Changes in Alcohol Use and Drinking and Driving Outcomes From Before Arrest for Driving Under the Influence to After Interlock Removal.

BACKGROUND: Half of the offenders convicted of impaired driving in the United States are sentenced to install alcohol ignition interlock devices (IIDs), which prevent them from starting their vehicles if they have been drinking. No research has yet explored offenders' patterns of alcohol consumption and driving under the influence of alcohol (DUI) from the time before the arrest to the time period after the IID is installed. This study aims to fill that gap in knowledge. METHODS: Using the Timeline Follow-back interview procedure, we assessed the daily drinking of 153 convicted DUI offenders' self-reported total alcohol consumption and rates of self-reported driving after drinking over 4 phases: before DUI arrest, between arrest and IID installation, during the phase on the interlock, and after the interlock is removed. Because information about behaviors in each period was not available for every participant, comparisons were made using paired-sample contrasts. RESULTS: Compared with before the arrest, total alcohol use decreased by 50% in the 4-month phase following arrest and before IID installation, though it did not change much afterward. The frequency of drinking and driving decreased sharply after the arrest (-82%), with further decrease upon installation of the interlock (-58%, p = 0.05). The frequency of drinking and driving after the IID was removed returned to preinstallation drinking and driving status (+58%, p = 0.01). CONCLUSIONS: Participants made significant adjustments to their drinking behavior by adhering to the traditional DUI driving restrictions in the postarrest phase. Although installation of an IID was not associated with a significant change in drinking, it further reduced the frequency of drinking and driving. Evaluations of the IID experience should take into account information on an individual's drinking and DUI behaviors not only before the IID was installed, but before the individual was arrested.

Convicted drinking and driving offenders: Comparing alcohol use before and after the pandemic outbreak.

BACKGROUND: Before the COVID-19 pandemic, very little was known about the impact of social isolation on individuals' alcohol use and misuse. This study examines how socially isolated individuals with a history of heavy drinking used alcohol during the pandemic. METHODS: Data for this study came from an add-on to the Managing Heavy Drinking (MHD) longitudinal study of drivers convicted of DWI that was conducted in Erie County, New York. Pre-COVID information (October 2019-March 2020) was augmented with a COVID-19 questionnaire collected between July and August 2020. A total of 92 participants completed the COVID-19 survey. RESULTS: The sample of problem drinkers showed a significant increase after the pandemic outbreak in the average number of drinking days from 1.99 to 2.49 per week (p = 0.047), but a significant decrease in the average number of drinks per drinking day, from 3.74 to 2.74 (p = 0.003). The proportion of individuals who drank more frequently was greater among those who, before the outbreak had an Alcohol Use Disorders Identification Test (AUDIT) score <8 (26% increase) compared with those with an AUDIT score of >8 (13%). Alcohol treatment was also associated with the frequency of drinking, with individuals who were not in alcohol treatment showing a 16% increase in frequency compared with a 10% increase among those in treatment. Further, individuals who, after the outbreak worried about their health (30%) or finances (37%) reported greater increases in the frequency of drinking than those who did not worry about their health (17%) or finances (10%). CONCLUSIONS: Overall, the individuals in our sample showed small changes in the frequency andheaviness of drinking after the outbreak of COVID-19, effects that opposite in direction from one another and thus resulted in no overall change in drinks consumed. Nonetheless, we identified factors that influenced the effects of the pandemic on drinking behavior among individuals convicted of DWI, which emphasizes the need to individualize these individuals' treatment, particularly in the context of dramatic environmental change.

Marijuana and the Risk of Fatal Car Crashes: What Can We Learn from FARS and NRS Data?

Lab studies have shown that marijuana can severely impair driving skills. Epidemiological studies, however, have been inconclusive regarding the contribution of marijuana use to crash risk. In the United States, case-control studies based on the merging of comparable crash Fatality Analysis Reporting System (FARS) and non-crash National Roadside Survey (NRS) data have been applied to assess the contribution of drugs to crash risk, but these studies have yielded confusing, even contradictory results. We hypothesize that such a divergence of results emanates from limitations in the databases used in these studies, in particular that of the FARS. The goal of this effort is to examine this hypothesis, and in doing so, illuminate the pros and cons of using these databases for drugged-driving research efforts. We took advantage of two relatively recent cannabis crash risk studies that, despite using similar databases (the FARS and the NRS) and following similar overall approaches, yielded opposite results (Li, Brady, & Chen, 2013; Romano, Torres-Saavedra, Voas, & Lacey, 2014). By identifying methodological similarities and differences between these efforts, we assessed how the limitations of the FARS and NRS databases contributed to contradictory and biased results. Because of its limitations, we suggest that the FARS database should neither be used to examine trends in drug use nor to obtain precise risk estimates. However, under certain conditions (e.g., based on data from jurisdictions that routinely test for drugs, with as little variation in testing procedures as possible), the FARS database could be used to assess the contribution of drugs to fatal crash risk relative to other sources of risk such as alcohol.

