Alcohol and Drug impairment

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What is Alcohol?
Intoxicating constituent of wine, beer, spirits and other drinks
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What are drugs defined as?
a medicine or substance which has a physiological effect when ingested or otherwise introduced to the body. This can be legal or illegal.
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What is fatigue?
The feeling of exhaustion or weakness after a period of mental or physical exertion which can have detrimental effects when driving
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What do all these factors have?
Big impacts on the ability to drive and can lead to serious road crashes
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How many crashes were there in 2017?
there was 12,973 crashes due to impairment or distraction (Department for Transport, 2018)
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What is the breakdown of this into how many accidents were caused by alcohol, drugs and fatigue?
4,415 were due to impairment by alcohol, 1,151 were due to impariment by drugs, 1,613 were due to impairment due to fatigue
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Impariments that lead to crashes is not only seen in the perpetrator but can be seen in who?
The victims
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Elliott, Woolacott and Braitwaite (2009) found what?
blood alcohol concentration was over the legal limit in 60% of victims. There is also implications made for indirect involvement or victims.
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Hill et al (1997) found what?
at 362 subjects who were passengers or other victims of road crashes: 14.5% had alcohol in their system, 8.5% had drugs and 6.5% had alcohol and drugs in their system of those that had drugs in their system 94% were under 40
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What does this show?
victims/passengers also have impairments which could have had an impact in the crashes. This is particularly seen in those who are under 40
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Where was the sample from?
Those who had been taken to hospital so cannot be a RCT and the original sample was over 800 subjects.
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What did the participants not accept?
Having their bloods taken and did not give accurate information
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Why is this not a representative sample?
The ones that did take part knew they had no impairment or thought it would be low/not affect their bloods
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What does this suggesT?
If the driver is impaired then the passenger is most likely to be as well.
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Who is most associated with impaired driving?
Younger drivers (Frith et al, 2004) and those that lack driving skills - novice drivers
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However, what is there a big issue with?
with impairment as it is hard to determine what was due to impairment of external factors (drug, alcohol etc) or if it is just lack of practice.
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Moskowitz and Robinson: Found what?
high Blood Alcohol Consumption affects reaction times, lacks divided attention and information processing and driving behaviour but there is varied findings.
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Vollrath and Fischer (2015) found that people do what when they have been drinking?
Compensatory behaviours
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Van Dyke and Fillmore (2015)
Alcohol increased risk taking by reducing time to collision (how close drivers maneuvered relative to other vehicles on the road.
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Miller, Mastin and Rothschild (2006) Intervention
Road Crew Program
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What does this intervention entail?
one key feature was to include rides to, between, and home from bars in older luxury vehicles
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What did the results show?
Results showed a 17% decline in alcohol-related crashes in the first year, no increase in drinking behaviour and large savings between the cost of cleaning up crashes
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Why are these types of intervention more effective than education/legal sanctions?
These types of interventions are good at raising awareness and at convincing those who are already prone to behave appropriately to do so, but most people are already knowledgeable about the societal norm that they are not to drive while impaired
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What do most interventions primarily focus on?
changing the behaviour of individuals. Educational campaigns and legal sanctions are designed to influence the attitudes and behaviours of individuals.
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Borkenstein et al (1964)
Found that those with a BAC of over .08 drank most frequently at home (51%) or public establishments (44%) and less frequently at friends or relatives (2%) or at parties and other locations (3%).
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What should interventions be aiming at?
interventions at aiming to not drink and drink after a social event has implications as it is not these places where drink driving are most likely.
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Therefore, enforcement is an intervention that has some benefits but what?
It does not appear to be effective enough
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Tay (2005)
looked at the effectiveness of the anit-drink driving enforcement and publicity campaigns implemented with the primary target being young male drivers
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What did the results show?
that the anti-drink driving enforcement and publicity campaigns had a significant independent effect in reducing crashes but their interactive effect was anti-complementary.
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Yadav and Kobayashi (2015)
Systematic review was conducted and found no evidence of media campaigns reducing the risk of alcohol-related crashes
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THerefore, why is finding the correct intervention vital?
alcohol related crashes causes the highest fatalities with 126 out of 379 fatal accidents in 2017 being caused by the driver drink-driving
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Kelly, Darke and Ross (2009) found?
Studies report that up to 25% of accident involved drivers were positive for drugs with cannabis being the most common drug detected
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What is there mixed evidence regarding?
