crash risk. Emphasis on the
hardcore has focused attention on the small proportion of drinking drivers who have been
detected and arrested, whereas the vast majority of drinking drivers go undetected. Some
countermeasures aimed at the hardcore group have been effective in reducing recidivism,
but attention and resources also need to be given to general deterrent initiatives (e.g., 0.08
g/dL, sobriety checkpoints, and administrative license suspension). There has been no
reduction in the overall alcohol-impaired driving problem since the mid-1990s.
CONCLUSION: Reductions in the alcohol-impaired driving problem require that
attention be focused on all relevant target groups. Some benefits could accrue by
recognizing that countermeasures developed for hardcore drinking drivers, such as
alcohol ignition interlocks and vehicle or plate impoundment, might also be effective
with more numerous first-time offenders. However, such strategies are likely to be most
effective against recidivism (specific deterrence). Greater gains could be achieved
through general deterrent efforts (increasing the real and perceived risk of arrest and
punishment to all drinking drivers), along with application of public health measures
designed to reduce overall consumption. Additional ways need to be found to separate
drinking and driving, either through cultural changes in drinking and/or driving behavior
or, in the future, with the use of technology that can make vehicles inoperable by drivers
with illegal blood alcohol concentrations.

Significance: Noteworthy in this article is the inclusion of 2 groups not usually included
in the hard core drinking driver profile: 1) drivers who on occasion drink heavily (this



                                                                                           38
would seem by definition to include ALL DUI offenders who are not regular drinkers);
and 2) moderate drinkers who are at increased risk for crashes. This article seems to
dramatically extend the traditional definition of the hard core drinking driver. If this is an
emerging trend, it could eliminate any significant meaning of the conceptualization of the
high risk offender. (WLW, August 2007).


Fiorentino, D.D., Berger, D.E. & Ramirez, J.R. (January 2007). Drinking and driving
among high-risk young Mexican-American men. Accid Anal Prev. 39(1):16-21.

Determinants of DUI were explored among a sample of relatively young Mexican-
American males with limited income and education, high levels of alcohol consumption,
and regular vehicle use. Data were collected using questionnaires (N=104) and focus
groups (N=27), including a focus group with wives and girlfriends (N=4). Four
mechanisms that may contribute to the high rate of DUI behavior in this population were
identified: (1) a subculture of permissiveness toward drinking and driving for men, (2)
heavy drinking, promoted by machismo and a propensity to measure masculinity with
alcohol intake, (3) inadequate knowledge of DUI statutes and inadequate understanding
of the relationships between BAC, impairment, and crash risk, and (4) for undocumented
drivers, lack of accountability in case of an alcohol-related incident.

Significance: This study begins by reviewing research confirming that Hispanics drive
under the influence of alcohol at rates greater than European Americans and African
Americans and that Mexican Americans drink and drive at higher rates than other
Hispanics. This study adds to the factors that may be contributing to recent increases in
Hispanic (and in particular Mexican) DUI rates. Note the similarities with the above
cited article by Medina-Mora. (WLW, August 2007).


Lapham, S.C., C'de Baca, J., McMillan, G.P. & Lapidus, J. (2006). Psychiatric
disorders in a sample of repeat impaired-driving offenders. J Stud Alcohol,
67(5):707-13.
Email: slapham@bhrcs.org

OBJECTIVE: This study was conducted to assess alcohol- and drug-use disorders and
other psychiatric disorders in a sample of repeat DUI offenders.
METHOD: We interviewed offenders to estimate lifetime and 12-month prevalence of
psychiatric disorders as designated by the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (alcohol and drug abuse and dependence, major depressive or
dysthymic disorder, bipolar disorder, post- traumatic stress disorder [PTSD], and
obsessive-compulsive disorder). The offenders interviewed (385 men, 74 women) were
those who had been adjudicated in the Multnomah County, OR, Driving Under the
Influence of Intoxicants Intensive Supervision Program. Psychiatric diagnoses were
assessed using the Composite International Diagnostic Interview.
RESULTS: The majority of respondents (53.8%) were alcohol dependent. Sixty-five
percent of men and 79.7% of women had at least one lifetime disorder comorbid with



                                                                                           39
alcohol abuse or dependence. The most prevalent lifetime non-substance-use disorder
was major depressive or dysthymic disorder (30.9%) followed by PTSD (15.3%).
Approximately 40% of subjects reported meeting criteria for lifetime nonalcohol drug
abuse for at least one drug type, and 30% were drug dependent for at least one drug type;
overall, 54% of all offenders had drug abuse or dependence disorders.
CONCLUSIONS: Assessment and treatment services for repeat alcohol-impaired driving
offenders should be sufficiently comprehensive to provide care for drug-use disorders
and other psychiatric problems.


Brice, M.R., Appenzeller, S., Maul, A, & Wennig, R. (August 2005). Relationship
between blood alcohol concentration and carbohydrate-deficient transferrin among
drivers, Drug and Alcohol Dependence, 79(2), 261-265

Carbohydrate-deficient transferrin (CDT) was quantified in 408 blood specimens,
randomly selected from 1260 drivers apprehended and submitted to BAC determination.
The first step of the study was to observe whether a BAC based pre-evaluation was
relevant for deciding to test drivers for chronic alcohol abuse. For this purpose, the
diagnosis of chronic alcohol abuse was verified by CDT quantification, with a voluntary
high positive cut-off fixed at 3% for high specificity. The results display a significant
increase in the part of chronic alcohol abusers with respect to increasing BAC: a few
alcohol abusers were present in the BAC category below .05 g/dL, and their frequency
increased to 47 and 67% when BAC was between .3 and .35 g/dL and above .35 g/dL,
respectively. Secondly, the usefulness of the biomarker CDT in the traffic safety context
was investigated by observing whether drivers with abnormally increased CDT value had
also higher BAC. The average BAC was .132 g/dL in drivers with CDT below 1%, and
increased to .228 g/dL in drivers with CDT above 3%. Statistical analysis showed
evidence of a monotone increasing link between BAC and CDT (P < 0.0001). We
confirmed here the relevance of BAC-based pre-evaluation before testing chronic alcohol
abuse among drivers, and demonstrated that CDT is a biomarker suitable for traffic safety
context, as drivers with increased CDT had significantly higher BAC.

Significance: This is an earlier study found cited in a 2008 report. Watch reports for
CDT. It may become one of the biological markers of the future used to screen DUI
offenders. See the Bortolotti report, cited in this section, above, for confirmation of that
possibility. (WLW, June 2008)


Schermer, C. R., Apodaca, T. R., Albrecht, R.M., Lu, S. W., & Demarest, G.B.
(December 2001). Intoxicated motor vehicle passengers warrant screening and
treatment similar to intoxicated drivers. Journal of Trauma-Injury Infection &
Critical Care, 51(6):1083-86.

BACKGROUND: Alcohol interventions decrease alcohol consumption and recurrent
injury. The study hypotheses are (1) intoxicated passengers are similar to intoxicated
drivers in crashes and DUI arrests, and (2) DUI conviction rates after injury are low.



                                                                                           40
METHODS: Intoxicated motor vehicle occupants hospitalized for injury in 1996-1998
were matched to the state traffic database for crashes and DUI. Drivers and passengers
were compared for crashes and DUI in the 2 years preceding and 1 year after admission.
Driver DUI citation at the time of admission was also recorded. A logistic regression
model for crash and DUI probability was constructed.
RESULTS: Six hundred seventy-four patients met inclusion criteria. In the 2 years
preceding admission, passengers and drivers were equally cited for crashes (14.7% vs.
19.3%, p = 0.12). In 1 year after admission, they were also equally cited (7.1% vs. 7.7%,
p = 0.92). Driver/passenger status was not a predictor by logistic regression; 13.4% of
intoxicated drivers were convicted of DUI for the admitting crash.
CONCLUSIONS: Intoxicated passengers and drivers are equally likely to be cited for
crashes and DUI before and after admission for injury. Few admitted intoxicated drivers
are convicted of DUI. Screening and intervention for all intoxicated crash occupants is
warranted.

Significance: This study suggests a potentially added item to the hard-core drinking
driver profile: having been a passenger at the time the driver of the car was arrested for
DUI. This may be a proxy for the heavy drinker social network which is the more direct
risk factor for DUI recidivism. (WLW, June 2008).


Anu, S., Jouko, M. Marjo-Riitta, J. & Pirkko, R. (February 2001). An examination
between single-parent family background and drunk driving in adulthood: Findings
from the Northern Finland 1966 birth cohort: Neurobiological, behavioral, and
environmental relations to drinking, Alcoholism: Clinical & Experimental Research.
25(2):206-09.

BACKGROUND: It has been suggested that parental loss could be an important risk
factor for alcoholism in adulthood. We explored the association between different types
of childhood families with later alcohol-related problems of the offspring, in particular
drunk driving.
METHODS: We used a large, prospectively collected general population birth cohort
database (n = 10,934), the Northern Finland 1966 Birth Cohort. Linked with the National
crime register, it provided information on drunk driving offenses known to the police that
involved persons 15 to 32 years of age (n = 432). Type of family was categorized into
five subgroups: two-parent family and four types of single-parent families (single-parent
all the time, single-parent at birth, parental death, and parental divorce). The information
about family type was obtained from questionnaires given to the mothers during mid-
pregnancy and at the time of the 14-year follow-up.
RESULTS: Single-parent family during childhood significantly increased the risk of
drunk driving in adulthood among both males and females. Males who were born in
single-mother families were at the highest risk of drunk driving offenses in adulthood
(adjusted OR 2.4; 95% CI 1.4-4.2). The association between single-parent family and
drunk driving among males was seen in all types of single-parent families except for
parental death.




                                                                                         41
CONCLUSIONS: Results suggest that growing up in a single-parent family is a
potentially powerful predictor of adult alcohol-related problems, i.e., early-onset, late-
onset, and recidivistic drunk driving.

Significance: Further support for looking at parental loss/separation in childhood as an
adult DUI and/or DUI recidivism risk. (WLW, June 2008)




                                                                                             42
3)     Evaluations of DUI Intervention Theory and Practice

B. Bjerre, J. Kostela (July 2008). Primary prevention of drink driving by the large-
scale use of alcolocks in commercial vehicles. Accid. Anal. & Prev. 40(4):1294-99.
Traffic Medicine, Swedish Road Administration, Borlänge, SE 781 87 Borlange, Sweden

Alcolocks are commercial breath test devices that prevent a motor vehicle from starting
when a driver'sBAC is elevated. This report is an evaluation of the experiences and BAC
data from the first use of alcolocks in commercial vehicles as a primary prevention
strategy. In most applications, the alcolock is imposed only after an impaired driving
conviction. This study, implemented in Sweden, estimates drink driving on a large scale
in a variety of commercial vehicles.
Officials from 118 companies were interviewed representing 3689 alcolock-equipped
vehicles used by 9614 professional drivers, an 80% compliance rate. In a contrast group
of 230 transport businesses without alcolocks the interview compliance rate was 57%.
Survey results probed motivation for and experience with alcolocks. Analysis of BAC
test patterns showed alcohol consumption among employees through prevalence
estimates of drink-driving attempts at the rate of BAC ≥ the legal limit 0.020%.
Before alcolock installation, 64% of the employers suspected alcohol problems among
their employees and their motive for installing alcolocks (cost averaged 1700 €/vehicle)
was to improve the transport quality. Several companies had technical problems with the
alcolocks; but 98% recommended that other companies install alcolocks.
Among 600, heavy vehicles, 0.19% of all starts were prevented by elevated BAC; most
during weekends and mornings. Daytime Saturday and Sunday mornings 0.72% of the
drivers had elevated BAC.
CONCLUSIONS: The prevalence of drink driving among professional drivers is
probably similar to that among drivers in general. Alcolocks would improve the safety
margin and reduce public risk. Provided that the entire fleet of trucks, buses, and taxis in
Sweden had installed alcolocks that would correspond to about half a million drink
driving trips being prevented every year.


M.J. Chen, J.W.Grube, P. Nygaard, B. Miller (March 2008). Identifying social
mechanisms for the prevention of adolescent drinking and driving Accid. Anal. &
Prev. 40(2):576-85
Prevention Research Center, Pacific Institute for Research and Evaluation, 1995
University Ave., Suite 450, Berkeley, CA 94704

This study identifies social mechanisms that might help prevent youth from being
involved in DUI and riding with drinking drivers (RWDD). Data collected through
telephone surveys with 1534 adolescents and young adults aged 15–20 years
(mean = 17.6, S.D. = 1.6) in California, USA, were analyzed. Structural equation
modeling analyses showed that DUI and RWDD were strongly related to drinking in
unstructured situations, modeling of DUI by peers and parents, and perceived peer
approval or disapproval of DUI. DUI outcome expectancies were indirectly related to
DUI and RWDD through situational drinking. Parental monitoring and DUI law



                                                                                          43
enforcement were also indirectly related to DUI and RWDD through DUI expectancies
and other mechanisms. The findings, overall, suggest that parental influence remains
important even through late adolescence. Parental monitoring, in particular, might help to
reduce unstructured socializing with peers, drinking, and affiliation with peers who
engage in DUI. Parental monitoring may also foster beliefs about the risks of DUI.
Conversely, parents’ own DUI behavior may normalize drinking and DUI behaviors, thus
countering monitoring efforts.


Holmgren, A., Holmgren, P., Kugelberg, F.C., Jones, A.W. &Ahlner, J. (March 2008).
High re-arrest rates among drug-impaired drivers despite zero-tolerance legislation.
Accid Anal Prev., 40(2):534-40.

BACKGROUND A zero-tolerance law for DUI-D in Sweden led to a 10-fold increase in
the number of cases submitted by the police for toxicological analysis. The statutory
BAC limit for driving is 0.02.
METHODS An in-house database (TOXBASE) was used to investigate re-arrests for
impaired driving over 4 years (2001–2004), which comprised 36,799 cases. The age,
gender, re-arrest rate of the offenders and the concentrations of ethanol and amphetamine
in blood samples were evaluated.
RESULTS We found that 44% of individuals (N = 16,277) re-offended 3.2 times on
average (range 1–23 arrests). Between 85 and 89% of first-time offenders were men and
there was also a male dominance among the recidivists (88–93%). The mean age of
drunken drivers was 40 years compared with 35 years for driving under the influence
of amphetamine, which was the drug identified in 50–60% of DUI-D cases, either alone
or together with other licit or illicit drugs. The median BAC was .15, which suggests a
dominance of heavy drinkers. The median BAC was even higher in recidivists (.16–.17).
The median concentration of amphetamine in blood was .10 in recidivists compared with
.05 in the first-time offenders. About 14% of drunken drivers re-offended 1–10 times
compared with 68% of DUI-D suspects, who were re-arrested 1–23 times. People with
only a scheduled prescription drug in blood were re-arrested much less frequently (
17%) compared with those taking illicit drugs (68%).
CONCLUSIONS The appreciable increase in number of arrests for DUI-D after a zero-
tolerance law might reflect a heightened enthusiasm by the police authorities armed with
knowledge that a prosecution is easier to obtain. Zero-tolerance laws do not deter people
from impaired driving judging by the high re-arrest rates. During the sentencing of
hardcore offenders, the courts should give more consideration to the underlying substance
abuse problem.

Significance: The authors argue that high re-arrest rates following passage of zero
tolerance laws confirms the limited deterrence value of such laws, but you could use the
same data to argue that intoxicated driving will reduce over time to a hard-core drinking
driving subgroup that will require different strategies to contain. The shrinkage of
drinking and driving to that population is a major goal of the early years of zero tolerance
laws. The question is does the total pool of drinking drivers shrink over time, and are




                                                                                         44
new methods being found to management this hard-core drinking driving population.
(WLW, July 2008)


Bjerre, B. & Thorsson, U. (January 2008). Is an alcohol ignition interlock programme
a useful tool for changing the alcohol and driving habits of drink-drivers? Accid
Anal Prev. 40(1):267-73.
Email: bo.bjerre@vv.se

This study evaluates whether the completion of an alcohol ignition interlock programme
(AIIP) results in lasting changes of the behavior of drink drivers and whether such a
program is more effective than a conventional license revocation followed by an
approved doctor's assessment. In Sweden, DWI offenders can voluntarily select a 2-year
AIIP in lieu of a 12-month license revocation. The AIIP includes regular medical
checkups designed to alter alcohol use habits. The study has a quasi-experimental design.
Two groups of controls were used for comparisons. One with revoked licenses, but with
no comparable opportunity to participate in an AIIP and another with DWI offenders who
had abstained from participating in the AIIP. Significantly more persons were re-licensed
in the AIIP group 2 and 3 years after the DWI offence. According to the AUDIT scores
participants in the AIIP had lower rates of harmful alcohol consumption than compared
controls 1 and 3 years after the DWI offence. In the post-treatment period the rate of
DWI recidivism was about 60% and the rate of police-reported traffic accidents about
80% lower than during the 5-year period prior to the offence. Among controls being re-
licensed a similar reduction in traffic accidents, but not in DWI recidivism, was observed.
In the post-treatment period sick leave, but not hospital-care utilization, differed
significantly between the groups.
CONCLUSIONS: The completion of an AIIP has favorable effects compared to
conventional license revocation and would appear to be a useful tool for attaining lasting
changes in the alcohol and driving habits of DWI offenders.

