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CORK Bibliography: Driving

110 citations. January 2008 to present

Prepared: September 2009

Arranz JM; Gil AI. Traffic accidents, deaths and alcohol consumption. Applied Economics 41(20): 2583-2595, 2009. (40 refs.)

The main goal of this article is to analyse the relationship existing among prices of alcoholic beverages, alcohol consumption and traffic fatalities for the Spanish Autonomous Communities during the time interval 1998 to 2002. Among the main results, we highlight a positive correlation between alcohol consumption and traffic mortality rate. Basically, governments implement two kinds of policies to reduce the traffic mortality rate. One is oriented to control the supply of alcohol by increasing alcohol taxes. The other is oriented to preserve traffic security, increasing the number of sanctions for traffic rule infraction. We find evidence that both policies exert a positive influence in the reduction of traffic fatalities. There is no empirical evidence to indicate that being a novice driver increases the tendency to be involved in a mortal traffic accident.

Akgur SA; Altintoprak AE; Yuncu Z; Coskunol H. The determination of non-alcoholic substance use in drivers: Why? How? Where? (Turkish). Clinical Psychopharmacology 18(3): 201-207, 2008. (36 refs.)

This article describes the background, legislations and new approaches in Turkey for control of drug use of drivers. In recent years, in parallel to the widespread use of illicit drugs, the number of drivers affected by drugs is also increasing. It is well established that alcohol impairs driving ability and increases the risk of accidents. New studies show the contribution of illicit drugs to fatal/nonfatal rood accidents. With the addition of social, economical and cultural factors, the traffic of drugs has resulted in an increased ratio of drugs of abuse and addiction in our country which is located in a crowded transition area (UNCLEAR). Drinking and driving have become less socially acceptable. Awareness has also grown about the impairment caused by other drugs. Driving under the influence of a legal (prescription drug) or an illegal drug as a controlled substance is controlled by low (Turkish Road Traffic Act 2918 and Related Legislation-Section/97 Prohibition for DUI of alcoholic beverages, narcotics and euphoric substances). In addition, using screening tests on the road (on-site tests) requirement for controlling DUID is compulsory in order to ensure security of our country's roads from materials including saliva, and sweat to determine the drivers who are under the influence of drugs, according to important developments in EU countries in recent years. Proof of drug consumption requires analysis of a body fluid to identify the drug. The various methods of drug analyses in alternative samples each have problems with respect to sample collection, handling, and transportation as well as toxicological assays used. Therefore the determination of illicit drug use in drivers and its influence on driving is very important. Many prescription drugs, especially sedative-hypnotic or strong analgesics, are classified as controlled substances. Also, it should be kept in mind that many addicted patients who constitute a considerable proportion of psychiatric patients may be drivers. Apprehension and punishment of people who chose to drive while impaired has become a higher priority. More stringent controls and onsite tests should be adopted. In this article, drug testing regulations on drivers were evaluated based on legal, social and toxicological principals and the requirements of international standards are discussed.

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.

Anderson DG; Riley P. Determining standards of care for substance abuse and alcohol use in long-haul truck drivers. Nursing Clinics of North America 43(3): 357+, 2008. (18 refs.)

The trucking industry employs approximately 9 million workers, with approximately 3 million being long-haul truck drivers. Truck drivers are exposed to a variety of stressful situations, such as working long hours, no sleep, inadequate rest and relaxation, being away from home and support systems, and driving in hazardous conditions. These risk factors place the long-haul truck driver at an increased risk for possible use or abuse of alcohol and drugs. Identification of those at risk and those who are abusing alcohol and drugs is vitally important for the health of these truckers.

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.

Bajaj JS; Soeian K; Hafeezullah M; Franco J; Thompson A; Anderson R. Failure to fully disclose during pretransplant psychological evaluation in alcoholic liver disease: A driving under the influence corroboration study. Liver Transplantation 14(11): 1632-1636, 2008. (16 refs.)

The prevention of recidivism in alcoholic liver disease is one of the aims of pretransplant psychological evaluation (PE). Failure to fully disclose the extent of alcohol use is evidence of ongoing alcoholism. Driving under the influence (DUI) represents objective evidence of alcohol abuse, but verifying DUIs through official records is not standard during PE. The aim of this study was to determine whether there was failure to fully disclose alcohol abuse on the part of patients on the basis of the Wisconsin Department of Transportation (DOT) DUI rate. Demographics, alcohol abuse/abstinence history, and DUIs admitted by the patient on PE were collected for 82 alcoholic patients with cirrhosis. The DOT was queried for DUIs before PE for all patients. Discrepancies between PE and DOT DUI numbers were evaluated and re-presented to the psychologist without identifiers. Psychosocial recommendation was then evaluated in light of DOT/PE DUI discrepancies. Six patients did not drive. The remaining 76 had 29 8 years of alcohol abuse and reported sobriety for 55 64 months before PE. Eighteen DUIs that were not originally admitted were discovered; 63% of DUIs occurred in the period during which patients claimed to be sober. Two patients had been rejected for transplant for other causes. Re-presenting the case to the psychologist with the new knowledge of DUIs would have prevented transplant clearance for the remaining 16 (21%, P = 0.000005 versus prior PE). In conclusion, official DUI records in prospective transplant candidates may identify patients who do not fully disclose the extent of their alcohol abuse and may be at risk for adverse outcomes.

Barker JC; Karsoho H. Hazardous use of gamma hydroxybutyrate: Driving under the influence. Substance Use & Misuse 43(11): 1495-1508, 2008. (45 refs.)

Focus group discussions elicited descriptive experiences of driving under the influence of gamma hydroxybutyrate (GHB), and uncovered motivations that led participants to decide whether to get behind the wheel after ingesting this illegal psychoactive substance. Of the 51 current and past users interviewed, average age 31.1 +/- 7.7 years, 40% were female. All were recruited from the San Francisco Bay Area, in 2004. Factors making users vulnerable to adverse complications of driving while under the influence of GHB are also examined. Study limitations were noted. Implications for various law enforcement agencies and health professionals are derived from the data.

Begg D; Langley J; Broughton J; Brookland R; Ameratunga S; McDowell A. New Zealand Drivers Study: A follow-up study of newly licensed drivers. Injury Prevention 15(4): e2, 2009. (76 refs.)

Background: Despite significant improvement since graduated licensing was introduced, traffic-related injury remains the leading cause of death and hospitalisation among young New Zealanders. Most research to date has used routinely collected crash data but has been limited in that these databases do not, and realistically cannot, include the level of detail required to ensure that learner driver policy and programmes are based on sound scientific evidence applicable to young drivers in the current New Zealand context. Objectives: To examine the driving-related experiences of newly licensed drivers to identify factors associated with increased or decreased risk of negative traffic outcomes. Design: Multistage prospective cohort study. Setting: New Zealand. Participants: Newly licensed drivers. Variables: Exposures: background demographic details, pre-licence driving, previous crashes, driving intentions, motivations for driving and licensing, sensation seeking, aggression, impulsivity, quality and quantity of driving experience, driving supervision, driving behaviour, alcohol and other drug use, compliance with New Zealand's graduated driver licensing scheme, driver training/education, cell phone use, and sleep. Outcomes: crash, conviction, infringements, risky driving. Data sources: Exposures: participants and their parents. Outcomes: participants and official records. Bias: On the basis of a pilot study, participation and attrition bias are likely to be minimal. A comparison of baseline data for those followed and those not followed will be undertaken. Information bias will be minimised by standardised questionnaires. Information on potential confounders is to be collected and controlled for in analyses. Study size: 5000 (including 1500 Maori). Statistical Methods: Survival analysis, logistic or Poisson regression, generalised estimating equations.

Begg DJ; Gulliver P. A longitudinal examination of the relationship between adolescent problem behaviors and traffic crash involvement during young adulthood. Traffic Injury Prevention 9(6): 508-514, 2008. (22 refs.)

Previous research examining the relationship between adolescent problem behaviors and young adult traffic outcomes (crashes, convictions, risky driving) has produced differing results. Possible reasons for this may be the heterogeneity of the crash outcomes (from minor fender-benders to fatal crashes), the gender of the driver, and/or the age of the driver. The aim of this research was to investigate the relationship between adolescent problem behaviors and young adult crashes to determine the extent to which the above factors influenced this relationship. This study was part of the Dunedin Multidisciplinary Health and Development Study (DMHDS), which is a longitudinal study of a cohort (n = 1,037) born in Dunedin, New Zealand, from April 1972 to March 1973. This cohort has been followed up regularly since birth, and the data for the present research were obtained at the 18-, 21-, and 26-year-old follow-up interviews. The problem behaviors examined were those identified by Jessor in the theory of problem behavior, namely, tobacco smoking, marijuana use, alcohol use, delinquent behavior, and unsafe sexual behavior. Data for these measures were obtained in personal interviews when the cohort was aged 18 years. The self-reported crash data were obtained at the age 21 and age 26 follow-up interviews. Driving exposure, academic qualifications, employment, being a parent, and marital status were included as potential confounders. The results show that involvement in adolescent problem behaviors predicted crash involvement at age 21 for the females but not the males and at age 26 for the males but not the females. Possible explanations for these differences by age and gender are discussed.

Biecheler MB; Peytavin JF; Facy F; Martineau H. SAM survey on "Drugs and Fatal Accidents": Search of substances consumed and comparison between drivers involved under the influence of alcohol or cannabis. Traffic Injury Prevention 9(1): 11-21, 2008. (29 refs.)

Objectives. A survey was conducted to produce reliable epidemiological data concerning the role played by alcohol and drugs in fatal road accidents in France. The aims are to describe the conduct of the survey, evaluate the overall quality of the findings, and analyze the substances consumed by the involved drivers. A comparison between drivers involved under the influence of alcohol only, cannabis only, or both substances is emphasized. Methods. By a June 1999 law, all drivers in France involved in an immediate fatality accident between October 2001 and 2003 had to undergo a urine test and, if that was not possible or the test proved positive, had a blood sample taken in order to test for drugs ( cannabis, cocaine, heroin, amphetamines). The results were combined with the usual procedures of the police force, which include the results of tests for illegal alcohol levels. A unique and reliable set of accident data on the role of drugs was thus compiled for epidemiological purposes: 10,000 accident reports involving over 17,000 drivers were analyzed. The responsibility level of each driver involved in an accident was determined. Results were generated for a representative sample of about 11,000 drivers. Results. Alcohol levels above the legal limit (0.5 g/L of blood) were found in 21% of all drivers involved in accidents ( killed, injured, or unharmed). Cannabis headed the list of illicit drugs detected, with a prevalence of 6.8% (THC >= 1 ng/mL); it was present in the under-35s and especially the under-25s. About 40% of drivers under the influence of cannabis also had an illegal alcohol level. The other drugs, whether alone or in association with cannabis, are relatively rare. Accident characteristics of drivers detected positive for cannabis only are markedly different from drivers under the influence of alcohol. The overrepresentation of drivers responsible, from 1.7 over the whole population, rises to 2.3 for cannabis alone ( THC >= 1 ng/mL), to 9.4 for alcohol alone (>= 0.5 mg/L), and to 14.1 for the alcohol-cannabis combination. Conclusions. The high incidence (26%) of alcohol or drugs among the population of drivers involved in fatal accidents highlights the importance for road safety of the consumption of these substances. Alcohol remains the major risk at any age. Young drivers consuming alcohol and cannabis represent a priority target for prevention.

Bingham CR; Shope JT; Parow JE; Raghunathan TE. Crash types: Markers of increased risk of alcohol involved crashes among teen drivers. Journal of Studies on Alcohol and Drugs 70(4): 528-535, 2009. (49 refs.)

Objective: Teens drink/drive less often than adults but are more likely to crash when they do drink/drive. This study identified alcohol-related crash types for which teen drivers were at greater risk compared with adults. Method: Michigan State Police crash records for drivers ages 16-19 (teens) and 45-65 years (adults) who experienced at least one crash from 1989 to 1996 were used to create alcohol crash types consisting of alcohol-related crashes that included specific combinations of other crash characteristics, such as drinking and driving at night (i.e., alcohol/nighttime). These data were combined with data from the 1990 and 1995 National Personal Travel Surveys and the 2001 National Household Travel Survey to estimate rates and rate ratios of alcohol-related crash types based on person-miles driven. Results: Teens were relatively less likely than adults to be involved in alcohol-related crashes but were significantly more likely to be in alcohol-related crashes that included other crash characteristics. Teen males' crash risk was highest when drinking and driving with a passenger, at night, at night with a passenger, and at night on the weekend, and casualties were more likely to result from alcohol-related nighttime crashes. All the highest risk alcohol-related crash types for teen female drinking drivers involved casualties and were most likely to include speeding, passenger presence, and nighttime driving. Conclusions: The frequency with which passengers, nighttime or weekend driving, and speeding occurred in the highest risk alcohol-related crash types for teens suggests that these characteristics should be targeted by policies, programs, and enforcement to reduce teen alcohol-related crash rates.

