rit¥i'"i; .. u ""'"' ""' .,,..,..,._ ,,u.;r.,,.i .u 11w
.-w1,,,.;....,i1 4'NIJ;,...i.1 ~...:··~'
.Unu6Fy 24,31, 1'i)86, Volume 2!15
Copyr9ht 1986,
>.m.11<;lUl
Mt1dical A.uo.;iation
Council Report
0
Alcohol and the Driver·
Council on Scientific Affairs
0
• Scientific Investigations have produced 50 years of accumulated
evidence showing a direct relationship between increasing blood alcohol
concentration {BAC) In drivers and Increasing risk of a motor vehicle crash.
There Is scientific consensus that alcohol causes deterioration of driving
skills beginning at 0.05°/o BAC or oven lower, and progressively serious
Impairment at higher BACs. Drivers aged 16 to 24 years have the highest
representation of all age groups In alcohol-related road crashes; young
drivers Involved In alcohol-related fatal crashes have lower average BACs
than older drivers. Alcohol Impairs driving skills by its ef1ects on the central
nervous system, acting like a general anesthetic. It renders slower and less
efficient both information acquisition and information processing, making
divided-attentio n tasks such as &leering and braking more difficult to carry
out without error. The influence of alcohol on emotions and attitudes may be
a crash risk factor related to driving style In addition to drivli:g skill Biologic
variability among humans produces substan~lal dlf1erenc:;~s lfl a_lc_ohol
influence and alcohol tolerance, making virtually useless any attempts to fix
a "safe" drinking level for drivers. The American Medical Association
supports a policy recommending (1) public education urging drivers not to
drink, (2) adoption by all states of O.OSo/o BAC as per se illegal tor driving, (3)
21 years as the legal drinking age In all stales, (4) adoption by all states of administrative driver's license suspen.slon In driving-under-th e-Influence cases,
and (5) encouragement for the automobile Industry to develop a safety module
that thwarts operation ot a motor vehicle by an Intoxicated person.
(JAMA 1986;255:522-5 27)
TIIREE resolutions relating to alcohol and driving \Vere referred to the
Board of 'frustees at the 198·1 Annual
Meeting of the llouse of fJelegales.
From lhEI Counl;it on Scientilic Allairs. Division ol
Personal and Public Health Policy, American Medical
As.:1oc1ahon. Chicago.
AttpOtl A ol the Council on Scienlilic Allairs.
adopled by lhEI House of Delegates ol the American
Mt1d1cal Association ol Iha Annual Moelmg, June
'rhe 1-Juuse requested that a comprehensive report on alcohol and its
effects he prepared for ·the 1985
Annual Meeting.
Resolution 18 called for the American Medical AssociatioH (A!iiIA) to
study methodology int.ended to deter
the use of an autornohile by an intoxicated person. Resolution G·i asked the
1985.
0
This report is 1101 in1ended to be consl1uE1d or to
serve as a standard al medical cam Shtndards or
medical care are determined on the basi:s of all of
the lacts and circumstances involved ir1 an indlll'idual
ca!te and are sub1ocl lo change as sdenlllic
knowledue an<1 technology advance and patti:rns of
prachce uvotve This report refll1Cls lhe 11iews ol tho
S<:Juntllic ~Wrutu1a as ul June 19U5
riepnnt 1aque~t3 to ~v1:s1on ol Pe1sonal and
Public Hoallh Polic"t. Council on Scitinl!fic AUairs.
A11•oncun Mu!l•Gal A3:-;oc1at1on. 5J5 N Ouurborn St.
C/uc1t1,10. IL 60610 (John C. Bo1lhn, Pl10)
522
See also pi: 450 and 529.
AMA to urge Arucricans to refrain
front drivinl{ under the influence of
alcohol, asked the A f\·1 A tu conduct an
education can1pail,'."n nu this st1bject,
an·d ask1•1I lhi• AMA lo su11port n1an-
datory susp1·11si(1n of a
JAMA, Jan 24/31, 1986-Vol 255, No
4
driv1~r's
for one year for any conviction for a
moving violation if any alcohol is
found in the driver's blood. Hesolution 83 urged an A~1A study of recent
legislation among the states on driving \Vhile impaired, \vith incorporation of the effective ele1nents into
1nodel legislation for distribution to
the 1nembership.
