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CORK Bibliography: Driving and Substance Use

99 citations. October 2007 to present

Prepared: September 2008

Albalate D. Lowering blood alcohol content levels to save lives: The European experience. Journal of Policy Analysis and Management 27(1): 20-39, 2008. (52 refs.)

Road safety is of increasing concern in developed countries because of the significant number of deaths and large economic losses. One tool commonly used by governments to deal with road accidents is the enactment of stricter policies and regulations. Drunk driving is one of the leading concerns in this field and several European countries have decided to lower their illegal Blood Alcohol Content levels to 0.5 mg/ml over the last decade. This study uses European panel-based data (CAPE) for the period 1991-2003 for the first time to evaluate the effectiveness of this transition by applying the differences-in-differences method in a fixed effects estimation that allows for any pattern of con-elation (Cluster-Robust). The results show positive policy impacts, particularly on certain groups of victims, such as young males in urban zones. However, there are reasons to expect a short lag in that effectiveness.

Alvarez FJ; Fierro I; Del Rio MC. Cannabis and driving: Results from a general population survey. Forensic Science International 170(2/3, special issue): 111-116, 2007. (27 refs.)

The role of illicit drugs on driving, and particularly of cannabis and driving, is the object of increasing awareness. While there is increasing evidence of their effect on psychomotor performance and increased risk of involvement in traffic accidents, limited information is available concerning factors that can predict the likelihood of driving under the influence of cannabis. The present study aims to determine the past year prevalence of driving under the influence of cannabis, and of being a passenger in a vehicle driven by a person under the influence of cannabis, as well as to examine the correlations with a broad range of potential risk factors. A total of 2500 people, aged between 14 and 70 and living in Castille and Leon (Spain), were surveyed in 2004 with regard to their consumption of alcohol and illicit drugs. Among those who reported cannabis use in the previous year, further assessment was carried out. 15.7% of those surveyed reported cannabis consumption in the previous 12 months, of whom 9.7% reported driving a vehicle under the influence of cannabis during this period, on average eight times. One out of five (19.9%) reported being a passenger in a vehicle driven by a person under the influence of cannabis, on average five times in the previous 12 months. The predictors of driving under the influence of cannabis were the population size of community, the number of drugs consumed, reference to cannabis-related problems and to being a passenger in a vehicle driven by a person under the influence of alcohol. The data show that cannabis consumption and driving is common, and requires more attention from policy makers.

Anpaa; Fleury B; Craplet M; Nalpas B. Alcohol problems in drinking drivers and clinical management methods. [French]. Revue d'Epidemiologie et de Sante Publique 56(2): 109-116, 2008. (11 refs.)

Background. In order to improve knowledge on the typology of drinking drivers, their clinical management and their outcome in terms of alcohol consumption following treatment, 1086 drinking drivers attending one of the 18 outpatient centres for the care of alcoholics participating to the study were studied; those requiring long-term therapy or those mandated to treatment were followed-up during one year. Most of them (95%) were men with a mean age of 38 years. The drinking-driving offence was recorded during an alcohol spot-check (62%), following a traffic accident (23%) or a traffic offence (15%). For 35%, it was the second offence and 19% have been mandated to treatment. Alcohol consumption before checking were based on spirits in 67% of cases and only wine or beer for the remaining 33%. Severe alcohol problems (i.e. abuse or dependence) were diagnosed in 38%, both in men and women. Mean blood alcohol level was 1.6 g/l, without any difference according to sex; it was significantly increased in those checked following a traffic accident, in those having drank spirits, wine and beer and in those having a severe alcohol problem. Follow-up was organized for those mandated to treatment and for a third of the others, including mainly those second-offenders and those with a severe alcohol problem. Observance to appointments were similar in both groups. At the end of follow-up (350 subjects were concerned), 75% were either non- or moderate drinkers while the 25% remaining were still abuser or dependent; the single parameter independently and significantly associated to an absence of alcohol behaviour improvement was "to be mandated to treatment" (RR = 4,4 CI [2,03-9,69], p < 0.001). Our results confirm the high prevalence of severe alcohol problems in drinking drivers and demonstrate that women are concerned as much as men. They assess that since increased blood alcohol levels in drivers are observed whatever the type of alcoholic beverages consumed, all these latter without any exception are dangerous when drank in excess before driving. Finally, our results suggest that mandating to treatment a drinking driver should be discussed and its efficacy revisited.

Arfken CL; Kubiak SP. Characteristics of facilities with specialized programming for drinking drivers and for other criminal justice involved clients: analysis of a national database. Substance Abuse Treatment, Prevention, and Policy 2: article 26, 2007. (26 refs.)

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 driving under the influence/driving while intoxicated offenders (DUI) 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.

Baewert A; Gombas W; Schindler SD; Peternell-Moelzer A; Eder H; Jagsch R et al. Influence of peak and trough levels of opioid maintenance therapy on driving aptitude. European Addiction Research 13(3): 127-135, 2007. (38 refs.)

To evaluate driving aptitude and traffic-relevant performance at peak and trough medication levels in opioid-dependent patients receiving maintenance therapy with either buprenorphine (mean: 13.4 mg) or methadone (52.7 mg) and a medication-free control group, the Addiction Clinic at Medical University Vienna conducted a prospective, open-label trial where 40 opioid-dependent patients maintained either on buprenorphine or methadone were assessed regarding their traffic-relevant performance. Using the standardized Act and React Testsystem (ART) 2020 Standard test battery, traffic-relevant performance was analysed 1.5 h (peak level) and 20 h (trough level) after administration of opioid maintenance therapy. Results showed that patients at trough level had a significantly higher percentage of incorrect reactions (p = 0.03) and more simple errors (p = 0.02) than patients at peak level as well as methadone-maintained patients at peak level tended to perform less well than buprenorphine-maintained patients in some of the test items, e. g. methadone-maintained patients at trough level had a higher number of delayed reactions in the RST3 phase 2 test (p = 0.09) and answered fewer questions correctly in the visual structuring ability test (p = 0.04). This investigation indicates that opioid-maintained patients did not differ significantly at peak vs. trough level in the majority of the investigated items and that both substances do not appear to affect traffic-relevant performance dimensions when given as a maintenance therapy in a population where concomitant consumption would be excluded.

Barry AE; Misra R; Dennis M. Assessing driving while intoxicated (DWI) offender characteristics and drinking problems utilizing the numerical drinking profile (NDP). Journal of Alcohol and Drug Education 50(3): 66-79, 2006

Driving a vehicle under the influence of alcohol is a major public health concern. By distinguishing the type of individuals violating driving while intoxicated (DWI) sanctions, intervention programs will be better suited to reduce drinking and driving. The purpose of this study was to examine the personal characteristics of DWI offenders and assess their drinking problem utilizing the Numerical Drinking Profile (NDP). Respondents consisted of 199 DWI offenders enrolled in a court mandated DWI education program from 2001-2003. Multivariate regression analysis indicated that older offenders, those who began drinking at an earlier age, and individuals arrested for their first alcohol-related offense at a younger age were more likely to have a potential or evident alcohol problem.

Beirness DJ; Davis CG. Driving after drinking in Canada. Canadian Journal of Public Health 95(6): 476-480, 2007. (22 refs.)

Background: Despite substantial decreases in the magnitude of the alcohol-crash problem over the past 25 years, many Canadians continue to drive under the influence of alcohol, causing thousands of serious injuries and deaths every year. Methods: Data from the 2004 Canadian Addiction Survey (CAS) were used to determine the prevalence of self-reported driving after drinking and the characteristics of those who engage in the behaviour. Results: Overall, 11.6% of licensed drivers in Canada reported operating a vehicle within an hour of consuming two or more drinks containing alcohol. Less than 5% of licensed drivers accounted for 86% of the more than 20 million (estimated) past-year drinking and driving occurrences. Drinking Drivers reported more extensive and problematic use of alcohol, and were more likely to report illegal drug use relative to Non-drinking Drivers. Conclusion: Driving after drinking remains a common behaviour among Canadian drivers. Those who persist in driving after drinking can be distinguished from other drivers on the basis of their greater use of alcohol and drugs. Those who drive after drinking frequently consume even greater quantities of alcohol on more frequent occasions and are more likely to experience problems as a result of their drinking. These findings suggest that countermeasure efforts need to be continued on all levels and expanded to specifically target high-risk heavy drinkers.

Biggs SN; Smith A; Dorrian J; Reid K; Dawson D; van den Heuvel C et al. Perception of simulated driving performance after sleep restriction and caffeine. Journal of Psychosomatic Research 63(6): 573-577, 2007. (32 refs.)

Objective: As feelings of alertness are reported to be highly correlated with performance perception, the objective of this study was to determine whether caffeine, a common countermeasure to driver sleepiness, affected a sleepy driver's ability to monitor his or her simulated driving performance. Methods: Twelve healthy young adults (six males, six females) participated in three counterbalanced, blinded, daytime conditions: control [9 h time in bed (TIB)], 100 mg caffeine (4 h TIB), and placebo (4 h TIB). Driving performance was measured through lane drift on a series of 30-min simulated driving sessions. Subjective sleepiness and perception of driving performance were measured at 5-min intervals during driving sessions via the Karolinska Sleepiness Scale and a corresponding perception scale. Results: Sleep restriction had a significant detrimental effect on driving performance and subjective measures. Caffeine resulted in significant improvements across all measures. Subjective measures were found to be significantly correlated after sleep restriction and prior to caffeine. Correlations between actual and perceived performance were nonsignificant across all conditions. Conclusions: The strong correlation between subjective measures supports the postulation that sleepiness is used as a cue for performance prediction when sleep restricted. The relationship between perceived and actual performance after fatigue countermeasures remains inconclusive. Further research, addressing limitations, is needed.

