The case for a 0.05% criminal law blood alcohol concentration limit for driving

Cost-utility analysis of an alcohol policy in Thailand: a case study of a random breath testing intervention

BACKGROUND

Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand.

METHODS

A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter.

RESULTS

This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%.

CONCLUSIONS

RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.

Ethical Acceptability of Reducing the Legal Blood Alcohol Concentration Limit to 0.05

Twenty-nine Americans die in alcohol-impaired driving crashes daily. The National Academies of Sciences, Engineering, and Medicine released a report that identified strategies to reduce alcohol-impaired driving deaths. One strategy suggests amending state laws to reduce the legal blood alcohol concentration (BAC) limit from 0.08 to 0.05. Although BAC 0.05 laws would likely reduce alcohol-related deaths, they are also controversial. Critics object to these laws because they restrict individual liberty and fail to consider that individuals value social drinking. We explored the ethical acceptability of BAC 0.05 laws. We made an ethical argument in support of BAC 0.05 laws, which include preventing harm to both drinking drivers and to others. We then considered and rejected liberty-based objections to BAC 0.05 laws. We concluded that BAC 0.05 laws are not only ethically defensible but desirable. States and Congress should work to promote them.

Support Vector Machine Classification of Drunk Driving Behaviour

Alcohol is the root cause of numerous traffic accidents due to its pharmacological action on the human central nervous system. This study conducted a detection process to distinguish drunk driving from normal driving under simulated driving conditions. The classification was performed by a support vector machine (SVM) classifier trained to distinguish between these two classes by integrating both driving performance and physiological measurements. In addition, principal component analysis was conducted to rank the weights of the features. The standard deviation of R–R intervals (SDNN), the root mean square value of the difference of the adjacent R–R interval series (RMSSD), low frequency (LF), high frequency (HF), the ratio of the low and high frequencies (LF/HF), and average blink duration were the highest weighted features in the study. The results show that SVM classification can successfully distinguish drunk driving from normal driving with an accuracy of 70%. The driving performance data and the physiological measurements reported by this paper combined with air-alcohol concentration could be integrated using the support vector regression classification method to establish a better early warning model, thereby improving vehicle safety.

Inhalation of Alcohol Vapor: Measurement and Implications

Decades of alcohol research have established the health risks and pharmacodynamic profile of oral alcohol consumption. Despite isolated periods of public health concern, comparatively less research has evaluated exposure to alcohol vapor. Inhaled alcohol initially bypasses first-pass metabolism and rapidly reaches the arterial circulation and the brain, suggesting that this route of administration may be associated with pharmacological effects that increase the risk of addiction. However, detailed reviews assessing the possible effects of inhaled alcohol in humans are lacking. A comprehensive, systematic literature review was conducted using Google Scholar and PubMed to examine manuscripts studying exposure to inhaled alcohol and measurement of biomarkers (biochemical or functional) associated with alcohol consumption in human participants. Twenty-one publications reported on alcohol inhalation. Fourteen studies examined inhalation of alcohol vapor associated with occupational exposure (e.g., hand sanitizer) in a variety of settings (e.g., naturalistic, laboratory). Six publications measured inhalation of alcohol in a controlled laboratory chamber, and 1 evaluated direct inhalation of an e-cigarette with ethanol-containing "e-liquid." Some studies have reported that inhalation of alcohol vapor results in measurable biomarkers of acute alcohol exposure, most notably ethyl glucuronide. Despite the lack of significantly elevated blood alcohol concentrations, the behavioral consequences and subjective effects associated with repeated use of devices capable of delivering alcohol vapor are yet to be determined. No studies have focused on vulnerable populations, such as adolescents or individuals with alcohol use disorder, who may be most at risk of problems associated with alcohol inhalation.

Effects of introducing an administrative .05% blood alcohol concentration limit on law enforcement patterns and alcohol-related collisions in Canada

Except for Quebec, all Canadian provinces have introduced administrative laws to lower the permitted blood alcohol concentration (BAC) to .05% or .04% for driving-or having the care of-a motor vehicle. Using linear mixed effects models for longitudinal data, this study evaluates the effect of administrative BAC laws on fatal alcohol related crashes and law enforcement patterns in Canada from 1987 to 2010. Results reveal a significant decrease of 3.7% (95% C.I.: 0.9-6.5%) in fatally injured drivers with a BAC level equal or greater than .05% following the introduction of these laws. Reductions were also observed for fatally injured drivers with BAC levels greater that .08% and .15%. The introduction of administrative BAC laws led neither to significant changes in the rate of driving while impaired (DWI) incidents reported by police officers nor in the probability of being charged for DWI under the Criminal Code.

Relationship of impaired-driving enforcement intensity to drinking and driving on the roads

BACKGROUND

It is principally the area of enforcement that offers the greatest opportunity for reducing alcohol-impaired driving in the near future. How much of a reduction in drinking and driving would be achieved by how much improvement in enforcement intensity?