Bingham CR; Shope JT; Zakrajsek J; Raghunathan TE. Problem driving behavior and psychosocial maturation in young adulthood. Accident Analysis and Prevention 40(5): 1758-1764, 2008. (40 refs.)

This study examined the association between psychosocial maturation and problem driving behavior in young adulthood. Psychosocial maturation is the process of adopting adult roles, attitudes and behaviors and completing developmental tasks associated with becoming an adult. Past research has demonstrated that individuals' participation in health-risk behaviors decreases as psychosocial maturity increases. Not surprisingly, decreases in driving risk that occur over the first years of driving have often been assumed to result in large degree from general maturation; however, no research has tested this assumption. This study used data from a telephone survey of young adults to begin addressing this gap in the literature by testing three hypotheses: (1) indicators of higher psychosocial maturity are associated with lower problem driving behavior: (2) the association between the level of psychosocial maturity and problem driving behavior is cumulative: and, (3) these associations are moderated by sex. Problem driving behavior was evaluated by assessing three measures: high-risk driving, drink/driving, and drug/driving. Results: supported all three hypotheses. Participants with greater psychosocial maturity had lower levels of problem driving behavior than participants who were less psychosocially mature. Second, problem driving behavior was lower with higher psychosocial maturity. Third, these associations between psychosocial maturity and problem driving behavior were moderated by sex. The primary contributions of this study are: (I) initial evidence that psychosocial maturation may play a role in improvements in the safety of young drivers; and (2) the generation of questions and hypotheses that provide direction for future research on the role Of maturation in observed declines in risk among young drivers.

Bingham CR; Shope JT; Zhu J. Substance-involved driving: Predicting driving after using alcohol, marijuana, and other drugs. Traffic Injury Prevention 9(6): 515-526, 2008. (43 refs.)

Objectives: Substantial research has examined the influence of alcohol, marijuana, and other illicit drugs on driving performance; however, which psychosocial characteristics of individuals who drive while under the influence of alcohol (DUIA), marijuana (DUIM), and other drugs (DUID), how these characteristics interrelate with each other, and how they differ across degrees of substance-involved driving (SID) have not been thoroughly investigated. This article identified psychosocial predictors of SID while accounting for driving behavior and the type and level of substance use and examined the associations of psychosocial characteristics and SID with citations for traffic offenses. Methods: Telephone survey data and state driver history records for a sample of 5,244 young adults were analyzed using t-tests and logistic and multinomial logistic regression analysis to examine the correlates and predictors of substance-involved driving. Results: Psychosocial characteristics predicted DUIA, DUIM, and DUID when tested in separate models and adjusting for driving behavior. When the substance in question was added to each model, a unique association between psychosocial characteristics and DUIA remained, but the associations between psychosocial characteristics and DUIM and DUID were completely mediated by the frequency of marijuana use and level of other drug use in their respective models. Multinomial logistic regression predicting the degree of SID, which was based on the types and combinations of SID behaviors, showed that after controlling for the use of alcohol, marijuana, and other drugs, psychosocial characteristics maintained a unique association with the degree of SID. Finally, when adjusting for driving behavior and psychosocial characteristics, the degree of SID predicted having a traffic offense. Conclusions: These results indicate that reducing substance use is not the only means of targeting substance-involved driving. Interventions could have enhanced effectiveness if they also targeted individual psychosocial and behavioral characteristics, either to alter these behaviors or by tailoring the intervention or program for these characteristics.

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.

Brown TG; Ouimet MC; Nadeau L; Gianoulakis C; Lepage M; Tremblay J et al. From the brain to bad behaviour and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol. (review). Drug and Alcohol Review 28(4): 406-418, 2009. (155 refs.)

Issues. Driving while impaired by alcohol (DWI) is responsible for substantial mortality and injury. Significant gaps in our understanding of DWI re-offending, or recidivism, reduce our ability to practically assess recidivism probability and to match interventions to individual risk profiles. These shortcomings reflect the baffling heterogeneity in the DWI population and the limited focus of much existing DWI recidivism research to psychosocial, psychological and substance use correlates. Approach. This narrative review summarises the evidence for the contribution of neurocognitive and psychobiological mechanisms to DWI behaviour and recidivism. Given the nascent nature of this literature, insight into the putative contribution of these mechanisms to DWI is also drawn from other experimental literatures, particularly those on alcohol use disorders and cognitive and behavioural neuroscience. Key Findings. Alcohol-related neurotoxicity and dysregulation of hypothalamic-pituitary-adrenal axis and serotonergic systems may underlie certain offender characteristics consistently correlated with heightened DWI risk, persistence and intervention resistance. Their markers are less vulnerable to sources of bias than subjective psychosocial indices and are more far-reaching than alcohol abuse in explaining DWI behaviour and recidivism. Implications. The investigation of neurocognitive and psychobiological mechanisms in DWI research is a promising avenue for discerning clinically meaningful subgroups within the DWI population. This can lead to research and development in alternative assessment and more targeted intervention technologies. Conclusion. Multidimensional research in DWI and recidivism offers novel avenues for increasing road safety.

Brown TG; Ouimet MC; Nadeau L; Lepage M; Tremblay J; Dongier M et al. DUI offenders who delay relicensing: A quantitative and qualitative investigation. Traffic Injury Prevention 9(2): 109-118, 2008. (48 refs.)

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

Calafat A; Adrover-Roig D; Blay N; Juan M; Bellis M; Hughes K et al. Which young people accept a lift from a drunk or drugged driver? Accident Analysis and Prevention 41(4): 703-709, 2009. (32 refs.)

Introduction: Riding with a drunk and/or a drugged driver (RDD) is a risk behaviour that has received very little attention in spite of its potential dangers. Young people involved in the recreational nightlife context are especially at risk. Method: 1363 regular users of recreational nightlife from nine European Countries (mean age: 21.75; 51.5% women) filled out a self-administered and anonymous questionnaire (in 2006). Results: 37.2% had practised RDD during the previous month. RDD is related to drunkenness and use of drugs, personality factors such as impulsivity, preferring to use a private car to get to nightlife venues, living in a southern European Country and being unemployed. No significant influence was found for age, gender, educational level or socioeconomic status. Discussion: It is important to raise awareness about the high prevalence of RDD. This lack of awareness can be related to its social acceptance among young people. The use of private cars for going to nightlife venues should be discouraged.

Cashman CM; Ruotsalainen JH; Greiner BA; Beirne PV; Verbeek JH. Alcohol and drug screening of occupational drivers for preventing injury. (review). Cochrane Database of Systemic Reviews 2009(2): article CD006566, 2009. (40 refs.)

Background: Workforce alcohol and drug testing is commonplace but its effect in reducing occupational injuries remains unclear. Objectives: To assess the effects of alcohol and drug screening of occupational drivers (operating a motorised vehicle) in preventing injury or work-related effects such as sickness absence related to injury. Search strategy: We searched the following databases up to June 2007 (or up to the latest issue then available): MEDLINE, EMBASE, The Cochrane Library, Cochrane Occupational Health Field's specialised register, DARE, PsychINFO, ERIC, ETOH, CISDOC, NIOSHTIC, TRANSPORT, Zetoc, Science Citation Index and Social Science Citation index and HSELINE. We also searched reference lists, relevant websites and conducted hand searching. Selection criteria: Randomised controlled trials (RCTs), cluster-randomised trials, controlled clinical trials, controlled before and after studies (more than three time points to be measured before and after the study) and interrupted time-series (ITS) studies that evaluated alcohol or drug screening interventions for occupational drivers (compared to another intervention or no intervention) with an outcome measured as a reduction in injury or a proxy measure thereof. Data collection and analysis: Two review authors independently extracted data and assessed study quality. We contacted authors of the included studies for further information. Main results: We included two interrupted time-series studies conducted in the. One study was conducted in five large US transportation companies (N = 115,019) that carried passengers and/or cargo. Monthly injury rates were available from 1983 to 1999. In the study company, two interventions of interest were evaluated: mandatory random drug testing and mandatory random and for-cause alcohol testing programmes. The third study focused only on mandatory random drug testing and was conducted on federal injury data that covered all truck drivers of interstate carriers. We recalculated the results from raw data provided by the study authors. Following reanalysis, we found that in one study mandatory random and for-cause alcohol testing was associated with a significant decrease in the level of injuries immediately following the intervention (-1.25 injuries/100 person years, 95% CI -2.29 to -0.21) but did not significantly affect the existing long-term downward trend (-0.28 injuries/100 person years/year, 95% CI -0.78 to 0.21). Mandatory random drug testing was significantly associated with an immediate change in injury level following the intervention (1.26 injuries/100 person years, 95% CI 0.36 to 2.16) in one study, and in the second study there was no significant effect (-1.36/injuries/100 person years, 95% CI -1.69 to 0.41). In the long term, random drug testing was associated with a significant increase in the downward trend (-0.19 injuries/100 person years/year, 95% CI -0.30 to -0.07) in one study, the other study was also associated with a significant improvement in the long-term downward trend (-0.83 fatal accidents/100 million vehicle miles/year, 95% CI -1.08 to -0.58). Authors' conclusions: There is insufficient evidence to advise for or against the use of drug and alcohol testing of occupational drivers for preventing injuries as a sole, effective, long-term solution in the context of workplace culture, peer interaction and other local factors. Cluster-randomised trials are needed to better address the effects of interventions for injury prevention in this occupational setting.

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.

Chen MJ; Cunradi C. Job stress, burnout and substance use among urban transit operators: The potential mediating role of coping behaviour. Work & Stress 22(4): 327-340, 2008. (42 refs.)

Urban transit operators, compared to other occupational groups, have higher rates of mortality and morbidity. A major risk factor is the highly stressful objective environment. This study used structural equation modelling to test a model hypothesizing that transit operators' coping behaviours in responding to daily job hassles mediate the associations of work stress with burnout and substance use. The study sample consisted of 1231 transit operators who participated in the San Francisco MUNI Health and Safety Study. The results showed a direct and strong association between transit operators' daily job stress and symptoms of occupational burnout even when a series of controls and coping behaviours were considered. In addition, use of disengage-deny and escapist strategies to cope with job stress was positively associated with burnout; the job stress-burnout association was partially mediated through such coping practices. Daily job stress was related to substance use only indirectly and mediated through burnout and use of disengage-deny and escapist coping strategies. Disengage-deny coping strategies might help reduce substance use whereas escapist coping strategies might increase such use. Overall, our findings suggest that coping behaviour may be an important correlate of transit operators' ill health. Interventions enabling healthy coping behaviours may help reduce health risks for this occupational group.

Christophersen AS; Morland J. Frequent detection of benzodiazepines in drugged drivers in Norway. Traffic Injury Prevention 9(2): 98-104, 2008. (25 refs.)

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

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.

Davey J; Freeman J. Screening for drugs in oral fluid: Drug driving and illicit drug use in a sample of Queensland motorists. Traffic Injury Prevention 10(3): 231-236, 2009. (28 refs.)

Objective: Random roadside oral fluid testing is becoming increasingly popular as an apprehension and deterrence-based countermeasure to reduce drug driving. This article outlines research conducted to provide an estimate of the extent of drug driving in a sample of drivers in Brisbane, Queensland. Methods: Oral fluid samples were collected from 1587 drivers who volunteered to participate at random breath testing (RBT) sites. Illicit substances tested for included cannabis (delta 9 tetrahydrocannibinol [THC]), meth/amphetamines, and cocaine. Drivers also completed a self-report questionnaire regarding their drug-related driving behaviors. Results: Oral fluid samples from 58 participants (3.7%) were confirmed positive for at least one illicit substance. The most common drugs detected in oral fluid were ecstasy (n = 35) followed by cannabis (n = 20). Similarly, cannabis was confirmed as the most common self-reported drug combined with driving. Nevertheless, individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving. Conclusions: This research provides evidence that drug driving is relatively prevalent on some Queensland roads, and thus the behavior presents as a serious road safety threat. This article will further outline the study findings and present possible directions for future drug driving research.

Davey J; Freeman J; Armstrong K. Drugs in oral fluid: Illicit drug use and drug driving in a sample of Gold Coast motorists. Road & Transport Research 17(4): 17-24, 2008. (34 refs.)

The present study examined the prevalence of drug driving in a sample of Queensland drivers. Oral fluid samples were collected from 276 drivers who volunteered to participate at random breath testing sites in the area of the Gold Coast, Queensland. Illicit substances tested for included cannabis (delta 9 tetrahydrocannibinol [THC]), ecstasy (MDMA), amphetamines and cocaine. Drivers also completed a self-report questionnaire regarding their drug-related driving behaviour. Oral fluid samples from 9 participants (3.3%) were found to be positive for at least one illicit substance. The most common drug detected in oral fluid was cannabis (n = 6), followed by amphetamines (n = 3). A key finding was that cannabis was also confirmed as the most common self-reported drug combined with driving, and that individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug-driving. This research provides preliminary evidence that drug driving may be relatively prevalent on Queensland roads. This paper will further outline the major findings of the study and present possible directions for future drug driving research.