Bjerre B; Kostela J; Selen J. Positive health-care effects of an alcohol ignition interlock programme among driving while impaired (DWI) offenders. Addiction 102(11): 1771-1781, 2007. (14 refs.)

Aims: To compare the costs of hospital care and sick leave/disability pensions between two groups of driving while impaired (DWI) offenders: participants in an alcohol ignition interlock programme (AIIP) and controls with revoked licences, but with no comparable opportunity to participate in an AIIP. Setting: As an alternative to licence revocation DWI offenders can participate in a voluntary 2-year AIIP permitting the offender to drive under strict regulations entailing regular medical check-ups. The participants are forced to alter their alcohol habits and those who cannot demonstrate sobriety are dismissed from the programme. Participants are liable for all costs themselves. Design: Quasi-experimental, with a non-equivalent control group used for comparison; intent-to-treat design. Based on the number of occasions/days in hospital and on sick leave/disability pension, the health-care costs for public insurance have been calculated. Finding: Average total health-care costs were 25% lower among AIIP participants (1156 individuals) than among controls (815 individuals) during the 2-year treatment period. This corresponds to over 1000 (SEK9610) less annual costs per average participant. For those who complete the 2-year programme the cost reduction was more pronounced; 37% during the treatment and 20% during the post-treatment period. Conclusions: The positive health-care effects were due apparently to reduced alcohol consumption. The social benefit of being allowed to drive while in the AIIP may also have contributed. The reduction in health-care costs was significant only during the 2-year treatment period, but among those who completed the entire AIIP sustained effects were also observed in the post-treatment period. The effects were comparable to those of regular alcoholism treatment programmes.

Bjerre B; Thorsson U. Is an alcohol ignition interlock programme a useful tool for changing the alcohol and driving habits of drink-drivers? Accident Analysis and Prevention 40(1): 267-273, 2008. (15 refs.)

This study evaluates whether the completion of an alcohol ignition interlock programme (AIIP) results in lasting changes of the behaviour of drink drivers and whether such a programme is more effective than a conventional licence 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 licence 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 licences, 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 relicensed 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 I 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 relicensed a similar reduction in traffic accidents, but not in DWI recidivism, was observed. In the post-treatment period sick leave, but not hospital-care utilisation, differed significantly between the groups. Conclusions: The completion of an AIIP has favourable effects compared to conventional licence revocation and would appear to be a useful tool for attaining lasting changes in the alcohol and driving habits of DWI offenders.

Bramness JG; Skuytveit S; Neutel CI; Morland J; Engeland A. Minor increase in risk of road traffic accidents after prescriptions of antidepressants: A study of population registry data in Norway. Journal of Clinical Psychiatry 69(7): 1099-1103, 2008. (33 refs.)

Objectives: Experimental studies have shown that both depression and the use of antidepressants may impair the ability to drive a motor vehicle. Population-based studies have been inconclusive. Differences in results have been shown for cyclic, sedating antidepressants and newer, nonsedating antidepressants. The objective of the present study was to examine whether the use of antidepressants by drivers increased the risk of being involved in traffic accidents. Method: From April 2004 to September 2006, information on prescriptions, road accidents, and emigrations/deaths was obtained from 3 Norwegian population-based registries. Data on people between the ages 18-69 (N = 3.1 million) were linked. Exposure consisted of receiving prescriptions for any antidepressants. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents during time exposed with the incidence over the time not exposed. Sedating antidepressants (tricyclic antidepressants, mianserin, and mirtazapine) were studied together as one group, and newer, nonsedating antidepressants (selective serotonin reuptake inhibitors, moclobemide, venlafaxine, and reboxetine) as another. Results: During the study period, 20,494 road accidents with personal injuries occurred, including 204 and 884 in which the driver was exposed to sedating antidepressants or newer, nonsedating antidepressants, respectively. The traffic accident risk increased slightly for drivers who had received prescriptions for sedating antidepressants (SIR = 1.4, 95% Cl = 1.2 to 1.6) or nonsedating antidepressants (SIR = 1.6, 95% CI = 1.5 to 1.7). The SIR estimates were similar for mate and female drivers and slightly higher for young drivers (18-34 years of age) using older sedative antidepressants. SIR estimates did not change substantially for different time periods after dispensing of the prescription, for concomitant use of other impairing drugs, or for new users. Conclusion: There was a slightly increased risk of being involved in a traffic accident after having received a prescription for any antidepressants. In the present study, it was not possible to determine whether this increase was due to the antidepressant, the effect of the depression, or characteristics of the patients being prescribed these drugs.

Bramness JG; Skurtveit S; Morland J; Engeland A. The risk of traffic accidents after prescriptions of carisoprodol. Accident Analysis and Prevention 39(5): 1050-1055, 2007. (45 refs.)

Objective: Carisoprodol, a drug used for acute lower back pain, may cause psychomotor impairment. We wanted to investigate if patients using carisoprodol had increased risk of being involved in a traffic accident. Methods: Data were retrieved from three population-based registries for the period April 2004-September 2005. The Norwegian Prescription Database contained individual information on all dispensed drugs at all pharmacies outside hospitals. The Norwegian Road Accident Registry contained information on all drivers involved in motor vehicle accidents with person injury. The Norwegian Central Population Registry was used to control for emigration or death. The accident incidence among carisoprodol exposed and unexposed subjects was compared by standardized incidence ratio. Results: Having a prescription for carisoprodol dispensed increased the standardized incidence ratio for being involved in an accident with person injury to 3.7 (95% CI 2.9-4.8) the first week after the date of dispensing. This was similar to diazepam (2.8; 2.2-3.6), but higher than for salbutamol (1.1; 0.6-1.8). Conclusions: Patients receiving carisoprodol seem to have an increased risk of being involved in traffic accidents involving person injury. The study gives support to earlier work published on the impairing effects of carisoprodol.

Broughton J. The correlation between motoring and other types of offence. Accident Analysis and Prevention 39(2): 274-283, 2007. (6 refs.)

This paper examines the link between traffic offences and criminal offences in Great Britain statistically by linking offence data from two national sources: the Driving and Vehicle Licensing Agency (DVLA) and the Home Office. A stratified sample of over 52,000 drivers was selected from DVLA records and matched with the Home Office Offenders Index. The numbers of motoring and non-motoring offences committed by these drivers between 1999 and 2003 were compared at various levels of detail. The results demonstrate the strength of the relationship between the number of motoring and non-motoring offences committed. For example, men who committed between 4 and 8 non-motoring offences committed on average 21 times as many serious motoring offences as men who committed no non-motoring offences, and 3.9 times as many other motoring offences. The strongest relationship was found for the offence of driving while disqualified: on average, men who committed at least 9 non-motoring offences between 1999 and 2003 committed more than 100 times as many of these offences as men who committed no non-motoring offences. At the other extreme, the number of speeding offences was found to decrease with the number of non-motoring offences committed.

Campbell G; Degenhardt L. Australian Capital Territory Drug Trends 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 269. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (26 refs.)

This report reports data on the use of illicit drugs in ACT, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, and antidepressants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 94 figures and tables.

Cavaiola AA; Strohmetz DB; Abreo SD. Characteristics of DUI recidivists: A 12-year follow-up study of first time DUI offenders. Addictive Behaviors 32(4): 855-861, 2007. (23 refs.)

77 individuals convicted of a drinking and driving (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 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.

Chamberlain E; Solomon R. Zero blood alcohol concentration limits for drivers under 21: Lessons from Canada. Injury Prevention 14(2): 123-128, 2008. (63 refs.)

Graduated licensing programs (GLPs) that include zero or low blood alcohol concentration (BAC) restrictions have proven to be a popular and effective measure for improving traffic safety among young people. However, a major drawback of such programs, at least in Canada, is that the BAC restriction is lifted on completion of the GLP, which typically occurs around the age of 18 or 19. This corresponds to the legal drinking age in Canada, a time when alcohol consumption and rates of binge drinking increase. It is not surprising, then, that 18 - 20 year-old drivers are dramatically overrepresented in alcohol-related deaths and injuries. One way to address this problem is to raise the legal drinking age, as has occurred in the United States. In jurisdictions, like Canada, that are unlikely to raise the legal drinking age, other measures are necessary to separate drinking from driving among 18 - 20 year-olds. This article recommends that the zero BAC restrictions be extended beyond the completion of the GLP, until drivers reach the age of 21. The scientific evidence for such a measure is reviewed, and the growing government support for enacting such BAC limits in Canada is described.

Chikritzhs T; Stockwell T. The impact of later trading hours for hotels (public houses) on breath alcohol levels of apprehended impaired drivers. Addiction 102(10): 1609-1617, 2007. (19 refs.)

Aims: To examine the impact of extended trading permits (ETPs) for licensed hotels in Perth, Western Australia on impaired driver breath alcohol levels (BALs) between July 1993 and June 1997. Design: Forty-three hotels obtained ETPs allowing later closing hours and 130 maintained standard closing time (controls). Impaired driver BALs were linked to 'last place of drinking' hotels. Before and after period BALs of drivers who last drank at ETP or non-ETP hotels were compared by time of day of apprehension and sex, controlling for age. Findings: Impaired female drivers apprehended between 10.01 p.m. and 12 midnight (before closing time) had significantly lower BALs after drinking at ETP hotels. Male drivers aged 18-25 years and apprehended between 12.01 and 2.00 a.m. after drinking at ETP hotels had significantly higher BALs than drivers who drank at non-ETP hotels. Conclusions: At peak times for alcohol-related offences, late trading is associated with higher BALs among those drinkers most at risk of alcohol-related harm.