Mandating Treatment Based on Interlock Performance: Evidence for Effectiveness.

BACKGROUND: Vehicle alcohol ignition interlocks reduce alcohol-impaired driving recidivism while installed, but recidivism reduction does not continue after removal. It has been suggested that integrating alcohol use disorder (AUD) treatment with interlock programs might extend the effectiveness of interlocks in reducing recidivism beyond their removal. This study evaluated the first implementation of a Florida policy mandating AUD treatment for driving under the influence (DUI) offenders on interlocks. Treatment was required when the offender accumulated 3 violations (defined as 2 "lockouts" within 4 hours; a lockout occurs when the device prevents a drinking driver from starting the vehicle). METHODS: Cox regression was used to compare alcohol-impaired driving recidivism during the 48 months following the interlock removal between 2 groups: (i) 640 multiple DUI offenders who received AUD treatment while interlocks were installed; and (ii) 806 matched offenders not mandated to treatment while interlocks were installed. RESULTS: The ignition interlock plus treatment group experienced 32% lower recidivism, 95% confidence interval [9, 49], following the removal of the interlock during the 12 to 48 months in which they were compared with the nontreatment group. We estimated that this decline in recidivism would have prevented 41 rearrests, 13 crashes, and almost 9 injuries in crashes involving the 640 treated offenders over the period following interlock removal. CONCLUSIONS: This study provides strong support for the inclusion of AUD treatment for offenders in interlock programs based on the number of times they are "locked out." The offenders required to attend treatment demonstrated a one-third lower DUI recidivism following their time on the interlock compared to similar untreated offenders.

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.

Method of transportation and drinking among club patrons.

OBJECTIVE: The current study examines the variation in alcohol use among nightclub patrons under three transportation conditions: those who departed from a club using modes of transportation other than cars or motorcycles (e.g., pedestrians, bicyclists, subway riders); those who were passengers of drivers (auto/taxi passenger patrons); and those who drove from the club (driving patrons). We seek to determine whether patrons' choice for how to leave the club contributes to their risk, as assessed by blood alcohol concentrations (BAC), after controlling for other factors that may contribute to their BAC including demographic characteristics and social drinking group influences. METHODS: Data were collected from social drinking groups as they entered and exited clubs for 71 different evenings at ten clubs from 2010 through 2012. Using portal methodology, a research site was established proximal to club entrances. Each individual participant provided data on themselves and others in their group. The present analyses are based upon 1833 individuals who completed both entrance and exit data. Our outcome variable is blood alcohol content (BAC) based upon breath tests attained from patrons at entrance and exit from the club. Independent variables include method of transportation, social group characteristics, drug use, and personal characteristics. We use step-wise multiple regressions to predict entrance BAC, change in BAC from entrance to exit, and exit BAC: first entering individual demographic characteristics, then entering group characteristics, then drug use, and finally entering method of transportation (two dummy coded variables such that drivers are the referent category). RESULTS: In sum, in all three of our analyses, only three variables are consistently predictive of BAC: presence of a group member who is frequently drunk and non-driving modes of transportation, either being the passenger or taking alternate methods of transportation. In particular, taking an alternate form of transportation was consistently and strongly predictive of higher BAC. CONCLUSIONS: Additional public health messages are needed to address patrons who are no longer drinking and driving but who are nonetheless engaged in high levels of drinking that may lead to various risky outcomes, for example: being targeted for physical and/or sexual assault, pedestrian accidents, and other adverse consequences. These risks are not addressed by the focus on drinking and driving. Key messages appropriate for patrons who use alternate transportation might include devising a safety plan before entering the club and a focus on sobering up before leaving.

Indicators of club management practices and biological measurements of patrons' drug and alcohol use.