De Boni R; Leukefeld C; Pechansky F. Young people's blood alcohol concentration and the alcohol consumption city law, Brazil. Revista de Saude Publica 42(6): June 2009, 2008. (5 refs.)

The paper assesses blood alcohol concentration and ? risk behaviors for traffic accidents before and after the implementation of a law which prohibits the use of alcoholic beverages on city gas stations. In Porto Alegre, Southern Brazil, young people go out at night and drive to gas station convenience stores to buy alcoholic beverages which are consumed on the premises of parking lots in gas stations. Data were obtained from self-administered questionnaires and breath analyzers in two cross-sectional collections with purposive samples of youngsters in May and July 2006 (n=62, and n=50, respectively). There were no significant differences between the groups before and after the city law was passed. Blood alcohol concentration greater than 0.06% was found in 35.5% of pre-law group and 40% of post-law group (p=0.62). Results point out heavy alcohol use in both groups, which did not change after the law was passed.

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.

Dubois S; Bedard M; Weaver B. The impact of benzodiazepines on safe driving. Traffic Injury Prevention 9(5): 404-413, 2008. (48 refs.)

Objective. Benzodiazepines are prescribed to relieve anxiety and aid sleep. Studies demonstrate that benzodiazepines increase odds of crash involvement, but little evidence exists regarding their impact on crash responsibility. We examined the impact of benzodiazepines on crash responsibility by drug half-life and driver age, using a case-control design with drivers aged 20 and over involved in fatal crashes in the United States from 1993-2006. Methods. Drivers (all with BAC = 0) were classified as having no benzodiazepines detected versus short, intermediate, or long half-life benzodiazepines. Cases were drivers with at least one potentially unsafe driving action (UDA) in relation to the crash (e.g., speeding), a proxy measure for crash responsibility; controls had no UDAs recorded. Odds ratios (ORs) of any UDA by benzodiazepines half-life exposure were calculated, with adjustment for age, sex, other medication usage, and prior driving record. Results. Compared with drivers not using benzodiazepines, drivers taking intermediate or long half-life benzodiazepines demonstrated increased odds of an UDA from ages 25 (intermediate OR: 1.59; 95% CI = 1.08, 2.33; long OR: 1.68; 95% CI = 1.34, 2.12) to 55 (intermediate OR: 1.50; 95% CI = 1.09, 2.06; long OR: 1.33; 95% CI = 1.12, 1.57). Drivers taking short half-life benzodiazepines did not demonstrate increased odds compared to drivers not using benzodiazepines. Conclusions. Given the potential impact of benzodiazepines on driver safety, further experimental research is needed to better understand the effect of benzodiazepines on crash responsibility.

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.

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.

Fell JC; Fisher DA; Voas RB; Blackman K; Tippetts AS. Changes in alcohol-Involved fatal crashes associated with tougher state alcohol legislation. Alcoholism: Clinical and Experimental Research 33(7): 1208-1219, 2009. (50 refs.)

Background: This study used a pre- to post-design to evaluate the influence on drinking-and-driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers. Methods: Data on the laws were drawn from the Alcohol Policy Information System data set (1998 to 2005), the Digests of State Alcohol Highway Safety Related Legislation (1983 to 2006), and the Westlaw database. The Fatality Analysis Reporting System data set (1982 to 2004) was used to assess the ratio of drinking to nondrinking drivers involved in fatal crashes [fatal crash incidence ratio (CIR)]. The data were analyzed using structural equation modeling techniques. Results: Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually. Conclusions: These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking-and-driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking-driver crashes.

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.

Fillmore MT; Blackburn JS; Harrison ELR. Acute disinhibiting effects of alcohol as a factor in risky driving behavior. Drug and Alcohol Dependence 95(1/2): 97-106, 2008. (52 refs.)

Automobile crash reports show that up to 40% of fatal crashes in the United States involve alcohol and that younger drivers are over-represented. Alcohol use among young drivers is associated with impulsive and risky driving behaviors, such as speeding, which could contribute to their over-representation in alcohol-related crash statistics. Recent laboratory studies,show that alcohol increases impulsive behaviors by impairing the drinker's ability to inhibit inappropriate actions and that this effect can be exacerbated in conflict situations where the expression and inhibition of behavior are equally motivating. The present study tested the hypothesis that this response conflict might also intensify the disruptive effects of alcohol on driving performance. Fourteen subjects performed a simulated driving and a cued go/no-go task that measured their inhibitory control. Conflict was motivated in these tasks by providing equal monetary incentives for slow, careful behavior (e.g., slow driving, inhibiting impulses) and for quick, abrupt behavior (fast driving, disinhibition). Subjects were tested under two alcohol doses (0.65 g/kg and a placebo) that were administered twice: when conflict was present and when conflict was absent. Alcohol interacted with conflict to impair inhibitory control and to increase risky and impaired driving behavior on the drive task. Also, individuals whose inhibitory control was most impaired by alcohol displayed the poorest driving performance under the drug. The study demonstrates potentially serious disruptions to driving performance as a function of alcohol intoxication and response conflict, and points to inhibitory control as an important underlying mechanism.

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.

Fromme K; Corbin WR; Kruse MI. Behavioral risks during the transition from high school to college. Developmental Psychology 44(5): 1497-1504, 2008. (23 refs.)

The transition from high school to college is an important developmental milestone that holds the potential for personal growth and behavioral change. A cohort of 2,245 students was recruited during the summer before they matriculated into college and completed Internet-based surveys about their participation in a variety of behavioral risks during the last 3 months of high school and throughout the 1 st year of college. Alcohol use, marijuana use, and sex with multiple partners increased during the transition from high school to college, whereas driving after drinking, aggression, and property crimes decreased. Those from rural high schools and those who elected to live in private dormitories in college were at highest risk for heavy drinking and driving after drinking.

Goss CW; Van Bramer LD; Gliner JA; Porter TR; Roberts IG; DiGuiseppi C. Increased police patrols for preventing alcohol-impaired driving. (review). Cochrane Database of Systematic Reviews 4(e-article CD005242), 2008. (170 refs.)

Road traffic injuries cause 1.2 million deaths worldwide each year. Alcohol consumption increases the risk of traffic crashes, especially fatal crashes. Increased police patrols aim to increase both the perceived and actual likelihood of being caught driving while alcohol-impaired, potentially reducing alcohol-related driving, crashes and injuries. Objectives: To assess the effects on injuries and crashes of increased police patrols that target alcohol-impaired driving. Search strategy: We searched the Cochrane Injuries Group Specialised Register (5/2006), CENTRAL (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to 5/2006), TRANSPORT (1968 to 5/2006), C2-SPECTR (2/2005), NCJRS ( 1/1951 to 5/2006), PsycINFO(1872 to 5/2006), Social Science Citation Index (1974 to 5/2006), SIGLE (1980 to 2/2006), Science Citation Index Expanded (1970 to 5/2006), Dissertation Abstracts ( 1870 to 5/2006), NTIS (1964 to 12/2004), conference proceedings, and reference lists. We contacted authors of eligible studies. Selection criteria: Randomized controlled trials, controlled trials, controlled before and after studies, interrupted time series (ITS) studies, and controlled ITS studies evaluating increased police patrols, either alone or combined with other interventions, targeting alcohol-impaired motor vehicle drivers. Data collection and analysis: Two investigators independently screened citations, extracted data, and assessed quality criteria. We compared intervention and no-intervention geographical areas or time periods. We re-analyzed study data as required. Results: are presented narratively. Main results: The 32 eligible studies included one randomized controlled trial, eight controlled before-after studies, 14 controlled ITS studies, six ITS studies, and three studies with both ITS and controlled before-after analyses. Most interventions targeted only alcohol-impaired driving (69%) and included additional interventions such as media campaigns or special training for police officers (91%). Only two studies reported sufficient information to assess study quality completely. Two-thirds of studies were scored 'not adequate' on at least one feature. Five of six studies evaluating traffic fatalities reported reductions with the intervention, but differences were statistically significant in only one study. Effects of intervention on traffic injuries were inconsistent in the six studies evaluating this outcome, and no results: were statistically significant. All four controlled studies evaluating fatal crashes reported reductions with the intervention, which were statistically significant in one study. All 12 controlled studies assessing injury crashes reported greater reductions with the intervention, though effects were minimal or not significant in several studies. ITS studies showed less consistent effects on fatal crashes (three studies) and injury crashes (four studies), and effect estimates were typically imprecise. Thirteen of 20 studies showed reductions in total crashes and about two-thirds of these were statistically significant. Authors' conclusions: Studies examining increased police patrol programs were generally consistent in reporting beneficial effects on traffic crashes and fatalities, but study quality and reporting were often poor. Methodological limitations included inadequate sample size, dissimilar baseline measures, contamination, and inadequate data analysis. Thus existing evidence, although supportive, does not firmly establish whether increased police patrols, implemented with or without other intervention elements, reduce the adverse consequences of alcohol-impaired driving.

Gustavsen I; Al-Sammurraie M; Morland J; Bramness JG. Impairment related to blood drug concentrations of zopiclone and zolpidem compared to alcohol in apprehended drivers. Accident Analysis and Prevention 41(3): 462-466, 2009. (35 refs.)

Background: About 3-7% of the adult population receives prescribed hypnotics. The benzodiazepine-like hypnotics, zopiclone and zolpidem, are the most commonly prescribed and may cause traffic-relevant impairment similar to that found for benzodiazepines. We investigated the relationship between blood zopiclone and zolpidem concentrations and driving impairment, as assessed by the clinical test for impairment. We compared these groups of drivers to a group suspected of alcohol-related impairment. Methods: Blood samples from suspected impaired drivers during 2000-2007, screened for approximately 25 possible impairing drugs with only one single drug detected, were studied in relation to the assessment of impairment. The 79 zopiclone positive drivers, the 43 zolpidem positive drivers, and the 3480 alcohol positive drivers were divided into groups depending on blood drug concentrations. Results/discussion: The proportion of drivers judged as impaired tended to increase the higher the blood zopiclone concentrations. Such a positive relationship was not found for zolpidem. For alcohol the proportion of impaired drivers was significantly related to blood alcohol concentrations (BACs). There were few drivers with low zopiclone or zolpidem concentrations included, which may have obscured any positive significant relationship. The percentage of impaired drivers among drivers with blood zopiclone concentrations above 130 mu g/l roughly corresponded to the percentage of impaired drivers among drivers with BACs higher than 0.1%.

Gustavsen I; Brarnness JG; Skurtveit S; Engeland A; Neutel I; Morland J. Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Medicine 9(8): 818-822, 2008. (31 refs.)

Background: Despite the high prescription rate of benzodiazepine-like hypnotics (z-hypnotics), there is limited information on the road traffic accident risk associated with the use of these drugs. We wanted to investigate whether filling a prescription for zopiclone or zolpidem was associated with increased risk of road traffic accidents at a national population level. Nitrazepam and flunitrazepam were used as comparator drugs. Method: All Norwegians 18-69 years (3.1 million) were followed-up from January 2004 until the end of September 2006. Information on prescriptions, road traffic accidents and emigration/death was obtained from three Norwegian population-based registries. The first week after the hypnotics had been dispensed was considered to be the exposure period. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents in the exposed person-time to the incidence of accidents in the unexposed person-time. Results: During exposure, 129 accidents were registered for zopiclone, 21 for zolpidem, 27 for nitrazepam and 18 for flunitrazepam. The SIRs were (SIR for all ages and both sexes combined; 95% CI): z-hypnotics (zopiclone + zolpidem) 2.3; 2.0-2.7, nitrazepam 2.7; 1.8-3.9 and flunitrazepam 4.0; 2.4-6.4. The highest SIRs were found among the youngest users for all hypnotics. Conclusions: This study found that users of hypnotics had a clearly increased risk of road traffic accidents. The SIR for flunitrazepam was particularly high.

Gustin JL; Simons JS. Perceptions of level of intoxication and risk related to drinking and driving. Addictive Behaviors 33(4): 605-615, 2008. (17 refs.)

This study investigated variables of perceived risk associated with one's decision to drink and drive, as well as with the occurrence and successfulness of intervention efforts by others in preventing individuals from drinking and driving. Undergraduate students were presented with scenarios manipulating number of drinks, consumption time, and distance needed to drive. Participants then provided estimates of intoxication, degree of impairment, and likelihood of getting in an accident and getting arrested for drinking and driving. In addition, participants rated three criterion variables: intention to drive, likelihood someone would try to intervene, and receptiveness to someone attempting to intervene. Data was analyzed using three random effects regression models, one for each of the criterion variables. Results indicated that perceptions of risk were associated with decisions to drive after drinking and expected likelihood of, and receptiveness to, intervention efforts, over and above one's estimate of intoxication

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.