In addressing the concerns cited in
the resolutions, re\•ie\vS were undertaken of current literature on (I) the
relationship between blood alcohol
levels and dr!ver impairment, (2) scientific issue·s regarding the reliability
of 1nethods to test blood alcohol levels
in drivers, and (3) alcohol-impaire d
ddving counterrneasure s.
Epidemiology ol Alcohol
in Road Crashes
Studies carried out in the United
St.ates and other developed nations
sinte the 1930s indicate a strong,
direct relationship between increas ..
ing blood alcohol concentration (BAC)
in a n1otor vehicle driver and increasing risk of his involvement in a road
crash. u
A driver's relative risk of having a
road crash sho\vS a dramatic rise as
Members of the Council on Scient1lic
Altairs include Iha following: John A. Beljan,
MD. Philad<;1lphia; Geo1ge M. Bohigian, MO,
St Louis; William D. Dolan. MD. Arlington,
Va E Harvey Estes J1. MO, Durham, NC.
lra R Friodland_<;1r, MD. Chicago; Ray W
Qdlord, _Jr, MO. Clcvti_land, Chai_rman~_John
H_ Moxley 111,-MD, eev~rly Hills: Calif, Vice·
Chairman; Pelar t-f_ Sayrn, Boston. Medical
Sludunt, William C. Scou, MD. Tucson,
.loscµh H. Skom. MD. Chicago; R~ers J
Sr~1•th. MO, Po1Uand, Ora: James B. Snow.
Jr. MO, Philadelt)~••a. John C Ballin. PhD,
Ch1Cal)O, Secrnlary: James L
Breeling,
5taH Author
license
Alcohol-Council on Scientific Aflairs
--- -r-:-.--
,
I-'"· .1
45
70
0
40
~
~
--
35
•
65
60
•
;-ao
~
-
-~
f--
--
55
il
0 25
50
i
~
45
20
d:
I
I
40
35
I
30
/
5
1
0.00
-~
~v
0.04
0.02
0.06
--
I
25
0_08
0. 12
0. 10
o. 16
0. 14
0.20
o. 18
Blood Alcohol Level, 'li
Fig 1. -Relat ive probab ility of causin g crash
rises wilh rising blood alcoho l levels.
15
0
0
JAMA, Jan 24131 , 1986 -Vol 255, No.
4
/,
,___ --
10
the drive r's BAC increa ses (l•"'igs 1
and 2).'·' Alcoh ol-im paired drive rs are
believed to be respo nsible for 25% to
::J5% of all crash es causin g seriou s
injury and 6% of all crash es. In
.single·vehicle crash es, 55% to 65% of
fatall y injure d drive rs have BACs of
0.10% or greate r.)
In most states of the Unite d States ,
a BAC of 0.10% is the legal defini tion
of being under the influence of alcohol for drivin g-und er-the -influ ence
(DUI) prose cution . Since 1960 the
AMA has recom mend ed that a blood
alcoh ol level of 0.10% be accep ted as
prima facie evidence of being under
lhe influence, a positi on that the
(AJuncil on Scien tific Affai rs believ es
shoul d be revise d to a lower BA C in
light of scient ific evidence. Significant alcoh ol involve1nent in injury causi ng road crash es begins at a
drive r BAC of 0.05%. Jn a recen t
review, Johns tonJ conclu ded that lO~t.i
of drive rs in crash es that cause property dama ge had BACs of 0.05% or
great er and that 16% to :J8% of
drive rs in injury -caus ing crash es had
BA Cs of 0.05% or great er (Tabl e 1).
Jn 1982, one in three perso ns killed
in Austr alian road crash es and one in
five injure d had a BAC of 0.05% or
I
•
20
----
5
1 < 10
I
I
30
-
--··
--
50
,,...--
70
,/
90
110
/
..
130
150
-
170
190
200
Blood Alcohol Concentration, mg/dl
Fig 2.-Ra lalive probab ility ol being respon
sible for fatal crash rises wilh rising blood alcoho
l
concen tration s.
more. 5 McDe rmott and Stron g' found
that drive rs with alcohol levels of
0.05% or niore have a greatl y
increa sed risk of being involved in a
road crash causi ng injury or death . In
the first three years of con11lulsory
BAC testin g of adult road crash victims in Austr alia's Victo ria State ,
27.1 % of 21,863 male drive r casua lties
and 8.7% of 9,187 femal e drtvc r casualti es had DACs excee ding the Victoria legal lhnit of 0.05'lo. Soder strorn
et al1 repor ted that of 413 road crash
victim s with n1easurahle BACs at an
emerg ency ruedical servic es cente r in
Mary land, 91 had RACs of less than
0.10%.