BACKGROUND: Electronic music and dance events in nightclubs attract patrons with heavy alcohol/drug use. Public health concerns are raised from risks related to these behaviors. Practices associated with increased risk in these club settings need to be identified. OBJECTIVES: The relationship between club management practices and biological measures of patrons' alcohol/drug use is examined. METHODS: Observational data from 25 events across six urban clubs were integrated with survey data (N = 738 patrons, 42.8% female) from patrons exiting these events, 2010-2012. Five indicators of club management practices were examined using mixed model regressions: club security, bar crowding, safety signs, serving intoxicated patrons, and isolation. RESULTS: Analyses revealed that serving intoxicated patrons and safety signs were related to substance use. Specifically, serving intoxicated patrons was related to heavy alcohol and drug use at exit, while safety signs were marginally related to less exit drug use. CONCLUSIONS/IMPORTANCE: Findings indicate observable measures in nightclubs provide important indicators for alcohol/drug use, suggesting practices to target. Study strengths include the use of biological measures of substance use on a relatively large scale. Limitations and future directions are discussed.

Administrative reinstatement interlock programs: Florida, a 10-year study.

BACKGROUND: Interlocks reduce driving-under-the-influence (DUI) recidivism by 64%, but offenders resist installing them, preferring to risk driving while their driver's licenses are revoked. One method of motivating offenders to install an interlock is require it for reinstatement of their driver's license. This report updates an earlier evaluation of the administrative reinstatement interlock program (ARIP) procedure implemented in Florida in 2002. METHODS: Driver records and interlock program records covering 120,000 DUI offenders were followed over 10 years. The flow through the sanction system--conviction, reinstatement, interlock program, and postinterlock period--is described. Logistical regression was used to identify the characteristics of offenders who installed interlocks, and survival analysis was used to evaluate the recidivism of offenders in the various stages in the ARIP. RESULTS: At any given time, approximately one-third of the convicted offenders were serving their license-revocation periods. Half of the offenders who completed their revocation periods remain unqualified for reinstatement because they do not fulfill other requirements. ARIP offenders who do qualify for reinstatement and install interlocks have lower recidivism rates while the devices are on their vehicles. CONCLUSIONS: After 10 years, Florida's ARIP is a mature system that succeeds in forcing all offenders in the program who qualify for reinstatement to install an interlock for at least 6 months. However, half of all offenders who complete their mandatory revocation period are either unable to or choose not to qualify for reinstatement.

Marijuana as a predictor of concurrent substance use among motor vehicle operators.

Despite the adverse effects associated with marijuana abuse and dependence, marijuana is becoming more common-place in activities such as driving. Previous literature has discussed the high rates of cocaine, opioid and benzodiazepine use among users of marijuana, but no research has addressed the rates of concurrent use among drivers meeting abuse or dependence criteria. Each of these substances may produce effects detrimental to driving safety which may be compounded by concurrent substance use. This research examines rates of marijuana use, abuse, and dependence among an active sample of drivers (N = 7,734) in the 2007 National Roadside Survey. Mean age of participants was 36.89 years, and the majority were male (60.1%) and identified as White (59.2%). Participants who used marijuana but did not meet diagnostic criteria for abuse (n = 165) or dependence (n = 112) were significantly more likely to test positive for all substances than were those who did not use marijuana. Further, those that met criteria for marijuana abuse or dependence were more likely than those who did not meet criteria to test positive for THC, cocaine, and benzodiazepines and THC, cocaine, and opioids, respectively. The current research has implications for policy development and drugged driving interventions.

Commentary on Fitzpatrick and colleagues (2012): Forecasting the effect of the amethyst initiative on college drinking.

BACKGROUND: There is considerable evidence that heavy episodic drinking (HED) is a serious problem among college students. Concern with this problem has led 135 college presidents to endorse the Amethyst Initiative, which promotes the lowering of the minimum legal drinking age (MLDA) from 21 to 18. The Amethyst Initiative claims that the current MLDA of 21 encourages underage college students to drink in unsupervised locations where they adopt misconceptions regarding the normative level of student drinking that leads to excessive consumption or HED. The study by Fitzpatrick and colleagues (2012) in this issue challenges this hypothesis by contrasting the potential reduction in misapprehension of the drinking norm against the increase in consumption that would be expected if the MLDA was lowered to 18. METHODS: This commentary places the Fitzpatrick study within the larger context of the MLDA, noting that full consideration of the lowering the MLDA requires the inclusion of 18- to 20-year-old noncollege youths in the work force and 15- to 17-year-old high school students who will have increased access to alcohol through their 18-year-old peers. RESULTS: Research suggests that alcohol consumption and its associated problems will increase for 15- to 20-year-olds if the MLDA was lowered. This commentary also identifies alternative strategies for reducing college student HED that do not require lowering the MLDA. CONCLUSIONS: Although college binge drinking is a significant problem, reducing the drinking age is unlikely to be effective. Instead, it will increase the risk of alcohol problems faced by even younger high school students.

Understanding non-installers of the ignition interlock device: A qualitative analysis.