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.

Holt LJ; O'Malley SS; Rounsaville BJ; Ball SA. Depressive symptoms, drinking consequences, and motivation to change in first time DWI offenders. American Journal of Drug and Alcohol Abuse 35(3): 117-122, 2009. (20 refs.)

Background: Psychological disorders are common among driving-while-intoxicated (DWI) offenders; thus, a DWI arrest may serve as an important opportunity for further screening and subsequent treatment. Objectives: The current study examined the extent to which mild to moderate pretreatment depressive symptoms, as measured by the Beck Depression Inventory (BDI), could predict intervention outcomes in 284 first-time DWI offenders. Methods: Participants were given drinking-related and psychosocial assessments at the beginning and end of a 10-week intervention and at 6- and 12-month follow-ups. Results: After the intervention and at both follow-ups, all participants reported declines in depressive symptoms, alcohol consumption, and negative drinking consequences and higher self-efficacy to avoid high-risk drinking. It was notable, however, that offenders with depressive symptoms reported more drinking-related consequences and lower self-efficacy at all time points, but greater motivation to change their drinking behavior. Conclusions: The findings suggest that offenders with depressive symptoms have more severe symptomatology than nondepressed offenders but may be more amenable to changing their drinking. Scientific Significance: The BDI may be a useful screening tool for determining which offenders are in need of an intervention following a DWI arrest.

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.

Impinen A; Rahkonen O; Karjalainen K; Lintonen T; Lillsunde P; Ostamo A. Substance use as a predictor of driving under the influence (DUI) rearrests. A 15-year retrospective study. Traffic Injury Prevention 10(3): 220-226, 2009. (37 refs.)

Background: Recidivism is a major problem in the prevention of DUI offenses. It is suggested that impairing substances used by drivers may relate to a higher risk of recidivism. This study aims to determine rearrest rates in different groups of arrested drivers focusing on different substances found in the blood. Material and Methods: The data utilized were obtained from the register of suspected DUI offenders maintained by the Finnish National Institute for Health and Welfare (THL). Data were available for the 15-year period between 1993 and 2007. The number of rearrests was traced from the individuals' ID codes. The mean blood alcohol concentration (BAC) of the DUI offenders was studied as well as their age at the time of the first arrest. Rearrest rates according to alcohol and drug findings were estimated using survival analysis methods. Results: At the time of the first arrest, the drivers with a single DUI arrest were older and had a lower BAC than those who had a later arrest. The proportion of female drivers decreased as the number of rearrests increased. Drivers with drugs only or a combination of drugs and alcohol had a significantly higher rearrest rate than drivers with alcohol alone. Drivers with amphetamines only had the highest rearrest rates. Findings of benzodiazepine and opioids alone did not increase the risk of rearrest in the long run. Young age, male sex, high blood alcohol level, and arrest during the nighttime and during weekdays constituted a higher risk for rearrest. Conclusions: A third of those suspected of driving under the influence of alcohol and/or drugs are rearrested within 15 years. Drugs, especially amphetamines, are a risk factor for faster rearrest. These results show that the groups at risk of recidivism can be pinpointed. Interventions to prevent recidivism should be developed particularly for drugged drivers. Substance abuse beginning in adolescence seems to be a greater risk.

Ingsathit A; Woratanarat P; Anukarahanonta T; Rattanasiri S; Chatchaipun P; Wattayakorn K et al. Prevalence of psychoactive drug use among drivers in Thailand: A roadside survey. Accident Analysis and Prevention 41(3): 474-478, 2009. (24 refs.)

The objective of this study was to determine the prevalence of psychoactive drug and alcohol use among general drivers and predictors of the drug use in Thailand. One thousand six hundred and thirty-five motor vehicle drivers were randomly selected from five geographical regions of Thailand between December 2005 and May 2006. The prevalence of psychoactive drugs was determined using urine tests by gas chromatography/mass spectrometry (GC/MS). Among 1635 drivers, 5.5% were tested positive for breath alcohol with 2% having a level exceeding the legal limit (>= 50 mg%). Psychoactive drug was presented in 158 (9.7%) urine samples for drug analysis. The top 3 most frequently detected licit drugs were antihistamines (2.0%), sedative cough suppressant (0.7%) and benzodiazepines (0.2%). Illicit drugs detected included amphetamine (1.8%), cannabis (1.1%), mitragynine (Kratom) (0.9%) and morphine (0.1%). Only type of driver (commercial/non-commetcial) was a significant predictor with psychoactive drug use. The prevalence of psychoactive drug use among drivers not involved in road crashes in Thailand was not as low as an earlier study in Europe using objective measurements, particularly among commercial drivers. However, for illicit drugs, the prevalence detected in this study was lower than those of earlier studies from high-income countries.

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. Age and gender differences in blood-alcohol concentration in apprehended drivers in relation to the amounts of alcohol consumed. Forensic Science International 188(1-3): 40-45, 2009. (43 refs.)

This article reports the age, gender, and blood-alcohol concentration (BAC) of people apprehended in Sweden for driving under the influence of alcohol (DUIA) over an 8-year period (2000-2007). Duplicate determinations of ethanol were made in venous blood by headspace gas chromatography and results were reported positive at a cut-off concentration of 0.1 g/L (10 mg/100 ml or 0.01 g%). The mean, median and highest BAC was 1.74 g/L, 1.70 g/L and 5.18 g/L, respectively. The vast majority of offenders were men (89.5%) with a mean age of 39.0 +/- 14.6 y (+/- SD). The women (10.5%) were a few years older 41.8 +/- 13.6 y (p < 0.001). The mean BAC in the men (1.73 +/- 0.85 g/L) did not differ significantly (p > 0.05) from women (1.77 +/- 0.87 g/L). The youngest offenders aged 15-20 y (N = 3513) had a mean BAC of 1.30 +/- 0.60 g/L (median 1.32), which was significantly less (p < 0.001) than people aged 40-50 y (N = 6644): mean 1.90 g/L (median 2.0 g/L). In 95 individuals (89 men and 6 women) the BAC exceeded 4.0 g/L, which is a level considered to cause death by acute alcohol poisoning. The Widmark formula was used to calculate that a man (80 kg) with a BAC of 1.7 g/L has 95 g ethanol (similar to 12 units of alcohol) in the body compared with 61 g (similar to 8 units) for a woman (60 kg). This study verifies that the average drunken driver in Sweden is typically a binge drinker and education programs and treatment for alcohol-use disorder might be a more appropriate sanction than the more conventional penalties for alcohol-impaired driving.

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.

Jones AW; Holmgren A; Kugelberg FC. Driving under the influence of gamma-hydroxybutyrate (GHB). Forensic Science, Medicine and Pathology 4(4): 205-211, 2008. (39 refs.)

We used an in-house forensic toxicology database (TOXBASE) to evaluate the occurrences of gamma-hydroxybutyrate (GHB) in blood samples from people arrested in Sweden for driving under the influence of drugs (DUID) between 1998 and 2007. Age, gender, and concentrations of GHB in blood were compared and contrasted when GHB was the only drug present and when it occurred along with other drugs. GHB was determined in blood by gas chromatography (GC) after conversion to gamma-butyrolactone (GBL) and analysis of the latter with a flame ionization detector. The cut-off concentration of GHB in blood for reporting a positive result was 8 mg/l, which served as limit of quantitation. The mean and median GHB concentrations were 89 mg/l and 82 mg/l, respectively (2 1/2 and 97 1/2 percentiles 12 and 220 mg/l) in 548 arrested drivers. These individuals were predominantly men (95%) with an average age of 26 +/- 5.5 years (range 15-50 years) and women (5%) were several years older with an average age of 32 +/- 8.0 years (range 19-47). There were 102 individuals (29%) who were arrested more than once with GHB in blood (average similar to 3 times per person) and one as many as 10 times. GHB was the only psychoactive substance detected in 215 cases (39%) at mean and median blood-concentrations of 91 mg/l and 83 mg/l, respectively. These concentrations were not significantly different from poly-drug users. A weak but statistically significant correlation existed between the concentration of GHB in blood and the person's age (N = 548, r = 0.135, P < 0.01). The signs of drug influence noted by arresting police officers included sedation, agitation, unsteady gait, slurred speech, irrational behavior, jerky body movements, dilated pupils, and spitting. The blood concentrations reported here are probably appreciably less than at time of driving (30-90 min earlier) owing to the short elimination half-life of GHB (t1/2 = 30-40 min).

Khiabani HZ; Opdal MS; Morland J. Blood alcohol concentrations in apprehended drivers of cars and boats suspected to be impaired by the police. Traffic Injury Prevention 9(1): 31-36, 2008. (24 refs.)

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

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.

Levy S; Williams JF; Knight JR. Screening, brief intervention, and referral to treatment for adolescents: Companion clinical case. Journal of Addiction Medicine 2(4): 222-226, 2008. (17 refs.)

This clinical case presentation which is synthesized from the authors' clinical experiences discusses a health maintenance visit for a 16-year-old boy. On routine screening, his pediatrician identifies that he is using marijuana and at times driving after smoking. Two expert clinicians discuss the challenges of managing adolescents and when and how to risk the therapeutic relationship by breaking confidentiality.

Liang L; Huang JD. Go Out or Stay In? The effects of zero tolerance laws on alcohol use and drinking and driving patterns among college students. Health Economics 17(11): 1261-1275, 2008. (19 refs.)

Zero tolerance laws make it illegal per se for anyone under age 21 to drive with any measurable amount of blood alcohol. Although a link has been established between zero tolerance laws and lower motor vehicle fatalities, research has not produced strong evidence on how zero tolerance laws influence individual alcohol use and drinking and driving behaviors. Using a unique data set and a difference-in-difference-in-difference-type research design, we are able to analyze a number of pathways through which zero tolerance laws can work among an important underage population, college students. We find that zero tolerance laws reduce drinking and driving among college students. Further analysis of our detailed alcohol use measures Suggests that zero tolerance laws are particularly effective at reducing the probability of driving after drinking for those who reported drinking away from home.

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.

Lin MR; Kraus JF. A review of risk factors and patterns of motorcycle injuries. (review). Accident Analysis and Prevention 41(4): 710-722, 2009. (219 refs.)

Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training. conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.

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.

MacDonald S; Mann R; Chipman M; Pakula B; Erickson P; Hathaway A et al. Driving behavior under the influence of cannabis or cocaine. Traffic Injury Prevention 9(3): 190-194, 2008. (23 refs.)

Objective. The purpose of this study is first to describe perceptions of driving under the influence of cannabis or cocaine among clients in treatment and, second, to assess whether these perceptions are related to the frequency of driving under the influence of cannabis or cocaine. Methods. A questionnaire was administered to clients in treatment for abuse of either cocaine or cannabis, many of whom also had a problem with alcohol; additional groups of clients consisted of those in smoking cessation and gambling programs (N = 1021). Open-ended and close-ended questions were used to assess self-reported effects of cannabis or cocaine on driving and frequency of driving under the influence of cannabis, cocaine, or alcohol. Results. Two dimensions of driving behavior under the influence of cocaine or cannabis were found in both qualitative and quantitative analyses: 1) physical effects and 2) reckless styles of driving. Common physical effects for both drugs were heightened nervousness, greater alertness, and poorer concentration. In terms of driving behavior, cautious or normal driving was commonly reported for cannabis, whereas reckless or reduced driving ability was frequently reported for cocaine. When comparing negative physical effects and reckless style of driving with frequency of driving under the influence of cannabis or cocaine, increased negative physical effects from cannabis were inversely related to frequency of driving under the influence of cannabis (p = .001), but other relationships were not significant. Conclusions. The findings indicate that both cannabis and cocaine have detrimental but different effects on driving. The negative physical effects of cannabis may reduce the likelihood of driving under the influence of cannabis.

Majdzadeh R; Feiz-Zadeh A; Rajabpour Z; Motevalian A; Hosseini M; Abdollahi M et al. Opium consumption and the risk of traffic injuries in regular users: A case-crossover study in an emergency department. Traffic Injury Prevention 10(4): 325-329, 2009. (30 refs.)

Objective. The cause-specific annual death rate due to traffic injuries is around 30 in 100,000 in Iran. On the other hand, this country has the highest proportion of opiate users in the world. Little is known about the transient effect of opium on traffic injuries. The objective of this study was to explore the effect of opium consumption on traffic injuries in drivers who use opium. Methods. Seventy-five regular opium users who suffered traffic injuries were studied in a case-crossover investigation. The study subjects had been admitted to the single trauma emergency department in Kerman, a city in southeast Iran. The relative risk (RR) of short-term opium effect was estimated by considering frequency of driving after opium consumption during 6 hours before the accident in comparison to the usual frequency of driving after opium consumption by the same persons. Stratified data analysis was performed by the Mantel-Haenszel method. Results. The opium consumption of drivers up to 6 hours before the accident was associated with an increased RR = 3.2, 95 percent confidence interval (CI): 1.9, 5.4. The third hour after consumption had the greatest magnitude of effect considering RR = 4.29, 95 percent CI:2.65, 6.95. Conclusions. These results suggest a heightened risk of traffic injuries after opium consumption in regular users. The RR in the third hour after consumption could be explained by considering the greater probability of driving compared to the immediate hours after use, rather than peak effect time of opiates. The results indicate necessity of regular assessment of all common drivers, especially truck and bus drivers, regarding use of opium.