Significance: Early interlock studies found them effective during the intervention period
but to not have sustainable effects. This study did find such lasting effects. (WLW,
June, 2008).


S. Couture, T. Brown, M.C. Ouiment, C. Gianoulakis, J. Tremblay, R. Carbonneau (Jan.
2008). Hypothalamic-pituitary-adrenal axis response to stress in male DUI
recidivists. Accid. Anal. & Prev. 40(1): 246-53
Addiction Research Program, Douglas Hospital Research Centre, Verdun, Quebec,
Canada

Cortisol is a stress hormone mediated by the hypothalamic-pituitary-adrenal (HPA) axis
and a psychobiological marker of genetic risk for alcoholism and other high-risk
behavioural characteristics. In previous work with(DUI recidivists, we uncovered a
significant inverse relationship between the frequency of past DUI convictions and
salivary cortisol, whose strength surpassed those observed between DUI frequency and



                                                                                        45
measures of alcohol abuse and other DUI-related characteristics. This finding emerged
using a methodology not specifically contrived to test this relationship. The goals of this
follow-up study were to (a) examine if a standardized stress-induction protocol would
produce a significant inverse relationship between cortisol response and number of DUI
offences; and (b) clarify whether HPA axis dysregulation could be linked to particular
DUI-related behavioural correlates, such as alcohol use severity, sensation seeking, and
antisocial features. Thirty male DUI recidivists were recruited as well as 11 male non-
DUI drivers as a comparison group. Results indicated an inverse relationship between
DUI frequency and cortisol response (r(39) = −0.36, p = 0.021), as well as a lower
cortisol response in DUI offenders than the comparison group (F(1,39) = 5.71,
p = 0.022). Finally, for recidivists, hierarchical regression analyses indicated that
experience seeking (R2 = 0.23, p = 0.008), followed by number of cigarettes smoked
daily (ΔR2 = 0.12, p = 0.031), combined to explain 35% of the variance in cortisol
(F(2,29) = 7.26, p = 0.003). These findings indicate that severe recidivism may have
psychobiological underpinnings, and that HPA axis dysregulation appears to be a
mechanism common to high-risk behaviors including DUI recidivism, sensation seeking,
and cigarette smoking.


Voas, R.B. (January 2008). A new look at NHTSA's evaluation of the 1984
Charlottesville Sobriety Checkpoint Program: implications for current checkpoint
issues. Traffic Inj Prev., 9(1):22-30.
Email: voas@pire.org

OBJECTIVE: Currently, the implementation of sobriety checkpoint programs, which
have been demonstrated to be effective in reducing alcohol-related crashes, is limited by
the belief that they require large consignments of police officers and result in few arrests.
However, one of the earliest evaluations of a checkpoint program in Charlottesville,
Virginia, demonstrated that effective checkpoints could be mounted in which police
officers made as many arrests as officers on regular patrols. That study was printed by the
NHTSA but was not published in a peer-reviewed journal. Because of its significance to
current issues in the staffing of and procedures for checkpoint operations, this article
reanalyzes the results of that study and describes the procedures implemented in
checkpoints.
METHODS: A before-and-after control design was used to measure the change in
nighttime crashes from three baseline years to the program year. Two analyses were
conducted: the first on the percentage of all crashes occurring at night in the test city--
Charlottesville--and the second on the percentage of all nighttime crashes in the state of
Virginia that occurred in the test city. In addition, three waves of random-digit-dialing
telephone surveys were conducted: one before and two during the checkpoint program in
the test city, and the comparison city, Blacksburg. Finally, the number of impaired-
driving arrests per officer hour at the checkpoints was compared with the number of
arrests per hour by officers on regular patrol and the effect on arrests of the use of passive
sensors was determined.
RESULTS: The monthly percentage of nighttime crashes in Charlottesville was reduced
by 17% (p = 000) in relation to the baseline level. The percentage of nighttime crashes in



                                                                                           46
the state of Virginia that occurred in Charlottesville was reduced by 11% (p = .013) from
baseline levels. Drivers arrested at checkpoints had lower BACs than those arrested by
the regular patrols; however, the conviction rates were the same. The arrest per officer
hour did not differ significantly between the two types of enforcement operations.
Awareness of the checkpoint activity was high (72%) among nighttime at-risk drivers in
the test city. Half reported seeing a checkpoint operation, and a quarter reported being
interviewed. Use of a passive alcohol sensor by officers at the checkpoint increased
arrests by almost a factor of three.
CONCLUSIONS: The results of the evaluation suggest that small-scale sobriety
checkpoints can be implemented as part of the regular enforcement program in moderate-
sized jurisdictions and that they can be as efficient in producing arrests as standard
enforcement patrols, particularly if passive alcohol sensors are used.

Significance: Another excellent Voas study supporting the effectiveness of sobriety
checkpoints and their applicability in smaller jurisdictions. (WLW, June 2008)


Roth, R., Voas, R. & Marques, P. (December 2007). Interlocks for first offenders:
effective? Traffic Inj Prev. 8(4):346-52.

OBJECTIVE: Vehicle interlocks have been shown to effectively reduce the recidivism of
multiple DWI offenders; however, the evidence for their effectiveness with first offenders
has been mixed. Two Canadian studies found that the installation of an interlock reduced
first DWI recidivism, but U.S. studies in West Virginia and California failed to find a
significant reduction in recidivism for first DWI offenders in interlock programs. The
objective of this study was to determine the extent to which such devices were effective
with first offenders in New Mexico.
METHODS: This study compared 1,461 first offenders, who installed interlocks in New
Mexico between January 1, 2003, and December 1, 2005, with 17,562 first offenders
convicted during the same period who did not install the units. Cox multivariate
proportional hazards regression (CMVPHR) was used to compare recidivism rates during
three periods: while the interlock was on the vehicles of offenders who installed them,
after those offenders removed the units until the end of the study period (approximately 2
years), and for the combined period (both while the interlock was installed and after it
was removed).
RESULTS: While the device was on the vehicles of the interlock group, their recidivism
rate, 2.6% per year of exposure, was significantly less than the 7.1% per year rate of the
comparison group (CMVPHR hazard ratio = 0.39, p < 0.0001). After the device was
removed, the annualized recidivism rate of the interlock group increased to 4.9% per year
of exposure, which was less than the 6.7% rate of the comparison group, but the hazard
ratio was not statistically significant (CMVPHR hazard ratio = 0.82, p = 0.16). When the
combined periods (interlock on and off) were considered, the interlock group had a
recidivism rate of 3.9% per year, which again was significantly lower than the 6.8% rate
for the comparison group (CMVPHR hazard ratio = 0.61, p < 0.0001).
CONCLUSION: The study provides evidence that interlocks are as effective with first
offenders (approximately 60% reduction in recidivism when on the vehicle) as they are



                                                                                       47
for multiple offenders. In addition, the benefits of requiring an interlock for first
offenders exceed the costs by a factor of three.

Significance: Another well-designed study on the potential effectiveness of interlock
devices. This study builds on earlier studies by finding positive effects on first offenders
and by positively evaluating the cost effectiveness of interlock programs. (WLW, July
2008).


S. Kaplan & C. Giacomo Prato (Nov. 2007). Impact of BAC limit reduction on
different population segments: A Poisson fixed effect analysis. Accid. Anal. & Prev.
39(6):1146-54.
Technion - Israel Institute of Technology, Faculty of Civil and Environmental
Engineering, Haifa 32000, Israel

Over the past few decades, several countries enacted the reduction of the legal BAC limit,
often alongside the administrative license revocation or suspension, to battle drinking-
and-driving behavior. Several researchers investigated the effectiveness of these policies
by applying different analysis procedures, while assuming population homogeneity in
responding to these laws.
The present analysis focuses on the evaluation of the impact of BAC limit reduction on
different population segments. Poisson regression models, adapted to account for possible
observation dependence over time and state specific effects, are estimated to measure the
reduction of the number of alcohol-related accidents and fatalities for single-vehicle
accidents in 22 U.S. jurisdictions over a period of 15 years starting in 1990.
Model estimates demonstrate that, for alcohol-related single-vehicle crashes, (i) BAC
laws are more effective in terms of reduction of number of casualties rather than number
of accidents, (ii) women and elderly population exhibit higher law compliance with
respect to men and to young adult and adult population, respectively, and (iii) the
presence of passengers in the vehicle enhances the sense of responsibility of the driver.


Lapham, S.C., C'de Baca, J., Lapidus, J.,& McMillan, G.P. (October 2007).
Randomized sanctions to reduce re-offense among repeat impaired-driving
offenders. Addiction. 102(10):1618-25.
Email: slapham@bhrcs.org

AIMS: This study, conducted within a DUI court intervention, evaluated the degree to
which removing electronic monitoring (EM) and/or mandatory vehicle sales requirements
increased rates of post-sentence traffic violations among repeat DUI offenders.
DESIGN: Randomized trial.
SETTING AND PARTICIPANTS: A total of 477 repeat DUI offenders entering the
Driving under the Influence of Intoxicants (DUI-I) Intensive Supervision Program
(DISP), Multnomah County, Oregon.
INTERVENTION: Subjects were randomized into four intervention groups. Group 1:
standard DISP with EM and vehicle sales requirements; group 2: standard DISP with



                                                                                          48
mandatory vehicle sale, but without EM; group 3: standard DISP with EM, but without
mandatory vehicle sale; and group 4: standard DISP without EM or mandated vehicle
sale. Standard DISP includes treatment for alcohol abuse and dependence, polygraph
testing, regular court appearances, and probation or court-based monitoring.
MEASUREMENTS: The risk of re-arrest for traffic violations was compared among the
four groups using hazard ratio estimates from complementary log-log regression models.
FINDINGS: Compared with group 1, subjects in group 2 initially had increased re-arrest
risks, but this effect dissipated within 3 years of entering DISP. Group 3 subjects had a
96% increase in re-arrest rates. Group 4 subjects had smaller increased risks than
predicted, with re-arrest rates similar to those of group 1 at the end of the follow-up
period.
CONCLUSIONS: Although some of the findings suggest that mandatory vehicle sales
may deter future traffic violations, inconsistent results across groups make this finding
equivocal. Positive effects of EM, while large in the short term, appear to have a
relatively small long-term value in reducing traffic arrest rates.

Significance: One of the first studies to test mandatory vehicle sales for repeat DUI
offenders. (WLW, July 2008).


C.B. Snowden, T.R. Miller, G.M. Waehrer, R.S. Spicer (Sept. 2007). Random Alcohol
Testing Reduced Alcohol-Involved Fatal Crashes of Drivers of Large Trucks. J.
Stud. Alcohol Drugs, 68(5):634-40.

OBJECTIVE: This study examined the impact of random alcohol testing, implemented
on August 1, 1994, on the likelihood that the driver of a large truck involved in a fatal
motor vehicle crash was alcohol-involved.
METHOD: Among fatal crashes, the proportion of alcohol-positive large truck drivers
(intervention group) was compared with the proportion of alcohol-positive light
passenger vehicle drivers (control group). Annual Fatality Analysis Reporting System
(FARS) data (1988-2003) were compiled for each of the 50 states and Washington, D.C.,
for the control and intervention groups. Using these pooled cross-sectional data, logistic
regression modeled the likelihood that a driver was alcohol-positive (bac > 0) before
compared with after random alcohol testing. We attributed the difference-in-difference
(the difference in likelihoods of being alcohol positive pre-testing versus post-testing in
large truck versus passenger vehicle drivers) to the impact of random testing.
RESULTS: Drivers of large trucks were 18.6% less likely to be alcohol-involved after
random testing was implemented than before random testing (odds ratio [OR] 0.814, 95%
confidence interval [CI]: 0.7130.930). The control group of passenger car drivers was
4.7% less likely to be alcohol-involved after random testing was implemented (OR 0.953,
95% CI: 0.9240.983). The net reduction in the odds of alcohol involvement for drivers of
large trucks was 14.5% (OR 0.855, 95% CI: 0.7480.976).
CONCLUSIONS: Controlling for the general declining trend in alcohol-involved drivers
in fatal crashes, random alcohol testing was correlated with a 14.5% reduction in alcohol
involvement among large truck drivers.




                                                                                        49
R.B. Voas; J.C. Fell; A.S. Tippetts; K. Blackman; J.L. Nichols (September 2007).
Impact of Primary Safety Belt Laws on Alcohol-Related Front-Seat Occupant
Fatalities: Five Case Studies, Traffic Injury Prev., 8(3):232-43.

OBJECTIVE: impaired drivers and other high-risk road users are less likely to use their
safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety
belt laws have been shown to increase wearing rates for daytime non-crash-involved
drivers and their front-seat passengers, little evidence is available on the effect these laws
have on belt usage by crash-involved drinking drivers and their passengers.
METHODS: This study evaluated the influence of primary safety belt law upgrades from
secondary laws on front-seat occupants of passenger cars driven by drinking drivers in
fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The
outcome measures used to evaluate these law upgrades were (1) the change in safety belt
usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal
crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger
cars driven by drinking drivers.
RESULTS: four of the five states demonstrated increases in safety belt use by front-seat
occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to
primary safety belt laws. Three states (California, Michigan, and Washington)
experienced significant reductions in the number of front-seat occupant fatalities in
vehicles driven by drinking drivers.
CONCLUSIONS: The adoption of primary law upgrades was associated with significant
increases in safety belt use (four of five states) and significant reductions in fatalities
among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles
driven by drinking drivers) in three of the five states studied.


A.C. Wagenaar, M.M. Maldonado-Molina, D.J. Erickson, L. Ma, A.L. Tobler and K.A.
Komro (Sept. 2007). General deterrence effects of U.S. statutory DUI fine and jail
penalties: Long-term follow-up in 32 states. Accid. Analy. & Prev. 39(5):982-94).
University of Florida, College of Medicine, Department of Epidemiology & Health
Policy Research and Institute for Child Health Policy, 1329 SW 16th St. Rm 5130, Box
100177, Gainesville, FL 32610-0177

INTRODUCTION: We examined effects of state statutory changes in DUI fine or jail
penalties for first time offenders from 1976 to 2002.
METHODS: A quasi-experimental time-series design was used (n = 324 monthly
observations). Four outcome measures of drivers involved in alcohol-related fatal crashes
are: single-vehicle nighttime, low BAC (0.01–0.07 g/dl), medium BAC (0.08–0.14 g/dl),
high BAC (≥0.15 g/dl). All analyses of BAC outcomes included multiple imputation
procedures for cases with missing data. Comparison series of non-alcohol-related crashes
were included to efficiently control for effects of other factors. Statistical models include
state-specific Box-Jenkins ARIMA models, and pooled general linear mixed models.
RESULTS: Twenty-six states implemented mandatory minimum fine policies and 18
states implemented mandatory minimum jail penalties. Estimated effects varied widely
from state to state. Using variance weighted meta-analysis methods to aggregate results



                                                                                            50
across states, mandatory fine policies are associated with an average reduction in fatal
crash involvement by drivers with BAC ≥ 0.08 g/dl of 8% (averaging 13 per state per
year). Mandatory minimum jail policies are associated with a decline in single-vehicle
nighttime fatal crash involvement of 6% (averaging 5 per state per year), and a decline in
low-BAC cases of 9% (averaging 3 per state per year). No significant effects were
observed for the other outcome measures.
CONCLUSIONS: The overall pattern of results suggests a possible effect of mandatory
fine policies in some states, but little effect of mandatory jail policies.


Rider, R., Voas, R.B., Kelley-Baker, T., Grosz, M. & Murphy, B. (June 2007).
Preventing alcohol-related convictions: The effect of a novel curriculum for first-
time offenders on DUI recidivism. Traffic Inj Prev., 8(2):147-52.
Email: rrider@pire.org

OBJECTIVE: To determine whether DUI offenders can better avoid future drinking and
driving by controlling their vehicle usage rather than by controlling their drinking.
METHODS: Using a randomized experimental post-test only design, 9,571 first-time
DUI offenders were randomly assigned to receive one of two 12-hour educational
programs: a traditional DUI curriculum or the PARC (Preventing Alcohol-Related
Convictions) curriculum, which uses a novel theoretical approach to preventing DUI
recidivism. Whereas traditional programs focus on participants controlling their drinking
to avoid future drinking and driving, the PARC curriculum focuses on participants
controlling their driving. Instead of trying to control alcohol consumption after driving to
a drinking venue (previously found to be a flawed strategy), PARC teaches students to
make a decision before leaving home not to drive to a drinking event, thus greatly
limiting the possibility of drinking and driving. Driving records were obtained from the
Florida Department of Motor Vehicles using driver's license numbers to assess DUI
recidivism rates among the students in the PARC and Traditional curricula for the first
year following program participation and again at 2 years post-intervention.
RESULTS: Binary logistic regression analyses revealed that offenders receiving the
PARC curriculum exhibited significantly lower 1-year and 2-year recidivism rates than
those receiving the Traditional curriculum. The effect was consistent across two different
measures of recidivism, and across gender, race, ethnicity, and location.
CONCLUSION: Results suggest that the PARC educational approach may be more
effective than the traditional approach in reducing DUI recidivism.