INTRODUCTION: Literature notes the efficacious use of alcohol ignition interlock devices (IID) in reducing rates of drinking and driving while installed on the vehicle. Some drivers who are convicted of driving while intoxicated (DWI) elect to have their license suspended/revoked instead of installing the device. These individuals represent a high-risk subsample of drivers, yet limited literature has addressed this concern. The current study seeks to fill this gap using qualitative interviews addressing: (i) why do non-installers make the choice to not install a mandated IID; and (ii) how are non-installers managing without the IID? METHODS: The study utilises the Managing Heavy Drinkers study of drivers in Erie County, New York, USA. Participants were purposively sampled from a group of non-installers (n = 6; four females, two males) who completed semi-structured interviews. Constructed grounded theory was used to develop a theoretical understanding of participant's experiences. RESULTS: To understand why participants elect not to install the IID, thematic analysis revealed: alleviating constraints, predominantly the financial burdens associated with an IID, and institutional mistrust. Additionally, data revealed that participants are managing without the IID by mitigating apprehension. This included driving cautiously to avoid detection and utilising alternative transportation. DISCUSSION AND CONCLUSIONS: This study furthers understanding of why drivers convicted of a DWI elect not to install an IID. Future research should seek to identify barriers to IID installation. This work provides evidence for establishing institutional protocols that ensure drivers convicted of a DWI receive consistent and correct information about the IID process.

DUI offenders delay license reinstatement: a problem?

BACKGROUND: We examined the extent to which driving under the influence (DUI) offenders delay reinstatement, the reasons for that delay, and the relationship of the delay to recidivism. Analyzed were the driving records of 40 million drivers (3 million convicted of DUI) from 7 of the largest states spanning 7 to 14 years. License suspension effectively reduces, but does not eliminate, impaired driving. Apparently, many feel they can avoid apprehension for unlicensed driving; the limited research to date suggests that up to 75% of convicted offenders continue to drive and up to 84% delay reinstatement for 3 or more years. METHODS: ANOVA and regression procedures were used to determine the relationship of prior driving record and sentence length to the DUI offender's delay in reinstatement. Meta-analysis was used to summarize results across the 7 states and survival analysis to determine the effect of the delay on recidivism. RESULTS: Forty-two percent of first offenders and 55% of multiple offenders convicted for DUI delay reinstatement for more than a year. For a third of the offenders, there were no records of their having reinstated within 5 years of becoming eligible. Both factors-more than one prior offense and the length of suspension imposed-were related to delay in reinstatement. Offenders who delayed reinstatement were more likely to recidivate both while they delayed before reinstating and after they reinstated. CONCLUSIONS: DUI offenders who delay reinstatement after they become eligible are high-risk drivers. Offenders who reinstate, however, have lower recidivism rates than those who do not. This suggests that encouraging reinstatement but with continued controls, as some states have provided through laws requiring interlocks as a condition of reinstatement, may be effective if they do not motivate extended delays.

The impact of underage drinking laws on alcohol-related fatal crashes of young drivers.

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.

Environmental Strategies for Prevention of Drug Use and Risks in Clubs.

Environmental prevention strategies in club settings where music and dance events are featured could provide an important new arena for the prevention of drug use and other risky behaviors (e.g., sexual risk taking, intoxication and drug use, aggression, and driving under the influence). Electronic music dance events (EMDEs) occur in clubs that attract young, emerging adults (18-25 years of age) and attract individuals who engage in various types of drug use. Borrowing from the environmental prevention studies that focus on reducing alcohol use and related problems, a model for drug prevention in the club setting is proposed. Initially, an overview of the relationships between EMDEs and drug use and other risky behaviors are presented. Next, rationales for environmental strategies are provided. Finally, an environmental approach to prevention of drug use and risky behaviors in clubs is described. This comprehensive set of environmental strategies, is designed to be mutually supportive and interactive. Environmental strategies are believed to provide potential for developing an efficacious prevention strategy. The environmental prevention approach presented here is composed of three intervention domains: (1) Mobilization, (2) Strategies for the Exterior Environment, and (3) Strategies for the Interior Environment.

Bringing alcohol on campus to raise money: impact on student drinking and drinking problems.