Mangold FT; Sommers MS; Kent G; Fargo J. Harmful drinking, depression, and conduct disorder among females involved in alcohol-related motor vehicle crashes: A secondary analysis. Journal of Addictions Nursing 10(1): 9-15, 2008. (35 refs.)

Alcohol is involved in 40% of the deaths that occur from traffic injury in the US. Little is known, however, about factors that are associated with alcohol-related traffic injury in women. The purpose of this study was to analyze the relationships among alcohol consumption and two psychological variables (depression and conduct disorder) in a sample of women with harmful drinking patterns and who were involved in an alcohol-related motor vehicle crash (ARMVC). Wilsnack's theoretical model of causes and consequences of problem drinking among women was used to guide the study. The sample included 43 participants, 18 to 45 years old, with a mean age of 28.84 years (SD = 7.10). Regression analyses were per formed to find the best fit regression model. Results indicated that the best-fit regression model that significantly explained approximately 25% of the variance in the average number of drinks per drinking day included depression over a life time, conduct disorder after age 15, and age. Although more work is needed to understand the relationships among the variables, when young women are injured in alcohol-related vehicular crashes, they should also be screened for depression and may have conduct disorder in their past history.

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; Fillmore MT. Acute alcohol tolerance on subjective intoxication and simulated driving performance in binge drinkers. Psychology of Addictive Behaviors 23(2): 238-247, 2009. (57 refs.)

High rates of binge drinking and alcohol-related problems, including drinking and driving, occur among college students. Underlying reasons for the heightened impaired driving rates in this demographic group are not known. The authors, hypothesized that acute tolerance to the interoceptive cues of intoxication may contribute to these maladaptive decisions to drive in binge drinkers. Groups of binge-drinking and non-binge-drinking college students (N = 28) attended sessions during which they received a moderate dose of alcohol (0.65 g/kg) or a placebo. The development of acute tolerance to subjective ratings of intoxication and simulated driving performance was assessed by comparing measures taken during the ascending phase and descending phases of the blood alcohol curve. Compared with placebo, alcohol increased ratings of intoxication and impaired multiple aspects of simulated driving performance in both binge and non-binge drinkers. During the descending phase of the blood alcohol curve, binge drinkers showed acute tolerance to alcohol's effect on subjective intoxication, and this effect was accompanied by an increased rating of willingness to drive. By contrast, non-binge drinkers showed no acute tolerance.

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. Too young to drink but old enough to drive under the influence: A study of underage offenders as seen in substance abuse treatment in Texas. Drug and Alcohol Dependence 104(1-2): 107-112, 2009. (32 refs.)

Driving under the influence (DUI) is a major road safety problem. Historically, alcohol has been assumed to play a larger role in crashes and DUI education programs have reflected this assumption, although recent evidence suggests that younger drivers are becoming more likely to drive drugged than to drive drunk. This is a study of 7096 Texas clients under age 21 who were admitted to state-funded treatment programs between 1997 and 2007 with a past-year DUI arrest, DUI probation, or DUI referral. Data were obtained from the State's administrative dataset. Multivariate logistic regressions models were used to understand the differences between those minors entering treatment as a DUI as compared to a non-DUI as well as the risks for completing treatment and for being abstinent in the month prior to follow-up. A major finding was that over time, the primary problem for underage DUI drivers changed from alcohol to marijuana. Being abstinent in the month prior to discharge, having a primary problem with alcohol rather than another drug, and having more family involved were the strongest predictors of treatment completion. Living in a household where the client was exposed to alcohol abuse or drug use, having been in residential treatment, and having more drug and alcohol and family problems were the strongest predictors of not being abstinent at follow-up. As a result, there is a need to direct more attention towards meeting the needs of the young DUI population through programs that address drug as well as alcohol consumption problems.

McCarthy DM; Pedersen SL. Reciprocal associations between drinking-and-driving behavior and cognitions in adolescents. Journal of Studies on Alcohol and Drugs 70(4): 536-542, 2009. (41 refs.)

Objective: The present study tested reciprocal associations between drinking-and-driving behavior and cognitions as youths transition to driving independently. We hypothesized that experience with driving and experience with drinking and driving would effect changes in cognitions about drinking and driving over time. We also tested cognitions as predictors of later drinking-and-driving behavior. Method: Two hundred and two high school youths completed mailed questionnaire measures at two time points, approximately 8 months apart. Questionnaire measures assessed youths' drinking-and-driving behavior, riding with a drinking driver, drinking-and-driving attitudes, normative beliefs, and perceived negative consequences at both time points. Results: Consistent with hypotheses, prior drinking-and-driving experience influenced changes in drinking-and-driving cognitions. Youths with drinking-and-driving experience at Time 1 saw drinking and driving as more dangerous over time; however, they perceived their peers as more accepting of this behavior. Time 1 attitudes predicted increased drinking-and-driving frequency at Time 2, and normative beliefs predicted increased frequency of riding with a drinking driver. Conclusions: These results support reciprocal associations between drinking-and-driving cognitions and behavior. Results of this study may have implications for the timing and content of drinking-and-driving interventions to reduce drinking and driving as well as riding with a drinking driver.

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.

Moore KA; Harrison M; Young MS; Ochshorn E. A cognitive therapy treatment program for repeat DUI offenders. Journal of Criminal Justice 36(6): 539-545, 2008. (27 refs.)

Driving under the influence is a devastating problem in the United States, killing almost 17,000 people in 2005. The present article describes a cognitive treatment program aimed at repeat drinking and driving offenders. Sixty-three participants were court mandated to the four-month outpatient treatment program. Before entering and after completing treatment, participants were administered self-report instruments measuring alcohol problems, readiness to change, self-esteem/efficacy, and criminal thinking patterns. Additionally, arrest histories were examined. Findings suggested that participants were characterized not only by repeated arrests, but elevated blood alcohol content and high levels of self-reported alcohol dependency and problem-drinking behaviors. The majority of clients expressed a readiness to change their drinking and driving behaviors with 87 percent graduating from the program. A DUI recidivism rate of 13 percent was found for graduates of the program at a twenty-one month follow-up. The results demonstrate that the treatment program is a valuable tool in the battle to reduce criminal recidivism.

Narenjiha H; Rafiey H; Jahani MR; Assari S; Moharamzad Y; Roshanpazooh M. Substance-dependent professional drivers in Iran: A descriptive study. Traffic Injury Prevention 10(3): 227-230, 2009. (18 refs.)

Objective: To determine characteristics of a nationwide sample of Iranian dependent drug users whose main profession is driving. Methods: Data were derived from a larger study, which aimed to describe pattern of drug dependency in Iran. A driver was defined as a person whose main profession was driving a motor vehicle to earn a living. Nine hundred twenty individuals were interviewed by a trained drug abuse team in all provinces of Iran during a 5-month period, from April to August 2007. Socioeconomic characteristics, substance abused, and high-risk behaviors were collected by a checklist. Results: All drivers were male and their mean ( standard deviation) age was 35.1 ( 8.6) years. Opioids (434 cases, 46.8%) and kerack (256 cases, 27.6%) were the two most common drugs used. Except for buprenorphine, which was used via intravenous injection, inhalation was the dominant method of us in other substances including opioids (56%), heroin (51.4%), kerack (80.1%), methamphetamine (73.9%), and cannabis (77.8%). Extramarital sexual relationships (414 cases, 45%) and nonfatal intoxication (362 cases, 39.3%) were the two most frequent high-risk behaviors. Conclusions: There are people with drug dependencies who drive for living in Iran. Deterrence programs through screening and random drug testing at police stations and legislation regarding charges of drugged drivers and prohibition from driving for long time periods are essential priorities in traffic safety.

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

Oladehinde MK; Adegbehingbe BO; Adeoye AO; Onakoya AO. Central nervous system stimulants: Effect on visual functions and occurrence of road traffic accidents. Annali Italiani di Chirurgia 80(1): 43-48, 2009. (26 refs.)

OBJECTIVE: To determine the influence of the use of central nervous system (CNS) stimulants on visual functions and occurrence of road traffic accidents (RTA) amongst commercial drivers. DESIGN: A cross-sectional study in which two hundred and fifteen consecutive drivers were interviewed and their eyes examined. SETTINGS: Ife Central Local Government Area (LGA) of Osun State, Nigeria. MATERIALS AND METHODS: Out of the estimated 270 commercial drivers registered in the four major parks of the LGA, 215 consecutive drivers participated in the survey. Questionnaires were administered by face-to-face interview and the drivers' eyes examined by the authors. RESULTS: The prevalence of visual impairment (visual acuity < 6118) in the better eye without correction was 3.3%, and there was a significant association between uncorrected visual acuity impairment in the better eye and RTA (p 0.0152). The prevalence of refractive error was 8.4%, but none of these drivers wear corrective glasses. Alcohol consumption is common (57.7%) amongst the drivers, and there was a significant association between alcohol consumption and RTA (p = 0.00124). There was also a significant association between the use of CNS stimulants (kolanut, marijuana and cigarette) and RTA (p = 0.005). CONCLUSION: It was therefore concluded that visual impairment in the better eye, alcohol consumption and the use of other CNS affecting substances contribute to the occurrence of RTA among the drivers.

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.

Pedersen SL; McCarthy DM. Person-environment transactions in youth drinking and driving. Psychology of Addictive Behaviors 22(3): 340-348, 2008. (67 refs.)

Drinking and driving is a significant health risk behavior for adolescents. This study tested mechanisms by which disinhibited personality traits (impulsivity and sensation seeking) and aspects of the adolescent home/social environment (parental monitoring and alcohol accessibility) can influence changes in drinking and driving behavior over time. Two hundred two high school age youths were assessed at 2 time points, approximately 8 months apart. Zero-inflated Poisson regression analyses were used to test (a) an additive model, where personality and environmental variables uniquely predict drinking and driving engagement and frequency: (b) a mediation model, where Time 2 en viron mental variables mediate the influence of disinhibited personality: and (c) an interaction model, where environmental factors either facilitate or constrain the influence of disinhibited personality on drinking and driving. Results supported both the additive and interaction model but not the mediation model. Differences emerged between results for personal drinking and driving and riding with a drinking driver. Improving our understanding of how malleable environmental variables can affect the influence of disinhibited personality traits on drinking and driving behaviors call help target and improve prevention/intervention efforts.

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; Lanctot KL; Streiner DL; Bedard M; Vingilis E; Murray B et al. Benzodiazepine use and driving: A meta-analysis. Journal of Clinical Psychiatry 70(5): 663-673, 2009. (56 refs.)

Objective: The purpose of the present study was to examine the experimental and epidemiologic evidence linking benzodiazepine use to driving impairment. Data Sources: We searched MEDLINE, PsycINFO, the Cochrane Collaboration, and EMBASE using the key terms ("benzodiazepines". OR "exp benzodiazepines") AND ("automobile driving" OR "accidents, traffic" OR "driving" OR "driver$") and limited the results to English citations from 196,6 to August 5, 2005, with auto-updates for MEDLINE and PsycINFO to November 30, 2007. Study Selection and Data Extraction: Experimental studies using driving simulators and on-road tests were sought, as were epidemiologic studies of a case-control or cohort design. Data were extracted by blinded raters and pooled using random-effects models. We excluded studies without control groups or without measures of driving or collisions. Studies with driving measures that could not be combined were also excluded. Data Synthesis: Of 405 potential articles, 11 epidemiologic and 16 experimental studies were included in the meta-analysis. Associations between motor vehicle collisions (MVCs) and benzodiazepine use were found among 6 case-control studies (OR = 1.61, 95% CI = 1.21 to 2.13, p < .001), and 3 cohort Studies (OR = 1.60, 95% CI = 1.29 to 1.97, p < .0001). Only 10 of 97 experimental driving variables could be pooled for analysis. While no consistent findings were observed in studies using driving simulators, increased deviation of lateral position was found on on-road driving tests (standardized mean difference = 0.80, 95% CI = 0.35 to 1.25, p = .0004). Conclusions: Benzodiazepine users were found to be at a significantly increased risk of MVCs compared to nonusers, and these differences may be accounted for by a difficulty in maintaining road position.

Reece AS. Experience of road and other trauma by the opiate dependent patient: a survey report. Substance Abuse Treatment, Prevention and Policy 3: e-article 10, 2008. (60 refs.)