METHODS

We developed logistic regression models to explore how enforcement intensity (6 different measures) related to the prevalence of weekend nighttime drivers in the 2007 National Roadside Survey who had been drinking (blood alcohol concentration [BAC] ≥ 0.00 g/dl), who had BACs ≥ 0.05 g/dl, and who were driving with an illegal BAC ≥ 0.08 g/dl.

RESULTS

Drivers on the roads in our sample of 30 communities who were exposed to fewer than 228 traffic stops per 10,000 population aged 18 and older had 2.4 times the odds of being BAC positive, 3.6 times the odds of driving with a BAC ≥ 0.05, and 3.8 times the odds of driving with a BAC ≥ 0.08 compared to those drivers on the roads in communities with more than 1,275 traffic stops per 10,000 population. Drivers on the roads in communities with fewer than 3.7 driving under the influence (DUI) arrests per 10,000 population had 2.7 times the odds of BAC-positive drivers on the roads compared to communities with the highest intensity of DUI arrest activity (>38 DUI arrests per 10,000 population).

CONCLUSIONS

The number of traffic stops and DUI arrests per capita were significantly associated with the odds of drinking and driving on the roads in these communities. This might reflect traffic enforcement visibility. The findings in this study may help law enforcement agencies around the country adjust their traffic enforcement intensity to reduce impaired driving in their community.

The impact on alcohol-related collisions of the partial decriminalization of impaired driving in British Columbia, Canada

INTRODUCTION

The purpose of this paper is to assess the impact of administrative sanctions introduced as part of a new law for drinking drivers in British Columbia, Canada. The new law, known as immediate roadside prohibitions (IRP), aimed to increase the efficiency of police and courts for processing drinking drivers, thereby increasing the certainty of their being apprehended and punished. However, in order to maintain these efficiencies, sanctions under this new law largely replaced laws under the Criminal Code of Canada for Driving While Impaired (DWI) by alcohol, which had more severe penalties but lower certainty of punishment. We examined whether the intervention was related to abrupt significant declines in three types of alcohol-related collisions (i.e. fatalities, injuries or property damage only) compared to the same type of collisions without alcohol involvement.

METHODS

An interrupted time series design, with a non-equivalent control was used, testing for an intervention effect. Monthly rates of the three types of collisions with and without alcohol involvement were calculated for the 15-year period before and the 1-year period after implementation of the new law. ARIMA time series analysis was conducted controlling for trend effects, seasonality, autocorrelation, and collisions without alcohol.

RESULTS

Significant average declines (p<0.05) in alcohol-related collisions were found as follows: 40.4% for fatal collisions, 23.4% for injury collisions and 19.5% for property damage only collisions. No significant effects were found for any of the three comparable non-alcohol-related types of collisions.

CONCLUSIONS

These results suggest that provincial law of administrative sanctions for drinking drivers and associated publicity was more effective for minimizing alcohol-related collisions than laws under the Canadian Criminal Code.

Breath alcohol concentrations of designated drivers

OBJECTIVE

This study established breath alcohol concentrations (BrACs) and alcohol-related behaviors of designated drivers (DDs) to determine (a) whether DDs are abstaining from drinking, (b) whether alcohol-related behaviors of non-DDs and DDs were different, and (c) whether the alcohol consumption of DDs resulted in BrAC levels that affected driving performance or caused psychomotor impairment.

METHOD

We conducted six anonymous field studies during a 3-month period in a southeastern college community restaurant and bar district. Intercept interviews were conducted with 1,071 bar patrons. Alcohol-related behaviors, BrAC, and whether one was serving as a DD were measured. The sample was primarily White (72.7%), male (62.4%) college students (64.7%). Descriptive statistics and an independent sample t test compared the BrACs of DDs versus non-DDs. A one-way analysis of variance examined the differences in the alcohol-related behaviors (Alcohol Use Disorders Identification Test-consumption [AUDIT-C] score) across DDs abstaining from drinking (BrAC = .00 g/210 L), drinking DDs (BrACs ≥ .02 and < .05 g/210 L), and impaired DDs (BrACs ≥ .05 g/210 L). A logistic regression assessed the impact of alcohol-related behaviors (AUDIT-C) on whether one was serving as a DD.

RESULTS

Of the 165 DDs, approximately 40% did not abstain from drinking. Approximately 17% of DDs had BrACs between .02 g/210 L and .049 g/210 L, whereas 18% recorded BrACs at .05 g/210 L or greater. The mean AUDIT-C score for impaired DDs significantly differed from both abstaining DDs and drinking DDs. Participants with greater AUDIT-C scores were more likely to serve as a DD and have a BrAC that significantly inhibited driving ability and psychomotor function.

CONCLUSIONS

These findings identify the need for consensus across researcher, layperson, and communication campaigns that a DD must be someone who has abstained from drinking entirely.