Ch'ng CW; Fitzgerald M; Gerostamoulos J; Cameron P; Bui D; Drummer OH et al. Drug use in motor vehicle drivers presenting to an Australian, adult major trauma centre. Emergency Medicine of Australasia 19(4): 359-365, 2007. (25 refs.)

Objectives: To determine the drug use in injured Victorian drivers involved in motor vehicle collisions and subsequently transported to a major adult trauma centre in Victoria. Methods: A blood sample was obtained from patients who had been taken to The Alfred Emergency & Trauma Centre (Prahran, Vic., Australia) following a motor vehicle collision. This was performed at the same time and under the same law as compulsory blood screening in Victoria (Section 56 of the Road Safety Act). Four hundred and thirty-six specimens were analysed. Blood stored in vacutainer tubes containing preservative were screened for drugs using enzyme-linked immunosorbent assay and gas chromatography-mass spectometry analysis. Medically administered drugs were excluded from the results. Results: Four hundred and thirty-six specimens were analysed. Metabolites of cannabis were the most commonly found drug (46.7%), the active form of cannabis (Delta 9-tetrahydrocannabinol) was found in 33 specimens (7.6%). The next most prevalent drugs were benzodiazepines (15.6%), opiates (11%), amphetamines (4.1%) and methadone (3%). Cocaine was detected in 1.4% of cases. Of the motor vehicle collisions 66% involved males and females of 15-44 years old and Delta 9-tetrahydrocannabinol was almost exclusively found in this age group. In motor vehicle collisions involving older drivers there was an increasing use of benzodiazepines. In women > 65 years old 30% were positive for benzodiazepines. Conclusions: Drug usage found in this group of injured drivers was disturbingly high. The introduction of further initiatives to decrease the prevalence of drug use in motor vehicle drivers is required.

Couture S; Brown TG; Ouimet MC; Gianoulakis C; Tremblay J; Carbonneau R. Hypothalamic-pituitary-adrenal axis response to stress in male DUI recidivists. Accident Analysis and Prevention 40(1): 246-253, 2008. (64 refs.)

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 driving under the influence of alcohol (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 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 I I 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 (R-2 = 0.23, p = 0.008), followed by number of cigarettes smoked daily (R-Delta(2) = 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 behaviours including DUI recidivism, sensation seeking, and cigarette smoking.

de Graaff B; Bruno R. Tasmanian Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 273. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (70 refs.)

This report reports data on the use of illicit drugs in Tasmania, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 135 figures and tables.

Dill PL; Wells-Parker E; Cross GW; Williams M; Mann RE; Stoduto G et al. The relationship between depressed mood, self-efficacy and affective states during the drinking driving sequence. Addictive Behaviors 32(8): 1714-1718, 2007. (6 refs.)

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 (Driving Under the Influence) 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.

Drummer OH. The role of drugs in road safety. Australian Prescriber 31(2): 33-35, 2008. (7 refs.)

Drug use is increasingly associated with road accidents. While alcohol and illicit substances dominate, a number of prescription drugs contribute to injury and death. Most drugs do not significantly increase the risks of accidents if they are taken as prescribed, however a number of commonly used drugs can impair the ability to drive safely. Awareness that some drugs affect driving will help to reduce their potential impact on road safety.

Drummer OH; Gerostamoulos D; Chu M; Swann P; Boorman M; Cairns I. Drugs in oral fluid in randomly selected drivers. Forensic Science International 170(2/3): 105-110, 2007. (29 refs.)

There were 13,176 roadside drug tests performed in the first year of the random drug-testing program conducted in the state of Victoria. Drugs targeted in the testing were methamphetamines and Delta(9)-tetrahydrocannabinol (THC). On-site screening was conducted by the police using DrugWipe (R), while the driver was still in the vehicle and if positive, a second test on collected oral fluid, using the Rapiscan (R), was performed in a specially outfitted "drug bus" located adjacent to the testing area. Oral fluid on presumptive positive cases was sent to the laboratory for confirmation with limits of quantification of 5, 5, and 2 ng/mL for methamphetamine (MA), methylenedioxy-methamphetamine (MDMA), and THC, respectively. Recovery experiments conducted in the laboratory showed quantitative recovery of analytes from the collector. When oral fluid could not be collected, blood was taken from the driver and sent to the laboratory for confirmation. These roadside tests gave 313 positive cases following GC-MS confirmation. These comprised 269, 118, and 87 cases positive to MA, MDMA, and THC, respectively. The median oral concentrations (undiluted) of MA, MDMA, and THC was 1136, 2724, and 81 ng/mL. The overall drug positive rate was 2.4% of the screened population. This rate was highest in drivers of cars (2.8%). The average age of drivers detected with a positive drug reading was 28 years. Large vehicle (trucks over 4.5 t) drivers were older; on average at 38 years. Females accounted for 19% of all positives, although none of the positive truck drivers were female. There was one false positive to cannabis when the results of both on-site devices were considered and four to methamphetamines.

Dula CS; Dwyer WO; LeVerne G. Policing the drunk driver: Measuring law enforcement involvement in reducing alcohol-impaired driving. Journal of Safety Research 38(3): 267-272, 2007. (49 refs.)

Introduction: With many thousands of deaths still annually attributable to driving under the influence (DUI), it remains imperative that we continually address the problem of producing and sustaining effective countermeasures, and that we subject these efforts to empirical scrutiny. This article presents relevant findings from state-wide datasets. Results: A formula generating a potentially useful metric for assessing aspects of the DUI prosecutorial chain is presented, focusing on the rate of proactive DUI arrests. While in need of cautious interpretation due to issues of inherent inaccuracies in large databases, small numbers of crashes and/or arrests in multiple jurisdictions, and the lack of replication in other states, the analyses show no relationship between the level of DUI arrest activity and DUI-related crashes. This finding brings into question the efficacy of the many millions of dollars devoted each year to targeted DUI enforcement, as it is currently being implemented. Conclusions: Results are discussed in terms of developing adequate disincentives to DUI so as to raise general deterrence via dramatic increases in proactive DUI enforcement and then engaging in pervasive and persistent social marketing of such efforts to maximize the perception that arrest and punishment for DUI is always imminent, that penalties will be swift, certain, and severe. It is echoed that accurate data need to be collected at all levels of the DUI arrest and prosecution process in every jurisdiction within a state, so as to facilitate the empirical assessment of countermeasure efficacy in reducing alcohol-related crashes. Impact on Industry: Given that this work needs to be replicated, the impact on the traffic safety industry is potentially huge. The present data indicate that law enforcement efforts to further abate DUI-related crashes are apparently ineffective, though likely necessary to maintain reductions achieved in the 80s and early 90s. Thus, to attain additional systematic reductions, a dramatic increase in enforcement will be necessary as will a diversification of abatement efforts, including an increase in aggressive social marketing tactics to positively impact our traffic safety culture by making DUI universally unacceptable (for a discussion of this latter issue and on the use of positive reinforcement to change driver behavior, see Dula & Geller, 2007).

Dyer KR; Wilkinson C. 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, 2008. (67 refs.)

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. In this Harm Reduction Digest, Dyer and Wilkinson describe the technology, its strengths and limitations and provide examples of where it is currently being employed in practice.

Engeland A; Skurtveit S; Morland J. Risk of road traffic accidents associated with the prescription of drugs: A registry-based cohort study. Annals of Epidemiology 17(8): 597-602, 2007. (24 refs.)

PURPOSE: The aim of this study was to examine the risk of a car driver being involved in a road traffic accident while using prescribed drugs. We used data from population-based registries. METHODS: Information on prescriptions, road traffic accidents, and emigrations/deaths was obtained from population-based registries. The incidence of accidents in the exposed person-time was compared with the incidence in the unexposed person-time, by the standardized incidence ratio (SIR). All Norwegians ages 18-69 between April 2004 and September 2005 (3.1 million), were included in the study. RESULTS: A total of 13,000 road traffic accidents with personal injuries were registered. The risk of being involved in an accident was somewhat increased in users of prescribed drugs in the first seven days after the date of dispensing (SIR for both sexes combined = 1.4; 95% confidence interval: 1.3-1.5). The risk was markedly increased in users of natural opium alkaloids (2.0; 1.7-2.4), benzodiazepine tranquillizers (2.9; 2.5-3.5), and benzodiazepine hypnotics (3.3; 2.1-4.7). Somewhat increased or unchanged SIRs were found for nonsteroidal antiiflammatory drugs 0.5; 1.3-1.9), selective beta-2-adrenoreceptor agonists (i.e., antiasthmatics, 1.5; 1.0-2.1), calcium receptor antagonists (0.9; 0.5-1.5), and penicillin (1.1; 0.8-1.5). CONCLUSIONS: The increased risk of being involved in a road accident as driver while receiving prescribed opiates and benzodiazepines supported the results from other studies.

Far AC; Roig DA; Jerez MJ; Franzke NTB. Relationship between alcohol, drug use and traffic accidents related to nightlife among a Spanish youth sample in three Autonomous Communities in 2007. Revista Espanola de Salud Publica (Spanish) 82(3): 323-331, 2008. (23 refs.)