Background: Trauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions. Methods: A survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia. Results: Of 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean +/- S. D. 33.72 +/- 8.14 vs. 44.24 +/- 16.91 years, P < 0.0001) and had shorter driving histories (15.96 +/- 8.50 vs. 25.54 +/- 15.03 years, P < 0.0001). They had less driving related medical problems (vision, spectacle use, diabetes) but more fractures, surgical operations, dental trauma and assaults. Addicted patients also had significantly worse driving histories on most parameters measured including percent with driving suspensions (O.R. = 7.70, C.I. 4.38-13.63), duration of suspensions (1.71 +/- 3.60 vs. 0.11 +/- 0.31 years, P < 0.0001), number of motor vehicle collisions (2.00 +/- 3.30 vs. 1.10 +/- 1.32, P = 0.01), numbers of cars repaired (1.73 +/- 3.59 vs. 1.08 +/- 1.60, P = 0.042), rear end collisions (O.R. = 1.90, CI 1.13-3.25), running away after car crashes (O.R. = 26.37, CI 4.31-1077.48), other people hospitalized (O.R. = 2.00, C. I. 0.93-4.37, P = 0.037) and people killed (17 vs. 0 P = 0.0005). Upon multivariate analysis group membership was shown to be a significant determinant of both cars repaired and cars hit when controlled for length of driving history. Hence use of all types of drugs (O.R. = 10.07, C.I. 8.80-14.72) was more common in addicted patients as were general (O.R. = 3.64, C.I. 2.99-4.80) and road (O.R. = 2.73, C.I. 2.36-3.15) trauma. Conclusion: This study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone.

Richmond DR. Drunk in the Serbonian bog: Intoxicated drivers' deaths as insurance accidents. Seattle University Law Review 32(Fall): 83-122, 2008. (316 legal refs.)

Summary: ... Drunk driving is dangerous and irresponsible, and a person's decision to drive drunk is a serious misjudgment. But the fact that drunk driving is risky does not render drunk drivers' deaths non-accidental. Courts that hold otherwise based on supposed common sense, common knowledge, or the simplistic notion that the dangers of drunk driving are widely known, are wrong as a matter of fact and as a matter of law. They have, in short, wandered into a Serbonian Bog. Treating drunk drivers' deaths as accidents for insurance purposes is much firmer ground. However, the majority approach holds that drunk drivers' deaths are not accidents for purposes of conferring accidental death benefits. ... Judge Boggs faulted the district court for concluding that the cases applying a reasonable foreseeability standard on which the administrator relied in denying benefits misinterpreted Wickman and were thus wrongly decided, and opined that a court reviewing a plan administrator's decision under a deferential standard cannot substitute its judgment for the administrator's. ... As for Aetna's rationale that the serious risks associated with drunk driving are widely publicized, the court was unwilling to make the leap from "'serious risks,' i.e. , the possibility of injury or death, that are 'widely publicized' to the conclusion that a drunk driver knew or should have known that the consequences of driving while intoxicated are that he or she is 'highly likely' to suffer injury or death, i.e. , the probability of injury or death." ... For that matter, what "common sense" and "common knowledge" truly tell us is that intoxicated drivers are "far more likely to be arrested . . . than to be injured or die in an alcohol-related automobile crash, and far more likely to arrive home than to be either arrested, injured, or killed."

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.

Santa AF; Cochran BN. Does the impact of anti-drinking and driving public service announcements differ based on message type and viewer characteristics? Journal of Drug Education 38(2): 109-129, 2008. (50 refs.)

The purpose of this study was to inform future Public Service Announcement (PSA) development by examining the potential effectiveness of different types of anti-driving under the influence (DUI) PSAs for persons with different characteristics. PSAs utilizing empathy, fear, and informational approaches were shown to persons recruited from psychology courses (n = 137) and individuals that were mandated to treatment following a DUI offense (n = 17). The empathy approach was perceived to be the most effective and evoked the most negative affect, followed by fear and infonnational approaches. Less experience with DUI, lower sensation seeking, higher motivation to change, and higher perception of dangerousness of DUI all emerged as good predictors of higher perceived effectiveness of anti-DUl PSAs. Gender differences in perceived effectiveness were examined for fear and empathy PSAs, with inconclusive findings.

Schermer CR; Omi EC; Ton-That H; Grimley K; Van Auken P; Santaniello J et al. A clustering of injury behaviors. Journal of Trauma, Injury, Infection and Critical Care 65(5): 1000-1004, 2008. (23 refs.)

Background: Alcohol is a well-known risk factor for injury. A number of other behaviors are also associated with injury risk. We hypothesized that risky drinking would be associated with other high risk behaviors, thereby delineating a need for behavioral interventions in addition to alcohol. Methods: A consecutive sample of trauma patients was interviewed for drinking and risky behaviors including seat belt use, helmet use, and driving behaviors. The Alcohol Use Disorders Identification Test was used to screen for risky drinking and risky behavior questions were taken from validated questionnaires. Behaviors were ranked on a Likert scale ranging from a low to a high likelihood of the behavior or assessed the frequency of behavior in the past 30 days. An Alcohol Use Disorders Identification Test score of 8 or more was considered risky drinking for adults age 21 to 64, and 4 or more for ages 16 to 20 and over 65. Risky and non-risky drinkers were compared on behavior risk items. A p value of less than 0.05 was considered significant. Results: One hundred sixty patients (mean age, 36.8 years, 72% men,) were interviewed. Risky drinkers were more likely to drive after consuming alcohol, ride with drinking drivers, tailgate, weave in and out of traffic, and make angry gestures at other drivers (all p < 0.05). Risky drinkers were less likely to wear motorcycle helmets. However, risky drinkers were no more or less likely to talk on the cell phone while driving, to use seatbelts, or use turn signals. Although number of lifetime vehicle crashes were similar, risky drinkers were more likely to have been the party at fault for the crash (mean 1.09 vs. 0.64, p = 0.03). Conclusions: Factors other than alcohol increase injury risk in problem drinkers. Injury prevention programs performing alcohol interventions should consider including behavioral interventions along with alcohol reduction strategies. New screening and intervention programs should be developed for injury behaviors that increase risk but are not alcohol related.

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 1990s and accelerated in 2000. Women's arrest gains, contrasted with no systematic change in DUI behavior, and the timing of this shift suggest an increased vulnerability to arrest. More stringent laws and enforcement directed at less intoxicated offenders may inadvertently target female offending patterns.

Schwartz SJ; Zamboanga BL; Ravert RD; Kim SY; Weisskirch RS; Williams MK et al. Perceived parental relationships and health-risk behaviors in college-attending emerging adults. Journal of Marriage and the Family 71(3): 727-740, 2009. (57 refs.)

The present study investigated the association of perceived parenting with health-risk behaviors in an ethnically diverse sample of 1,728 college-attending emerging adults. Participants completed retrospective measures of perceived maternal and paternal nurturance, connection, psychological control, and disrespect and reported their frequency of binge drinking, illicit drug use, unsafe sexual behavior, and impaired driving. Multivariate Poisson regression analyses indicated that perceived paternal acceptance was associated inversely with 6 of the 12 health-risk behaviors measured, whereas perceived mothering was related only to 2 of these health-risk behaviors. These patterns were consistent across gender, ethnicity, and family structure.

Sendzik T; Fong GT; Travers MJ; Hyland A. An experimental investigation of tobacco smoke pollution in cars. Nicotine & Tobacco Research 11(6): 627-634, 2009. (35 refs.)

Tobacco smoke pollution (TSP) has been identified as a serious public health threat. Although the number of jurisdictions that prohibit smoking in public places has increased rapidly, just a few successful attempts have been made to pass similar laws prohibiting smoking in cars, where the cabin space may contribute to concentrated exposure. In particular, TSP constitutes a potentially serious health hazard to children because of prolonged exposure and their small size. The present study investigated the levels of TSP in 18 cars via the measurement of fine respirable particles (< 2.5 microns in diameter or PM2.5) under a variety of in vivo conditions. Car owners smoked a single cigarette in their cars in each of five controlled air-sampling conditions. Each condition varied on movement of the car, presence of air conditioning, open windows, and combinations of these airflow influences. Smoking just a single cigarette in a car generated extremely high average levels of PM2.5: more than 3,800 mu g/m(3) in the condition with the least airflow (motionless car, windows closed). In moderate ventilation conditions (air conditioning or having the smoking driver hold the cigarette next to a half-open window), the average levels of PM2.5 were reduced but still at significantly high levels (air conditioning = 844 mu g/m(3); holding cigarette next to a half-open window = 223 mu g/m(3)). This study demonstrates that TSP in cars reaches unhealthy levels, even under realistic ventilation conditions, lending support to efforts occurring across a growing number of jurisdictions to educate people and prohibit smoking in cars in the presence of children.

Simsekoglu O; Lajunen T. Relationship of seat belt use to health and driver behaviors. Transportation Research. Part F, Traffic Psychology and Behaviour 12(3): 235-241, 2009. (16 refs.)

Seat belts are effective safety devices for protecting car occupants from injuries and fatalities in road vehicle accidents. Seat belt use has been reported to be related to some health and driving-related behaviors. The aim of the present study was to investigate to what degree seat belt use can be seen as health behavior or driver behavior. Participants were 252 licensed Turkish drivers (180 males, 72 females) with the mean age of 30.8 (SD = 12.15). A questionnaire including questions related to health-related behaviors, driver behaviors and seat belt use was used. Results of factor analysis showed that seat belt use in front seat grouped with driver behaviors (e.g., driving errors and violations) but not with health-related behaviors (e.g., healthy diet and sports participation). Regression analyses showed that seat belt use in back seat; and, regular walking and adequate sleep were positively related to seat belt use in front seat, whereas being male, driving errors and smoking frequency were negatively related to seat belt use in front seat. The present findings suggest that seat belt use can be considered in the context of driver behaviors Such as driving errors and violations.

Small K. Interventions to prevent adolescent motor vehicle crashes a literature review. Orthopaedic Nursing 27(5): 283-290, 2008. (36 refs.)

Adolescent injury and death from motor vehicle crashes continues to be a pressing public health concern. The adolescent age group present a unique challenge in terms of prevention because of their age and thought processes. Over the years, many intervention strategies have emerged to target prevention of motor vehicle crashes in this age group. Some have been more successful than others. When implementing intervention programs for their own communities, nurses must be aware of information regarding adolescent injury prevention in the literature. Reality-based prevention programs appear to be a promising intervention strategy to target motor vehicle crash prevention in adolescents.

Smith KC; Twum D; Gielen AC. Media coverage of celebrity DUIs: Teachable moments or problematic social modeling? Alcohol and Alcoholism 44(3): 256-260, 2009. (26 refs.)

Aim: Alcohol in the media influences norms around use, particularly for young people. A recent spate of celebrity arrests for drinking and driving (DUI) has received considerable media attention. We asked whether these newsworthy events serve as teachable moments or problematic social modeling for young women. Method: Qualitative analysis of US media coverage of four female celebrities (Michelle Rodriguez, Paris Hilton, Nicole Richie and Lindsay Lohan) was conducted over the year following their DUI arrest (December 2005 through June 2008). The media sample included five television and three print sources and resulted in 150 print and 16 television stories. Results: Stories were brief, episodic and focused around glamorous celebrity images. They included routine discussion of the consequences of the DUI for the individual celebrities without much evidence of a consideration of the public health dimensions of drinking and driving or possible prevention measures. Conclusions: Our analysis found little material in the media coverage that dealt with preventing injury or promoting individual and collective responsibility for ensuring such protection. Media attention to such newsworthy events is a missed opportunity that can and should be addressed through media advocacy efforts.

Stafstrom M; Ostergren PO. A community-based intervention to reduce alcohol-related accidents and violence in 9th grade students in southern Sweden: The example of the Trelleborg Project. Accident Analysis and Prevention 40(3): 920-925, 2008. (26 refs.)

The purpose of the present study was to analyse if a community-based intervention has led to a decrease in alcohol-related accidents and violence, and whether this was mediated by a reduction in excessive drinking and frequency of distilled spirits consumption. We applied logistic regression analyses on cross-sectional, non-repeated data, which was collected from a questionnaire distributed in classrooms to all 9th graders from 1999 to 2001, and in 2003 (n = 1376, 724 boys and 652 girls; response rate = 92.3%). All alcohol abstainers (n = 330) were excluded from the analyses, making the sample 1046 individuals. The odds ratio for alcohol-related accidents was significantly lower, comparing the baseline year (1999) with 2003 (OR 0.5, 95% CI 0.27-0.76). There was also an indication that self-reported alcohol-related violence had decreased between 1999 and 2003 (OR 0.7, 95% CI 0.43-1.01). When controlling these estimates for excessive drinking and frequency of distilled spirits consumption, the differences between survey years were substantially reduced or even deleted. In conclusion, the decrease in alcohol-related accidents and violence among 15-16-year-olds in Trelleborg, between 1999 and 2002, is likely to be attributed to the identified reduction in excessive drinking and frequency of distilled spirits consumption.