AIMS: Universities are striving to raise funds, often attracting spectators by selling alcohol at campus events. This study evaluates the effect of a policy change on student drinking at a large western university that had historically banned alcohol on campus but transitioned to permitting the sale of alcohol in some of its facilities. METHODS: Surveys of student drinking and perceptions of other students' drinking were conducted before, during and after the policy change at the transition university (TU) and compared to similar data from a control university (CU). Surveys of student drinking at on-campus and off-campus venues and observations of alcohol service practices were also conducted. RESULTS: The policy change at the TU was introduced cautiously, and sales to underage drinkers were relatively well controlled. Despite this, student drinking rose initially, then declined after 1 year. Perceptions of the amount of drinking by other students increased slightly, but there was no overall measurable increase in student drinking during the first 3 years of the new policy. CONCLUSIONS: The conservative TU policy-to sell alcohol only at select events and to control sales to minors-may have limited the impact of on-campus alcohol sales on student consumption. Although the study results did not find a stable increase in student drinking, they do not necessarily support the liberalization of campus alcohol policy, because the transition is still 'in progress' and the final outcome has not been evaluated.

The relationship of underage drinking laws to reductions in drinking drivers in fatal crashes in the United States.

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

The relationship between blood alcohol concentration (BAC), age, and crash risk.

PROBLEM: The role of age (youth and driving inexperience) and alcohol as major risk factors in traffic crash causation has been firmly established by numerous studies over the past 50 years. Less well established is how the two variables interrelate to influence crash risk. Some investigations have hypothesized an interactive or synergistic effect in which young drivers with less experience and a greater tendency to take risks are more adversely affected at lower blood alcohol concentrations (BACs) than are older drivers. The evidence for this hypothesis is mixed. Resolution of this issue has important implication for developing countermeasures directed at the young driver crash problem. METHOD: Case control data previously collected in Long Beach and Fort Lauderdale were reanalyzed using a more sensitive method for detecting interaction effects than used in the original analysis. A conditional logistic regression analyses found a highly significant agexBAC interaction (P<.0001) involving differences between drivers under 21 and those 21 and older. DISCUSSION: The results clearly indicate that positive BACs in drivers under 21 are associated with higher relative crash risks than would be predicted from the additive effect of BAC and age. It is likely that two mechanisms are operating to cause the interaction. First, it seems likely that the crash avoidance skill of young novice drivers would be more adversely affected by alcohol due to their driving inexperience, immaturity, and less experience with alcohol. Second, drivers under 21 who choose to drink and to drive after drinking probably have pre-existing characteristics that predisposed them to risk taking and crash involvement apart from any increased vulnerability to alcohol impairment. IMPACT ON INDUSTRY: The results support increased enforcement of zero-tolerance BAC laws for minors.

A Night in Tijuana: Female Victimization in a High-Risk Environment.

We examine the epidemiology of victimization among females crossing the U.S. border to drink in Tijuana, Mexico, with the purpose of creating a framework for an intervention to improve safety among female youth in drinking settings. Drinking history, history of victimization, evening drinking experience, and environmental factors are assessed.Among female crossers surveyed in 2005-2006, 53% reported experiencing some type of victimization, with 29% experiencing moderate physical aggression and 38% experiencing unwanted moderate sexual incidents. Youth and reported history of verbal abuse were consistently associated with victimization with more participants frequently reporting incidents of victimization. Predictors of victimization among young females (aged 16-20) generally included environmental factors, whereas evening drinking was associated with victimization among women aged 21 and older.

Drivers with alcohol use disorders and their risks of crash involvement.

BACKGROUND: The relationship between driver blood alcohol concentration (BAC) and crash involvement is well understood. However, the role of alcohol use disorders (AUDs) (i.e., dependence or abuse) in crash occurrence, as distinguished from non-clinical heavy alcohol consumption, has not been adequately explored. METHODS: Data from the 2010-2011 Crash Risk Study conducted in Virginia Beach, VA, were used in this study. Drivers involved in crashes were compared with control drivers, and four drinker groups were examined: alcohol dependent, alcohol abusers, heavy drinkers, and all other current (i.e., normative) drinkers. Logistic regression analyses were conducted on two outcomes: having a moderate BAC (≥0.05 g/dl), and crash involvement. RESULTS: Overall, 2411 crash-involved and 5514 control drivers provided useable data, 52.4% of which were men and 70.8% Whites. The prevalence of drivers with AUDs was lower for the crash-involved drivers (8.7%) than for the control drivers (12.7%). Only heavy drinkers, but not abusive or dependent drinkers, were over four times more likely to drive with moderate BACs at nighttime. More important, at nighttime, the odds of crash involvement for dependent drinkers were only one third of those for normative drinkers. Daytime crashes, however, were more likely to involve normative drinkers than any of the other three drinker types. CONCLUSIONS: Drivers with AUDs are not more likely than normative drinkers to drive with moderate BACs at night. After accounting for the influence of BAC, dependent drinkers have a lower risk of being involved in a crash, at any time of the day.