Background: The phenomenon known as binge drinking and other drug abuse frequently occurs among young people in nightlife-related areas. This study analyzes the risk behaviours and the accident rate related to alcohol and other drugs among a sample of young people involved in nightlife. Method: A total of 440 young people from 3 Spanish Autonomous Communities took part. The sample size was estimated by means of Respondent Driven Sampling. The statistical analyses mined frequencies and measurements of the relationship of driving risk-related behaviour in relation to the accident rate, number of cases of drunkenness, frequency of accidents during the past month, influence of gender and age, as well as the predictiveness of these variables as regards the accident rate. Results: A total of 50.2% of these young people bad gotten into a vehicle with a driver who was drunk and/or under the influence of drugs, 23.2% has driven when drunk and 23.5% under the influence of drugs. The greater the degree of involvement in nightlife, the higher the frequency of drunkenness [chi(2) (9)= 112.24; p<.000]; the greater the man her of cases of drunkenness, the higher the frequency of thes behaviors: getting into a vehicle with drivers who are drunk or under the influence of drugs [c(2)=36,442, (3) p<0.001], drunken driving [chi(2) =23,748, (3) p<0.001] and driving while under the influence of drugs [chi(2)=23,816 (3) p<0.001]. The regression analysis highlighted drunken driving (odds-ratio=5.4) as the risk behaviour most related to traffic accidents. Conclusions: There is a high incidence of risk behaviours while driving vehicles. Drunkenness, drug use and involvement in nightlife increase the frequency of these behaviours. Drunken driving was the best accident predictor.

Farrell LJ; Kerrigan S; Logan BK. Recommendations for toxicological investigation of drug impaired driving. Journal of Forensic Sciences 52(5): 1214-1218, 2007. (6 refs.)

Investigation of a suspected alcohol or drug impaired driving (DUID) case ideally contains several key elements, including a trained officer documenting observations of driving and subject behavior, and collection of a biological specimen for comprehensive toxicology testing. There is currently no common standard of practice among forensic toxicology laboratories in the United States as to which drugs should be tested for, and at what analytical cutoff. Having some uniformity of practice among laboratories would ensure that drugs most frequently associated with driving impairment were consistently evaluated, that appropriate methods were used to screen and confirm the presence of drugs, and that more accurate data were collected on the extent of drug use among drivers. A survey of United States laboratories actively involved in providing analytical support to the Drug Evaluation and Classification Program identified marijuana, benzodiazepines, cocaine, prescription and illicit opiates, muscle relaxants, amphetamines, CNS depressants, and sleep aids used as hypnotics, as being the most frequently encountered drugs in these cases. This manuscript presents recommendations as to what specific members of these drug classes should at a minimum be tested for in the investigation of suspected DUID cases. Additionally we include recommendations for analytical cutoffs for screening and confirmation of drugs in blood and urine. Adopting these guidelines would ensure that the most common drugs would be detected, that laboratories could compare epidemiological findings between jurisdictions, and that aggregate national statistics on alcohol and drug use in drivers involved in fatal injury collisions were representative of the true rates of drug use in the driving population.

Featherston J; Lenton S. Western Australia Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 268. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (22 refs.)

This annual survey reports data on the use of illicit drugs in Western Australia. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs. For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 77 figures and tables.

Fergusson DM; Horwood LJ; Boden JM. Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a longitudinal study. Accident Analysis and Prevention 40(4): 1345-1350, 2008. (41 refs.)

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 behaviours. 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.

Flowers NT; Naimi TS; Brewer RD; Elder RW; Shults RA; Jiles R. Patterns of alcohol consumption and alcohol-impaired driving in the United States. Alcoholism: Clinical and Experimental Research 32(4): 639-644, 2008. (46 refs.)

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 drivers in the United States. Methods: 2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged >= 18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as >= 5 drinks for men 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 alcohol-impaired 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 alcohol-impaired driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of alcohol-impaired driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of alcohol-impaired 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/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively. Conclusions: There is a strong association between binge drinking and alcohol-impaired driving. Most alcohol-impaired drivers and almost half of all alcohol-impaired driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce alcohol-impaired driving.

Grotenhermen F; Leson G; Berghaus G; Drummer OH; Krueger HP; Longo M et al. Developing limits for driving under cannabis. Addiction 102(12): 1910-1917, 2007. (32 refs.)

Objective: Development of a rational and enforceable basis for controlling the impact of cannabis use on traffic safety. Methods: An international working group of experts on issues related to drug use and traffic safety evaluated evidence from experimental and epidemiological research and discussed potential approaches to developing per se limits for cannabis. Results: In analogy to alcohol, finite (non-zero) per se limits for delta-9-tetrahydrocannabinol (THC) in blood appear to be the most effective approach to separating drivers who are impaired by cannabis use from those who are no longer under the influence. Limited epidemiological studies indicate that serum concentrations of THC below 10 ng/ml are not associated with an elevated accident risk. A comparison of meta-analyses of experimental studies on the impairment of driving-relevant skills by alcohol or cannabis suggests that a THC concentration in the serum of 7-10 ng/ml is correlated with an impairment comparable to that caused by a blood alcohol concentration (BAC) of 0.05%. Thus, a suitable numerical limit for THC in serum may fall in that range. Conclusions: This analysis offers an empirical basis for a per se limit for THC that allows identification of drivers impaired by cannabis. The limited epidemiological data render this limit preliminary.

Haberfellner EM. Referrals for psychiatric examination of driving ability: A comparison of illicit drugs and alcohol. (German). Neuropsychiatrie 22(2): 137-142, 2008. (19 refs.)

Introduction: In Austria vehicle drivers impaired by drugs or alcohol have to undergo a psychiatric examination. Drivers who are not accused for impaired driving have to undergo a psychiatric examination too if they are suspected to be alcohol - or drug addicted. Public health officers decide on the need to refer to psychiatric examination. Methods: 145 drivers suspected to be alcohol - or drug addicted had been referred to the author for psychiatric examination between January 2002 and August 2005. The records of these patients were examined for the following criteria: the reason for psychiatric examination (accident, impaired driving, others), the pattern of substance using, abnormal laboratory testing (urine test, lever function test, carbohydrate-deficient transferrin). Alcohol consumers/abusers and drug consumers/abusers were compared. Results: Alcohol consumers/abusers (n=75) had regularly been penalized for impaired driving (86.7%) or for accidents (26.7%) and 88% had consumed alcohol regularly (once a week or more). Only few drug consumers/abusers (n=86, mostly cannabis) had been penalized for impaired driving (7%), none had an accident and 69.8% had consumed illicit drugs once a week or more. In the vast majority of these cases other reasons than impaired driving caused authorities' action. Laboratory tests were abnormal in 37.3% of alcohol consumers/abusers and in 4.7% of drug consumers/abusers indicating ongoing substance use. Conclusion: Although the increasing use of cannabis and amphetamines is a problem, our data indicate that still alcohol is by far the most dangerous psychotropic substance for traffic safety. Authorities seem to overestimate the risk for road safety associated with illicit drug use.

Hall W; Homel R. Reducing cannabis-impaired driving: Is there sufficient evidence for drug testing of drivers? Addiction 102(12): 1918-1919, 2007. (16 refs.)

There is increasing evidence that cannabis users who drive while intoxicated put themselves and others at increased risk of motor vehicle crashes. Cannabis produces dose-related cognitive and behavioural impairments in laboratory and simulator studies; cannabis users in surveys are more likely to report being involved in accidents than drivers who do not use the drug , and cannabis is the illicit drug detected most often in drivers who have been killed in motor vehicle crashes. Cannabis use appears to increase the risk of motor vehicle crashes by two to three times, a much lower risk than alcohol (from six to 15 times). Given the lower risk and lower prevalence of cannabis than alcohol use, the proportion of accidents attributable to cannabis is much lower than that for alcohol (an estimated 2.5% of fatal accidents in France compared to 29% for alcohol. Is there now sufficient evidence to discourage cannabis users from driving by conducting roadside drug testing? Any such policy requires specification of a level of THC in blood that provides per se evidence of impaired driving. Grotenhermen and colleagues, in this issue, have derived a provisional definition of a per se level using epidemiological evidence and a meta-analysis of laboratory and simulator studies. Given the limited scientific evidence for a per se level of THC the Australian drug testing regimens lack evidential support. The illegality of cannabis has prompted a 'zero tolerance' approach in Australia, with any detectable amount of the drug tested constituting an offence . On this policy, the definition of a per se level is irrelevant because road safety benefits are secondary to enforcement of drug laws. The success of Australian roadside drug testing, accordingly, needs to be evaluated thoroughly to see if it reduces drug driving at an acceptable social and economic cost. If evidence of an impact on drug driving is forthcoming, citizens should have the right to debate whether these public health benefits offset the threats to democratic freedoms.

Harrison ELR; Marczinski CA; Fillmore MT. Driver training conditions affect sensitivity to the impairing effects of alcohol on a simulated driving test to the impairing effects of alcohol on a simulated driving test. Experimental and Clinical Psychopharmacology 15(6): 588-598, 2007. (31 refs.)

Research shows that prior behavioral training in a challenging environment reduces alcohol-induced impairment on simple psychomotor tasks. However, no studies have examined if this relationship generalizes to driving performance. The present study examined simulated driving performance and tested the hypothesis that a challenging training history would protect against the impairing effects of alcohol on driving performance. The challenging training history involved driving in a visual ly-impoveri shed environment. Thirty adults were randomly assigned to one of three groups. Two groups were tested under alcohol (0.65 g/kg) after prior experience performing the task under either a visually-impoverished environment or a normal visual environment. The remaining group served as a control and was trained and tested under the visually-impoverished condition environment. Results showed that individuals trained in the impoverished environment displayed sober levels of performance when their performance was subsequently tested under alcohol. By contrast, volunteers trained in a normal environment showed impairment under alcohol. The findings suggest that differences in driving training history can affect a driver's sensitivity to the impairing effects of alcohol.