Significance: This is an interesting study that seeks to modify risk-taking decisions
before drinking begins. Very congruent with studies that have pointed out the problems
of trying to get high risk offenders to decide when they are too intoxicated to drive after
the process of intoxication is already underway. Studies (e.g., McKnight, et al, 1995)
have found three target decision points for DUI intervention: before the person leaves
home, arrival at the drinking location, and point of leaving the drinking location. This
study suggests the first of these may be the best target for preventive decision-making.
(WLW August 2007). This approach might be thought of as the ultimate “harm
reduction” approach to DUI recidivism. The approach of targeting driving behaviors



                                                                                          51
rather than drinking behaviors has merit, but it is limited at the point it assumes all people
can make rational decisions after drinking has begun. PARC’s approach of targeting pre-
drinking decision points is a good one. (WLW, July 2008)


B. Watson; J. Freeman (March 2007). Perceptions and Experiences of Random
Breath Testing in Queensland and the Self-Reported Deterrent Impact on Drunk
Driving, Traffic Injury Prev., 8(1):11-19.

OBJECTIVE: The present study explored the impact of random breath testing (RBT) on
the attitudes, perceptions, and self-reported behavior of motorists in the Australian state
of Queensland. Particular attention was given to how exposure to RBT impacted
motorists' perceived risk of apprehension and self-reported behavior, relative to other
variables of interest such as alcohol consumption.
METHODS: The study involved a telephone survey of 780 motorists drawn from
throughout the state of Queensland. Participants were volunteers recruited from a random
sample of all listed telephone numbers in the state, adjusted according to district
population figures. The survey questionnaire collected information relating to the
participants' socio-demographic characteristics, drinking and drunk driving behaviors,
attitudes toward drunk driving and RBT, and experiences and perceptions of RBT.
RESULTS: The analysis indicated that a large proportion of the sample had both
observed RBT and been breath tested within the last six months and believed the practice
served an important role in improving road safety. However, a considerable percentage
also reported drunk driving at least once in the last six months without being detected,
with further analysis indicating that the threat of apprehension associated with RBT did
not appear to greatly influence their offending behavior. Rather, a higher frequency of
alcohol consumption, combined with more favorable attitudes to drunk driving and lower
levels of support for RBT, appeared to be associated with offending behavior.
CONCLUSIONS: While the results confirm the high levels of exposure to RBT
achieved in Queensland, the direct impact of recent exposure on drunk driving behavior
appears less important than other factors such as alcohol consumption and attitudes to
drunk driving and RBT. Further research is required to better understand how recent and
lifetime exposure to RBT impacts on motorists' perceived risk of apprehension and
subsequent drunk driving behavior.


MacDonald, J.M., Morral, A.R., Raymond, B. & Eibner, C. (February 2007). The
efficacy of the Rio Hondo DUI court: a 2-year field experiment. Eval Rev. 31(1):4-23.
University of Pennsylvania, PA, USA.

This study reports results from an evaluation of the experimental Rio Hondo DUI court of
Los Angeles County, California. Interviews and official record checks with 284 research
participants who were randomly assigned to a DUI court or a traditional criminal court
were assessed at baseline and at 24-month follow-up. The interviews assessed the impact
of the DUI court on self-reported drunk driving behavior, the completion of treatment,
time spent in jail, alcohol use, and stressful life events. Official record checks assessed



                                                                                           52
the impact of the DUI court on subsequent arrests for driving under the influence and
other drinking-related behaviors. Few differences on any outcomes were observed
between participants in the experimental DUI court and those assigned to the traditional
court. The results suggest that the DUI court model had little additional therapeutic or
public safety benefit over the traditional court process. The implication of these findings
for the popularity of specialized courts for treating social problems is discussed.

Significance: Compare the conclusions of this study the following study published by
the same authors. (WLW, August 2007)


Hennessy DA, Lanni-Manley E, Maiorana N. (January 2007). The effects of fatal vision
goggles on drinking and driving intentions in college students. Traffic Inj Prev.
8(1):11-9. Dept. of Psychology, Buffalo State College, New York 14222, USA.
hennesda@buffalostate.edu

The present study was designed to examine the effectiveness of Fatal Vision Goggles in
reducing intentions to drink and drive. Participants performed a field sobriety task and
drove in a traffic simulator while wearing the goggles. A regression analysis was
performed in order to predict changes in intentions to drink and drive, using typical
drinking patterns, perceived likelihood of getting into a collision when drinking and
driving, self efficacy, and driving independence as predictor variables. Results showed
that drinking and driving intentions were reduced following the use of Fatal Vision
Goggles among those that typically drink more during outings, among those that believe
the likelihood of collisions when drinking and driving are greater, and among those less
likely to drive to achieve independence and autonomy. These results indicate that Fatal
Vision Goggles can be an effective tool in altering drinking and driving attitudes among
drivers with specific attitudinal and personal characteristics.

Significance: The question of this study is whether alteration of sober attitudes is
transferable to changes in behavior during drinking episodes. (WLW, August 2007).


Roth R, Voas R, & Marques P. (January 2007). Mandating interlocks for fully revoked
offenders: the New Mexico experience. Traffic Inj Prev. 8(1):20-5.

OBJECTIVE: In New Mexico, between July 1999 and December 2002, the installation of
an ignition interlock was an optional judicial sanction for second and third DWI
offenders. This is a study of the recidivism of 437 offenders who were convicted and
installed interlocks for an average of 322 days during that period.
METHODS: The comparison group was a stratified random sample (N = 12,554) of the
20,949 offenders who were convicted during the same period but did not install
interlocks. DWI arrest and conviction data for all study participants were received from
the Motor Vehicle Department's Citation Tracking System.
RESULTS: Only 11 (2.5%) of the interlock offender group were rearrested for DWI
while interlocks were installed, whereas 1,017 (8.1%) of the comparison group were



                                                                                          53
rearrested during an equivalent 322-day period. Survival graphs and Cox proportional
hazard regression analyses were used to compare the interlock and non-interlock groups
during installation, after installation, and for the entire period up to December 2004.
Results indicate a reduction in recidivism of 65% during installation. After removal, there
was no significant difference in recidivism rates in a 3-year follow-up period. Following
all offenders for 4 years, including both the period while the interlock was installed and
the period after its removal, indicates that the difference in recidivism achieved during
installation, though not increased, is maintained, so at the end of 4 years, interlock users
still have lower total recidivism than nonusers.
CONCLUSIONS: The magnitude of interlock effectiveness reported here is similar to
those in other published studies with comparable samples.

Significance: This study adds to the body of literature confirming the effectiveness of
mandated interlock devices with DUI recidivists and confirming the limitations of such
effectiveness (only for as long as the devices remain installed). (WLW, August 2007).


Webster, G.D. & Gabler, H.C. (2007). Feasibility of transdermal ethanol sensing for
the detection of intoxicated drivers. Annual Proceedings of the Association for the
Advancement of Automotive Medicine., 51:449-64.

Transdermal ethanol detection is a promising method that could prevent drunk driving if
integrated into an ignition interlock system. However, experimental data from previous
research has shown significant time delays between alcohol ingestion and detection at the
skin which makes real time estimation of blood alcohol concentration via skin
measurement difficult. Using a validated model we studied the effects that body weight,
metabolic rate and ethanol dose had on the time lag between the blood alcohol
concentration and transdermal alcohol concentration. The dose of alcohol ingested was
found to have the most significant effect on the skin alcohol lag time; a dose of 15 ml of
ethanol resulted in a peak lag time of approximately 33 minutes, while a dose of 60 ml of
ethanol resulted in a peak time lag of 53 minutes. The time lag was found to be
insensitive to body mass and only moderately sensitive to changes in metabolic rates.


SC. Lapham, L. Ring-Kapitula, J. C’de Baca & G. P. McMillan (Jan. 2006). Impaired-
driving recidivism among repeat offenders following an intensive court-based
intervention. Accid. Anal. & Prev. 38(1):162-9.
Behavioral Health Research Center of the Southwest, 612 Encino Place, NE,
Albuquerque, NM 87102.

PURPOSE: Repeat impaired-drivers resist successful rehabilitation. This paper describes
and evaluates an innovative court-based intervention for repeat impaired-driving
offenders, the DUI Intensive Supervision Program (DISP) developed in Multnomah
County, Oregon.
METHODS: The hazard of re-offending was compared between DISP participants
(N = 460) and a comparison group (N = 497). The stratified Cox proportional hazards



                                                                                          54
model was used to model the hazard of re-offense, adjusting for matching criteria and
stratified by county of residence.
RESULTS: Adjusted hazard of DUI re-offense for DISP participants was 0.52 that of
comparison offenders (95% CI = 0.36–0.76). DISP clients also had lower arrest rates for
driving while revoked/suspended and for all other traffic offenses.
CONCLUSION: Preliminary results suggest the DISP is an effective means of reducing
recidivism among repeat impaired-driving offenders.




                                                                                     55
4)     Drugged Driving

The research literature reveals increased concern with drugged driving. The studies
below are typical of these latest studies.

D. Fergusson, L.J. Horwood, J. Bodon (July 2008). Is driving under the influence of
cannabis becoming a greater risk to driver safety than drink driving? Findings from
a longitudinal study. Accid. Anal. & Prev. 40(4):1345-50
University of Otago, Christchurch School of Medicine and Health Sciences, New
Zealand

The present study examined the associations driving under the influence of (a) cannabis
and (b) alcohol, and motor vehicle collisions during, in a longitudinal study of a New
Zealand birth cohort (n = 936). Participants reported significantly (p < .0001) greater
rates of driving under the influence of cannabis than driving under the influence of
alcohol during ages 21–25. Also, there were statistically significant bivariate associations
between increasing levels of both: (a) driving under the influence of cannabis and (b)
self-reported driving under the influence of alcohol, and increased risks of active motor
vehicle collisions (p < .0001). These associations were adjusted for potentially
confounding factors including average distance driven and self-reported risky driving
behaviors. After adjustment, the associations between driving under the influence of
cannabis and motor vehicle collisions remained marginally significant (p = .064),
whereas adjustment for confounding factors reduced the association between driving
under the influence of alcohol and motor vehicle collisions to statistical non-significance
(p > .70). The results of the present study suggest that, for some populations, the risks of
driving under the influence of cannabis may now be greater than the risks of driving
under the influence of alcohol.


S. MacDonald; R. Mann; M. Chipman; B. Pakula; P. Erickson; A. Hathaway; P.
MacIntyre (May 2008) Driving Behavior Under the Influence of Cannabis or Cocaine
Traffic Injury Prev., 9(3):190-194.

OBJECTIVE: The purpose of this study is first to describe perceptions of driving under
the influence of cannabis or cocaine among clients in treatment and, second, to assess
whether these perceptions are related to the frequency of driving under the influence of
cannabis or cocaine.
METHODS: A questionnaire was administered to clients in treatment for abuse of either
cocaine or cannabis, many of whom also had a problem with alcohol; additional groups
of clients consisted of those in smoking cessation and gambling programs (N = 1021).
Open-ended and close-ended questions were used to assess self-reported effects of
cannabis or cocaine on driving and frequency of driving under the influence of cannabis,
cocaine, or alcohol.
RESULTS: Two dimensions of driving behavior under the influence of cocaine or
cannabis were found in both qualitative and quantitative analyses: 1) physical effects and
2) reckless styles of driving. Common physical effects for both drugs were heightened



                                                                                          56
nervousness, greater alertness, and poorer concentration. In terms of driving behavior,
cautious or normal driving was commonly reported for cannabis, whereas reckless or
reduced driving ability was frequently reported for cocaine. When comparing negative
physical effects and reckless style of driving with frequency of driving under the
influence of cannabis or cocaine, increased negative physical effects from cannabis were
inversely related to frequency of driving under the influence of cannabis (p = .001), but
other relationships were not significant.
CONCLUSIONS: The findings indicate that both cannabis and cocaine have detrimental
but different effects on driving. The negative physical effects of cannabis may reduce the
likelihood of driving under the influence of cannabis.


A. Ronen, P. Gershon, H. Drobiner, A. Robinovich, R. Bar-Hamburger, R. Mechoulam,
Y. Cassuto, D. Shinar (May 2008). Effects of THC on driving performance,
physiological state and subjective feelings relative to alcohol. Accid. Anal & Prev.
40(3): 926-34
Ben Gurion University of the Negev, Beer Sheva Israel

BACKGROUND: The effects of marijuana or THC on driving has been tested in several
studies, but usually not in conjunction with physiological and subjective responses and
not in comparison to alcohol effects on all three types of measures.
OBJECTIVE: To assess the effects of two dosages of THC relative to alcohol on driving
performance, physiological strain, and subjective feelings.
METHOD: We tested the subjective feelings and driving abilities after placebo, smoking
two dosages of THC (13 mg and 17 mg), drinking (0.05% BAC) and 24 h after smoking
the high dose THC cigarette, while monitoring physiological activity of the drugs by
heart rate. Fourteen healthy students, all recreational marijuana users, participated in the
study.
RESULTS: Both levels of THC cigarettes significantly affected the subjects in a dose-
dependent manner. The moderate dose of alcohol and the low THC dose were equally
detrimental to some of the driving abilities, with some differences between the two drugs.
THC primarily caused elevation in physical effort and physical discomfort during the
drive while alcohol tended to affect sleepiness level. After THC administration, subjects
drove significantly slower than in the control condition, while after alcohol ingestion,
subjects drove significantly faster than in the control condition. No THC effects were
observed after 24 hours on any of the measures


Pil, K. & Verstraete, A. (April 2008). Current developments in drug testing in oral
fluid. Therapeutic Drug Monitoring, 30(2):196-202.

In the last few years, significant developments have occurred on the key issues involved
in oral fluid drug testing. New pharmacokinetic studies have been conducted, optimal
cutoffs have been proposed, and new studies have examined the correlation between oral
fluid drug concentrations and impairment. Recent studies (e.g., the discovery of the
presence of THC-COOH in oral fluid) can contribute to solve the issue of false-positive



                                                                                         57
results caused by passive exposure to marijuana. Reliable point-of-care drug testing is
still problematic, especially for cannabinoids and benzodiazepines. To date, there is no
device that allows both reliable and practical point-of-care testing. The importance of
liquid chromatography- tandem mass spectrometry in confirmation analysis has increased
over the last several years. It can be expected that this trend will continue because the low
sample volumes make simultaneous detection of different drug classes with limited
sample preparation necessary. Literature on proficiency testing to ensure reliability and
comparability of results is limited. Oral fluid has become an important sample type in
driving under the influence research, and the first legal random drug testing program in
oral fluid since 2004 has been organized in Victoria. It can be expected that the role of
oral fluid as an alternative matrix will keep increasing in the future.


A.S. Christophersen; J.M rland (March 2008). Frequent Detection of Benzodiazepines
in Drugged Drivers in Norway, Traffic Injury Prev., 9(2):99-104.

OBJECTIVE: To describe the Norwegian system for handling suspected drugged driving
cases according to an impairment-based law, with primary focus on benzodiazepines
(BZDs), blood concentrations and combination with other psychoactive compounds.
METHODS: Routines for handling suspected driving under the influence of drugs other
than alcohol are described. These include primary police investigation, blood sampling,
and clinical tests of impairment performed by a police physician, a standard analytical
program covering the most relevant illegal drugs and medicines relevant to traffic safety
(approximately 25 compounds), and expert witness statements prepared for the court. The
drug use patterns, blood drug concentrations, and frequency of multi-drug use have been
recorded, with primary focus on benzodiazepines (BZDs). Use of BZDs among
apprehended drivers has been compared with patient prescriptions recorded for the same
BZDs.
RESULTS: One or more drugs have been detected in approximately 80% of the cases
received for analysis every year. BZDs have been the most prevalent drugs and have been
detected in 38-57% of the cases, which is more frequent than other common illegal drugs;
e.g., tetrahydrocannabinol (THC; 30-43%) and amphetamine (33-39%). The majority of
the BZDs have been detected at supratherapeutic blood concentrations and frequently in
combination with illegal drugs, other psychoactive medicines, or alcohol. Less than 5%
of the BZDs (except for nitrazepam - 7.6%) have been found to be the only drug present
at therapeutic blood levels. The majority of the drivers were 20-39 years old (median age
29-33), while the majority of BZDs prescribed were to users over 50 years of age.
CONCLUSIONS: Drivers with BZD detected are probably not representative of
ordinary patients with BZD prescriptions, as shown by the age disparity of drivers and
patients. The frequent detection of BZDs suggests that these compounds should be
included in the analytical program used for blood samples from apprehended drivers and
for studies on drug involvement in road traffic accidents and risk calculations.




