Physiology / Alcohol and the Human Body / Alcohol Properties //-- Alcohol and the Human Body Alcohol's Properties 1 Alcohol is a general term denoting a family of organic chemicals with common properties. Members of this family include ethanol, methanol, isopropanol, and others. This introduction discusses the physical, chemical, and physiological aspects of the most commonly ingested of these - ethanol. Alcohol (ethanol) is a clear, volatile liquid that burns (oxidizes) easily. It has a slight, characteristic odor and is very soluble in water. Alcohol is an organic compound composed of carbon, oxygen, and hydrogen; its chemical formula is C2H5OH. Alcohol is a central nervous system depressant and it is the central nervous system which is the bodily system that is most severely affected by alcohol (see chart below). The degree to which the central nervous system function is impaired is directly proportional to the concentration of alcohol in the blood 2 . When ingested, alcohol passes from the stomach into the small intestine, where it is rapidly absorbed into the blood and distributed throughout the body. Because it is distributed so quickly and thoroughly the alcohol can affect the central nervous system even in small concentrations. In low concentrations, alcohol reduces inhibitions. As blood alcohol concentration increases, a person's response to stimuli decreases markedly, speech becomes slurred, and he or she becomes unsteady and has trouble walking. With very high concentrations - greater than 0.35 grams/100 milliliters of blood (equivalent to 0.35 grams/210 liters of breath ) - a person can become comatose and die. The American Medical Association has defined the blood alcohol concentration level of impairment for all people to be 0.04 grams/100 milliliters of blood (equivalent to .04 grams/210 liters of breath). The following is a generally accepted guide to the effects of alcohol. Stages of alcohol intoxication 3 3 BAC (g/100 ml of blood or g/210 l of breath) Stage Clinical symptoms 0.01 - 0.05 Subclinical Behavior nearly normal by ordinary observation 0.03 - 0.12 Euphoria Mild euphoria, sociability, talkitiveness Increased self-confidence; decreased inhibitions Diminution of attention, judgment and control Beginning of sensory-motor impairment Loss of efficiency in finer performance tests 0.09 - 0.25 Excitement Emotional instability; loss of critical judgment Impairment of perception, memory and comprehension Decreased sensitory response; increased reaction time Reduced visual acuity; peripheral vision and glare recovery Sensory-motor incoordination; impaired balance Drowsiness 0.18 - 0.30 Confusion Disorientation, mental confusion; dizziness Exaggerated emotional states Disturbances of vision and of perception of color, form, motion and dimensions Increased pain threshold Increased muscular incoordination; staggering gait; slurred speech Apathy, lethargy 0.25 - 0.40 Stupor General inertia; approaching loss of motor functions Markedly decreased response to stimuli Marked muscular incoordination; inability to stand or walk Vomiting; incontinence Impaired consciousness; sleep or stupor 0.35 - 0.50 Coma Complete unconsciousness Depressed or abolished reflexes Subnormal body temperature Incontinence Impairment of circulation and respiration Possible death 0.45 + Death Death from respiratory arrest Absorption 4 Alcohol is absorbed from all parts of the gastrointestinal tract largely by simple diffusion into the blood. However the small intestine is by far the most efficient region of the gastrointestinal tract for alcohol absorption because of its very large surface area. In a fasting individual, it is generally agreed that 20% to 25% of a dose of alcohol is absorbed from the stomach and 75% to 80% is absorbed from the small intestine. Because of this peak blood alcohol concentrations are achieved in fasting people within 0.5 to 2.0 hours, (average 0.75 - 1.35 hours depending upon dose and time of last meal) while non-fasting people exhibit peak alcohol concentrations within 1.0, and in extreme cases up to as much as 6.0 hours (average 1.06 - 2.12 hours). Distribution Alcohol has a high affinity for water and is therefore found in body tissues and fluids inasmuch as they contain water. Absorbed alcohol is rapidly carried throughout the body in the blood and once absorption of alcohol is complete an equilibrium occurs such that blood at all points in the system contains approximately the same concentration of alcohol. Elimination The liver is responsible for the elimination - through metabolism - of 95% of ingested alcohol from the body. The remainder of the alcohol is eliminated through excretion of alcohol in breath, urine, sweat, feces, milk and saliva. The body uses several different metabolic pathways in its oxidation of alcohol to acetaldehyde to acetic acid to carbon dioxide and water. Healthy people metabolize alcohol at a fairly consistent rate. As a rule of thumb, a person will eliminate one average drink or .5 oz (15 ml) of alcohol per hour. Several factors influence this rate. The rate of elimination tends to be higher when the blood alcohol concentration in the body is