Alcohol involv emen t in crash es had
been called an epidctnic, with little
dimin ution in its propo rtions despi te
heigh tening of puLlic consci1:,usncss
by the activi ties of variou s co1nn1uni-
ty group s and anti-d runk- drivin g
campaigns.• Ravag es of the epide mic
have been great er amon g the young.
Fatal Accident Repo rting Syste m
(FAR S) data show, from 1977 to 1981,
a stead y increa se in the overa ll proportio n of measu reable blood alcohol
levels in drive rs aged 16 to 25 years
involved in fatal crash es.' The authors believed the data to be more
repre senta tive of patter ns of alcohol
use in that age group than impro vement in BAC testin g and repor ting.
Drive rs aged 16 lo -19 ye:irs have
. the highe st rate of alcohol-involved
fatal crash es per unit of trave_~-~ _Epiden1iolcgic data from .F'ARS also indicate over a numb er of years that
young er drive rs involv ed in fatal
crash es have lower avera ge BACs
than older drive rs. 1" Previo us reviews
of biogra phica l variahle:i in alcohol-
Alcoh ol-Cou ncil on Scient ific Affairs
523
115
Table 1.-lncidence of Blood
Alcohol Concentra11o ns ol 50 mg I dl.
by Crash Se1,1erily and
Type ol Road User
0
150
125
Cra•h Severity,%
Type ot
Road Uaer
Orivttr
Paaitenger•
Mo1orcydisl
Podealtlan •
~
13
Ptoperty
Damage
Injury
Fatal
::::: 10
16-38
45-55
25-35
35
30
..
165
25
22-25
19-25
• Percenlag<i shown is ol those older than
•
"-
100
~
a:
75
50
14
Yt:LlfS.
25
related crashes furnished the same
finding.
The role of alcohol in crashes of
tl'cnage drivers also is indicated in
FARS data for 1981 showing that
l\-vice as many with positive BACs
\Vere
involved
in single-veh ide
crashes as oppo~(~d to n1ultiple-vc hicle fatal crashes. A driver in a singlevehiclt! accident is presu1ned r·csponsible for his own crash. In the sarne
data, five tirnes rnore male than
ft>.rnale teenage drivers were lnvolved
in single-vehi cle fatal accidents, bearing oul by trend if not by precise ratio
another consistent biographic al find-
0
0
ing
Analysis of 198:! l•'Al!S data
showed that :la% (17,764) of all drivers in fatal road crashes that year
\\'ere 16 to 2-1 years uld. Of that
nu111bcr, 68'.1<) (G,83:1) were alcohol
involved, con1pared \vith 26% in all
olher age groups. Fatalities in road
crashes involving drinking drivers
aged 16 to 2,1 years numbered 7,784 in
1Hl:IB, of whurn 5l'Y" (J,~)02) were the
drivers themselves . 11
A rnodel developed by Siin1isonu
(Fig 3) shows the relative risk by age
group of having a fatal crash if
drivers were in1paired by BACs of
0.08'%, or greater. With the risk of a
sober driver having- a fatal crash set
at 1, the risk for in1paired 16- to
17-yc,tr-uld s is 165.
Young drivers arc overrepres ented
in crashes and also in alcoholinvolvcd crashes \vhen IlACs are low
lo 1noderate. Overreµres entution 1na.v
include cxiiosure (rniles driven} as a
l"Olllponenl. {)vcrrepres entation at
lo\\' BA Cs 1nay he a function of young-t•r drinkers having !t•ss alcohol tolerance than CXJJerience1l drinker::; and
younger drivers having less cxperit•ru·e than older drivt~rs."'
524
MSL"
16-17
20-24
25-29
30-34
35.44
45.49
50+
Total Impairment Risk Fact°'s
Fig 3.-Age group and risk ol fatal collision if impaired.
The Effects of Alcohol
\vith the drug.