                                                                                          58
A.W. Jones, A. Holmgren, F.C. Kugelberg (March 2008). Driving Under the Influence
of Central Stimulant Amines: Age and Gender Differences in Concentrations of
Amphetamine, Methamphetamine, and Ecstasy in Blood. J. Stud. Alcohol Drugs
69(2):202-08.

OBJECTIVE: A zero-tolerance law for DUI-D was introduced in Sweden in 1999. This
change in legislation has led to a 12-fold increase in the number of blood samples sent by
the police for toxicological analysis. Here we report the age and gender of offenders,
along with the concentrations of amphetamine, methamphetamine, and ecstasy (3,4-
methylenedioxymeth-amphetamine) in blood samples analyzed since the institution of the
new legislation.
METHOD: A forensic toxicology database (TOXBASE) was used to identify cases of
DUID in which central stimulant amines were verified in blood during a 5-year period
(2000-2004).
RESULTS: Amphetamine was present in 15,898 of 26,556 cases of DUID (60%) either
alone or together with other licit or illicit drugs. In 6,094 cases, amphetamine was the
only psychoactive substance in blood at mean (median) and highest concentrations of
1.01 mg/L (0.80 mg/L) and 11.9 mg/L, respectively. The users of amphetamine were
mainly men (85% vs 15% women; p < .001), and men tended to be a few years older than
the women; the mean (SD) age for men was 37 (9.2) years and for women it was 35 (8.1)
years (p < .001). In 644 cases, amphetamine and methamphetamine were present in blood
samples at mean (median) concentrations of 0.85 mg/L (0.60 mg/L) and 0.34 mg/L (0.20
mg/L), respectively (p < .001). The mean (median) and highest concentrations of ecstasy
in 493 DUID offenders were 0.23 mg/L (0.10 mg/L) and 3.5 mg/L, respectively. The
mean age of ecstasy users was 26 (7.2) years, which was about 10 years younger than
those using amphetamine (p < .001).
CONCLUSIONS: The high prevalence of amphetamines in blood of apprehended drivers
in Sweden verifies widespread use of these stimulants as recreational drugs. The findings
from this study suggest that a zero-tolerance DUID law has not deterred offenders, which
suggests that more attention should be given to the underlying substance-abuse problem
instead of conventional penalties such as monetary fines and/or imprisonment.


Dyer, K.R. (2008). The detection of illicit drugs in oral fluid: another potential
strategy to reduce illicit drug-related harm, Drug and Alcohol Review, 27(1), 99 –
107.

As many of the harms associated with drug use may be due to intoxication, particularly
where the individual is driving, operating machinery or involved in other tasks requiring
high level psycho-motor functioning, it follows that having a valid, reliable convenient
measure of recent drug use and, if possible, intoxication, will be important in reducing
drug-related harm. Oral fluid testing is the latest technology offering promise in this area.
As with any such technology, it has advantages and disadvantages.




                                                                                          59
Significance: The above two articles note the continued improvements in saliva-based
testing for recent drug use. Saliva testing may become a routine part of chemical testing
of impaired drivers in the next 10-15 years. (WLW, July 2008).


D.J. Beirness; J. LeCavalier; D. Singhal (December 2007). Evaluation of the Drug
Evaluation and Classification Program: A Critical Review of the Evidence, Traffic
Injury Prev., 8(4):368-76.

OBJECTIVE: A critical review of the existing evaluation studies on the Drug Evaluation
and Classification (DEC) program was conducted to determine the validity and accuracy
of the technique for identifying drivers under the influence of drugs.
METHODS: Studies were divided into two categories—laboratory studies and field (i.e.,
enforcement) studies. A classification process was devised using common criteria based
on the toxicology findings (i.e., drug positive or drug negative) and the opinion of the
police officer who assessed the driver (i.e., drug positive or drug negative). A series of
standard measures (Sensitivity, Specificity, False Alarm Rate, Miss Rate, Corroboration,
and Accuracy) were calculated for each to assess the effectiveness of the DEC program.
RESULTS: Laboratory studies do not provide overwhelming support for the accuracy
with which officers trained in the DEC program can detect and identify the particular
class(es) of drug involved based on psychophysical assessment alone. The detection and
identification of the relatively low levels of drugs administered were typically better than
chance but many cases were missed. The fact that some drugs were detected with greater
accuracy than others suggests that the effects of these substances were more prominently
manifested in the symptomology assessed by the DEC procedure. Although field
enforcement studies are not as scientifically rigorous as laboratory studies, DEC
assessments in an enforcement context have the benefit of information obtained from the
arresting officer and from interviews with the suspect. In addition, the drug doses
consumed by users are typically much higher than those permitted in controlled
laboratory studies. In general, officers trained in the DEC program are able to identify
persons under the influence of drugs and to specify the drug class responsible with a
degree of accuracy that not only exceeds chance, but in some cases reaches a very high
level.
CONCLUSIONS: There remains room for improvement in the DEC program. As further
research becomes available, either from laboratory or field investigations or both, it needs
to be incorporated into the program to enhance its validity and accuracy.


A. Holmgren; P. Holmgren; F.C. Kugelberg; A.W. Jones; J. Ahlner (December 2007).
Predominance of Illicit Drugs and Poly-Drug Use Among Drug-Impaired Drivers in
Sweden, Traffic Injury Prev., 8(4):361-67.

OBJECTIVES: After Sweden's zero-tolerance law came into force (1 July 1999), the
number of cases of DUID submitted by the police for toxicological analysis increased
more than 10-fold. This prompted an in-depth investigation into the kinds of drugs used
by DUID offenders, whether licit or illicit, and the frequency of their occurrence.



                                                                                         60
METHODS: All blood samples from DUID suspects sent by the police for toxicological
analysis over a 4-year period (2001-2004) were investigated (N = 22,777 cases).
Specimens of blood or urine were subjected to a broad screening analysis by
immunoassay methods aimed at detecting amphetamines, cannabis, opiates, cocaine
metabolite, and the major benzodiazepines. All positive results from the screening stage
were verified by use of more specific analytical methods (e.g., GC-MS, LC-MS, GC-FID,
and GC-NPD).
RESULTS: Between 80 and 85% of all the blood samples contained at least one banned
substance and many contained two or more therapeutic and/or illicit drugs. About 15% of
cases were negative for drugs, although these frequently (30-50%) contained ethanol
above the legal limit for driving in Sweden, which is 0.20 mg/g (0.02 g%). Amphetamine
was the most prominent illicit drug seen in 55-60% of cases either alone or together with
other drugs of abuse. Stimulants like cocaine and/or its metabolite were infrequently
encountered (1.2% of cases). The next most prevalent illicit drug was cannabis, with
positive results for tetrahydrocannabinol (THC) in blood either alone (4%) or together
with other psychoactive substances (20%). Morphine, codeine, and/or 6-acetyl morphine
were identified in 2% of all DUID suspects, being indicative of heroin abuse. The major
prescription drugs identified in blood were benzodiazepines (10%) as exemplified by
diazepam, alprazolam, nitrazepam, and flunitrazepam. Drugs for treating insomnia,
zolpidem and zopiclone, were also identified in blood samples from DUID suspects over
the study period. Other therapeutic agents were encountered in only 1-2% of all cases.
CONCLUSIONS: The dramatic increase in DUID after the zero-tolerance law came into
force probably reflects enhanced police activity and more enthusiasm to apprehend and
charge individuals for this offence. Illicit drugs, particularly amphetamine and cannabis,
and poly-drug use were predominant compared with use of scheduled prescription drugs.
The typical DUID offender in Sweden abuses central stimulants, particularly
amphetamine, and has probably done so over many years. Options for treating offenders
for their underlying substance abuse problem should be considered instead of the more
conventional penalties for drug-impaired driving.


O'Malley, P.M. & Johnston, L.D.. (November 2007). Drugs and driving by American
high school seniors, 2001-2006. J Stud Alcohol Drugs. 68(6):834-42.
Email: pomalley@umich.edu

OBJECTIVE: The aim of this study was to report trends from 2001 to 2006 in the
percentage of all high school seniors who drive after using marijuana, other illicit drugs,
or alcohol or who are exposed as passengers to such behaviors. A second objective is to
examine demographic and psychosocial correlates of these behaviors.
METHOD: The data were obtained from the Monitoring the Future study, in which
nationally representative samples of high school seniors have been surveyed annually
since 1975.
RESULTS: In 2006, 30% of high school seniors reported exposure to a drugged or
drinking driver in the past 2 weeks, down from 35% in 2001. Exposure was demonstrated
to be widespread as defined by demographic characteristics (population density, region of
the country, socioeconomic status, race/ethnicity, and family structure). Individual



                                                                                        61
lifestyle factors (religiosity, grade point average, truancy, frequency of evenings out for
fun, and hours of work) showed considerable association with the outcome behaviors.
CONCLUSIONS: Impaired driving by youth remains a problem needing serious attention
despite some progress in recent years

Significance: There is progress being made on the youth drugged driving front, but the
prevalence remains high enough to require all persons arrested for impaired driving under
the age of 21 to undergo drug testing. (WLW, June 2008)


M. Boorman; K. Papafotiou (September 2007). The Victorian Legislative Framework
for Testing Drivers for Impairment Caused by Drugs Other than Alcohol: An
Evaluation of the Characteristics of Drivers Detected from 2000 to 2005, Traffic
Injury Prev., 8(3):217-23.

On December 1, 2000, new legislation came into force in Victoria, Australia, that
involved a framework for the procedure to be followed by the police for the detection of
drivers impaired by drugs other than alcohol. An integral part of the procedure is the use
of performance tests known as the standardized field sobriety tests (SFSTs) and the
analysis of blood samples for the presence of drugs other than alcohol. This paper
outlines the new legislative framework and the drug impairment detection procedures
currently in place in Victoria. This paper also evaluates the data collected using the
framework for the first five years since implementation in Victoria.


J. Davey; N. Richards; J. Freeman (September 2007). Fatigue and Beyond: Patterns of
and Motivations for Illicit Drug Use Among Long-Haul Truck Drivers, Traffic Injury
Prev.8(3):235-59.

OBJECTIVES: The present study aimed to investigate the illicit drug use patterns of
long-distance truck drivers. This population is considered to be a special interest group in
terms of drug-driving research and policy due to high rates of use, involvement of drugs
in truck accidents, and the link between drug use and work-related fatigue.
METHODS: Qualitative interview data were collected from 35 long-haul truck drivers in
Southeast Queensland and analyzed through grounded theory techniques. Interviews were
conducted at truck stops and loading facilities in both metropolitan and regional cites
throughout Queensland.
RESULTS: High rates of licit and illicit drug use (particularly amphetamines) were
reported by the majority of the sample. However, unlike previous studies that focus on
fatigue, this research found overlapping and changing motivations for drug use during
individual lifetimes. Becker's model of a drug use “career” was utilized to reveal that
some drivers begin illicit drug use before they commence truck driving. As well as
fatigue, powerful motives such as peer pressure, wanting to fit the trucking “image,”
socialization, relaxation, and addiction were also reported as contributing factors to self-
reported drug driving.
CONCLUSIONS: The results indicate that these additional social factors may need to be



                                                                                         62
considered and incorporated with fatigue factors when developing effective drug
prevention or cessation policies for truck drivers.


McCarthy, D.M., Lynch, A.M. & Pederson, S.L. (September 2007). Driving after use of
alcohol and marijuana in college students. Psychol Addict Behav.21(3):425-30.
Email: mccarthydm@missouri.edu

Driving after use of marijuana is almost as common as driving after use of alcohol in
youth (P. M. O'Malley & L. D. Johnston, 2003). The authors compared college students'
attitudes, normative beliefs and perceived negative consequences of driving after use of
either alcohol or marijuana and tested these cognitive factors as risk factors for
substance-related driving. Results indicated that youth perceived driving after marijuana
use as more acceptable to peers and the negative consequences as less likely than driving
after alcohol use, even after controlling for substance use. Results of zero-inflated
Poisson regression analyses indicated that lower perceived dangerousness and greater
perceived peer acceptance were associated with increased engagement in, and frequency
of, driving after use of either substance. Lower perceived likelihood of negative
consequences was associated with increased frequency for those who engage in
substance-related driving. These results provide a basis for comparing how youth
perceive driving after use of alcohol and marijuana, as well as similarities in the risk
factors for driving after use of these substances.

Significance: The principles underlying this finding are important to note to DUI judges,
namely that youthful DUI is shaped by perceptions not of societal views of drinking and
driving but peer views of drinking and driving and that perception of likelihood of
consequences is a crucial deterrent factor. (WLW, June 2008).


Jones, A.W. (July 2007) Age- and gender-related differences in blood amphetamine
concentrations in apprehended drivers: lack of association with clinical evidence of
impairment. Addiction, 102(7), 1085-1091.

BACKGROUND: New legislation aimed at combating DUI-D in Sweden stipulated
zero-concentrations in blood for scheduled substances. DUI-D suspects (n = 300), with
amphetamine as the only psychoactive drug identified in blood, were investigated in
relation to age and gender. In a smaller retrospective sample (n = 70) the relationship
between clinical tests of impairment were compared with the concentration of
amphetamine in blood.
MEASUREMENTS All forensic blood samples were subjected to a broad toxicological
screening analysis by immunoassay methods [enzyme multiplied immunoassay
technique/cloned enzyme donor immunoassay (EMIT/CEDIA)] and positive results were
verified by gas chromatography-mass spectrometry (GC-MS). The limit of quantification
(LOQ) for determination of amphetamine in blood was 0.03 mg/l. People suspected of
being under the influence of drugs were examined by a physician who asked various
questions about state of health and use of drugs and also administered simple



                                                                                       63
 psychomotor and cognitive tests of impairment. After conducting these tests the
 physician concluded whether the suspects were not impaired, slightly, moderately or
 highly impaired by drugs other than alcohol.
 FINDINGS: Among 300 DUI-D suspects with amphetamine in blood there were 246
 men (82%) and 54 women (18%). Mean age (± SD) of the men was 37.1 ± 8.7 years
 compared with 35.5 ± 7.1 years for the women (P > 0.05). The frequency distribution of
 blood amphetamine concentration was positively skewed with mean, median and highest
 values of 1.0 mg/l, 0.9 mg/l and 7.1 mg/l, respectively. The mean concentrations were
 slightly higher in the women 1.11 mg/l (median 1.0 mg/l) compared with 0.97 mg/l
 (median 0.8 mg/l) in the men (P > 0.05). There was a weak but statistically significant
 correlation between the person's age and the concentration of amphetamine in blood
 (r = 0.18, P < 0.05). The results of clinical tests of impairment showed no relationship
 with the concentration of amphetamine in blood according to analysis of variance
 (P > 0.05).
 CONCLUSIONS: The lack of association between degree of drug influence and the
 concentration of amphetamine in blood speaks against the notion of introducing
 concentration per se limits or graded penalties depending on the blood-concentration of
 this stimulant. Zero-concentration limits or LOQ-limits are a much more pragmatic way
 to enforce DUID legislation.

 Significance: This study underscores why blood concentrations of drugs other than
 alcohol cannot be used to determine impairment because of the lack of a linear
 relationship between blood concentrations and predictable levels of impairment. (WLW,
 June 2008).


 Matthew, J.W., Pimentel, J.H. & Clark, D.B. (May 2007). Characteristics of DUI
 offenders convicted in wet, dry, and moist counties. Accident Analysis & Prevention,
 40(3), 976-982

Although several studies have examined the effectiveness of local alcohol sales policies on
 reducing the incidence of DUI, less is known about whether characteristics of DUI
 offenders convicted in alcohol-restricted areas differ from those convicted in areas where
 alcohol is more readily available. A total of 21,647 DUI assessment records were divided
 into four groups based on the alcohol sales policy of the county of conviction and were
 compared. DUI offenders convicted in counties that limit or ban the sale of alcohol were
 more likely to be male, have more drug problems, meet DSM-IV-TR substance abuse or
 dependence criteria, and have multiple DUI convictions. Implications for practitioners
 and policy makers are discussed.

 Significance: Fascinating findings but a bit difficult to interpret. This study would
 suggest the need for greater drug screening and greater treatment linkages in counties
 with more rigorous alcohol control laws. (WLW, June 2008).