Hingson RW; Heeren T; Edwards EM. 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. Journal of Studies on Alcohol and Drugs 69(2): 192-201, 2008. (32 refs.)

Objective: We explored among people who ever consumed alcohol whether early age at 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 US. 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 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.

Hutchens L; Senserrick TM; Jamieson PE; Romer D; Winston FK. Teen driver crash risk and associations with smoking and drowsy driving. Accident Analysis and Prevention 40(3): 869-876, 2008. (48 refs.)

Motor vehicle crashes are the leading cause of death for young people in the United States. The goal of this study was to identify risk factor profiles of teen and young adult drivers involved in crashes. General demographic and behavioral as well as driving-related factors were considered. Analysis of a nationally representative telephone survey of U.S. young drivers ages 14 to 22 (N=900) conducted in 2005 was restricted to 506 licensed drivers (learners excluded). Statistically significant univariate associations between factors of interest and the primary outcome, crash involvement (ever) as a driver, were identified and included within a multivariate logistic regression model, controlling for potential demographic confounders. Aside from length of licensure, only driving alone while drowsy and being a current smoker were associated with having been in a crash. Gaining a better understanding of these behaviors could enhance the development of more customized interventions for new drivers.

Jerome L. Re: Long-acting stimulants for novice drivers with ADHD. (letter). Canadian Journal of Psychiatry 52(9): 614-614, 2007. (3 refs.)

Jewell JD; Hupp SDA; Segrist DJ. Assessing DUI risk: Examination of the Behaviors & Attitudes Drinking & Driving Scale (BADDS). Addictive Behaviors 33(7): 853-865, 2008. (25 refs.)

Despite research findings indicating attitudinal differences among drivers with and without a history of driving under the influence (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' 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 BADDS scale scores. Support for the construct validity as well as concurrent and predictive criterion validity of BADDS scores was also demonstrated. Potential applications for the measure, as well as need for future research are described.

Jones AW; Holmgren A; Kugelberg FC. Concentrations of cocaine and its major metabolite benzoylecgonine in blood samples from apprehended drivers in Sweden. Forensic Science International 177(2-3): 133-139, 2008. (28 refs.)

Cocaine and its major metabolite benzoylecgonine (BZE) were determined in blood samples from people arrested in Sweden for driving under the influence of drugs (DUID) over a 5-year period (2000-2004). Venous blood or urine if available, was subjected to a broad toxicological screening analysis for cannabis, cocaine metabolite, amphetamines, opiates and the major benzodiazepines. Verification and quantitative analysis of cocaine and BZE in blood was done by gas chromatography-mass spectrometry (GC-MS) at limits of quantitation (LOQ) of 0.02 mg/L for both substances. Over the study period 26,567 blood samples were analyzed and cocaine and/or BZE were verified in 795 cases (3%). The motorists using cocaine were predominantly men (>96%) with an average age of 28.3 +/- 7.1 years ( standard deviation, S.D.). The concentration of cocaine was below LOQ in 574 cases although BZE was determined at mean, median and highest concentrations of 0.19 mg/L, 0.12 mg/L and 1.3 mg/L, respectively. In 221 cases, cocaine and BZE were together in the blood samples at mean and (median) concentrations of 0.076 mg/L (0.05 mg/L) and 0.859 mg/L (0.70 mg/L), respectively. The concentrations of BZE were always higher than the parent drug; mean BZE/cocaine ratio 14.2 (median 10.9) range 1-55. Cocaine and BZE were the only psychoactive substances reported in N = 61 cases at mean (median) and highest concentrations of 0.095 (0.07) and 0.5 mg/L for cocaine and 1.01 (0.70) and 3.1 mg/L for BZE. Typical signs of drug influence noted by the arresting police officers included bloodshot and glossy eyes, agitation, difficulty in sitting still and incoherent speech.

Jones AW; Holmgren A; Kugelberg FC. Driving under the influence of cannabis: a 10-year study of age and gender differences in the concentrations of tetrahydrocannabinol in blood. Addiction 103(3): 452-461, 2008. (57 refs.)

Background: Delta(9)-Tetrahydrocannabinol (THC) is the major psychoactive constituent of cannabis and its various preparations. Increasing use of cannabis for recreational purposes has created a problem for road-traffic safety. This paper compares age, gender and the concentrations of THC in blood of individuals apprehended for driving under the influence of drugs (DUID) in Sweden, where a zero-tolerance law operates. Measurements Specimens of blood or urine were subjected to a broad screening analysis by enzyme immunoassay methods. THC positives were verified by analysis of blood by gas chromatography-mass spectrometry (GC-MS) with a deuterium-labelled internal standard (d(3)-THC). All toxicology results were entered into a database (TOXBASE) along with the age and gender of apprehended drivers. Findings: Over a 10-year period (1995-2004), between 18% and 30% of all DUID suspects had measurable amounts of THC in their blood (> 0.3 ng/ml) either alone or together with other drugs. The mean age [+/- standard deviation (SD)] of cannabis users was 33 +/- 9.4 years (range 15-66 years), with a strong predominance of men (94%, P < 0.001). The frequency distribution of THC concentrations (n = 8794) was skewed markedly to the right with mean, median and highest values of 2.1 ng/ml, 1.0 ng/ml and 67 ng/ml, respectively. The THC concentration was less than 1.0 ng/ml in 43% of cases and below 2.0 ng/ml in 61% of cases. The age of offenders was not correlated with the concentration of THC in blood (r = -0.027, P > 0.05). THC concentrations in blood were higher when this was the only psychoactive substance present (n = 1276); mean 3.6 ng/ml, median 2.0 ng/ml compared with multi-drug users; mean 1.8 ng/ml, median 1.0 ng/ml (P < 0.001). In cases with THC as the only drug present the concentration was less than 1.0 ng/ml in 26% and below 2.0 ng/ml in 41% of cases. The high prevalence of men, the average age and the concentrations of THC in blood were similar in users of illicit drugs (non-traffic cases). Conclusions: The concentration of THC in blood at the time of driving is probably a great deal higher than at the time of sampling (30-90 minutes later). The notion of enacting science-based concentration limits of THC in blood (e.g. 3-5 ng/ml), as discussed in some quarters, would result in many individuals evading prosecution. Zero-tolerance or limit of quantitation laws are a much more pragmatic way to enforce DUID legislation.

Jones AW; Holmgren A; Kugelberg FC. Driving under the influence of central stimulant amines: Age and gender differences in concentrations of amphetamine, methamphetamine, and ecstasy in blood. Journal of Studies on Alcohol and Drugs 69(2): 202-208, 2008. (34 refs.)

Objective: A zero-tolerance law for driving under the influence of drugs (DUID) 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-methylenedioxymethamphetamine) 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.

Kim JK; Kim S; Ulfarsson GF; Porrello LA. Bicyclist injury severities in bicycle-motor vehicle accidents. Accident Analysis and Prevention 39(2): 238-251, 2007. (56 refs.)

This research explores the factors contributing to the injury severity of bicyclists in bicycle-motor vehicle accidents using a multinomial logit model. The model predicts the probability of four injury severity outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. The analysis is based on police-reported accident data between 1997 and 2002 from North Carolina, USA. The results show several factors which more than double the probability of a bicyclist suffering a fatal injury in an accident, all other things being kept constant. Notably, inclement weather, darkness with no streetlights, a.m. peak (06:00 a.m. to 09:59 a.m.), head-on collision, speeding-involved, vehicle speeds above 48.3 km/h (30 mph), truck involved, intoxicated driver, bicyclist age 55 or over, and intoxicated bicyclist. The largest effect is caused when estimated vehicle speed prior to impact is greater than 80.5 km/h (50 mph), where the probability of fatal injury increases more than 16-fold. Speed also shows a threshold effect at 32.2 km/h (20 mph), which supports the commonly used 30 km/h speed limit in residential neighborhoods. The results also imply that bicyclist fault is more closely correlated with greater bicyclist injury severity than driver fault.

Kinner SSA; Lloyd B. Queensland Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 272. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (14 refs.)

This report reports data on the use of illicit drugs in Queensland, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 127 figures and tables.

Kreft SF; Epling NM. Do border crossings contribute to underage motor-vehicle fatalities? An analysis of Michigan border crossings. Canadian Journal of Economics 40(3): 765-781, 2007. (22 refs.)

Currently, Michigan residents can avoid the national drinking age of 21 by crossing into Ontario, where the drinking age is 19. This paper explores the impact that border crossings, connecting areas with different minimum legal drinking ages (MLDA), have on motor-vehicle fatalities. We analyse border crossings connecting Michigan to Ontario as well as to its surrounding states in the period in which Michigan's MLDA was raised to 21. Using a 'differences-in-differences-in-differences' approach, we find that the MLDA change did not contribute to increased underage fatalities in border-crossing counties.

LaBrie RA; Kidman RC; Albanese M; Peller AJ; Shaffer HJ. Criminality and continued DUI offense: Criminal typologies and recidivism among repeat offenders. Behavioral Sciences and the Law 25(4): 603-614, 2007. (24 refs.)

We examined over 20,000 arraignment records to define criminal typologies and post-treatment driving under the influence of alcohol (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 reoffense 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.

Lapham SC; Baca JC; Lapidus J; McMillan GP. Randomized sanctions to reduce re-offense among repeat impaired-driving offenders. Addiction 102(10): 1618-1625, 2007. (30 refs.)

Aims: This study, conducted within a driving under the influence (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 (DUII) 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 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.

Laplante DA; Nelson SE; Odegaard SS; Labrie RA; Shaffer HJ. Substance and psychiatric disorders among men and women repeat driving under the influence offenders who accept a treatment-sentencing option. Journal of Studies on Alcohol and Drugs 69(2): 209-217, 2008. (14 refs.)