One effect of alcohol in road
Dose/weig ht charts may not be
crashes is its contrihuLio n to enhanceappropriat e guides to drinking behav1ncnt of injury in alcohol-in1paircd
ior.11 Biologic variability of response
victin1s. Prevention or liniitation of
to alcohol has been den1onstra tcd
trau1na is less likely in alcoholunder controlled experiznen tal condii1nµaircd .drivers because they are
tions \vith both n1ale and female
less likely to use seat belts. - ~ Consubjects: in single-dose drinking tests
trary tc the pe;,111;..:· helicl in being
the elapsed tiine f--orry c.n4 of drinking
11
too drunk to g~t hurt," 1110!·~ alcoholtu peak BAG varied from 14 to 138
irnpaired crash victiins suffer serious
minutes in one group, and in a followinjury than i;olier victin1s.1.' Aleohol
up study the sa1~e investigato r found
con1plicates the physi.:ian's task of
a 14-fold variation between aLsorptreating traurna: neurc>logic injury . tion times in different subjects. 19-w
nuty be 1naskeJ hy drunkenne ss, and
Women achieve higher peak BACs
acute and/or chronic intoxicat.ion
than men Y:hen given identical
rnay Lie linked Lt> a consitlerab lc range
weight-adj usted doses.
of metabolic disturbanc es, as \vcll as
A reviey.· of seven studies spanning
to altered responses to anesthesia and
a 50-year period (Table 2) indicates
alterations in host defenses against
that at BACs of up to 0.05%, 0% to'
infection. 1 Expcri1nen tally controlled
ioc;o of persons were considered to be
injuries to laboratory anirnals result
"drunk"; at levels of 0.05% to 0.10%,
in lower survival rates for animals
149b to 68'.lh of persons were considfirst given alcohol and n1ore t!xtensive
ered to be 'jdrunk"; and at levels of
intracrania l hernorrhag e in alcohol0.10% to 0.15%, 83% to 97% were
in1pairetl animals after experin1cn tal
considered to he tlrunk. 11
penetration of brain tissue. 1. . '
'fhe deleterious effect of alcohol at
The influence of alcohol related to
BAC levels of 0.05% to 0.06% is seen
driving hchavior and driving skills is
in pcrson8 performing curve-nego niediated through its effects on the
tiating Hdriving" tasks under laboracentral nervous systen1, si1nilar to
tory conditions. Verhaegen et aizi conthose of general anc•.;thetic. Alcohol
cluded that at BACs between 0.05%
in sn1all doses 1:1ay cause JH~rforrn­
and 0.06'.Y,,, perforrnanc.e in informa·
ance of drivi11g--relatcd skills to fall
lion processing and curve-nego tiation
off; in n1otleratl! tu high a1nounls,
skill deteriorate d in test subjects.
alcohol
dirnini:,;hes
perfonuanc e
Burns and Moskowitz 21 observed a
across tlu~ lioard with gt•1H:ral i1npairJO';;, lo 15'Yr1 degree of in1pairn1ent at
rnent of nervous function. Effects
BACs of 0.05% tq 0.08% when subn1ay vary \vith p'.'.>ychologic.al profiles,
jcets had to perform a divided-att en·
tolerance to alcohol, and CX)jericncc
tion task of tracking and reaction.
JAMA, Jan 24.'31, 1986-Vol 255, No. 4
11 1
Alcohol-Co uncil on Scientilic Affairs
,.
---
-:-:i
Jt
Table 2.-Relation Between Blood Alcohol Level and Drunkenness
I
% of P•r11on11 Found to Be Drunk
0
0.00-
0.051-
0.05°
0.10
19
0
0.1010.15
50
0.1510.20
0.201·
0.25
83
93
0.2510.30
98
0.301·
0.35
100
2
38
93
97
99
100
100
10
16
47
83
90
95
96
10
66
61
92
97
100
0
46
50
92
100
100
0
14
69
90
94
94
0.3510.40
Total
Peraona
0.401
Examined
lnYe11tlg11tora t
1,984
Wtdmark
221
Schwarz
195
IOO
950
93
100
1,000
Jetter
...
. ..
1.712
Ander Sen
100
100
100
140
100
IOO
100
100
I
b
133
r
9
Harger
111
"''•
I
188
7
25
49
85
93
97
98
100
99
750
•
32
82
89
95
98
99
99
100
6,69.ot
Hine
123
. ..
