Alcohol—What it Is and What it Does - Alcohol And Trauma

The association between alcohol and unintentional injury has long been recognized. A passage in an Egyptian papyrus from 1500 B.C., for example, warned that drinking could lead to falls and broken bones. Short-term effects of alcohol include diminished motor coordination and balance, and impaired attention and judgment. Alcohol contributes to many types of unintentional injuries: motor vehicle and pedestrian accidents, as well as falls, drownings, and burns.

Motor Vehicle and Pedestrian Accidents

The National Highway Traffic Safety Administration (NHTSA) of the U.S. Department of Transportation defines a traffic crash as alcohol-related if either the driver or an involved pedestrian had a blood alcohol FIGURE 3.9
Prevalence of binge drinking among women aged 18-44 years, by state, 2002
SOURCE: J. Tsai and R.L. Floyd, "Figure. Prevalence of Binge Drinking among Childbearing-Aged Women (18-44 years), by State—United States, 2002," in "Alcohol Consumption among Women Who Are Pregnant or Who Might Become Pregnant—United States, 2002," Morbidity and Mortality Weekly Report, vol. 53, no. 50, December 24, 2004, http://www.cdc.gov/mmwr/PDF/wk/mm5350.pdf (accessed March 14, 2005) concentration (BAC) of 0.01% (grams per deciliter) or greater. People with a BAC of 0.08% or higher are considered intoxicated.

The NHTSA reported that 42,643 people were killed in traffic accidents in 2003, with 17,013 of them caused by alcohol-related crashes. These alcohol-related traffic deaths represented 40% of all car crash fatalities in 2003. The percentage of alcohol-related traffic fatalities has declined somewhat steadily from a high of 60% in 1982. (See Figure 3.10.) The peak number of fatalities occurred in 1988, when 47,087 traffic accident deaths (including both alcohol-related and nonalcohol-related) were recorded.

A number of important factors have contributed to the decline of drunk driving fatalities. Mothers against Drunk Driving (MADD) was founded in 1980. This organization's greatest achievement was lobbying to get the legal drinking age raised to twenty-one in all states, which occurred in 1988. There were also successful campaigns such as "Friends Don't Let Friends Drive Drunk." The use of seat belts has also helped reduce deaths in motor vehicle accidents.

As of July 2004, all states, the District of Columbia, and Puerto Rico had lowered the limit for drunk driving from 0.1 to 0.08, with all states implementing this limit by August 2005. At the beginning of 2005, forty-two states and the District of Columbia also had administrative license revocation (ALR) laws, which require prompt, mandatory suspension of drivers' licenses for failing or refusing to take the BAC test. This immediate suspension, prior to conviction and independent of criminal procedures, is invoked right after arrest.

TABLE 3.15
Prevalence of binge drinking and number of binge episodes per
person among women aged 18-44 years who might become
pregnant, by selected characteristics, 2002
SOURCE: J. Tsai and R.L. Floyd, "Table 2. Prevalence of Binge Drinking and Number of Binge Episodes per Person among Women Aged 18-44 Years Who Might Become Pregnant, by Selected Characteristics—United States, 2002," in "Alcohol Consumption among Women Who Are Pregnant or Who Might Become Pregnant—United States, 2002," Morbidity and Mortality Weekly Report, vol. 53, no. 50, December 24, 2004, http://www.cdc.gov/mmwr/PDF/wk/mm5350.pdf (accessed March 14, 2005)

Characteristic	Binge drinking %	Odds ratio	Episodes/person/year number
Age group (years)
18-24	19.4	2.5	8.0
25-34	13.1	1.6	4.0
35-44	8.6	1.0	3.0
Race/ethnicity
White, non-Hispanic	15.0	2.3	5.0
Non-white or Hispanic	7.0	1.0	2.2
Education
Less than a college degree	13.3	1.2	4.9
College degree	11.1	1.0	3.1
Current smoker
Yes	25.2	3.8	9.6
No	8.1	1.0	2.5
Married
Yes	10.3	1.0	3.0
No	19.6	2.1	8.5
Annual income
<$25,000	11.2	0.8	4.6
≥$25,000	13.3	1.0	4.4
Employment
Yes	13.5	1.3	5.0
No	10.3	1.0	2.6
Impaired drivera
Yes	90.7	78.1	52.9
No	11.1	1.0	3.5
Health coverageb
Yes	11.7	1.0	3.7
No	15.9	1.4	7.2
Notes: Estimated prevalence population weighted to represent U.S. women aged 18–44 years (U.S. average: 12.4%; state range: 5.4%–21.6%).Binge drinking is defined as having five or more drinks on any one occasion.
aBased on response to the question: Driven when had perhaps too much to drink?
bBased on response to the question: Have any health coverage, including health insurance, HMO, or Medicare?