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Cochems, A, Harding, P. & Liddicoat, L. (May 2007). Dextromethorphan in
Wisconsin drivers. J Anal Toxicol., 31(4):227-32.
E-mail: cochemak@mail.slh.wisc.edu

Dextromethorphan is a synthetic analogue of codeine used in hundreds of over-the-
counter medications for its antitussive effects. There have been numerous reports of
dextromethorphan abuse by young adults. Dextromethorphan can produce psychoactive
effects similar to that of marijuana, and higher doses will produce dissociative effects,
including sensory enhancement and hallucinations. The Wisconsin State Laboratory of
Hygiene examined data from blood samples submitted from January 1999 through
December 2004 to determine the incidence of dextromethorphan in suspected impaired
drivers. A total of 108 samples were found to be positive for dextromethorphan during
this time. Dextromethorphan concentrations in these cases ranged from less than 5 to
1800 ng/mL (mean 207 ng/mL), compared to an expected therapeutic concentration range
of 0.5-5.9 ng/mL. Overall, the highest dextromethorphan concentrations observed were in
males aged 16-20 years. Ninety-six percent of the specimens included in this study were
also found to be positive for drugs other than dextromethorphan. A review of police and
drug recognition expert reports from several of these cases showed that
dextromethorphan-impaired drivers exhibited poor psychomotor performance on
standardized field sobriety tests, horizontal gaze nystagmus, vertical gaze nystagmus, and
overall signs of central nervous system depression.

Significance: Traffic safety programs have focused primarily upon impairment from
alcohol, prescription and illicit drugs. This article calls attention to the potential abuse of
over-the-counter medications and their potential threat to public safety. (WLW, June
2008).


Jones, C., Donnelly, N., Swift, W. & Weatherburn, D. (September 2006). Preventing
cannabis users from driving under the influence of cannabis, Accident Analysis &
Prevention, 38(5); 854-861.

Face-to-face, structured interviews were conducted with 320 recent cannabis users in
New South Wales, Australia to assess the likely deterrent effects of (a) increasing the
certainty of apprehension for driving under the influence of cannabis (DUI-C) and (b)
doubling the severity of penalties for DUIC. Participants were presented with a drug-
driving scenario and asked to indicate their likelihood of driving given that scenario. The
perceived risk of apprehension and severity of punishment were manipulated in each
scenario to create four different certainty/severity conditions and participants were
randomly allocated to one of these four groups. A subsidiary aim was to assess the likely
impact of providing factual information about the accident risk associated with DUI-C.
Recent drug drivers who felt at low risk of accident when DUI-C were asked to rate their
willingness to drive if convinced that it was dangerous. The results suggested that
increasing the certainty but not severity of punishment would produce reductions in
cannabis-intoxicated driving among recent cannabis users. Providing factual information




                                                                                             65
about the risks associated with DUI-C would appear to have little impact on drug-driving
rates among this population.

Significance: These are discouraging findings, suggesting that cannabis can pose threats
to public safety but that cannabis users would not be discouraged by threats of increasing
penalties for drugged driving nor influenced by educational efforts to inform them about
the effects of cannabis on driving. (WLW, August 2007)




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5)     Treatment/Recovery-related & Miscellaneous Studies

Each year a voluminous body of literature is published related to alcohol and drug use
patterns & addiction treatment and recovery. I’ve highlighted a few studies here that I
think have significant implications for the DUI arena.

N.P. Barnett, B. Borsari, J.T.P. Hustad, T. O'Leary Tevyaw, S.M. Colby, C.W. Kahler,
P.M. Monti (Sept. 2008). Profiles of College Students Mandated to Alcohol
Intervention. J. Stud. Alcohol Drugs 69(5):684-94.

OBJECTIVE: Most colleges have sanctions or required interventions for students who
receive alcohol violations or medical evaluation for intoxication. The aim of this study
was to establish profiles of mandated students from a combined data set using
exploratory and replication cluster analysis.
METHOD: Data sets from three samples of mandated students (total participant n = 393)
were combined for exploratory analyses, and a fourth sample (n = 289) was analyzed for
replication. Clustering variables were past-month heavy drinking, past-year alcohol
problems, incident alcohol use, responsibility for the incident, and aversiveness of the
incident.
RESULTS: A three-cluster solution was produced in the exploratory analysis and
confirmed in replication and cross-replication analyses. Clusters formed included a "Why
Me?" cluster characterized by a pattern of relatively low heavy drinking and alcohol-
related problems, very little incident drinking, and low responsibility and aversiveness. A
"So What?" cluster was characterized by high heavy drinking and alcohol-related
problems, moderate incident drinking and responsibility, and low aversiveness. A "Bad
Incident" cluster was characterized by low scores for heavy drinking and problems and
high levels of incident drinking, responsibility, and aversiveness. External variables
supported the validity of the cluster solution.
CONCLUSIONS: Mandated students form clinically meaningful profiles on easily
measured constructs.


K.M. King, L. Chassin (Sept. 2008). Adolescent Stressors, Psychopathology, and
Young Adult Substance Dependence: A Prospective Study. J. Stud.Alcohol Drugs,
69(5):629-38.

OBJECTIVE: There is much theory, but sparse empirical evidence, supporting the notion
that internalizing symptoms and negative affect are the mechanism by which exposure to
stressful life events influence the development of substance-use disorders in adolescence
and young adulthood. However, many empirical studies have shown that, in addition to
elevations in internalizing symptoms, exposure to stressful life events also produces
elevations in externalizing behaviors and conduct problems, which are important risk
factors for substance-use disorders. The current study tested adolescent externalizing and
internalizing symptoms as competitive mediators of the effects of stressors on young
adult drug dependence.




                                                                                          67
METHOD: Data from an ongoing study of children of alcoholics (n = 223) and matched
controls (n = 204) were collected in two annual interviews in adolescence and two
follow-ups in young adulthood.
RESULTS: Experiencing stressful life events during adolescence led to increases in both
externalizing and internalizing symptoms, but only externalizing symptoms mediated the
later effects of adolescent stressors on young adult drug dependence.
CONCLUSIONS: These findings suggest that understanding how stressors produce
elevations in behavioral problems may provide important insights into understanding how
broad environmental risk factors lead to substance dependence and suggests that
processes other than affect regulation may operate in the pathway from the experiences of
stressors to substance use and disorder.


J.R. Kramer, G. Chan, D.M. Dick, S. Kuperman, K.K. Bucholz, H.J. Edenberg, L.A.
Polgreen, V.M. Hesselbrock, M.A. Schuckit, J.I. Nurnberger, E.S. Kapp, B. Porjesz, L.J.
Bierut (Sept. 2008). Multiple-Domain Predictors of Problematic Alcohol Use in
Young Adulthood. J. Stud. Alcohol Drugs 69(5):649-59.

OBJECTIVE: The goal of this study was to identify predictors of problematic young
adult alcohol use.
METHOD: The sample consisted of 141 subjects (81 females) participating in a national
study of genetic risk factors for alcoholism. All subjects were evaluated first as children
or adolescents, then approximately 5 years later as young adults. Outcome consisted of
the number of alcohol symptoms (0-10) endorsed at this second time point. Predictors of
outcome were drawn from five domains representing: (1) Demographic Characteristics,
(2) Child/Adolescent Problematic Alcohol Use, (3) Biological Risk, (4) Externalizing
Behaviors, and (5) Family Environment. A two-stage analytic strategy was used in which
(1) separate multiple regression analyses were conducted within each of the five domains
and (2) statistically significant predictors of problematic alcohol use from each domain
were combined into one regression model to determine which remained significant.
RESUTLS: In the final model, 31% of the variance in the number of alcohol symptoms in
young adulthood was predicted by a high number of alcohol symptoms in childhood and
adolescence, low initial sensitivity to alcohol, and a negative child/adolescent relationship
with the father.
CONCLUSIONS: These results demonstrated that GABRA2 originally associated with a
diagnosis of alcohol dependence in adults also predicted the onset of symptoms among
subjects in their 20s, confirmed specific hypotheses about three other predictors in the
final model, and suggested the utility of incorporating biological and non-biological
predictors to optimally predict young adult alcohol problems.




                                                                                          68
S. Lemke, K.K. Schutte, P.L. Brennan, R.H. Moos (Sept. 2008). Gender Differences in
Social Influences and Stressors Linked to Increased Drinking. J. Stud Alcohol Drugs
69(5):695-702.

OBJECTIVE: To explore reasons for gender differences in problem-drinking prevalence
and to compare the experiences of problem-drinking women and men, this article
examines gender differences in exposure and drinking reactivity to social influences and
stressors during adulthood.
METHOD: A community sample of 831 older adults (347 women and 484 men; average
age = 69), comprising problem and non-problem drinkers, provided information about
their drinking histories. Respondents indicated whether they had experienced particular
social influences and stressors during adulthood (exposure) and, if so, whether they had
increased alcohol consumption in response (reactivity).
RESULTS: Overall, women were more likely than men to report exposure to a partner's
drinking, family interpersonal problems, death of someone close, and emotional distress.
Men reported more exposure to peers' drinking and workplace problems and were more
likely to report drinking reactivity to social influences and stressors. Among problem
drinkers, gender differences in exposure to social influences and stressors paralleled those
in the overall sample, but gender differences in reactivity were minimal.
CONCLUSIONS: Gender differences in exposure to social influences and stressors
generally do not help explain men's higher problem-drinking prevalence, but men's
overall greater drinking reactivity corresponds with their propensity to develop problem
drinking. Problem-drinking women and men tend to be exposed to somewhat different
social influences and stressors but share a tendency to respond to these experiences with
increased drinking. Information about experiences that may place upward pressure on
drinking for men and women can inform efforts to prevent and treat alcohol-use
disorders.


M.A. Walton, A.L. Goldstein, S.T. Chermack, R.J Mccammon, R.M. Cunningham, K.L.
Barry, F.C. Blow (July 2008). Brief Alcohol Intervention in the Emergency
Department: Moderators of Effectiveness. J. Stud. Alcohol Drugs, 69(4):550-60.

OBJECTIVE: Prior research supports the effectiveness of brief interventions for reducing
alcohol misuse among patients in the emergency department (ED). However, limited
information is available regarding the mechanisms of change, which could assist
clinicians in streamlining or amplifying these interventions. This article examines
moderators of outcomes among ED patients, ages 19 and older, who participated in a
randomized controlled trial of a brief intervention for alcohol misuse.
METHOD: Injured patients (N = 4,476) completed a computerized survey; 575 at-risk
drinkers were randomly assigned to one of four brief intervention conditions, and 85%
were interviewed again at 3-month and 12-month follow-ups.
RESULTS: Regression models using the generalized estimating equations approach
examined interaction effects between intervention condition (advice/no advice) and
hypothesized moderator variables (stage of change, self-efficacy, acute alcohol use,
attribution of injury to alcohol) on alcohol outcomes over time. Overall, participants who



                                                                                         69
reported higher levels of self-efficacy had lower weekly consumption and consequences,
whereas those with higher readiness to change had greater weekly consumption and
consequences. Furthermore, individuals who attributed their injury to alcohol and
received advice had significantly lower levels of average weekly alcohol consumption
and less frequent heavy drinking from baseline to 12-month follow-up compared with
those who attributed their injury to alcohol but did not receive advice.
CONCLUSIONS: This study provides novel data regarding attribution for alcohol-related
injury as an important moderator of change and suggests that highlighting the
alcohol/injury connection in brief, ED-based alcohol interventions can augment their
effectiveness.


H. Kuendig, M. Hasselberg, L. Laflamme, J.B. Daeppen, G. Gmel (March 2008). Acute
Alcohol Consumption and Injury: Risk Associations and Attributable Fractions for
Different Injury Mechanisms. J. Stud. Alcohol Drugs, 69(2):218-26.

OBJECTIVE: Most studies on alcohol as a risk factor for injuries have been mechanism
specific, and few have considered several mechanisms simultaneously or reported
alcohol-attributable fractions (AAFs)--which was the aim of the current study.
METHOD: Data from 3,592 injured and 3,489 non-injured patients collected between
January 2003 and June 2004 in the surgical ward of the emergency department of the
Lausanne University Hospital (Switzerland) were analyzed. Four injury mechanisms
derived from the International Classification of Diseases, 10th Revision, were considered:
transportation-related injuries, falls, exposure to forces and other events, and
interpersonal violence. Multinomial logistic regression models were calculated to
estimate the risk relationships of different levels of alcohol consumption, using non-
injured patients as quasi-controls. The AAFs were then calculated.
RESULTS: Risk relationships between injury and acute consumption were found across
all mechanisms, commonly resulting in dose-response relationships. Marked differences
between mechanisms were observed for relative risks and AAFs, which varied between
15.2% and 33.1% and between 10.1% and 35.9%, depending on the time window of
consumption (either 6 hours or 24 hours before injury, respectively). Low and medium
levels of alcohol consumption generally were associated with the most AAFs.
CONCLSUIONS: This study underscores the implications of even low levels of alcohol
consumption on the risk of sustaining injuries through any of the mechanisms considered.
Substantial AAFs are reported for each mechanism, particularly for injuries resulting
from interpersonal violence. Observation of a so-called preventive paradox phenomenon
is discussed, and prevention or intervention measures are described.


T. J. Morgan, H.R. White, E.Young Mun (March 2008). Changes in Drinking Before a
Mandated Brief Intervention With College Students. J. Stud. Alcohol Drugs,
69(2):286-90.

OBJECTIVE: Little is known about the effects of alcohol-related infractions and
resulting reprimands for invoking behavioral change among mandated college students.



                                                                                       70
The primary aim of this study was to assess the extent to which students significantly
reduce their drinking between the time of an alcohol-related violation and the sanctioned
intervention.
METHO: Data came from 175 (70% male) students mandated to the Rutgers University
Alcohol and Other Drug Assistance Program for Students because of infractions of
university rules about alcohol and drug use. At intake, students reported on their alcohol
consumption for the 30 days before the violation and the 30 days before the intake
assessment.
RESULTS: Mandated students significantly reduced peak BAC levels, total weekly
drinks, and frequency of alcohol use after the violation before any intervention. Those
students who had received a legal or medical referral (i.e., a serious infraction) reduced
their alcohol consumption (BAC and total drinks) significantly more than those referred
by residence hall advisors.
CONCLUSIONS: The alcohol-related violation (including the event itself, getting
caught, and/or getting mandated to an intervention) contributes to reductions in alcohol
use for mandated college students. The finding that the seriousness of the infraction
resulted in greater reductions in alcohol use suggests that the students' cognitive self-
appraisal and affective response to the incident may be underlying mechanisms for their
changes. Knowing if mandated students have already made significant changes in their
drinking before intake would provide counselors with a valuable opportunity to identify
and reinforce successful harm reduction strategies and could inform the type or intensity
of intervention needed.


Will, K.E. & Sabo, C.S. (Spring 2008). Targeting Underage Drinking and Driving in
Juvenile and Domestic Relations Courts: The Reinforcing Alcohol Prevention
(RAP) Program. Juvenile and Family Court Journal, 59 (2) , 39–49
Email: willke@evms.edu

Alcohol use is a concern among our nation's least experienced drivers, and underage
drinking contributes to the overall burden of traffic injury and mortality. The goal of the
Reinforcing Alcohol Prevention (RAP) Program was to develop a court-based program
targeting underage drinking and driving among teens. An advisory board created the
program which included changes to the drivers' licensing ceremonies and traffic dockets
conducted in Juvenile and Domestic Relations Courts. Additions included 5-minute
videos of individuals in alcohol-related crashes and a crash-photo display. Exit
evaluations garnering impressions/opinions of the program indicated 84% of teenagers
felt every teen should view the presentation and 96% would be less likely to drive after
drinking. The RAP Program has been well-received by judges and participants and could
be easily implemented by other jurisdictions.

Significance: This is an example of how not to design and evaluate a program. Such
impressional outcome reports have little relationship to post-intervention prevalence of
under-age drinking and driving. This is how millions of dollars were spent on DARE
before rigorous scientific studies questioned its effectiveness. (WLW, July 2008)




                                                                                           71
Arfken, C.L. & Kubiak, S.P. (August 2007). Characteristics of facilities with
specialized programming for drinking drivers and for other criminal justice
involved clients: analysis of a national database. Subst Abuse Treat Prev Policy, 2:26.
Email: carfken@med.wayne.edu.