Stewart TC; Polgar D; Girotti MJ; Vingilis E; Caro D; Corbett BA et al. Evaluation of an adolescent hospital-based injury prevention program. Journal of Trauma, Injury, Infection and Critical Care 66(5): 1451-1459, 2009

Background: IMPACT (Impaired Minds Produce Actions Causing Trauma) is an adolescent, hospital-based program aimed to prevent injuries and their consequences caused by alcohol or drug impairment and other high-risk behaviors. The overall objective of this evaluation was to determine the effect of the program on students' knowledge and behavior regarding drinking and driving, over time. Methods: A randomized control trial between students randomly selected to attend IMPACT and those not selected served as a control group. Students completed a questionnaire before the program and at three posttime periods (1 week, 1 month, and 6 months). Panel data models were used to analyze the effects of the experiment on students' knowledge of alcohol and crash issues and negative driving behaviors (no seat belt, driving while using a cell phone, involved in conversation, eating, annoyed with other drivers, and drowsy). Descriptive statistics and logistic regression models were used to analyze the effect of IMPACT on students' influence on friends and family about road safety. Results: This study consisted of 269 students (129 IMPACT; 140 control) with an overall response rate of 84% (range, 99% presurvey to 71% at 6 months). The IMPACT group had a 57%, 38%, and 43% increase in the number of correct answers on alcohol and crash issues during the three time periods, respectively (p < 0.05). Students in the IMPACT group would try to influence friends and family to improve their road safety twice as often as 1-week postprogram (odds ratio 1.94, confidence interval 1.07, 3.53). The models did not suggest that the program had an effect on negative driving behaviors. Men and students who drove more frequently had worse driving behavior. Conclusions: Our evaluation demonstrates that the IMPACT program had a statistically significant, positive effect on students' knowledge of alcohol and crash issues that was sustained over time. IMPACT had an initial effect on students' behaviors in terms of peer influence toward improving road safety (i.e., buckling up, not drinking, and driving) 1 week after the program, but this effect diminished after I month. Other negative driving behaviors had low prevalence at baseline and were not further influenced by the program.

Stoduto G; Dill P; Mann RE; Wells-Parker E; Toneatto T; Shuggi R. Examining the link between drinking-driving and depressed mood. Journal of Studies on Alcohol and Drugs 69(5): 777-780, 2008. (23 refs.)

Objective: Because both alcohol and depressed mood exert deleterious effects on psychomotor performance, the possibility that people with depressed mood may be more likely to drive after drinking may have important implications for traffic safety. In this work, we examine the association between depressed mood and self-reported driving after drinking in a large representative sample of adults in Ontario. Method: Data are based on the 2001-2004 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults ages 18 and older (N = 3,979), Logistic regression analysis was performed to identify the risk of driving after drinking two or more drinks in the previous hour within the past 12 months associated with scores on a screening measure of depressed mood (depression-anxiety and social functioning subscales of the 12-item General Health Questionnaire), while controlling for alcohol-use measures (weekly volume and frequency of heavy drinking), driving exposure, and demographic factors. Results: Logistic regression analysis revealed that the odds of reporting driving after drinking within the past year increase significantly as depressed mood (specifically, depression-anxiety scores) increases. Conclusions: Additional research on the nature of the link between depressed mood and impaired driving should be undertaken, including assessing whether there exists any synergistic effects of depressed mood and alcohol on collision risk and considering the implications of this relationship for prevention and remedial activities.

Stramesi C; Polla M; Vignali C; Zucchella A; Groppi A. Segmental hair analysis in order to evaluate driving performance. Forensic Science International 176(1): 34-37, 2008. (8 refs.)

On the 31st of July 2002 the Lombardy local government issued a memorandum, C.R. 35/SAN, providing "guidelines to investigate drugs of abuse addiction in order to judge driving performance". About hair samples, this memorandum advises that the proximal lock of 6 cm-length would be analysed for opiates, cocaine, cannabinoids, amphetamine and derivatives, divided into two segments of 3 cm, each. The Local Medical Driving Licence Commissions (CML) can decide whether or not to enforce these instructions; from our survey it resulted that most CMLs do not abide by the memorandum, not requiring segmental analysis. The purpose of our study was to verify whether this procedural discordance could affect analytical results and, consequently, the evaluation of the subject's driving performance. We analysed hair samples taken from subjects who were requesting the renewal of their driving licence in our Laboratory during the period from 1 August 2002 to 31 December 2006. We divided samples into two groups: (1) samples previously analysed in one single segment which resulted positive for at least one analyte, but under the cut-off (0.5 ng/mg), were re-analysed in accordance with the guidelines; (2) samples previously processed following guidelines which resulted positive in one of the segments were newly analysed in a single segment. Comparing the new results with the original ones, an increase of positive results emerged in the first group. The second set of results fully supported the first ones. These results underscore the importance of the 35/SAN memorandum, so if the guidelines had been followed there would have been a larger amount of driving licence renewal denied.

Sun IY; Longazel JG. College students' alcohol-related problems: A test of competing theories. Journal of Criminal Justice 36(6): 554-562, 2008. (58 refs.)

This study examined binge drinking, drinking-driving, and other negative behaviors among college students. Specifically, this study tested the explanatory power of three criminological theories: self-control, social bonds, and routine activities. Data used in this research were collected from a survey of 558 students in a state university. Findings indicated that college students with low self-control were significantly more likely to engage in binge drinking, drinking-driving, and negative behaviors. Students who rarely participated in university-organized events or frequently attended parties were more likely to have problems of binge drinking, drinking-driving, and negative behaviors. Several control variables. such as gender and location of residence, were also predictive of alcohol-related problems among college students. Implications for future research are discussed.

Thangavelu K; Rhinds D. Driving among drug users: Are we doing enough? A chart review of assessment of driving and related issues in drug misusers. (review). Drugs: Education, Prevention and Policy 16(3): 266-272, 2009. (14 refs.)

Aim: Driving among drug users is a major health concern. Professionals working in substance misuse service have a duty of care to manage the risks involved. We analysed the practice of multidisciplinary team in drug treatment service discussing driving with the patient and providing them with relevant information regarding the regulations. We compared this practice with the existing policies and guidelines. Method: A chart review of healthcare professionals in the drug treatment services discussing driving and related issues with the patient was carried out. One hundred case records were analysed for evidence of documentation of the above information. Results: A clear record of discussion of all driving-related issues was documented in only 28% of records reviewed. In more that half of the cases there was no record as to whether the patient was driving or not. Conclusions: The results raised some ethical questions that would influence the policy makers and practitioners. These finding suggest that major changes are needed in our practice both for our legal protection and for the best interests of patients and public.

Thomson G; Wilson N. Public attitudes to laws for smoke-free private vehicles: A brief review. (review). Tobacco Control 18(4): 256-261, 2009. (67 refs.)

As smoke-free car policy is a frontier domain for tobacco control, attitudes to smoke-free private car laws are briefly reviewed. Medline and Google Scholar searches for the period up to mid-November 2008, from English language sources, were undertaken. Studies were included that contained data from national and subnational populations (eg, in states and provinces), but not for smaller administrative units, eg, cities or councils. Jurisdiction, sample size and survey questions were assessed. One reviewer conducted the data extraction and both authors conducted assessments. A total of 15 relevant studies (from 1988) were identified, set in North America, the UK and Australasia. The available data indicates that, for the jurisdictions with data, there is majority public support for laws requiring cars that contain children to be smoke free. There appears to be an increase over time in this support. In five surveys in 2005 or since (in California, New Zealand and Australia), the support from smokers was 77% or more. The high levels of public (and smoker) support for smoke-free car laws found in the studies to date suggest that this can be a relatively non-controversial tobacco control intervention. Survey series on attitudes to such laws are needed, and surveys in jurisdictions where the issue has not been investigated to date.

Timko C; Moos BS; Moos RH. Gender differences in 16-year trends in assault- and police-related problems due to drinking. Addictive Behaviors 34(9): 744-750, 2009. (52 refs.)

This study examined the frequency and predictors of physical assault and having trouble with the police due to drinking over 16 years among women and men who, at baseline, were untreated for their alcohol use disorder. Predictors examined were the personal characteristics of impulsivity, self-efficacy, and problem-solving and emotional-discharge coping, as well as outpatient treatment and Alcoholics Anonymous (AA) participation. Women and men were similar on rates of perpetrating assault due to drinking, but men were more likely to have had trouble with the police due to drinking. Respondents who, at baseline. were more impulsive and relied more on emotional discharge coping, and less on problem-solving coping, assaulted others more frequently during the first year of follow-up. Similarly, less problem-solving coping at baseline was related to having had trouble with the police more often at one and 16 years due to drinking. The association between impulsivity and more frequent assault was stronger for women, whereas associations of self-efficacy and problem-solving coping with less frequent assault and police trouble were stronger for men. Participation in AA was also associated with a lower likelihood of having trouble with the police at one year, especially for men. Interventions aimed at decreasing impulsivity and emotional discharge coping, and bolstering self-efficacy and problem-solving coping, during substance abuse treatment, and encouragement to become involved in AA, may be helpful in reducing assaultive and other illegal behaviors.

Tin ST; Ameratunga S; Robinson E; Crengle S; Schaaf D; Watson P. Drink driving and the patterns and context of drinking among New Zealand adolescents. Acta Paediatrica 97(10): 1433-1437, 2008. (30 refs.)

Aim: To examine the association between drink driving and the patterns and locations of usual drinking among New Zealand adolescents. Methods: This is a secondary analysis of data from a nationally representative youth health survey, the sampling frame for which was all New Zealand secondary schools with more than 50 students enrolled in years 9 to 13 (ages 12 to 18 years) in 2001. The analysis was restricted to the 3408 survey respondents aged 15 years or older who were current drinkers and drivers. Results: In total, 17.3% of participants reported drink driving in the previous month. Drink driving was significantly associated with frequent (at least weekly) alcohol use, binge drinking and usually drinking away from home, that is in cars, outdoors, at bars or nightclubs, at parties, at school and at work. Students' perception that parents and schools care about them, parental monitoring, and high academic achievement was associated with a reduced risk of drink driving while having friends who drink alcohol increased this risk. These associations were similar among boys and girls. Conclusion: The findings support calls to address how and where young people drink, and indicate the potential gains to be made with family- and school-based interventions.

Valencia-Martin JL; Galan I; Rodriguez-Artalejo F. The joint association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes. Addiction 103(5): 749-757, 2008. (62 refs.)

Background Previous studies on alcohol-related road safety have not assessed the joint impact of average volume of alcohol and binge drinking. Aim To examine the joint and separate association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes. Methods Data were drawn from telephone interviews conducted in the period 2000-2005, with 12 037 individuals representative of the population aged 18-64 years in the Madrid region, Spain. The threshold between average moderate and heavy volumes was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of >= 80 g of alcohol in men and >= 60 g in women, during any drinking occasion in the preceding 30 days. Individuals were classified into the following categories: (i) non-drinkers; (ii) moderate drinkers with no binge drinking (MDNB); (iii) moderate drinkers with binge drinking (MDB); (iv) heavy drinkers with no binge drinking (HDNB); and (v) heavy drinkers with binge drinking (HDB). Analyses were performed using logistic regression, with adjustment for sex, age and educational level. Findings: Frequency of inadequate seat-belt use increased progressively across categories of alcohol consumption, with odds ratio (OR) 1 in non-drinkers, 1.19 [95% confidence interval (CI) 1.06-1.33] in MDNB, 1.69 (1.41-2.03) in MDB, 1.68 (1.24-2.29) in HDNB and 2.41 (1.83-3.18) in HDB (P for trend < 0.001). Compared with MDNB, alcohol-impaired driving was also more frequent in MDB (OR 7.43; 95% CI: 5.52-10.00), HDNB (OR 7.31; 95% CI: 4.37-12.25) and in HDB (OR 15.50; 95% CI: 10.62-22.61). Lastly, compared with non-drinkers, frequency of traffic crashes increased progressively across categories of alcohol consumption (P for trend = 0.028), although it only reached statistical significance in HDB (OR 2.01; 95% CI: 1.00-4.09). Conclusions: Self-reported average volume of alcohol and binge drinking are both associated with self-reported hazardous driving behaviour and traffic crashes. The strength of the association is greater when average heavy consumption and binge drinking occur jointly.

Van Vleck VNL; Brinkley GL. Alert eyes and DWIs: An indirect evaluation of a DWI witness reward program in Stockton, CA. Accident Analysis and Prevention 41(3): 581-587, 2009. (35 refs.)