As Table 3.17 shows, in both 1993 and 2003, drivers aged twenty-one to forty-four were the ones most likely to be in fatal crashes in which the driver had a BAC of 0.08 or higher. While the percentage of drivers within this group dropped between 1993 and 2003, the sharpest decline (16%) occurred among drivers aged twenty-five to thirty-four. The rate of fatal crashes for drivers between the ages of fifty-five and sixty-four and having a BAC of 0.08 or greater decreased by 14% as well.

In 2003 the percentage of male drivers involved in fatal crashes who had a BAC of 0.08 or greater was twice that of female drivers involved in fatal crashes (24% versus 12% respectively). When compared with 1993, TABLE 3.16
Interactions between alcohol and medications
SOURCE: Created by Staff of Information Plus for Thompson Gale

Substances	Interactions
Antidepressants	Alcohol slows the breakdown of these drugs and increases their toxicity.
Acetaminophen (aspirin substitute)	Alcohol can increase this pain killer's toxic effects on the liver.
Aspirin	Aspirin may increase stomach irritation caused by alcohol.
Antihistamines	Alcohol increases the sedative effects of these drugs.
Sedatives	Alcohol increases the effects of many of these drugs and can be dangerously toxic.
Antacid histamine blockers	These drugs can interfere with the metabolism of alcohol, making it more intoxicating.

the ratio remains somewhat consistent, but the percentages of drunk male and female drivers in fatal accidents dropped by 11% in males and 14% in women. (See Table 3.17.)

Alcohol was related to a higher percentage (29%) of fatal crashes by motorcycles than for crashes involving automobiles and light trucks (22% for each vehicle type). Fatal crashes involving large trucks were very unlikely to be alcohol related (1%). (See Table 3.17.)

As Table 3.18 shows, in both 1993 and 2003, roughly half of all pedestrians aged twenty-one to forty-four who were killed in a traffic accident had a BAC of 0.08 or higher. This percentage was considerably higher than that for other age groups. Alcohol consumption is less of a factor in fatal pedestrian/motor vehicle accidents than it once was. The percentage of pedestrians killed in traffic accidents who were legally alcohol impaired dropped between 1993 and 2003 for all age groups except forty-five- to sixty-four-year-olds, who stayed at 38%.

Falls, Drowning, and Burns

Data from the National Center for Injury Prevention and Control (NCIPC), an office of the Centers for Disease Control and Prevention, show that excessive alcohol consumption is a significant factor in accidental deaths. In 2003, 16,926 fatalities resulted from falls, up from 16,257 in 2002 (National Vital Statistics Reports, February 28, 2005). It was the third-leading cause of unintentional injury death, closely following accidental poisoning. (Motor vehicle accidents were first.) According to the NCIPC's Fact Book for the Year 2000, alcohol consumption is involved in 18 to 53% of nonfatal falls each year. Alcohol (and its misuse) can be linked to as much as 40% of industrial fatalities and 47% of industrial injuries, according to the U.S. Department of Labor.

The NCIPC reports that alcohol is involved in 40 to 50% of drowning deaths among teenage boys. In addition, alcohol use is involved in about 50% of all deaths FIGURE 3.10
Total fatalities and alcohol-related fatalities in motor vehicle accidents, 1982-2003
SOURCE: Adapted from "Table 13. Persons Killed, by Highest Blood Alcohol Concentration (BAC) in the Crash, 1982-2003," in Traffic Safety Facts 2003, U.S. Department of Transportation, National Highway Traffic Safety Administration, January 2005, http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSFAnn/2003HTMLTSF/TSF2003.htm (accessed February 24, 2005) associated with water recreation, such as boating. An NCIPC analysis of survey data on alcohol use during recreational boating revealed that 31% of respondents who operated motorboats reported doing so at least once while alcohol-impaired. Most of these respondents were male and between the ages of twenty-five and thirty-four.

All fifty states, the District of Columbia, and Puerto Rico impose a BAC limit of below 0.08 for driving. In addition, states impose a BAC limit of either 0.08 or 0.10 or lower for boating. All states have boating-under-the-influence laws (National Association of State Boating Law Administrators, Reference Guide to State Boating Laws, 5th ed., 1999 [most recent edition available at this writing]). Penalties for boating while intoxicated include fines, imprisonment, substance abuse or boating safety classes, and suspension of boat operating privileges.

Fires were the fourth-leading cause of unintentional injury death in the United States in 2003, killing 3,363 people (National Vital Statistics Reports, February 28, 2005). According to a study cited by the NCIPC in its Fact Book for the Year 2000, alcohol contributes to 40% of deaths in residential fires.