Objective: Driving under the influence (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.

Leadbeater BJ; Foran K; Grove-White A. How much can you drink before driving? The influence of riding with impaired adults and peers on the driving behaviors of urban and rural youth. Addiction 103(4): 629-637, 2008. (31 refs.)

Aims: Following an ecological model to specify risks for impaired driving, we assessed the effects of youth attitudes about substance use and their experiences of riding in cars with adults and peers who drove after drinking alcohol or smoking cannabis on the youths' own driving after drinking or using cannabis. Design and methods Participants were 2594 students in grades 10 and 12 (mean age = 16 years and 2 months; 50% girls) from public high schools in urban (994) and rural communities (1600) on Vancouver Island in British Columbia, Canada; 1192 of these were new drivers with restricted licenses. Self-report data were collected in anonymous questionnaires. Regression analyses were used to assess the independent and interacting effects of youth attitudes about substance use and their experiences of riding in cars with adults or peers who drove after drinking alcohol or smoking cannabis on youth driving. Findings: Youth driving risk behaviors were associated independently with their own high-risk attitudes and experiences riding with peers who drink alcohol or use cannabis and drive. However, risks were highest for the youth who also report more frequent experiences of riding with adults who drink alcohol or use cannabis and drive. Conclusions: Prevention efforts should be expanded to include the adults and peers who are role models for new drivers and to increase youths' awareness of their own responsibilities for their personal safety as passengers.

Lenne MG. Roadside drug testing: Unanswered questions and future challenges. (editorial). Drug and Alcohol Review 26(2): 107-108, 2007. (8 refs.)

Lillsunde P. Analytical techniques for drug detection in oral fluid. Therapeutic Drug Monitoring 30(2): 181-187, 2008. (47 refs.)

Analytical techniques for detection of drugs in oral fluid (OF) are reviewed with emphasis on applications used in European Union (EU) roadside testing projects. Oral fluid is readily accessible and collectible. It has become an interesting material because no medical personnel are needed for sampling; This matrix is especially applicable for preliminary drug testing in driving under the influence controls and for monitoring illicit drug use in drug treatment. Oral fluid is also an increasingly used specimen in epidemiologic studies and in workplace drug testing. Drugs are present at lower levels in OF than in urine. The window of detection of drugs in OF reflects the corresponding window in blood, suggesting OF as a specimen of choice for roadside testing. Saliva/blood ratios vary from drug to drug, from person to person, and even intraindividually making therapeutic drug monitoring in OF challenging. Several sensitive methods for drug testing in OF have been developed during the last years.

Liourta E; van Empelen P. The importance of self-regulatory and goal-conflicting processes in the avoidance of drunk driving among Greek young drivers. Accident Analysis and Prevention 40(3): 1191-1199, 2008. (40 refs.)

The present study examined self-regulatory and goal-conflicting processes in the avoidance of drunk driving among Greek young drivers. A total of 361 university students in Greece completed a questionnaire, using a retrospective cross-sectional survey design. One-third reported to have driven under the influence of alcohol. Although prior intentions were clearly related to actual avoidance of drunk driving, one out of five respondents had not complied with their intention. An examination of post-intentional correlates of avoidance of drunk driving among positive intenders showed that avoidance of drunk driving was positively related to alcohol limitation plans and alcohol limitation self-efficacy, whereas negative relations were found for goal conflict and behavioural willingness. The present study suggests that people should not only be motivated but also be equipped with self-regulatory strategies aiming at the avoidance of drinking. Finally, goal commitment should be enhanced by increasing the salience of the avoidance goal.

Lynskey MT; Bucholz KK; Madden PAE; Heath AC. Early-onset alcohol-use behaviors and subsequent alcohol related driving risks in young women: A twin study. Journal of Studies on Alcohol and Drugs 68(6): 798-804, 2007. (43 refs.)

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 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.

Mann RE; Adlaf E; Zhao JH; Stoduto G; Ialomiteanu A; Smart RG et al. Cannabis use and self-reported collisions in a representative sample of adult drivers. Journal of Safety Research 38(6): 669-674, 2007. (37 refs.)

Problem: This study examines the relationships between collision involvement and several measures of cannabis use, including driving after using cannabis, among drivers, based on a population survey of Ontario adults in 2002 and 2003. Method: Logistic regression analyses examined self-reported collision involvement in the last 12 months by lifetime use of cannabis, past year use of cannabis, and past year driving after using cannabis, while controlling for demographic characteristics. Results: We found that the odds of reporting collision involvement was significantly higher among cannabis users, and among those who reported driving after cannabis use. Some evidence for a dose-response relationship was seen as well. Discussion: Cannabis users and people who report driving after cannabis use are also more likely to report being involved in a collision in the past year. These observations suggest that collision prevention efforts could be aimed at these groups. Additional work to determine the causal pathways involved in the relationships observed here is needed.

March J. Counseling about proper use of motor vehicle occupant restraints and avoidance of alcohol use while driving: A systematic evidence review for the U.S. Prevention Services Task Force. (editorial). Southern Medical Journal 101(4): 341-342, 2008. (8 refs.)

Marczinski CA; Harrison ELR; Fillmore MT. Effects of alcohol on simulated driving and perceived driving impairment in binge drinkers. Alcoholism: Clinical and Experimental Research 32(7): 1329-1337, 2008. (57 refs.)

Background: Binge drinking (heavy episodic alcohol use) is associated with high rates of impaired driving and myriad alcohol-related accidents. However, the underlying reasons for the heightened accident risk in this demographic group are not known. This research examined acute alcohol effects on simulated driving performance and subjective ratings of intoxication and driving ability in binge and nonbinge drinkers. Methods: Young social drinking college students (24 binge drinkers and 16 nonbinge drinkers) participated in this study. Participants attended a session during which they received a moderate dose of alcohol (0.65 g/kg) and a session during which they received a placebo. A simulated driving task measured participants' driving performance in response to each dose. Subjective responses to each dose were also assessed, including ratings of sedation, stimulation, and driving ability. Results: The acute dose of alcohol impaired multiple aspects of driving performance in both binge and nonbinge drinkers. Under alcohol, all participants had greater difficulty in maintaining their lane position, maintaining the appropriate speed and made multiple driving errors compared to placebo performance. By contrast, compared with nonbinge drinkers, binge drinkers reported feeling less sedated by the alcohol and reported having a greater ability to drive following the acute dose of alcohol. Conclusion: Reduced subjective intoxication and perceived driving impairment in binge drinkers may account for the greater accident risk in this demographic group. Binge drinkers may lack the internal sedation cue that helps them accurately assess that they are not able to effectively drive a vehicle after drinking.

Maxwell JC; Freeman J; Davey J. A large-scale study of the characteristics of impaired drivers in treatment in Texas. Journal of Addiction Medicine 1(4): 173-179, 2007. (41 refs.)

Purpose: This is a study of individuals entering treatment who had been arrested for DUI in the past year or who entered treatment while on probation for DUI to determine their levels of impairment and the factors that predict treatment completion and abstinence at follow-up. Methods: Secondary data analysis was performed on an administrative dataset of 29,566 adult Texans who entered publicly funded substance abuse treatment between 2000 and 2005. Multivariate logistic regressions predicted multiple past-year arrests, treatment completion, and abstinence at follow-up. Results: Being older, homeless, having more problems with peer or social relationships, using daily, and having more public intoxication arrests predicted entering treatment with more than 1 DUI arrest in the past year. Individuals with multiple arrests in the past year were more impaired and the least likely to complete treatment or be abstinent in their last month of treatment. The strongest predictor of completing treatment was having been treated in a residential environment (odds ration [OR], 3.35; 95% confidence interval [CI], 2.44-4.6; P < 0.0001), the strongest predictor of past-month abstinence at follow-up was completing treatment (OR, 2.18. 95% CI, 1.83-2.59; P < 0.0001), and the strongest risk factor was living in a situation in which the individual was exposed to alcohol abuse or drug use (OR, 0.13; 95% CI, 0.1-0.17; P < 0.0001). Conclusions: This study provides evidence of the extent of abuse and dependence among DUI arrestees and their need for treatment not only for their substance abuse problems but also for other problems, including co-occurring mental health problems. Closer supervision by probation during follow-up could reinforce abstinence and prevent recidivism.

McCarthy DM; Lynch AM; Pedersen SL. Driving after use of alcohol and marijuana in college students. Psychology of Addictive Behaviors 21(3): 425-430, 2007. (35 refs.)

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.

McIntosh J; O'Brien T; McKeganey N. Drug driving and the management of risk: The perspectives and practices of a sample of problem drug users. International Journal of Drug Policy 19(3): 248-254, 2008. (6 refs.)

This paper reports on a qualitative study of the attitudes and risk management strategies of a sample of problem drug users in relation to driving while under the influence of drugs. Interviews were conducted with 26 individuals (21 men and 5 women) all of whom had been addicted to heroin and had admitted to driving while under the influence of illegal drugs. The drug users reported four main strategies for managing the risks associated with drug driving: attempting to limit their drug intake to their tolerance level; delaying driving after taking a drug until they felt safe; stopping driving if they felt unsafe while behind the wheel; and avoiding driving altogether under the influence of certain drugs. However, the interviewees' accounts of their drug driving behaviour suggest that these strategies are not only far from reliable, they may also act to encourage drug driving by creating a false sense of security. The reassurance they provide may also undermine any educational messages targeting drug driving. There was little in the problem users' accounts to suggest that media campaigns or a more effective method of detection would have much influence upon their behaviour. The paper concludes that the most realistic approach to the problem may be to incorporate drug driving interventions within drug treatment programmes.