'Percent weigh! by volume (0.05% w/v=-50 rngtdl; 0.15% w/v= 150 1119/dl) ol blood alcohol.
fNumbers under namas ol inveSll\l&lors are ralerenca citalions in reference 35. source ol Table 2
ar
0
1
A tl\vood et
te:-;ted driver:; on
closed-course conditions and using a
nu1ltivariate analysis technique found
that drivers with BACs of 0.06% to
0.ClH'X. exhibited n1ore variability than
alcohol-free drivers in lane position,
brake use, and steering controls.
ln1pairment of judgrnent by alcohol
\vas dernonslrate<l at BAC~ as low as
0.04 % when skilled bus drivers misjudged their ability to drive a vehicle
through a space as much as 12 in
narrower than the bus. H
Johnston) states that many tests of
alcohol use and skills relevant to
driving show that both information
acquisition and information processing are rendered slower ancl less
efficient, and the ability to carry out
a divided-attention task that requires
intellectual time sharing is impaired.
I le hypothesizes that \vhen impaired
drivers enter curves, they devote so
rnuch attention to the steering task
that other perception of cues related
to road curvature suffers, and they
fail to reduee speed adequately.
has been a revival of interest in
saliva-alcohol testing.
Laboratory rnethods for analysis of
blood san1ples include (1) che1nical
reduction of acid dichro1natc, (2)
enzyn1atic oxidation by alcohol dehydrogenase with colorin1etric determi. nation of NAfHI (the reduced for1n of
nicolinarnitlc - adenine dinucleoti1le)
conversion, and (3) gas-li_quid chromatography. Choice of the mclhod
used Ly a laboratory 1nay be influenced by the size and sophistication
of the facility and the reliability of
the rnethod for confirn1ation of roadside breath analyses, All three n1ethods have strengths ant! \veaknesses,
but gas chromatol{raphy is the n1ost
accurate and best suited for handling
large nun1bers of san1ples. IL al~o has
lhe advantage of sensitivity to other
aliphatic alcohols or volatile toxins
that a suspecl may have been ingesting with, or without, elhanol. ~
Breath analysis is by far the nlost
comn1on rnethod of n1easuring BAC.
The concentration of ethanol in one
volume of blood is stated in inost
textbooks anJ highway safely regulations to be equivalent to lhat in 2,100
volun1cs of alveolar air.~
llulio\vskii~ challenges the 2,100:1
conversion factor un the hasis of
sopliistiti\ll'd chcniie~tl a11alyses of
blood and breath alcohol. I le and
O'Nt~ill plal'e the 1nean alcohol partition factor between blood and breath,
in tht~ postahsorptive phase in
h1•allhy adult n1ales, al approxi1natl'ly ~.:100:1, \vith a range of I.7~17:1 to
~.71;:1: I f(Jr !I.")':;. of a population of :1~1;1
1
Chemical Tests for SAC
0
Determination of BAC is made
directly by che1nical testing of blood
dra\vn fro1n the subject or indirectly
by testing of expired Lrcath or urine.
A1ore and rnore, breath-alcohol analy::3is is performed for the purpose of
dl~terrnining the concentration of alcohol in hreath, rather than for
atlernpted conversion to blood-alcohol
eunl·enlrution. ()thcr fluids and tissut~s 1nay be tested bu! usually are not
in the livin~ ~uhjt•1·t; r1•e1•11tly, lh1·n·
JAMA, Jan 24131, 1986-VQ\ 2!:l0, No
1
4
healthy adult n1en and a range of
1,555:1 to 3,005:1for99.7%. Quantitative breath-alcohol analyzers are all
currently factory calibrated to a conversion factor of 2,100:1 to 1neet oflicial guidelines of the National l:ligh-
way Traffic Safety Administration.
Dubowski questions whether the conversion of breath alcohol concentra-
. tion. to BAC .should be retained for
for~~1sic p.urpOS~S' ~nd recommends
that breath alcohol coneentration
alone be used-for statutory definition
of DUL
That the 2,100:1 ratio is too low has
been raised as a possibility to explain
why breath analysis values from one
well-regarded instrument are on the
average 10%, to 153 lower than alcohol concentration in blood samples
taken at the san1e time_2<1
In a seven-1nonth trial in London or
three types of breath-testing instrun1ents used in the United States, the
breath-testing instruments tended to
underread actual blood alcohol levels
by 0 to 20 mg/dL in the RAC range of
0.05<Jo to 0.10%.)0
The US National Highway Traffic
Safety Administration
publishes
rnodel specifications for the performanee, calibration, and testing of
breath alcohol testing devices to
ensure their reliilhility.