BACKGROUND: Offering specialized programming at substance abuse treatment
facilities can help diversify clientele and funding sources, potentially enhancing the
facilities' ability to survive and/or expand. Past research has shown that facilities only
offering specialized programming for DUI offenders are predominately private-for-profit
owned. As criminal justice populations, both DUI and other criminal justice offenders,
comprise a large proportion of those in community-based substance abuse treatment
knowing facilities' characteristics would be important for administrators and
policymakers to consider when updating programming, training staff or expanding
capacity to ensure efficient use of scarce resources. However, while such characteristics
are known for DUI programs, they are not known for facilities offering specialized
programming for other criminal justice offenders.
METHODS: Analysis of the 2004 US National Survey of Substance Abuse Treatment
Facilities.
RESULTS: Almost half the facilities (48.2%) offered either DUI or other criminal justice
specialized programming. These facilities were divided between those offering DUI
specialized programming (17.7%), other criminal justice specialized programming
(16.6%) and both types of programming (13.9%). Certain characteristics were
independently associated with offering DUI specialized programming (private ownership,
rural location, for profit status) or other criminal justice specialized programming
(receiving public funds, urban location, region of country).
CONCLUSION: Offering specialized programming for DUI or other criminal justice
offenders was common and associated with distinct characteristics. These observed
associations may reflect the positioning of the facility to increase visibility, or diversify
clientele and possibly funding streams or the decision of policymakers. As the criminal
justice populations show no sign of decreasing and resources are scarce, the efficient use
of resources demands policymakers recognize the prevalence of these specialized
programming, join forces to examine them for efficacy, and explicitly incorporate these
characteristics into strategies for workforce training and plans for treatment expansion

Significance: This study underscores the growing connection between addiction
treatment and the criminal justice system in the US in general and the unique niche filled
by DUI service providers. The fact that the overwhelming majority of DUI service
providers are privately owned and for-profit corporations raises troubling questions about
competition and conflict of interests. For example, if DUI providers are dependent upon
referrals from defense attorneys, is there a progressive decline in the rigor of evaluations
due to the loss of referrals (and profits) of those service providers that develop a
reputation for vigorous evaluation and higher rates of treatment recommendations?
(WLW, July 2008)




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Carpenter, C.S., Kloska, D.D.; O'Malley, P., & Johnston, L. (January 2007). Alcohol
control policies and youth alcohol consumption: Evidence from 28 Years of
Monitoring the Future, The B.E. Journal of Economic Analysis & Policy, 7(1), Article
25.
Available at: http://www.bepress.com/bejeap/vol7/iss1/art25

We provide the first historical comparative analysis of the effects of Minimum Legal
Drinking Ages (MLDA), beer taxes, and "Zero Tolerance" (ZT) underage drunk driving
laws on the drinking behaviors of high school seniors using confidential area-identified
data from the 1976-2003 waves of the Monitoring the Future (MTF) Surveys. We
estimate reduced form models of drinking participation and heavy episodic drinking that
account for state and year fixed effects. Our findings confirm that nationwide increases in
the MLDA in the late 1970s and 1980s and adoption of ZT laws in the 1990s both
significantly reduced alcohol consumption by high school seniors, with larger effects for
the MLDA than for ZT laws. Higher beer taxes are also estimated to reduce youth
drinking participation. Overall, the results confirm that a variety of types of government
intervention can have important effects on youth alcohol consumption.

Significance: The best data available on the effectiveness of minimum age drinking laws
and zero tolerance laws. When anyone asks whether these laws have ever been evaluated,
refer them to this study. (WLW, June 2008)




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6)     Drug Impairment - Detection


Cheng, W.C., Ng, K. Chan, K., King-Kuen Mok, V. & Kin-Leung Cheung, B. (July
2007). Roadside detection of impairment under the influence of ketamine—
Evaluation of ketamine impairment symptoms with reference to its concentration in
oral fluid and urine, Forensic Science International, 170(1); 51-58.

Although there are many roadside testing devices available for the screening of abused
drugs, none of them can be used for the detection of ketamine, a popular abused drug in
Hong Kong. In connection to local drug driving legislation, effective roadside detection
of ketamine in suspected drug-impaired drivers has to be established. According to the
drug evaluation and classification program (DEC), ketamine is classified in the
phencyclidine (PCP) category. However, no study has been performed regarding the
signs and symptoms exhibited by users under the influence of ketamine. In a study to
develop a protocol for effective roadside detection of drug-impaired drivers, 62
volunteers exiting from discos were assessed using field impairment tests (FIT) that
included measurements of three vital signs (i.e. body temperature, pulse rate and blood
pressure), three eye examinations [pupil size, lack of convergence (LOC) and horizontal
gaze nystamus (HGN)] and four divided attention tests (Romberg, one-leg stand, finger-
to-nose and walk-and-turn tests). Subsequent laboratory analysis of oral fluid and urine
samples from the participants revealed the presence of common abused drugs in both the
urine and oral fluid samples of 55 subjects. The remaining 7 subjects with no drug in
their oral fluid samples were used as drug-free subjects. In addition, 10 volunteers from
the laboratory who were regarded as drug-free subjects were also assessed using the same
FIT. Among the 62 volunteers, 39 of them were detected with ketamine in their oral fluid.
Of these ketamine users, 21 of them (54%) with only ketamine found in their oral fluid
samples while the rest (18 subjects) of them had other drugs (i.e. MA, MDMA,
benzodiazepines and/or THC) in addition to ketamine. Of the 21 ketamine-only users, 15
of them (71%) were successfully identified by FIT. It was found that when salivary
ketamine concentrations were greater than 300 ng/mL, signs of impairment became
evident, with over 90% detection rate using the FIT. By comparing the FIT observations
on the 21 ketamine-only users with the drug-free subjects, the typical signs and
symptoms observable for subjects under the influence of ketamine included LOC, HGN,
elevated pulse rate and in general, failing the divided attention tests, especially the walk-
and-turn and one-leg stand.


Silber, B.Y., Papafotiou, K., Croft, R.J. & Stough, C.K. (October 2005). An evaluation
of the sensitivity of the standardized field sobriety tests to detect the presence of
amphetamine. Psychopharmacology (Berl). 182(1):153-9.
Email: bsilber@swin.edu.au

RATIONALE: The Standardized Field Sobriety Tests (SFSTs), designed and validated to
assess impairment associated with alcohol intoxication, are currently being employed by




                                                                                          74
the Victoria Police (Australia) for the identification of driving impairment associated
with drugs other than alcohol.
OBJECTIVES: The aim of this study was to evaluate whether the SFSTs are a sensitive
measure for identifying the presence of dexamphetamine and methamphetamine.
METHODS: Three studies each employed a repeated-measures, counterbalanced, double-
blind placebo-controlled design. In each study, 20 healthy volunteers completed two
treatment conditions: either 0.42 mg/kg d,l-dexamphetamine and placebo, 0.42 mg/kg d,l-
methamphetamine and placebo, or 0.42 mg/kg d-methamphetamine and placebo.
Performance was assessed using the SFSTs, consisting of the Horizontal Gaze
Nystagmus test, the Walk and Turn test, and the One Leg Stand test. Blood and saliva
samples were obtained before and immediately after the administration of the SFSTs (120
and 170 min post drug administration).
RESULTS: At 120 and 170 min post drug administration, d,l-dexamphetamine blood
levels were 83.16 and 98.42 ng/ml, respectively; d,l-methamphetamine levels were 90
and 95 ng/ml, respectively; and d-methamphetamine blood levels were 72 and 67 ng/ml,
respectively. None of the three amphetamine doses impaired performance on the SFSTs.
Using the SFSTs, the presence of dexamphetamine was identified in 5% of cases, d-
methamphetamine in 5%, and d,l-methamphetamine in 0% of cases.
CONCLUSIONS: Under these conditions, the SFSTs are not a sensitive measure for
detecting the presence of low levels of amphetamine.

Significance: This study supports the contention that a full DRE evaluation is necessary
for an effective investigation and prosecution


Shinar and, D. & Schechtman. E. (September 2005). Drug identification performance
on the basis of observable signs and symptoms, Accident Analysis & Prevention, 37(5),
843-851.

A double blind study was performed to evaluate the ability of trained police officers to
detect drug impairments and to identify the type of drug responsible for the impairment,
on the basis of observed symptoms and psychophysical measurements of performance
alone. The officers were not allowed to interview the subjects, and their conclusions were
based solely on observable signs and symptoms on systematically measured vital signs,
and on standardized sobriety tests of motor coordination. Results showed that with this
partial information, the officers are able to detect drug impairment at better-than-chance
levels with a sensitivity (correct detection of impairments) of 72%, but with a specificity
of 43% (false alarm rate of 57%). Furthermore, the association between drug ingestion
and identification of the specific impairing drug category was not very high, with
sensitivities ranging from a low of 10% for amphetamine to a high of 49% for cannabis.
Based on both sensitivity and specificity, drug identification was best for alprazolam
impairment, noticeably poorer for cannabis and codeine impairment, and no better than
chance for amphetamine impairment. Performance could have been improved if the
officers were to list the two most probable impairing drugs (rather than limit their
decision to only one), and if they were more consistent in their interpretation of
observable signs and symptoms.



                                                                                        75
Significance: This study supports the DRE protocol and the ability of an officer to form
an opinion of drug impairment based upon the observations made in conducting a full
drug evaluation.


Smith, J.A., Hayes, C.E., Yolton, R.L., Rutledge, D.E., Citek, K. (July 2002). Drug
Recognition Expert Evaluations Using Limited Data, Forensic Science International
130(3); 167-173.

The Drug Evaluation Classification (DEC) Program is used by Drug Recognition Expert
officers to determine whether a suspect is under the influence of a drug or drugs at the
time of the arrest, and, if so, what category of drug(s). The goal of this project was to
investigate the relative importance of face-to-face interactions with the suspect, physical
evidence (drugs or paraphernalia found), and confessions/statements made by the suspect
(or others) in making these determinations.
Seventy records of DRE evaluations were selected from a database containing
information from all evaluations conducted in Oregon between 1996 and 1998. Each of
the 70 records represented a suspect who had either taken a drug from one of four
categories (CNS depressant, CNS stimulant, narcotic analgesic, or cannabis) or who had
not taken a drug. To be included, the original DRE evaluation and the subsequent
toxicology analysis had to agree that the suspect was under the influence of a drug from
on of the four categories or not under the influence of a drug.
Records from the 70 cases were submitted in written form to 18 Oregon DREs with
statements made by suspects or arresting officers, confessions, toxicology results, and
descriptions of drugs or paraphernalia found on the suspect omitted. Based only on the
written reports of direct observations, and with physiological and psychophysical test
results, the DREs attempted to determine whether each of the 70 suspects was under the
influence of a drug or drugs, and, if so, what category of drug(s).
If the officers determined that a suspect was under the influenced of a drug, their
accuracy in specifying the drug category was 81% for cannabis, 94% for narcotic
analgesics, 78% for CNS stimulants, and 69% for CNS depressants. Overall accuracy in
recognizing drug intoxication was 95%. These percentages indicate that although face-to-
face interactions, physical evidence, and confessions/statements can be useful adjuncts to
DRE decision-making, the majority of drug category decisions can be made solely on the
basis of recorded suspect observations and DRE evaluations results.

Significance: This study supports the DRE protocol and the ability of an officer to form
an opinion of drug impairment based upon the observations made in conducting a full
drug evaluation.




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7)   The Standardized Field Sobriety Tests & the Horizontal Gaze Nystagmus
(HGN) Test

The attached abstracts are presented without commentary as to their significance as I do
not have the technical expertise to evaluate them. I have also included a few posted items
from the Internet.

Meunier, F. & Laperriere, D., (April 2008). A video-based image processing system
for the automatic implementation of the eye involuntary reflexes measurements
involved in the Drug Recognition Expert (DRE). This paper appears in proceedings:
Computer Systems and Applications, 2008. AICCSA 2008. IEEE/ACS International
Conference, March 31 2008-April 4 2008, pp. 599-605.

In order to detect drivers under the influence of substances such as alcohol or drugs,
police officers use a standardized set of tests such as the HGN test, the eye convergence
test and the pupilary reaction. These tests are part of the more complete DRE protocol.
These procedures are administered by law enforcement officers. The present work
describes a video-based image processing system implementing the HGN test, the
convergence test and the dark room examination. This system generates visual stimuli
and captures video sequences of the eyes following and reacting to these visual stimuli.
The video sequences are processed and analyzed using feature extraction techniques. In
the present study, the video-based image processing system is used to detect alcohol
related intoxication. This system was tested in an experiment involving 32 subjects dosed
to a blood alcohol concentration (BAC) in the interval of 0.04 to 0.22. In order to
demonstrate the effects of alcohol on eye signs comparisons are made between pre-dose
and post-dose BAC.


Walden. T.D. (2007). Standardized Field Sobriety Testing: Learning from Our Mistakes
**PDF available at http://www.icadts2007.org/print/19learningmistakes.pdf

The purpose of this paper is to examine whether there was a significant difference
between the NHTSA/IACP standardized administrative procedures learned by officers in
the basic SFST practitioner course and the manner in which these same officers
administer the SFST procedures in the field. Furthermore, if there is a significant
difference from the standardized NHTSA/IACP approved procedures, what elements had
the most significant deviations. This examination was based on more than three hundred
and fifty evidentiary videotapes which were analyzed over a four year period. The benefit
of this analysis is to identify the overall rate of compliance as well as identify
contributing factors to any non-compliance. By identifying proper and improperly
administered elements of the SFST’s, it is believed that a course of correction can be
undertaken in order to eliminate officer error while administering SFST’s in enforcement
settings.




                                                                                       77
Newaz, D.D. (Spring 2006). The impaired dual system framework of United States
drunk-driving law: how international perspectives yield more sober results, Houston
Journal of International Law • Wntr.

Drunk drivers create a very serious social and international problem that needs to be
corrected. However, the United States' use of poor investigatory tools to establish proof,
ineffectual sanctions for refusal to submit to a breath test, and convictions that are
obtained haphazardly and improperly is not acceptable.
This is especially true given that a myriad of other countries and regions, including
Scandinavia, Great Britain, Australia, and Canada, have not resorted to such measures.
This Comment engages in a comparative analysis of international and U.S. drunk-driving
laws and proposes an optimal solution to the intersection of two cornerstones of
American society--alcohol and driving. Part I explores the specifics of U.S. drunk-driving
laws with a focus on the two biggest problems with U.S. drunk-driving prosecution: field
sobriety tests and administrative license revocation. Part II reviews how the drunk-
driving laws of Scandinavia, Great Britain, Australia, and Canada can "contribute to our
understanding of impaired driving countermeasures and of how the current situation in
the United States compares to other countries." Part III uses this international perspective
to propose a solution that would make U.S. drunk-driving laws more effectual and
balanced.


Stuster, J. (Fall 2006). Validation of the Standardized Field Sobriety Test Battery
at 0.08% Blood Alcohol Concentration, Human Factors, 48(3); 608–614.
E-Mail: jstuster@ anacapasciences.com.

OBJECTIVE: A field study was conducted to evaluate the accuracy of the SFST battery
to assist officers in making arrest decisions at BACs below 0.10.
BACKGROUND: The SFST Battery was validated at 0.10 BAC in 1981, but since then
many states have reduced statutory limits for driving while intoxicated to 0.08 BAC.
METHODS: During routine patrols, participating officers followed study procedures in
administering SFSTs, scoring results, making arrest/no arrest decisions, and completing a
data collection form for each of the 297 motorists evaluated during the study period. The
officers’ final step in each case was the administration of an evidentiary breath alcohol
test.
RESULTS: Overall, officers’ decisions were correct in more than 91% of the cases at the
0.08 BAC level. Cohen’s kappa tests found all officers’ scores to be within the
categories of “substantial” and “near perfect” agreement, indicating low variance among
the officers and a high degree of interrater reliability.
CONCLUSION: The results of this study provide evidence of the validity of the SFST
Battery as an accurate and reliable decision aid for discriminating between BACs above
and below 0.08.
APPLICATION: The SFST Battery presently is used by law enforcement officers
throughout the United States to help make roadside arrest decisions for impaired driving.




                                                                                         78
Stuster, J. (2005). The Standardized Field Sobriety Test Battery: A Summary of
Issues, Impaired Driving Update (9) 3-4: 63-70, 75-76, 89-92.

The purpose of this paper is to provide information concerning the development of the
SFST battery, of which theHGN test is the principal component. The paper also discusses
additional issues, including the acceptability of SFST results by the courts. Various terms
are used throughout the United States for offenses involving drinking and driving. In this
paper,
DWI is used to refer to all occurrences of driving at or above the illegal BAC limit of a
jurisdiction.
CONCLUSIONS: The results of the 1998 study discussed in this paper show the SFSTs
to be accurate, reliable, and fully-validated for field use. The HGN test proved to be the
most accurate and reliable component of the SFST battery. Approximately 50 people die
each day in the U.S. as a consequence of alcohol involved crashes. Many more are
seriously injured, and countless friends and family members are affected indirectly.
Drinking and driving is a serious national problem that is worthy of our attention.


Burns, M. (December 2003). An Overview of Field Sobriety Test Research Perceptual
and Motor Skills, 97:1187-1199.

Traffic officers stop moving vehicles for probable cause, most frequently a traffic code
violation. When an officer approaches the driver of a stopped vehicle, he may note an
odor of alcohol or other signs indicating alcohol consumption. In such circumstances, it
is the officer’s duty to undertake an alcohol investigation. If the driver is asked to get out
of the vehicle to perform roadside maneuvers, the performance of the maneuvers,
together with the officer’s observations and the driver’s responses to questions, are the
evidence on which an arrest or release decision is based. In some jurisdictions, officers
also obtain a measurement of the driver’s alcohol level with a Preliminary Breath Test,
but not all agencies permit breath tests at roadside or provide the instruments for them. A
Standardized Field Sobriety Test battery, which includes HGN, Walk and Turn test, and
One-Leg Stand test, is widely used. If the driver is arrested, the admissibility of the
officer’s testimony about them at trial often is challenged. Sobriety tests have been
examined in three laboratory studies and five field studies in the US. Two additional
studies were conducted in Finland. To provide an overview of sobriety test research in a
single publication, this paper presents the methods and findings of these studies.