McLeod AI; Vingilis ER. Power computations in time series analyses for traffic safety interventions. Accident Analysis and Prevention 40(3): 1244-1248, 2008. (32 refs.)

The evaluation of traffic safety interventions or other policies that can affect road safety often requires the collection of administrative time series data, such as monthly motor vehicle collision data that may be difficult and/or expensive to collect. Furthermore, since policy decisions may be based on the results found from the intervention analysis of the policy, it is important to ensure that the statistical tests have enough power, that is, that we have collected enough time series data both before and after the intervention so that a meaningful change in the series will likely be detected. In this short paper, we present a simple methodology for doing this. It is expected that the methodology presented will be useful for sample size determination in a wide variety of traffic safety intervention analysis applications. Our method is illustrated with a proposed traffic safety study that was funded by NIH.

McMillan GP; Timken DS; Lapidus J; C'de Baca J; Lapham SC; McNeal M. Underdiagnosis of comorbid mental illness in repeat DUI offenders mandated to treatment. Journal of Substance Abuse Treatment 34(3): 320-325, 2008. (25 refs.)

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 underdiagnosis 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 overdiagnosis were low for all disorders, with the exception of drug use disorders. These rates of underdiagnosis represent missed opportunities to improve treatment outcomes among repeat DUI offenders.

Mello MJ; Longabaugh R; Baird J; Nirenberg T; Woolard R. DIAL: A telephone brief intervention for high-risk alcohol use with injured emergency department patients. Annals of Emergency Medicine 51(6): 755-764, 2008. (39 refs.)

Study objective: Brief interventions for high-risk alcohol use for injured emergency department (ED) patients have demonstrated effectiveness and may have a more pronounced effect with motor vehicle crash patients. We report on 3-month outcome data of a randomized controlled trial of injured patients, using a novel model of telephone-delivered brief interventions after ED discharge. Methods: ED research assistants recruited adult injured patients who screened positive for high-risk alcohol use and were to be discharged home. After discharge, participants received by telephone an assessment of alcohol use and impaired driving and then were randomized to treatment (n=140) or standard care (n=145). Treatment consisted of 2 sessions of brief interventions done by telephone, focusing on risky alcohol use. At 3 months, both groups had an assessment of alcohol use and impaired driving. Results: Two hundred eighty-five patients were randomized and had a baseline mean Alcohol Use Disorders Inventory Test (AUDIT) score of 11.0 (SD=7.4). Three-month follow-up assessments were completed on 273 (95%). Mean AUDIT score decreased in both the treatment (mean change=-3.4; 95% confidence interval [CI] -4.5 to -2.3) and standard care group (mean change=-3.2; 95% CI -4.2 to -2.2). Measures of impaired driving decreased for the treatment group (mean change=-1.4 95%; CI -3.0 to 0.2) compared with standard care group (mean change=1.0; 95% CI -0.9 to 2.9; P=.04; d=0.31). Participants were stratified post hoc into 3 groups by baseline alcohol problem, with the treatment effect only being in the highest-scoring group (d=.30). Conclusion: Telephone brief interventions decreased impaired driving in our treatment group. Telephone brief intervention appears to offer an alternative mechanism to deliver brief intervention for alcohol in this at-risk ED population.

Mills KL; Hodge W; Johansson K; Conigrave KM. An outcome evaluation of the New South Wales Sober Driver Programme: A remedial programme for recidivist drink drivers. Drug and Alcohol Review 27(1): 65-74, 2008. (38 refs.)

Introduction and Aims. Recidivist drink drivers pose a considerable threat to public safety. The present study evaluates the effectiveness of a remedial programme for recidivist drink drivers, the New South Wales Sober Driver Programme (SDP). SDP combines educational components and elements of group cognitive behavioural therapy in relation to drink driving behaviour. It is delivered in conjunction with punitive sanctions. Design and Methods. The evaluation design included a comparison of recidivism rates over 2 years for SDP participants and a community control group of convicted drink drivers who received legal sanctions alone. Quantitative and qualitative surveys of SDP participants were also conducted before, immediately after and 4 months after the programme. Outcome measures included recidivism, change in participant knowledge and attitudes, self-reported behavioural intentions and skill development. Results. SDP participants were 43% less likely to re-offend over 2 years compared with community controls who had received sanctions alone. Survey respondents demonstrated improved knowledge, attitudes and skills regarding drink driving. Discussion and Conclusions. SDP appears to be an effective intervention, demonstrating greater reductions in recidivism when compared with legal sanctions alone.

Montgomery FH; Leu MC; Montgomery RL; Nelson MD; Sirdeshmukh M. Use of a virtual reality driving simulator as an alcohol abuse prevention approach with college students. (letter). Journal of Alcohol and Drug Education 50(3): 31-40, 2006. (6 refs.)

Moon C. Northern Territory Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 271. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (50 refs.)

This report reports data on the use of illicit drugs in New South Wales (NSW), derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 123 figures and tables.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Facilities Offering Special Treatment Programs or Groups. (June 14, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (2 refs.)

SAMHSA's National Survey of Substance Abuse Treatment Services (N-SSATS) provides information as to whether substance abuse treatment facilities offered special services. These special treatment services include specially designed treatment programs for adolescents, clients with co-occurring substance abuse and mental disorders, criminal justice clients, persons with HIV or AIDS, gays or lesbians, pregnant or postpartum women, adult women, adult men, seniors or older adults, and persons arrested for driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI). A total of 13,371 substance abuse treatment facilities responded to the 2005 National Survey of Substance Abuse Treatment Services and 83% of them offered at least one special program or group addressing particular needs of specific client types. Among the largest facilities the proportion was 88% and among the smallest, 72%. The most commonly offered special program or group was for persons with co-occurring substance abuse and mental disorders (38%), followed by programs for adult women (33%), adolescents (32%), DWI offenders (31%), criminal justice system clients (28%), adult men (25%), pregnant or post-partum women (14%), those with HIV/AIDS (11%), seniors (7%), and gays/lesbians (6%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: State Estimates of Persons Aged 18 or Older Driving Under the Influence of Alcohol or Illicit Drugs. (April 10, 2008). Rockville MD: Substance Abuse and Mental Health Services Administration, 2008. (7 refs.)

Based on SAMHSA's National Survey on Drug Use and Health, in 2006 an estimated 30.5 million persons aged 12 or older reported driving under the influence of alcohol at least once in the past year and 10.2 million reported driving under the influence of illicit drugs during the past year. Illicit drugs included marijuana/hashish, cocaine, crack cocaine, inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically. Combined survey data from 2004 through 2006 were used to produce average annualized data on driving under the influence of alcohol or illicit drugs in the past year for each State based on self reports by adults aged 18 or older. Based on this combined data from current drivers aged 18 or older, 15.1% had driven under the influence of alcohol during the past year and 4.7% had driven under the influence of illicit drugs. States with the highest rates of driving under the influence of alcohol in the past year among adults aged 18 or older were Wisconsin (26.4%), North Dakota (24.9%), Minnesota (23.5%), Nebraska (22.9%), and South Dakota (21.6%). The highest rates of driving under the influence of illicit drugs in the past year among adults aged 18 or older were in the District of Columbia (7.0%), Rhode Island (6.8%), Massachusetts (6.4%), Montana (6.3%), and Wyoming (6.2%).

Public Domain

O'Malley PM; Johnston LD. Drugs and driving by America high school seniors, 2001-2006. Journal of Studies on Alcohol and Drugs 68(6): 834-842, 2007. (22 refs.)

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 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.

Papadodima SA; Athanaselis SA; Stefanidou ME; Dona AA; Papoutsis I; Maravelias CP et al. Driving under the influence in Greece: A 7-year survey (1998-2004). Forensic Science International 174(2-3): 157-160, 2008. (28 refs.)

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the southern part of Greece. The objective of the present study was to identify the prevalence of alcohol and other psychoactive substances among drivers involved in road traffic accidents in Greece during the period 1998-2004. Alcohol was detected in the blood of about 37% of the drivers involved in traffic accident during the years 1998-2000. The detection of alcohol was lower (29%) in the years 2001-2004. Cannabis, benzodiazepines, opiates, and cocaine were found in 4%, 4%, 4% and 1% of the total number of cases, respectively. The above values were compared with those of a previous study concerning the period 1995--1997 and the reasons for the reduction of the number of alcohol-related traffic accidents during the last years are discussed.

Pehrsson A; Gunnar T; Engblom C; Seppa H; Jama A; Lillsunde P. Roadside oral fluid testing: Comparison of the results of Drugwipe 5 and Drugwipe Benzodiazepines on-site tests with laboratory confirmation results of oral fluid and whole blood. Forensic Science International 175(2-3): 140-148, 2008. (31 refs.)