Policy Implications of the WHO Strategy to Reduce the Harmful Use of Alcohol

Aims: To describe the supporting evidence and policy implications of the 10 target areas of the WHO strategy to reduce the harmful use of alcohol. Methods: Based on published systematic reviews of the literature and publications of the World Health Organization, the supporting evidence and policy implications of the 10 target areas are described. Findings: There is evidence to support action in each of the 10 target areas: leadership, awareness and commitment; health services’ response; community action; drink-driving policies; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of intoxication; reducing the public health impact of illegal and informal alcohol; and monitoring and surveillance. Conclusions: The following policy measures have the strongest evidence: increasing alcohol taxes; government monopolies for the retail sale of alcohol; restricting the density of outlets and the days and hours of sale; increasing the minimum age of purchase; lowering the legal BAC levels for driving; introducing random breath-testing for driving; implementing widespread brief advice for hazardous and harmful alcohol consumption; and ensuring treatment for alcohol use disorders. There is reasonable evidence to support the introduction of a minimum price per gram of alcohol; restricting the volume of commercial communications; and enforcing the restrictions of sales to intoxicated and under-age people.

Effects of different blood alcohol concentrations and post-alcohol impairment on driving behavior and task performance

OBJECTIVE

A study using simulator methodology was conducted to investigate the effects of (1) different blood alcohol concentrations (BAC) of 0, 0.05, 0.08, and 0.10 percent and (2) post-alcohol impairment (where BAC approximately 0%) on driving behavior and subsidiary cognitive task performance.

METHODS

Two driving sessions were investigated, that is, drunk driving and post-alcohol driving, with each requiring approximately 20 min of driving. In addition to driving safely, participants were instructed to perform the critical flicker fusion (CFF) test and completed the NASA-TLX mental workload questionnaire. Eight licensed drivers (6 males, 2 females) participated in this 2 (road complexities) x 2 (simulated driving sessions) x 4 (levels of BAC) within-subjects experiment.

RESULTS

The study revealed that higher BAC levels were associated with lower performing driving behavior. The driver's mental workload reached the highest values in the post-alcohol session. In terms of tasks involving divided attention, the traffic sign distance estimation showed significant deterioration with increased BAC levels.

CONCLUSIONS

The relationship between drunk-driving behavior and alcohol dosage was supported in this study. Noticeably, no significant difference was found between drunk driving and post-alcohol driving, indicating that even in the post-alcohol situation, the impairment still remained significant enough to jeopardize traffic safety as much as it does in the case of drunk driving. In real-life situations, adopting a rest-time strategy to avoid post-alcohol impairment effects may not be the most appropriate solution by drivers; rather, drivers should be given some tests to verify the probability of post-alcohol effects on driving.

The effects of alcohol intoxication on neuronal activation at different levels of cognitive load

The aim of this study was to investigate how alcohol intoxication at two blood alcohol concentrations (BAC) affected neuronal activation during increasing levels of cognitive load. For this purpose we used functional magnetic resonance imaging (fMRI) together with a working memory n-back paradigm with three levels of difficulty. Twenty-five healthy male participants were scanned twice on two separate days. Participants in the control group (N=13) were scanned after drinking a soft-drink at both scanning sessions, while participants in the alcohol group (N=12) were scanned once after drinking an alcoholic beverage resulting in a BAC of 0.02%, and once after drinking an alcoholic beverage resulting in a BAC of 0.08%. A decrease in neuronal activation was seen in the dorsal anterior cingulate cortex (dACC) and in the cerebellum in the alcohol group at the BAC of 0.08% when the participants performed the most demanding task. The dACC is important in cognitive control, working memory, response inhibition, decision making and in error monitoring. The results have revealed that the effect of alcohol intoxication on brain activity is dependent on BAC and of cognitive load.

A safe, sensible and social AHRSE: New Labour and alcohol policy

When the Labour government came to power in the UK in 1997, it took over high and rising levels of alcohol consumption and alcohol-related harm. Contrary to 'old Labour''s views on alcohol policy, New Labour did nothing to reverse this trend, and, if anything, exacerbated it. Since New Labour has been in power, alcohol has become 40% more affordable; consumption has increased by 14% and alcohol-related deaths have increased by over 40%. New Labour viewed alcohol-related harm as a question of individual responsibility and, as expressed in its long awaited 2004 alcohol harm reduction strategy (commonly known as AHRSE), viewed partnerships with the alcohol industry as the solution to reducing harm. Ten years on we have safe, sensible and social, the 3Ss, AHRSE's next steps. On first reading it would seem that the government has learnt nothing from its mistakes of the previous ten years, and in its approach to alcohol policy continues to disable the public interest. Nevertheless, there remain areas where science might inform policy, including health sector policy where there is an emphasis on early diagnosis and treatment, and transport policy, where reducing the legal blood alcohol level to the European Commission maximum recommended level of 0.5g/L is again on the agenda. The 3Ss propose an independent review of the evidence of the relationship between alcohol price, promotion and harm. However, unless this fully reviews the international evidence of the relationship between the economic and physical availability of alcohol, the marketing of alcohol and alcohol related harm, AHRSE and its successor will continue to be a recipe for ineffectiveness.