Impairment behaviours associated with drugs
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Such as?
Cannabinoids cause more driving errors (Downey et al, 2018) but effects are cognitive and behaviours are compensatory according to Bondallaz et al (2017
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What did Opiods lead to?
increased crash involvement (Chihuri & Li, 2017) but codeine specifically does not impact behaviours (Nilsen et al, 2011).
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What could these mixed findings be due to?
Differences in metabolism rates and it is often mixed with other factors such as fatigue which could be leading factor in the rate of crashes
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What are education programs based on?
Theory of planned behaviour: PARTY program (Holmes et al, 2014)
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What does this do?
o Raises awareness of risk of injury through hospital visits. Those in the program have lower risk of injury, fewer traffic offences, and changed attitudes towards risk-taking
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what have competence enhancement prevention programs been found to do?
Reduce the chance of drug driving in young drivers
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Nichols, Botvin and Griffin (2004)
conducted a long term large scale randomised trial to determine the extent to which participation in a school-based drug abuse prevention program during high school led to less risky driving among students
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Those that received the program were less likely to have what?
violations and points on their licenses relative to the control group. Findings indicated that it had an effect on drinking violations but not so much on points
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However, what?
not all programs can change attitudes.
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Clapp et al (2014)
Used subjects who had used illegal drugs in the past 30 days in a randomised controlled trial
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What intervention were they given?
Either Life shift intervention or a control group, focusing on driving and traffic safety
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What was found?
no evidence of effectiveness of Life Shift on the primary drug use outcome as their normal intake of drugs did not differ
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What is driver fatigue?
The major cause of road accidents, accounting for over 20% of serious accidents on motorways and monotonous roads in the UK
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What does the Effort regulation theory (Hancock and Warm, 1989) theory suggest?
attributed performance impairments to a failure to match effort to environmental task demands
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What might fatigued drivers do?
drivers may misperceive task demands or fail to apply appropriate effort to the task
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Therefore?
, they will reduce their effort but this can lead to crashes.
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Multiple Resource theory (Wickens, 1991) suggests?
): there is not one single information processing source but several different pools of resources that can be tapped simultaneously
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Depending on the task, these resources may have what?
process info sequentially if the different tasks require the same pool of resources
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What does the theory views performance decrement as?
shortage of these different resources and describes humans as having limited capability for processing information. This is further limited when going through fatigue.
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How can fatigue be assessed behaviourally and physiologically?
Increased rate of lane deviations (Reyner & Horne, 1998) and smaller time headways (Zhang et al, 2016). o Increased in EEG alpha waves (Otmani et al, 2005) and lower heart rate (Lal & Craig, 2002).
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What interventions are the most effective at combating fatigue?
Engineering interventions
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Gasper et al (in press)
Forward collision warning systems could help prevent road crashes. - However not all interventions work.
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What is another intervention that has been suggested?
nother intervention is a drowsiness alert detector. It uses lane deviations and eye movements to tell you if it thinks you’re tired and suggests taking a break. However it doesn’t necessarily change the car’s behaviour and does not mean the person wi
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What is it based on?
The decision of the driver
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Nguyen, Jauregui & Dinges (1998)
interventions are based on self-management, it is believed that when questioning what people would do the two highest responses was to let someone else drive for a bit (23.3.%) and pulling off the road for >1 nap (23.3%)
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Therefore, if a detector was to say take a break what would most people do?
Abide and take a break
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Oron-Gilad (2008)
cognitive load to counteract fatigue- they gave truck drivers an additional memory task during a long drive. There was no changes in speed but it did make the drivers more alert (shown by a reduced HRV)
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Jamson and Merat (2009)
When testing chevron road-surface markings, transverse carriageway rumble strips and variable message signs
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What was found?
that these alerting effect appeared to be relatively weak and potentially quite short-lived
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Where was this study conducted?
driving stimulator which may reduce the perceived risk as they know it is not real and do not need to take it as seriously as if they were on the real road.
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Card 2

Front

What are drugs defined as?

Back

a medicine or substance which has a physiological effect when ingested or otherwise introduced to the body. This can be legal or illegal.

Card 3

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What is fatigue?

Back

Preview of the front of card 3

Card 4

Front

What do all these factors have?

Back

Preview of the front of card 4

Card 5

Front

How many crashes were there in 2017?

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