We evaluate a "grassroots" anonymous reward program targeting drunken driving in Stockton, CA. The time-series cross-sectional data covers 19 years for Stockton and six other California cities. Exploiting interrupted time-series regression, Zellner's seemingly unrelated regression (SUR) framework, and boot-strapped standard errors, we test for an impact of this program on alcohol-related injury or fatality accidents, the proportion of all accidents involving alcohol, and the number of DWI arrests. In its first decade, the citizen reward program appears to have averted some 275 alcohol-related accidents for social cost savings of between $21,000 and $5.6 million. Further, possibly 4495 arrests were precluded, saving some $1-3 million in arrest-related costs. Incentivized public monitoring of driving-after-drinking may be an effective drunken driving abatement program though our exploratory findings need further confirmation.

Vanlaar W; Simpson H; Robertson R. A perceptual map for understanding concern about unsafe driving behaviours. Accident Analysis and Prevention 40(5): 1667-1673, 2008. (31 refs.)

The objective of this paper is to develop a model that can help explain the public's level of concern associated with six dangerous driving behaviours (drinking and driving, speeding, distracted driving, using a cell phone while driving, fatigued or drowsy driving, and using illegal drugs while driving). Understanding the genesis of concern can be useful in addressing it and leveraging it to improve safe driving. Building on a risk perception model that was developed previously, the study investigated the relationship between the level of concern about the unsafe driving behaviours and the perceived level of concern of others about the dangerous driving behaviours, the perception of the prevalence of the dangerous driving behaviours, the perception of the level of risk imposed by these dangerous driving behaviours, and the perception of the severity of injuries that can result from them. Data from two independent samples were modeled using multidimensional scaling and logistic regression analysis. Both samples come from telephone surveys; one was administered to a random sample of 750 drivers in the province of Ontario, Canada in November 2006, the other to a random sample of 1201 drivers across Canada in September 2006. Two dimensions in particular were found to fit the data well: perceived risk and the perceived level of concern of others. The results from these analyses are summarized using a perceptual map. The relevance of such a map is illustrated by explaining the factors that impact levels of concern regarding several of the unsafe driving behaviours.

Vassallo S; Smart D; Sanson A; Cockfield S; Harris A; McIntyre A et al. Risky driving among young Australian drivers. II: Co-occurrence with other problem behaviours. Accident Analysis and Prevention 40(1): 376-386, 2008. (40 refs.)

This study examined the co-occurrence of risky driving with a range of externalising and internalising problems among 1055 young Australian drivers participating in an ongoing, 23-year longitudinal study. This issue was examined by: (1) investigating the co-occurrence of risky driving and other problem outcomes at 19-20 years; (2) exploring the rate of single and multiple problems among high, moderate and low young risky drivers and (3) investigating connections between risky driving in early adulthood and adolescent problem behaviours. Concurrent and longitudinal associations between risky driving and both substance use (alcohol, cigarette and marijuana use, binge drinking) and antisocial behaviour were found. However, risky driving generally appeared unrelated to internalising problems (depression, anxiety) and early sexual activity. Overall, young risky drivers varied considerably in the number and types of problem behaviours exhibited, although the great majority (70%) had displayed at least one other type of problem behaviour.

Verster JC; Mets MAJ. Psychoactive medication and traffic safety. International Journal of Environmental Research and Public Health 6(3): 1041-1054, 2009. (29 refs.)

Driving a car is important to maintain independence and participate in society. Many of those who use psychoactive medication are outpatients and are thus likely to drive a vehicle. Most common adverse effects that impair driving are reduced alertness, affected psychomotor functioning and impaired vision. This review discusses the effects on driving ability of most commonly prescribed psychoactive drugs, including hypnotics, antidepressants, antihistamines, analgesics and stimulant drugs. Within these categories of medicines significant differences concerning their impact on driving ability are evident. The International Council on Alcohol, Drugs and Traffic Safety (ICADTS) categorization can help physicians to make a choice between treatments when patients want to drive a car.

Voas RB. Guidelines for research on drugged driving: A good first step. (editorial). Addiction 103(8): 1269-1270, 2008. (12 refs.)

Voas RB; Romano E; Peck R. Validity of surrogate measures of alcohol involvement when applied to nonfatal crashes. Accident Analysis and Prevention 41(3): 522-530, 2009. (18 refs.)

Since the 1970s, nighttime fatal crashes have been used as a surrogate measure for alcohol-related fatalities for crashes for which more direct measures were absent. The validity of this approach was confirmed in 1985 but has not been re-evaluated since. Although this measure has also been applied to identify alcohol involvement in nonfatal crashes, its validity when applied to nonfatal cases has never been determined. The objective of this study was to evaluate the appropriateness of using nighttime crashes as surrogate measures for alcohol impairment when applied to fatal and nonfatal injury and property damage only (PDO) crashes. To do so. we used data from a crash-control design study collected at the roadside in two U.S. states between 1997 and 1999, as well as from the 1997-1999 and 2004-2006 Fatality Analysis Reporting System. The outcome of this study confirms the validity of using nighttime crashes as a surrogate measure for alcohol-related fatalities and supports the use of after-midnight crashes for measuring alcohol involvement in nonfatal and PDO crashes when the number of late-night crashes permits.

Walsh JM; Verstraete AG; Huestis MA; Morland J. Guidelines for research on drugged driving. Addiction 103(8): 1258-1268, 2008. (8 refs.)

Aim: A major problem in assessing the true public health impact of drug-use on driving and overall traffic safety is that the variables being measured across studies vary significantly. In studies reported in a growing global literature, basic parameters assessed, analytical techniques and drugs tested are simply not comparable due to lack of standardization in the field. These shortcomings severely limit the value of this research to add knowledge to the field. A set of standards to harmonize research findings is sorely needed. This project was initiated by several international organizations to develop guidelines for research on drugged driving. Methods A September 2006 meeting of international experts discussed the harmonization of protocols for future research on drugged driving. The principal objective of the meeting was to develop a consensus report setting guidelines, standards, core data variables and other controls that would form the basis for future international research. A modified Delphi method was utilized to develop draft guidelines. Subsequently, these draft guidelines were posted on the internet for global review, and comments received were integrated into the final document. Results The Guidelines Document is divided into three major sections, each focusing upon different aspects of drugged driving research (e.g. roadside surveys, prevalence studies, hospital studies, fatality and crash investigations, etc.) within the critical issue areas of 'behavior', 'epidemiology' and 'toxicology'. (1) The behavioral section contains 32 specific recommendations; (2) the epidemiology section contains 40 recommendations; and (3) the toxicology sets forth 64 recommendations. Conclusions: It is anticipated that these guidelines will improve significantly the overall quality of drugged driving research and facilitate future cross-study comparisons nationally and globally.

Webster JM; Pimentel JH; Clark DB. Characteristics of DUI offenders convicted in wet, dry, and moist counties. Accident Analysis and Prevention 40(3): 976-982, 2008. (24 refs.)

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

Weinstein A; Brickner O; Lerman H; Greemland M; Bloch M; Lester H et al. Brain imaging study of the acute effects of Delta 9-tetrahydrocannabinol (THC) on attention and motor coordination in regular users of marijuana. Psychopharmacology 196(1): 119-131, 2008. (64 refs.)

Procedure Twelve regular users of marijuana underwent two positron emission tomography (PET) scans using [F-18] Fluorodeoxyglucose (FDG), one while subject to the effects of 17 mg THC, the other without THC. In both sessions, a virtual reality maze task was performed during the FDG uptake period. Results When subject to the effects of 17 mg THC, regular marijuana smokers hit the walls more often on the virtual maze task than without THC. Compared to results without THC, 17 mg THC increased brain metabolism during task performance in areas that are associated with motor coordination and attention in the middle and medial frontal cortices and anterior cingulate, and reduced metabolism in areas that are related to visual integration of motion in the occipital lobes. Conclusion These findings suggest that in regular marijuana users, the immediate effects of marijuana may impact on cognitive-motor skills and brain mechanisms that modulate coordinated movement and driving.

Wille SMR; Raes E; Lillsunde P; Gunnar T; Laloup M; Samyn N et al. Relationship between oral fluid and blood concentrations of drugs of abuse in drivers suspected of driving under the influence of drugs. Therapeutic Drug Monitoring 31(4): 511-519, 2009. (66 refs.)

In recent years, the interest in the use of oral fluid as a biological matrix has increased significantly, particularly for detecting driving under the influence of drugs (DUID). In this study, the relationship between the oral fluid and the blood concentrations of drugs of abuse in drivers suspected of DUID is discussed. Blood and oral fluid samples were collected from drivers Suspected of DUID or stopped during random controls by the police in Belgium, Germany, Finland, and Norway for the ROSITA-2 project. The blood samples were analyzed by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS), sometimes preceded by immunoassay screening of blood or urine samples. The oral fluid samples were analyzed by GC-MS or LC-MS(/MS). Scatter plots and trend lines of the blood and oral fluid concentrations and the median, mean, range, and SD of the oral fluid to blood (OF:B) ratios were calculated for amphetamines, benzodiazepines, cocaine, opiates, and Delta(9)-2 tetrahydrocannabinol. The ratios found in this study were comparable with those that were published previously, but the range was wider. The ORB ratios of basic drugs such as amphetamines, cocaine, and opiates were > 1 [amphetamine: median (range) 13 (0.5-182), methylenedioxyamphetamine: 4 (1-15), methylenedioxymethamphetamine: 6 (0.9-88), methamphetamine: 5 (2-23), cocaine: 22 (4-119), benzoylecgonine: 1 (0.2-11), morphine: 2 (0.8-6), and codeine: 10 (0.8-39)]. The ratios for benzodiazepines were very low, as could be expected as they are highly protein bound and weakly acidic, leading to low oral fluid concentrations [diazepam: 0.02 (0.01-0.15), nordiazepam: 0.04 (0.01-0.23), oxazepam: 0.05 (0.03-0.14), and temazepam: 0.1 (0.06-0.54)]. For tetrahydrocannabinol, an OF:B ratio of 15 was found (range 0.01-569). In this study, the time of last administration, the dose, and the route of administration were unknown. Nevertheless, the data reflect the variability of the OF:B ratios in drivers thought to be under the influence of drugs. The wide range of the ratios, however, does not allow reliable calculation of the blood concentrations from oral fluid concentrations.

Woratanarat P; Ingsathit A; Suriyawongpaisal P; Rattanasiri S; Chatchaipun P; Wattayakorn K et al. Alcohol, illicit and non-illicit psychoactive drug use and road traffic injury in Thailand: A case-control study. Accident Analysis and Prevention 41(3): 651-657, 2009. (34 refs.)

The objective of this study was to determine the relationship between alcohol use, psychoactive drug use and road traffic injury (RTI). A case-control study was conducted among drivers in Bangkok, Thailand. Two hundred cases and 849 controls were enrolled between February and November 2006. Cases who sustained a RTI were matched with four controls recruited from petrol stations within a 1-km radius of the reported crash site of the case. A positive alcohol breath test (>= 50mg/dl), and positive tests for the presence of illicit (amphetamine, cocaine, marijuana) and non-illicit psychoactive drugs (antihistamine, benzodiazepine, antidepressants), using gas chromatography/mass spectrometry (GC/MS) were documented as primary measures. There were significantly higher odds of an alcohol breath test >= 50mg/dl (adjusted odds ratio (OR) 63.6 (95% CI: 25.5-158.9)), illicit psychoactive drugs (adjusted OR 3.4 (95% CI: 1.7-6.6)) and non-illicit psychoactive drug (adjusted OR 3.1 (95% CI: 1.5-6.3)) among cases than controls. Even though driving under the influence of psychoactive drugs has been significantly linked to RTI, its contribution to road safety is much lower than driving under the influence of alcohol. With limited resources, the priority for RTI prevention should be given to control of driving under the influence of alcohol.

Zakletskaia LI; Mundt MP; Balousek SL; Wilson EL; Fleming MF. Alcohol-impaired driving behavior and sensation-seeking disposition in a college population receiving routine care at campus health services centers. Accident Analysis and Prevention 41(3): 380-386, 2009. (50 refs.)

Accidents stemming from alcohol-impaired driving are the leading cause of injury and death among college students. Research has implicated certain driver personality characteristics in the majority of these motor vehicle crashes. Sensation seeking in particular has been linked to risky driving, alcohol consumption, and driving while intoxicated. This study investigated the effect of sensation seeking on self-reported alcohol-impaired driving behavior in a college student population while adjusting for demographics, residence and drinking locations. A total of 1587 college students over the age of 18 completed a health screening survey while presenting for routine, non-urgent care at campus heath services centers. Student demographics, living situation, most common drinking location, heavy episodic drinking, sensation-seeking disposition and alcohol-impaired driving behavior were assessed. Using a full-form logistic regression model to isolate sensation seeking after adjusting for covariates, sensation seeking remains a statistically significant independent predictor of alcohol-impaired driving behavior (OR = 1.52; CI = 1.19-1.94; p < 0.001). Older, white, sensation-seeking college students who engage in heavy episodic drinking, live off-campus, and go to bars are at highest risk for alcohol-impaired driving behaviors. interventions should target sensation seekers and environmental factors that mediate the link between sensation seeking and alcohol-impaired driving behaviors.