Drugged drivers pose a serious threat to other people in traffic as well as to themselves. Reliable oral fluid screening devices for on-site screening of drugged drivers would be both a useful and convenient means for traffic control. In this study we evaluated the appropriateness of Drugwipe 5 and Drugwipe Benzodiazepines oral fluid on-site tests for roadside drug screening. Drivers suspected of driving under the influence of drugs were screened with the Drugwipe tests. Oral fluid and whole blood samples were collected from the drivers and tested for amphetamine-type stimulant drugs, cannabis, opiates, cocaine and benzodiazepines by immunological methods, GC and GC-MS. The performance evaluations of the tests were made by comparing the results of the Drugwipe tests with laboratory GC-MS confirmation results of oral fluid or whole blood. In addition to the performance evaluations of the Drugwipe tests based on laboratory results, a questionnaire on the practical aspects of the tests was written for the police officers who performed the tests. The aim of the questionnaire was to obtain user comments on the practicality of the tests as well as the advantages and weak points of the tests. The results of the performance evaluations were: for oral fluid (sensitivity; specificity; accuracy) amphetamines (95.5%; 92.9%; 95.3%), cannabis (52.2%; 91.2%: 85.1%), cocaine (50.0%; 99.3%; 98.6%), opiates (100%; 95.8%; 95.9%), benzodiazepines (74.4%; 84.2%; 79.2%) and for whole blood accordingly, amphetamines (97.7%; 86.7%; 95.9%), cannabis (68.3%; 87.9%; 84.9%), cocaine (50.0%; 98.5%; 97.7%), opiates (87.5%; 96.9%; 96.6%) and benzodiazepines (66.7%; 87.0%; 74.4%). Although the Drugwipe 5 successfully detected amphetamine-type stimulant drugs and the police officers were quite pleased with the current features of the Drugwipe tests, improvements must still be made regarding the detection of cannabis and benzodiazepines.

Pil K; Verstraete A. Current developments in drug testing in oral fluid. Therapeutic Drug Monitoring 30(2): 196-202, 2008. (62 refs.)

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 (eg, the discovery of the presence of THC-COOH in oral fluid) can contribute to solve the issue of false-positive 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.

Ponce JD; Leyton V. Illegal drugs and the traffic: A problem rarely discussed in Brazil. (review) [Portuguese]. Revista de Psiquiatria Clinica 35(Supplement 1): 65-69, 2008. (20 refs.)

Background: Driving is a complex task in which the driver receives, analyzes and reacts to information continuously. Substances that influence brain functions and/or mental processes involved in driving will certainly affect the driver's performance. Psychomotor alterations caused. by illegal drugs have received growing attention in recent years as a possible threat to roadway safety. Research has shown the presence of psychoactive drugs in drivers who were killed or injured in driving accidents, and experimental studies have shown impairment in the performance of individuals under the influence of drugs. Objectives: This study aims to present data on the problem of drug abuse by drivers, the current Brazilian legislation on driving and drug abuse, and what possible measures might be adopted in order to reduce drug-related driving accidents. Methods: The method applied was a literature review of the last fifteen years of publications. Results: The most relevant publications indicate clear evidence of impairment in driving skills under the influence of psychotropic drugs. Conclusions: All psychotropic drugs cause impairment in psychomotor functions and as such, a higher risk of involvement in driving accidents, which makes specific legislation dealing with this issue necessary.

Rapoport MJ; Banina MC. Impact of psychotropic medications on simulated driving: A critical review. (review). CNS Drugs 21(6): 503-519, 2007. (81 refs.)

Driving a motor vehicle is central to the functional autonomy of patients with psychiatric illnesses. There have been many studies of the deleterious effects of psychotropic medications such as benzodiazepines, typical antipsychotics and tricyclic antidepressants (TCAs) on human motor skills; however, in the literature little attention has been paid to how such impairment affects driving ability. Computerised driving simulators offer a laboratory-based method of assessing the effects of specific psychotropic medications on driving abilities, in a standardised, controlled and safe manner. The purpose of the present article is to review research undertaken to-date on the effects of psychotropic medications on computer-simulated driving. A search of various databases, including MEDLINE, EMBASE and PsycInfo, was conducted. Forty-one articles assessing the impact of psychotropics on computer-simulated driving were identified. The pooled total number of subjects assessed in these simulator studies was 1336 (mean sample size 30.36 [SD 35.8]). The most common outcome measures in the various studies were speed, steering, deviation from lateral position (tracking, lane drifting), reaction time or braking accuracy, driving errors (e.g. errors in turning, coordination, gap acceptance, signalling, following distance) and vehicle collisions. The results of the studies were quite variable; however, the most common drug-related impairments included those of tracking and reaction time. Benzodiazepines and TCAs were most commonly associated with impairment, although the level of impairment was dependent on the population studied, the dose and the time of testing relative to drug administration. Computer-simulated driving provides a useful tool to research psychotropic-related impairment of driving abilities. Limitations of currently available data include the lack of generalisability, standardisation and small sample sizes.

Reiling DM; Nusbaumer MR. An exploration of the potential impact of the designated driver campaign on bartenders' willingness to over-serve. International Journal of Drug Policy 18(6): 458-463, 2007. (30 refs.)

Much has been written about the impact of the presence of a designated driver on patrons' consumption, but heretofore, its impact on the behaviour of the server has been virtually ignored. The goal of this paper, then, was to explore the potential impact of the presence of a designated driver on alcoholic beverage servers' self-reported willingness to knowingly serve an already intoxicated customer. chi(2) analysis of survey data collected from 938 licensed servers, in the state of Indiana, USA, was performed. Approximately 43% of the bartenders surveyed reported that they either would be or might be willing to over-serve an already intoxicated customer. Of those who answered the follow-up question as to under what conditions they would be willing to over-serve, almost 80% reported that they would do so if the patron were accompanied by a designated driver. The statistical significance of the relationship between these two variables (.000) raises the question of whether the Designated Driver Campaign has the latent function of enabling some servers to neutralize their responsibility for over-serving by disregarding other types of intoxication-related harm.

Ronen A; Gershon P; Drobiner H; Rabinovich A; Bar-Hamburger R; Mechoulam R et al. Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol. Accident Analysis and Prevention 40(3): 926-934, 2008. (28 refs.)

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 h on any of the measures.

Rupp TL; Acebo C; Seifer R; Carskadon MA. Effects of a moderate evening alcohol dose. II: Performance. Alcoholism: Clinical and Experimental Research 31(8): 1365-1371, 2007. (19 refs.)

Background: This second of a pair of papers investigates the effects of a moderate dose of alcohol and staying up late on driving simulation performance and simple visual reaction time (RT) at a known circadian phase in well-rested young adults. Methods: Twenty-nine adults (9 males), ages 21 to 25 years, spent 1 week on an at-home stabilization schedule of 8.5 to 9 hours, followed by 3 nonconsecutive nights in-lab: adaptation, placebo, and alcohol. Performance task practice occurred on 3 occasions before the study. Alcohol (vodka; 0.54 g/kg men; 0.49 g/kg women mixed with tonic) was consumed over 30 minutes ending 1 hour before normal bedtime; the same quantity of beverage was given on placebo. Driving simulation (with drive-only and dual-task drive and subtract components) and psychomotor vigilance task (PVT) testing occurred before and after alcohol/placebo ingestion. Breath alcohol concentration (BrAC) readings were taken before all test sessions. Saliva samples were taken approximately every 30 minutes to determine circadian phase. Results: Driving simulation and PVT variables significantly deteriorated with increasing time awake. Driving simulator lane variability was worse with alcohol compared with placebo at 15.5 hours awake. No PVT variable showed an effect of alcohol. Conclusions: Driving simulation performance deteriorated with extended waking and with alcohol; driving was most impaired at the peak alcohol level. The PVT, less complex than the driving simulation, did not show effects of alcohol, a finding consistent with previous literature that disruptive effects of low alcohol concentrations increase with task complexity. Overall, simulated driving performance is significantly impaired late at night when even a moderate dose of alcohol is consumed.

Sagaspe P; Taillard J; Chaumet G; Moore N; Bioulac B; Philip P. Aging and nocturnal driving: Better with coffee or a nap? A randomized study. Sleep 30(12): 1808-1813, 2007. (40 refs.)

Study Objective: To test the effects of coffee and napping on nocturnal driving in young and middle-aged participants. Design: A cup of coffee (200 mg of caffeine), a placebo (decaffeinated coffee, 15 mg of caffeine), or a 30-minute nap were tested. Participants drove 125 highway miles between 18:00 and 1930 and between 02:00 and 03:30 after coffee, placebo, or a nap. Setting: Sleep laboratory and open French highway. Participants: Twelve young (range, 20-25 years) and 12 middle-aged participants (range, 40-50 years). Measurements: Inappropriate line crossings, self-perceived fatigue and sleepiness, and polysomnographic recordings were analyzed. Results: Compared to daytime, after placebo the number of inappropriate line crossings was significantly increased (2 versus 73 for young participants, P < 0.01 and 0 versus 76 for the middle-aged participants, P < 0.05). Both coffee and napping reduced the risk of inappropriate line crossings, compared with placebo, in young participants (respectively, by three-quarters, incidence rate ratios [IRR] = 0.26 95% confidence interval [CI], 0.09-0.74, P < 0.05 and by two thirds, IRR = 0.34 95% Cl, 0.20-0.58, P < 0.001) and in middle-aged participants (respectively by nine tenths, IRR = 0.1195% Cl, 0.05-0.21, P < 0.001 and by one fifth, IRR = 0.77 95% Cl, 0.63-0.95, P < 0.05). A significant interaction between age and condition (IRR = 2.27 95% Cl, 1.28-4.16 P < 0.01) showed that napping led to fewer inappropriate line crossings in younger participants than in middle-aged participants. During napping, young participants slept more (P < 0.01) and had more delta sleep (P < 0.05) than middle-aged participants. Self-perceived sleepiness and fatigue did not differ in both age groups, but coffee improved sleepiness (P < 0.05), whereas napping did not. Conclusions: Coffee significantly improves performance in young and middle-aged participants. Napping is more efficient in younger than in older participants. Countermeasures to sleepiness should be adapted according to the age of drivers.

Schwartz J. Gender differences in drunk driving prevalence rates and trends: A 20-year assessment using multiple sources of evidence. Addictive Behaviors 33(9): 1217-1222, 2008. (11 refs.)

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 and Transportation 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