DUI Countermeasures
Strengthening of state DUI laws
has lH·t!n a trend over the past several
year~.
State ltq.,dslalon; are apparently
that a growing national
n·,·oi~11izing
Alcohol ·--Council on Scientific Allairs
·-----,-
I
525
0
consensus against driving under the
inlluence ruu!'lt be hacked by specific
laws needed by police, courts, and
licensing ag-encics to get alcoholi1npaircd drivers otf the road.
The A MA in May 1982 issued to
state and medical specialty societies a
rlocun1ent
titled
"Drunk
Driving
La\vs" and urged state medical
a~so­
ciations to consider seeking enact1ncnt of legislation to strengthen l)UI
la\vs in their respective stales.
'l'hc AMA !louse of l)elagates at its
l98J Annual Meeting (Resolution 95,
A-8:1) rcafllrn1cd AMA policy to
encourage each state 1nedical society
to seek an<l support legislation lo
raise the n1inin1utn drinking age Lo 21
years, and it urged all physicians to
educate their patients about the dan-
0
0
gcr!i of alcohol abuse in general and
operating a motor vehicle while under
the influence of alcohol in particular.
An1ong the tnore visible and easily
identified strengthening of state l)Ul
laws is the rcplacernent of "presumptive" Ly "per se" Ja,vs. The latter laws
1nake it illegal in and of itself to drive
'vilh a BAC over certain specified
lin1its. In states with "illegal per se"
ht\\'S, proof of driving under the influence of alcohol is automatic \Vhen a
properly ad1ninistered test of the
specified type shows the driver's BAC
to Le over a specified limit. ~lost
states with illegal per se la\vs set the
BAC limit at 0.10%, but the range
an\ong all such stale laws is front
0.08% lo 0.15%.
A variation on the illegal per se la\\'
is a l\vo-stcp la\v adopted in sou1e
slatl!s: (1) illegal per se set at a
specified BAC, and (2) presu111ption of
driving under the influence set at a
lo\'..·er BAC, requiring supporting evid~nce other than breath or blood test
for prosecution.
'fhe Iiighway Users Fetleration rt•c01nn1ends an illegal per se law as one
provision in any driving legislative
package. Provisions incluJe (1) adrninistrative driver's lict'nse suspension, \Vhcrcliy the liccns(! of any tlrivcr arrested for driving under thl•
inllul'f\t'.c is s11spc111led for a spt~cilied
period, \vith harsh penalties itnposeJ
for driving: while the license is suspended (the 1neasure is .ain1cd at the
rcpe•1t offender); and (2) rl'Conling of
all aleohol-relateJ arrc::;ts, a provision
incant to identify repeat uffcndcn;
and particularly those whose aJc(Jhol526
related arrc::.ts are frequently plea
()n three occasions, in 1972, 1978,
hargaint•d to a lt!:-;~rr charge not
and 1H8:~. large assctnhlic:i of North
related lo alcohol.