Citek, K., Ball, B., Rutledge, D.E. (November 2003). Nystagmus Testing in Intoxicated
Individuals Optometry 74(11); 695-710.

BACKGROUND: Law enforcement officers routinely conduct psychophysical tests to
determine if an impaired driver may be intoxicated or in need of medical assistance.
Testing includes assessment of eye movements, using the HGN and Vertical Gaze
Nystagmus (VGN) tests, which are conducted at roadside by patrol officers. These tests
previously have been validated when the subject is placed in a standing posture with head
upright. However, certain conditions require that the subject be tested while seated or


                                                                                           79
supine. Under these conditions, Positional Alcohol Nystagmus (PAN) could be induced
and mistaken for HGN or VGN.
METHODS: The study was conducted at law enforcement training academy alcohol
workshops in the Pacific Northwest. Ninety-six volunteer drinkers were tested when
sober and three times after drinking alcohol by 40 volunteer officers experienced in
administering the tests. BAC was measured objectively with a calibrated breath analysis
instrument each time a subject was tested.
Results: The number of eye movement signs observed during the HGN test at any posture
increases with increasing BAC. The presence of VGN at any test posture occurs only in
the presence of signs of HGN and only at high levels of impairment. PAN was most often
observed at BACs of 0.08 and higher, but was never confused with the observation of
HGN or VGN, regardless of test posture.
CONCLUSIONS: The HGN test administered in the standing, seated, and supine
postures is able to discriminate impairment at criterion BACs of 0.08 and 0.10. The VGN
test can identify high levels of impairment at any test posture. Therefore, these tests can
be used by an officer to determine if a driver is impaired, regardless of whether the driver
is standing, seated, or supine.


McKnight, A., Langston, E., McKnight, A.S., Lange, J. (May 2002). Sobriety tests for
lowblood alcohol concentrations, Accident Analysis and Prevention, 34 (3), 305-11.

The legal limits of BAC for operators of commercial vehicles throughout the US, and
underage drivers in most states, are approximately half the 0.08 – 0.20 imposed on other
drivers. Easily administered measures involving performance and appearance are needed
to establish probably cause for requesting breath tests. Several measures showing
relationships to blood alcohol were examined for their ability to distinguish BACs under
and over 0.04 within the controlled experiments with alcohol-dosed subjects. The only
reliable index of blood alcohol wasHGN as administered in the SFST, using alternative
scoring criteria. Although other measures evidenced intra-individual change at low
BACs, the magnitude of change was greatly exceeded by inter-individual differences,
thwarting their use in detecting drivers with BACs lower than 0.08. HGN, however,
proved as valid in detecting BACs in the 0.04-0.08 range as at the higher levels of the
SFST. It is also as valid when administered to a seated subject as one standing, making it
of particular benefit in enforcement, where the behavior of low BAC drivers rarely
provides probable cause to request that they leave a vehicle to be tested in a standing
position.




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The following articles are included so that law enforcement and prosecutors may be
aware of the arguments that will be made against the admissibility and credibility of the
HGN test in court.


Rubenzer, S.J. (October 2007). The Standardized Field Sobriety Tests: A Review of
Scientific and Legal Issues. Law and Human Behavior, DOI 10.1007/s10979-007-
9111-y	
  

This article details the history and development of the NHTSA’s SFSTs. They are
reviewed in terms of relevant scientific, psychometric, and legal issues. It is concluded
that the research that supports their use is limited, important confounding variables have
not been thoroughly studied, reliability is mediocre, and that their developers and
prosecution-oriented publications have oversold the tests. Further, case law since their
development has severed the tests from their validation data, so that they are not
admissible on the criterion for which they were validated (blood alcohol concentration),
and admissible for a criterion for which they were not (mental, physical, or driving
impairment). Directions for further research are presented.


Hlastala MP, Polissar NL, Oberman S. (May 2005). Statistical evaluation of
standardized field sobriety tests. J Forensic Sci., 50(3):662-9.
Email: hlastala@u.washington.edu

SFSTs are used as qualitative indicators of impairment by alcohol in individuals
suspected of DUI. Stuster and Burns authored a report on this testing and presented the
SFSTs as being 91% accurate in predicting Blood Alcohol Concentration (BAC) as lying
at or above 0.08%. Their conclusions regarding accuracy are heavily weighted by the
large number of subjects with very high BAC levels. This present study re-analyzes the
original data with a more complete statistical evaluation. Our evaluation indicates that the
accuracy of the SFSTs depends on the BAC level and is much poorer than that indicated
by Stuster and Burns. While the SFSTs may be usable for evaluating suspects for BAC,
the means of evaluation must be significantly modified to represent the large degree of
variability of BAC in relation to SFST test scores. The tests are likely to be mainly useful
in identifying subjects with a BAC substantially greater than 0.08%. Given the moderate
to high correlation of the tests with BAC, there is potential for improved application of
the test after further development, including a more diverse sample of BAC levels,
adjustment of the scoring system and a statistically-based method for using the SFST to
predict a BAC greater than 0.08.


Booker, J.L. (July 2004). The Horizontal Gaze Nystagmus test: fraudulent science in
the American courts. Sci Justice, 44(3):133-9.

The HGN test was conceived, developed and promulgated as a simple procedure for the
determination of the blood alcohol concentration of drivers suspected of DWI. Bypassing



                                                                                         81
the usual scientific review process and touted through the good offices of the federal
agency responsible for traffic safety, it was rushed into use as a law enforcement
procedure, and was soon adopted and protected from scientific criticism by courts
throughout the United States. In fact, research findings, training manuals and other
relevant documents were often held as secrets by the state. Still, the protective
certification of its practitioners and the immunity afforded by judicial notice failed to
silence all the critics of this deeply flawed procedure. Responding to criticism, the
sponsors of the test traveled the path documented in this paper that led from mere (if that
word can ever truly apply to a matter of such gravity) carelessness in research through
self-serving puffery and finally into deliberate fraud--always at the expense of the citizen
accused.




                                                                                          82
                                       Index – Alphabetical By Author


Adams, S. & Cotti, C. (June, 2008). Drunk driving after the passage of
  smoking bans in bars. Journal of Public Economics, 92(5-6):1288-1305. .................. 3

G.M. Ames, C.B. Cunradi, R.S. Moore, P. Stern (May 2007). Military Culture
  and Drinking Behavior Among U.S. Navy Careerists. J. Stud. Alcohol
  Drugs, 68(3):336-44. ..................................................................................................... 17

Anu, S., Jouko, M. Marjo-Riitta, J. & Pirkko, R. (February 2001). An examination
  between single-parent family background and drunk driving in adulthood:
  Findings from the Northern Finland 1966 birth cohort: Neurobiological,
  behavioral, and environmental relations to drinking, Alcoholism: Clinical &
  Experimental Research. 25(2):206-09........................................................................... 41

Arfken, C.L. & Kubiak, S.P. (August 2007). Characteristics of facilities with
  specialized programming for drinking drivers and for other criminal
  justice involved clients: analysis of a national database.
  Subst Abuse Treat Prev Policy, 2:26 ............................................................................. 72

N.P. Barnett, B. Borsari, J.T.P. Hustad, T. O'Leary Tevyaw, S.M. Colby,
  C.W. Kahler, P.M. Monti (Sept. 2008). Profiles of College Students Mandated
  to Alcohol Intervention. J. Stud. Alcohol Drugs 69(5):684-94. ................................. 67

Barquín, J., Luna, J.D., & Hernández, A.F. (May 2008). A controlled study
  of the time-course of breath alcohol concentration after moderate
  ingestion of ethanol following a social drinking session.
  Forensic Science International, 177(2-3), 140-145. ....................................................... 3

D.J. Beirness; J. LeCavalier; D. Singhal (December 2007). Evaluation of the Drug
  Evaluation and Classification Program: A Critical Review of the Evidence,
  Traffic Injury Prev., 8(4):368-76. .................................................................................. 60

Bingham, C.R., Elliott, M.R. & Shope, J.T. (April 2007). Social and behavioral
  characteristics of young adult drink/drivers adjusted for level of
  alcohol use. Alcohol Clin Exp Res., 31(4):655-64. ....................................................... 37

B. Bjerre, J. Kostela (July 2008). Primary prevention of drink driving
  by the large-scale use of alcolocks in commercial vehicles.
  Accid. Anal. & Prev. 40(4):1294-99. ............................................................................. 43

Bjerre, B. & Thorsson, U. (January 2008). Is an alcohol ignition interlock
  programme a useful tool for changing the alcohol and driving habits
  of drink-drivers? Accid Anal Prev. 40(1):267-73. ...................................................... 45




                                                                                                                           83
Blalock, G., Kadiyali, V. & Simon, D.H. (January 2008). Driving fatalities
  after 9/11: a hidden cost of terrorism. Applied Economics, January, 2008. ............. 10

Booker, J.L. (July 2004). The Horizontal Gaze Nystagmus test: fraudulent
  science in the American courts. Sci Justice, 44(3):133-9......................................... 81

M. Boorman; K. Papafotiou (September 2007). The Victorian Legislative
 Framework for Testing Drivers for Impairment Caused by Drugs Other
 than Alcohol: An Evaluation of the Characteristics of Drivers Detected from
 2000 to 2005, Traffic Injury Prev., 8(3):217-23 ........................................................... 62

Bortolotti, F., Trettene, M., Gottardo, R., Bernini, M., Ricossa, M.C. & Tagliaro, F.
  (August 2007). Carbohydrate-deficient transferrin (CDT): a reliable
  indicator of the risk of driving under the influence of alcohol when
  determined by capillary electrophoresis. Forensic Sci Int., 170(2-3), 175-8............ 32

Bray, R.M. & Hourani, L.L. (July 2007). Substance use trends among active
  duty military personnel: findings from the United States Department
  of Defense Health Related Behavior Surveys, 1980–2005.
  Addiction, 102(7):1092-1101. ....................................................................................... 14

Brice, M.R., Appenzeller, S., Maul, A, & Wennig, R. (August 2005). Relationship
  between blood alcohol concentration and carbohydrate-deficient transferrin
  among drivers, Drug and Alcohol Dependence, 79(2), 261-265 ................................. 40

Brown, T.G., Ouimet, M.C., Nadeau, L., Lepage, M., Tremblay, J., Dongier, M.
  & Kin, N.M.. (March 2008). DUI offenders who delay relicensing: a
  quantitative and qualitative investigation. Traffic Inj Prev. 9(2),109-18. ................ 26

Burns, M. (December 2003). An Overview of Field Sobriety Test Research
  Perceptual and Motor Skills, 97:1187-1199. ................................................................ 79

Caetano, R., Ramisetty-Mikler, S. & Rodriguez, L.A. (March 2008). The Hispanic
  Americans baseline alcohol survey (HABLAS): DUI rates, birthplace,
  and acculturation across Hispanic national groups.
  J Stud Alcohol Drugs. 69(2):259-65. ............................................................................... 8

J. Carlisle Maxwell; J. Freeman (December 2007). Gender Differences in DUI
   Offenders in Treatment in Texas, Traffic Injury Prev., 9(4):353-60 ......................... 10

Carpenter, C.S., Kloska, D.D.; O'Malley, P., & Johnston, L. (January 2007).
  Alcohol control policies and youth alcohol consumption: Evidence
  from 28 Years of Monitoring the Future, The B.E. Journal of
  Economic Analysis & Policy, 7(1), Article 25. ............................................................ 73




                                                                                                                     84
Cavaiola, A.A., Strohmetz, D.B. & Abreo, S.D. (April 2007). Characteristics of
  DUI recidivists: a 12-year follow-up study of first time DUI offenders.
  Addict Behavior, 32(4):855-61. ..................................................................................... 37

M.J. Chen, J.W.Grube, P. Nygaard, B. Miller (March 2008). Identifying social
 mechanisms for the prevention of adolescent drinking and driving
 Accid. Anal. & Prev. 40(2):576-85 ................................................................................ 43

Cheng, W.C., Ng, K. Chan, K., King-Kuen Mok, V. & Kin-Leung Cheung, B.
  (July 2007). Roadside detection of impairment under the influence
  of ketamine—Evaluation of ketamine impairment symptoms with
  reference to its concentration in oral fluid and urine, Forensic Science
  International, 170(1); 51-58. ......................................................................................... 74

Christoffersen , K . Soothill , B. & Francis, M. (June 2008). Risk factors for a first-
  time drink-driving conviction among young men: A birth cohort study
  of all men born in Denmark in 1966, Journal of Substance Abuse
  Treatment, 34(4), 415 - 425. .......................................................................................... 24

A.S. Christophersen; J.Mrland (March 2008). Frequent Detection of
  Benzodiazepines in Drugged Drivers in Norway, Traffic Injury
  Prev., 9(2):99-104. ........................................................................................................ 58

Citek, K., Ball, B., Rutledge, D.E. (November 2003). Nystagmus Testing
  in Intoxicated Individuals Optometry 74(11); 695-710. ............................................. 79

Cochems, A, Harding, P. & Liddicoat, L. (May 2007). Dextromethorphan in
  Wisconsin drivers. J Anal Toxicol., 31(4):227-32. ..................................................... 65

S. Couture, T. Brown, M.C. Ouiment, C. Gianoulakis, J. Tremblay, R. Carbonneau
   (Jan. 2008). Hypothalamic-pituitary-adrenal axis response to stress in
   male DUI recidivists. Accid. Anal. & Prev. 40(1): 246-53 ........................................ 45

J. Davey; N. Richards; J. Freeman (September 2007). Fatigue and Beyond: Patterns of
   and Motivations for Illicit Drug Use Among Long-Haul Truck Drivers, Traffic
   Injury Prev.8(3):235-59. ................................................................................................ 62

Dill, P.L., Wells-Parker, E., Cross, G.W., Williams, M., Mann, R.E., Stoduto, G.
  & Shuggi. R.(August 2007). The relationship between depressed mood, s
  elf-efficacy and affective states during the drinking driving sequence.
  Addict Behav. 32(8):1714-8. ......................................................................................... 33

Durant, .R.H, McCoy, T.P., Champion, H., Parries, M.T., Mitra, A,. Martin, B.A.,
  Newman, J. & Rhodes, S.D. (January 2008). Party behaviors and
  characteristics and serial drunkenness among college students.
  J Stud Alcohol Drugs, 69(1):91-9. ................................................................................. 30



                                                                                                                             85
Dyer, K.R. (2008). The detection of illicit drugs in oral fluid: another potential
  strategy to reduce illicit drug-related harm, Drug and Alcohol Review, 27(1), 99 –
  107. ................................................................................................................................ 59

J. Fell, D. Fisher, R. Voas, K. Blackman, A.S. Tippetts (July 2008). The
   relationship of underage drinking laws to reductions in drinking drivers
   in fatal crashes in the United States. Accid. Anal. & Prev. 40(4): 1430-40. ............ 23

D. Fergusson, L.J. Horwood, J. Bodon (July 2008). Is driving under the influence
  of cannabis becoming a greater risk to driver safety than drink driving?
  Findings from a longitudinal study. Accid. Anal. & Prev. 40(4):1345-50 ............... 56

Fiorentino, D.D., Berger, D.E. & Ramirez, J.R. (January 2007). Drinking and
  driving among high-risk young Mexican-American men.
  Accid Anal Prev. 39(1):16-21. ....................................................................................... 39

E.A. Fleming, G. Gmel, P. Bady, B. Yyersin, J.C. Givel, D. Brown, J.B Daeppen
  (Jan. 2007). At-Risk Drinking and Drug Use Among Patients Seeking
  Care in an Emergency Department.
  J. Stud. Alcohol Drugs, 68(1):28-35. ............................................................................. 20

Flowers, N.T., Naimi, T.S., Brewer, R,.D., Elder, R.W., Shults, R.A., & Jiles, R.
  (April, 2008). Patterns of alcohol consumption and alcohol-impaired
  driving in the United States. Alcoholism: Clinical & Experimental
  Research, 32(4):639-44. .................................................................................................. 6

M.T. Gómez-Talegón & F.J. Alvarez (Jan. 2006). Road traffic accidents among
 alcohol-dependent patients: The effect of treatment. Accid Anal. & Prev.
 38(1):201-07. ................................................................................................................. 20

Gonzalez-Wilhelm, Leonardo (June 2007). Prevalence of Alcohol and
  Illicit Drugs in Blood Specimens from Drivers Involved in Traffic
  Law Offenses. Systematic Review of Cross-Sectional Studies,
  Traffic Injury Prev., 8(2):189-98. .................................................................................. 16

Hennessy DA, Lanni-Manley E, Maiorana N. (January 2007). The effects
  of fatal vision goggles on drinking and driving intentions in college
  students. Traffic Inj Prev. 8(1):11-9 ............................................................................. 53

Hettema, J.E., Miller, W.R., Tonigan, J.S. & Delaney, H.D. (March 2008). The test-
  retest reliability of the Form 90-DWI: an instrument for assessing
  intoxicated driving. Psychol Addict Behav, 22(1):117-21........................................... 27