American investigators ranked huIn rcvie\ving: tht! recent records of
rnan-related risk factors at or near
control rneasures, \Valler 11 identified
lhe top of DUI research needs. In
t\vO as being associated with positive
each instance, the group asked for
results: (1) An ine!"ca~"-' in thP age at
1nultivariate st~dies that incorporate
\vhir.h one can h.:! h,sucd a driver's
hun1an-related variables of an attitulicense or can drink legally see1ns to
dinal-personality nature and a longhave a positive effect in reducing the
term research strategy coordinated
nun1ber of alcohol-related crashes L:v
thrc.. 1gh so1ne cen~ral organization. 11
16- and 17-year-olds. (~) License susYouthful drh·ini~ and drinking is an
pension or revocation is the most
area \vhere research on multicausalicost-effective countern1easure yet
ty seemed urgently warranted to
identified for reducing driving by
investigators, in light of the peculiardrunk driving offenders. Arrest, trial,
ly high risk of dealh and injury from
and irnprison1nent are far n1ore
alcohol-related
crashes
in
this
expensive in public servant tirne and
group.u Some suggestive research
public funds. Revocation of a license
indicates that drinking and driving
for driving under the influence may
populations contain drinking/drivbe 1nandatory on conviction or n1ay
ing/crash-prone subpopulations in
occur ad1ninistratively upon evidence. whon1 the influence of alcohol on
that the person co1nn1it tetl the ofe1notions and attitudes rnay be an
fense. Waller noted that several
important causative factor.n The ininvestigators have reported that one
fluence of alcohol on an ernotionally
third to l\vo thirds of persons with
charged driving style may be as
revolu~d lict~nses eontinuctl to drive
irnportant as its influence on driving
skill.JU
while the revocation or suspension
\Vas in effect but \Vere driving less
Social and cultural factors that
often and 1norc carefully; n1ultiple .influence the magnitude, characterisl)LJJ 1.1ffen..ler:> wh,~ ''·t·i·c sn~- 1 .enl!ed
tics, and persis~encc of the drinking
had Letter subsequent records than
and driving problem arc not yet
co1nparable convictees whose licenses
defined. Whether sustained shifts in
\Vere not suspended.
sociai norms related ta rlrinking and
The i1npact of per s1' legislation
drivL1g can be brought about-as
upon deterrence of alcohol-irnpaired
they were in relation to littering,
driving \Vas unclear in four reviews of
smoking, and diet/fitness/heart disthe data, according to Waller. A diffiease-is a qaestion yet to be anculty often encountered was the
swered_»
inability of the revie\ver to separate
Conclusions
the effect of per sc laws fron1 that of
other countcr1neasures instituted at
1. Alcohol causes deterioration of
about the san1e tin1e in the san1e
driving skills beginning at 0.05%
states.u
llAC (50 mg of ethanol per deciliter of
Con1parison of n1~uit.1atory licensing
blood) or even lower. Deterioration
sanctions \vith education and rehabilprogresses r~pidly \\'ith rising BAC to
itation IJrogran1s for [){JI offenders in
serious impairment of driving skills
four state::> dc1nonstratcd clear supeat BACs of 0.10% and above, accordriority of the licensing sanctioni;; in
ing to scientific consensus.
reducing DUI recidivism and suhse2. Drivers with BACs of 0.05% to
t}UeJtt crash involve1ncnt. 11
• o.iory(J are significantly represented in
road crash statistics.
Research and Human-Rolatod
3. fJrivers aged 16 to 21 years have
Risk Factors
the highest rate of alcohol-involved
!vtu !Lidi!ici pl i nury i II\ cstiga lions of fatai cra:;hes per rr::Je, ;vith lo\vcr
driving and drinking are rare to nonaverage BACs than older drivers.
existt~nl. lirlultiplt~ foci of research
The Council on Scientific Affairs
interest-eg, higlnvay and auto saferecom1nc11d::; that the: AMA (1) direct
ty, phannaetilog-y, a!cobu~ and subpublic :riformation and education
stance abuse, trau111a trt'at.nH~nt, legagainst any drinking by drivers and
islation, anti rcgulatio11-·-have ten(lt•d
encourage other organizations to do
to OfH!rate \\'ithout strong linkages.
the san1c; (2) adopt a position sup-
JAMA. Jan 24131. 1986-Vol 255, No. 4
Alcohol- Council on Scientific Affairs
I
6
wi.·.
(
I
~.
porting a 0.05% RAC as per se illegal
for driving and urge incorporation
that position into all state DUI laws;
(3) reaftlrm the position supporting
21 years as the legal drinking age,
strong penalties for providing alcohol
or
0
to persons younger than 21 years, and
stronger penalties for JJroviding alcohol to drivers younger than 21 years;
(4) urge adoption by all states of an
adn1inistrative suspension or revocation of driver license8 after f)l!I con-
viction and mandalory revocation
after a specifred number of repeat
offenses; (5) encourage automobile
industry efforts to develop a safety
module that thwarts operation of a
car by an intoxicated person.
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0
JAMA, Jan 24131, 1986-Vol 255, No. 4
Alcohol-Council on Scientific Affairs
527
Pnnted 1Jnd Pu/J/1st•e<I 111 lf1tj United States of An·1t:1rica
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