Hingson, R.W., Heeren, T & Edwards, E.M. (March 2008). Age at drinking onset,
  alcohol dependence, and their relation to drug use and dependence, driving



                                                                                                                                      86
   under the influence of drugs, and motor-vehicle crash involvement because
   of drugs. J Stud Alcohol Drugs. 69(2):192-201........................................................... 27

Hlastala MP, Polissar NL, Oberman S. (May 2005). Statistical evaluation of
  standardized field sobriety tests. J Forensic Sci., 50(3):662-9. ................................ 81

Holmgren, A., Holmgren, P., Kugelberg, F.C., Jones, A.W. &Ahlner, J.
  (March 2008) High re-arrest rates among drug-impaired drivers despite
  zero-tolerance legislation. Accid Anal Prev., 40(2):534-40. ....................................... 44

A. Holmgren; P. Holmgren; F.C. Kugelberg; A.W. Jones; J. Ahlner (December 2007).
Predominance of Illicit Drugs and Poly-Drug Use Among Drug-Impaired
  Drivers in Sweden, Traffic Injury Prev., 8(4):361-67 ................................................ 60

B. Hubicka; H. Bergman; H. Laurell (September 2007). Alcohol Problems among
  Swedish Drunk Drivers: Differences Related to Mode of Detection and
  Geographical Region, Traffic Injury Prev., 8(3):224-31. ............................................ 13

Jackson, K.M. (March, 2008). Heavy episodic drinking: Determining
  the predictive utility of five or more drinks. Psychology of Addictive
  Behaviors, 22(1) 68-77 .................................................................................................... 8

Jewell, J.D., Hupp, S.D.A, & Segrist, D.J. (July 2008). Assessing DUI risk:
  Examination of the Behaviors & Attitudes Drinking & Driving
  Scale (BADDS), Addictive Behaviors, 33(7):853-65.................................................... 23

M.B Johnson, R.B. Voas, T. Kelley-Baker, C.D.M. Furr-Holden (July 2008). The
 Consequences of Providing Drinkers With Blood Alcohol Concentration
 Information on Assessments of Alcohol Impairment and Drunk-Driving
 Risk. J. Stud. Alcohol Drug,s 69(4):539-49. ............................................................... 24

Jones, A.W. (March 2008). Ultra-rapid rate of ethanol elimination from blood in
  drunken drivers with extremely high blood-alcohol concentrations.
  International Journal of Legal Medicine, 122(2), 129-34. ............................................. 9

Jones, A.W. (July 2007) Age- and gender-related differences in blood
  amphetamine concentrations in apprehended drivers: lack of association
  with clinical evidence of impairment. Addiction, 102(7), 1085-1091........................ 63

A.W. Jones, A. Holmgren, F.C. Kugelberg (March 2008). Driving Under the
  Influence of Central Stimulant Amines: Age and Gender Differences in
  Concentrations of Amphetamine, Methamphetamine, and Ecstasy in Blood.
  J. Stud. Alcohol Drugs 69(2):202-08. ............................................................................ 59




                                                                                                                           87
Jones, C., Donnelly, N., Swift, W. & Weatherburn, D. (September 2006).
  Preventing cannabis users from driving under the influence of cannabis,
  Accident Analysis & Prevention, 38(5); 854-861. ......................................................... 65

S. Kaplan & C. Giacomo Prato (Nov. 2007). Impact of BAC limit reduction on
   different population segments: A Poisson fixed effect analysis.
   Accid. Anal. & Prev. 39(6):1146-54. ............................................................................. 48

L.A. Kaskutas, W.C. Kerr (July 2008). Accuracy of Photographs to Capture
  Respondent-Defined Drink Size. J. Stud. Alcohol Drugs, 69(4):605-10. ................... 2

H.Z. Khiabani; M.Stokke Opdal; J. Mrland (January 2008). Blood Alcohol
  Concentrations in Apprehended Drivers of Cars and Boats Suspected to Be
  Impaired by the Police, Traffic Injury Prev., 9(1):31-36. ........................................... 11

K.M. King, L. Chassin (Sept. 2008). Adolescent Stressors, Psychopathology, and
  Young Adult Substance Dependence: A Prospective Study. J. Stud.Alcohol
  Drugs, 69(5):629-38. ..................................................................................................... 67

J.R. Kramer, G. Chan, D.M. Dick, S. Kuperman, K.K. Bucholz, H.J. Edenberg,
   L.A. Polgreen, V.M. Hesselbrock, M.A. Schuckit, J.I. Nurnberger, E.S. Kapp,
   B. Porjesz, L.J. Bierut (Sept. 2008). Multiple-Domain Predictors of
   Problematic Alcohol Use in Young Adulthood.
   J. Stud. Alcohol Drugs 69(5):649-59. ............................................................................ 68

H. Kuendig, M. Hasselberg, L. Laflamme, J.B. Daeppen, G. Gmel (March 2008).
  Acute Alcohol Consumption and Injury: Risk Associations and Attributable
  Fractions for Different Injury Mechanisms.
  J. Stud. Alcohol Drugs, 69(2):218-26. ........................................................................... 70

S. Laapotti; Esko Keskinen (2008) Fatal Drink-Driving Accidents of Young
   Adult and Middle-Aged Males—A Risky Driving Style or Risky Lifestyle?
   Traffic Injury Prev., 9(3):195-200. .................................................................................. 5

LaBrie, R.A., Kidman, R.C., Albanese, M., Peller, A.J. & Shaffer, H.J. (July 2007).
  Criminality and continued DUI offense: criminal typologies and
  recidivism among repeat offenders. Behav Sci Law. 25(4); 603-614. ...................... 34

Lapham, S.C., C'de Baca, J., Lapidus, J.,& McMillan, G.P. (October 2007).
  Randomized sanctions to reduce re-offense among repeat impaired-driving
  offenders. Addiction. 102(10):1618-25. ....................................................................... 48

SC. Lapham, L. Ring-Kapitula, J. C’de Baca & G. P. McMillan (Jan. 2006).
  Impaired-driving recidivism among repeat offenders following an intensive
  court-based intervention. Accid. Anal. & Prev. 38(1):162-9..................................... 54




                                                                                                                           88
Lapham, S.C., C'de Baca, J., McMillan, G.P. & Lapidus, J. (2006). Psychiatric
  disorders in a sample of repeat impaired-driving offenders. J Stud Alcohol,
  67(5):707-13. ................................................................................................................. 39

LaPlante, D.A., Nelson, S.E., Odegaard, S.S., LaBrie, R.A. & Shaffer, H.J.. (March
  2008). Substance and psychiatric disorders among men and women repeat
  driving under the influence offenders who accept a treatment-sentencing
  option. J Stud Alcohol Drugs, 69(2):209-17 ................................................................. 28

S. Lemke, K.K. Schutte, P.L. Brennan, R.H. Moos (Sept. 2008). Gender
   Differences in Social Influences and Stressors Linked to Increased
   Drinking. J. Stud Alcohol Drugs 69(5):695-702. ........................................................ 69

Lynskey, M.T., Bucholz, K.K., Madden, P,A, & Heath, A.C. (November 2007).
  Early-onset alcohol-use behaviors and subsequent alcohol-related driving
  risks in young women: a twin study. J Stud Alcohol Drugs, 68(6):798-804. ........... 12

MacDonald, J.M., Morral, A.R., Raymond, B. & Eibner, C. (February 2007). The
 efficacy of the Rio Hondo DUI court: a 2-year field experiment. Eval Rev.
 31(1):4-23. ..................................................................................................................... 52

S. MacDonald; R. Mann; M. Chipman; B. Pakula; P. Erickson; A. Hathaway; P.
   MacIntyre (May 2008) Driving Behavior Under the Influence of Cannabis or
   Cocaine Traffic Injury Prev., 9(3):190-194. ................................................................. 56

Martinez , J.A., Rutledge, P.C., & Sher, K.J. (June 2007). Fake ID ownership and
 heavy drinking in underage college students: prospective findings.
 Psychol Addict Behav., 21(2):226-32. ........................................................................... 35

Matthew, J.W., Pimentel, J.H. & Clark, D.B. (May 2007). Characteristics of DUI
 offenders convicted in wet, dry, and moist counties. Accident Analysis &
 Prevention, 40(3), 976-982............................................................................................ 64

McCarthy, D.M., Lynch, A.M. & Pederson, S.L. (September 2007). Driving
 after use of alcohol and marijuana in college students. Psychol Addict
 Behav. 21(3):425-30. ..................................................................................................... 63

A.T. McCartt; K. Blackman; R.B. Voas (December 2007). Implementation of
  Washington State's Zero Tolerance Law: Patterns of Arrests, Dispositions,
  and Recidivism, Traffic Injury Prev., 8(4):339-45 ...................................................... 12

McKnight, A., Langston, E., McKnight, A.S., Lange, J. (May 2002). Sobriety tests
 for lowblood alcohol concentrations, Accident Analysis and Prevention,
 34(3):305-11. ................................................................................................................. 80




                                                                                                                                 89
McMillan, G.P., Timken, D.S., Lapidus, J., C'de Baca, J., Lapham, S.C. &
 McNeal, M. (April 2008). Underdiagnosis of comorbid mental illness in
 repeat DUI offenders mandated to treatment. J Subst Abuse Treat,
 34(3):320-5. ................................................................................................................... 25

G.P. McMillan, T.E. Hanson & S.C. Lapham (March 2007). Geographic variability
  in alcohol-related crashes in response to legalized Sunday packaged alcohol
  sales in New Mexico. Accid. Analy. & Prev. 39(2):252-7.......................................... 19

Medina-Mora, M.E. (July 2007). Mexicans and Alcohol: Patterns, problems
 and policies. Addiction, 102(7);1041-1045 ................................................................. 34

Meunier, F. & Laperriere, D., (April 2008). A video-based image processing system
 for the automatic implementation of the eye involuntary reflexes
 measurements involved in the Drug Recognition Expert (DRE).
 This paper appears in proceedings: Computer Systems and Applications, 2008.
 AICCSA 2008. IEEE/ACS International Conference, March 31 2008
 -April 4 2008, pp. 599-605. ........................................................................................... 77

J.R. Miller, T.J. Pikora (March 2008). Alcohol consumption among recreational
   boaters: Factors for intervention. Accid. Anal. & Prev. 40(2): 496-501. ................. 29

T. J. Morgan, H.R. White, E.Young Mun (March 2008). Changes in Drinking
   Before a Mandated Brief Intervention With College Students. J. Stud.
   Alcohol Drugs, 69(2):286-90......................................................................................... 70

Moss, H.B., Chen, C.M. & Yi, H.Y. (December 2007). Subtypes of alcohol
 dependence in a nationally representative sample. Drug Alcohol
 Depend., 91(2-3):149-58. .............................................................................................. 31

J.L. Muilenburg, W.D. Johnson, S.L. Usdan, L. Annang & D.L. Clayton
    (Nov. 2007). Prevalence of impaired driving behaviors in a diverse, rural,
    southern middle school. Accid. Anal & Prev. 39(6):1080-87
     ..................................................................................................................................... 31

Newaz, D.D. (Spring 2006). The impaired dual system framework of United
  States drunk-driving law: how international perspectives yield more
  sober results, Houston Journal of International Law • Wntr. ...................................... 78

O'Brien, M.C., McCoy, T.P., Rhodes, S.D., Wagoner, A. & Wolfson, M.
  (May 2008). Caffeinated cocktails: energy drink consumption, high-risk
  drinking, and alcohol-related consequences among college students.
  Acad Emerg Med. 15(5):453-60. ..................................................................................... 6




                                                                                                                                         90
O'Malley, P.M. & Johnston, L.D.. (November 2007). Drugs and driving by
  American high school seniors, 2001-2006. J Stud Alcohol Drugs.
  68(6):834-42 .................................................................................................................. 61

Ouimet, M.C., Brown, T.G., Nadeau, L., Lepage, M., Pelletier, M., Couture, S.,
  Tremblay, J., Legault, L., Dongier, M., Gianoulakis, C., & Ng Ying Kin, N.M..
  (July 2007). Neurocognitive characteristics of DUI recidivists.
  Accid Anal Prev. 39(4):743-750. ................................................................................... 34

Pil, K. & Verstraete, A. (April 2008). Current developments in drug testing in
   oral fluid. Therapeutic Drug Monitoring, 30(2):196-202. ........................................... 57

Poulin, C., Boudreau, B., & Asbridge, M. (April 2007). Adolescent passengers
  of drunk drivers: a multi-level exploration into the inequities of risk and
  safety. Addiction, 102(1):51-61. ................................................................................... 18

M. Rakauskas, N. Ward, E. Boer, E. Bernat, M. Cadwallader, C. Patrick
 (Sept. 2008). Combined effects of alcohol and distraction on driving
 performance. Accid. Analy. & Prev. 40(5):1742-49. ................................................... 22

M. Ramstedt (July 2007). Alcohol and fatal accidents in the United States—
 A time series analysis for 1950–2002. Accid. Anal. & Prev. 40(4):1257-81. ............. 15

Rider, R., Voas, R.B., Kelley-Baker, T., Grosz, M. & Murphy, B. (June 2007).
  Preventing alcohol-related convictions: The effect of a novel curriculum
  for first-time offenders on DUI recidivism. Traffic Inj Prev., 8(2):147-52. ............. 51

A. Ronen, P. Gershon, H. Drobiner, A. Robinovich, R. Bar-Hamburger,
  R. Mechoulam, Y. Cassuto, D. Shinar (May 2008). Effects of THC on driving
  performance, physiological state and subjective feelings relative to alcohol.
  Accid. Anal & Prev. 40(3): 926-34 ................................................................................ 57

Roth, R., Voas, R. & Marques, P. (December 2007). Interlocks for first offenders:
  effective? Traffic Inj Prev. 8(4):346-52. ...................................................................... 47

Roth R, Voas R, & Marques P. (January 2007). Mandating interlocks for fully
  revoked offenders: the New Mexico experience. Traffic Inj Prev. 8(1):20-5........... 53

Rubenzer, S.J. (October 2007). The Standardized Field Sobriety Tests: A Review
  of Scientific and Legal Issues. Law and Human Behavior,
  DOI 10.1007/s10979-007-9111-y ................................................................................. 81

Ryb, G.E., Dischinger, P., Kufera, J. & Soderstrom, C. (May 2007). Smoking is a
  marker of risky behaviors independent of substance abuse in injured
  drivers. Traffic Inj Prev. 8(3):248-52. .......................................................................... 36




                                                                                                                                91
Schermer, C. R., Apodaca, T. R., Albrecht, R.M., Lu, S. W., & Demarest, G.B.
  (December 2001). Intoxicated motor vehicle passengers warrant screening
  and treatment similar to intoxicated drivers. Journal of Trauma-Injury
  Infection & Critical Care, 51(6):1083-86. .................................................................... 40

Schwartz, J. (April 2008) Gender differences in drunk driving prevalence
  rates and trends: A 20-year assessment using multiple sources of evidence.
  Addictive Behavior, April, 2008. ..................................................................................... 7

Shaffer, H.J., Nelson, S.E., LaPlante, D.A., LaBrie, R.A., Albanese, M.,
  & Caro, G. (October 2007). The epidemiology of psychiatric disorders
  among repeat DUI offenders accepting a treatment-sentencing option.
  J Consult Clin Psychol., 75(5):795-804. ....................................................................... 32

Shinar and, D. & Schechtman. E. (September 2005). Drug identification
  performance on the basis of observable signs and symptoms, Accident
  Analysis & Prevention, 37(5), 843-851. ........................................................................ 75

Silber, B.Y., Papafotiou, K., Croft, R.J. & Stough, C.K. (October 2005). An
   evaluation of the sensitivity of the standardized field sobriety tests to detect
   the presence of amphetamine. Psychopharmacology (Berl). 182(1):153-9. ............. 74

Smith, J.A., Hayes, C.E., Yolton, R.L., Rutledge, D.E., Citek, K. (July 2002).
  Drug Recognition Expert Evaluations Using Limited Data, Forensic Science
  International 130(3); 167-173. ...................................................................................... 76

C.B. Snowden, T.R. Miller, G.M. Waehrer, R.S. Spicer (Sept. 2007). Random
  Alcohol Testing Reduced Alcohol-Involved Fatal Crashes of Drivers of Large
  Trucks. J. Stud. Alcohol Drugs, 68(5):634-40. ........................................................... 49

G. Stoduto, P. Dill, R.E. Mann, E. Wells-Parker, T. Toneatto, R. Shuggi
  (Sept. 2008). Examining the Link Between Drinking-Driving and
  Depressed Mood. J. Stud. Alcohol Drugs 69(5):777-80. ............................................ 22

Stuster, J. (Fall 2006). Validation of the Standardized Field Sobriety Test Battery
   at 0.08% Blood Alcohol Concentration, Human Factors, 48(3); 608–614.
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Stuster, J. (2005). The Standardized Field Sobriety Test Battery: A Summary
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