very high or very low. Also chronic alcoholics may (depending on liver health) metabolize alcohol at a significantly higher rate than average. Finally, the body's ability to metabolize alcohol quickly tend to diminish with age. Body Weight and Body Type In general, the less you weigh the more you will be affected by a given amount of alcohol. As detailed above, alcohol has a high affinity for water. Basically one's blood alcohol concentration is a function of the total amount of alcohol in one's system divided by total body water. So for two individuals with similar body compositions and different weights, the larger individual will achieve lower alcohol concentrations than the smaller one if ingesting the same amount of alcohol. However, for people of the same weight, a well muscled individual will be less affected than someone with a higher percentage of fat since fatty tissue does not contain very much water and will not absorb very much alcohol. Rate Of Consumption Blood alcohol concentration depends on the amount of alcohol consumed and the rate at which the user's body metabolizes alcohol. Because the body metabolizes alcohol at a fairly constant rate (somewhat more quickly at higher and lower alcohol concentrations), ingesting alcohol at a rate higher than the rate of elimination results in a cumulative effect and an increasing blood alcohol concentration. Alcohol Content It's not how many drinks that you have, but how much alcohol that you consume. As you can see from the chart below some drinks are more potent than others. Alcohol Content of Some Typical Drinks 5 Drink Alcohol Content Manhattan 1.15 oz. (34 ml) Dry Martini 1.00 oz. (30 ml) Malt liquor -12 oz. (355 ml) 0.71 oz. (21 ml) Airline miniature 0.70 oz. (21 ml) Whiskey Sour/Highball 0.60 oz. (18 ml) Table Wine - 5 oz. (148 ml) 0.55 oz. (16 ml) Beer - 12 oz. (355 ml) 0.54 oz. (16 ml) Reduced Alcohol Beer 0.28 oz. (8 ml) Mixed drinks are based on typical drink recipes using 80 proof liquor . The amount of alcohol in actual mixed drinks may vary. Alcohol Content (in Percent) of Selected Beverages 6 Beverage Alcohol Content (%) Beers (lager) 3.2 - 4.0 Ales 4.5 Porter 6.0 Stout 6.0 - 8.0 Malt Liquor 3.2 - 7.0 Sake 14.0 - 16.0 Table wines 7.1 - 14.0 Sparkling wines 8.0 - 14.0 Fortified wines 14.0 - 24.0 Aromatized wines 15.5 - 20.0 Brandies 40.0 - 43.0 Whiskies 40.0 - 75.0 Vodkas 40.0 - 50.0 Gin 40.0 - 48.5 Rum 40.0 - 95.0 Aquavit 35.0 - 45.0 Okolehao 40.0 Tequila 45.0 - 50.5 The concentration of the drinks that one ingest can have a slight effect on the peak alcohol concentration due to the differences in absorption rate of different concentrations of alcohol. Alcohol is most rapidly absorbed when the concentration of the drink is between 10% and 30%. Below 10% the concentration gradient in the gastrointestinal tract is low and slows absorption and the added volumes of liquid involved slow gastric emptying. On the other hand concentrations higher than 30% tend to irritate the mucous membranes of the gastrointestinal tract and the pyloric sphincter, causing increased secretion of mucous and delayed gastric emptying. Food Food taken along with alcohol results in a lower, delayed blood alcohol concentration peak (the point of greatest intoxication). There are two major factors involved in this phenomenon. First, because alcohol is absorbed most efficiently in the small intestine, the ingestion of food can slow down the absorption of alcohol into one's system. The pyloric valve at the bottom of the stomach will close in order to hold food in the stomach for digestion and thus keep the alcohol from reaching the small intestine. While alcohol will be absorbed from the stomach it is a slower and less efficient transition. Second and equally important is the fact that alcohol elimination rates are inversely proportional to alcohol concentration in the blood. Therefore the suppressed levels of alcohol due to food ingestion cause the body to eliminate the alcohol that is absorbed at a faster rate. The type of food ingested (carbohydrate, fat, protein) has not been shown to have a measurable influence on this affect but the larger the meal and closer in time between eating and drinking, the greater the diminution of peak alcohol concentration. Studies have shown reductions in peak alcohol concentration (as opposed to those of a fasting individual under otherwise similar circumstances) of 9% to 23%. Medication If you are taking any medication, it could increase the effects of alcohol. You should always consult your physician or the medical information that accompanies the medication when drinking alcohol in conjunction with any medication. Fatigue Fatigue causes many of the same symptoms that are caused by alcohol intoxication. These and other symptoms will be amplified if alcohol intoxication is concurrent with fatigue. Tolerance Tolerance is the diminution of the effectiveness of a drug after a period of prolonged or heavy use of that drug or a related drug (cross-tolerance). There are two types of tolerance at work with alcohol. The first is metabolic tolerance in which the alcohol is metabolized at a higher rate (up to 72% more quickly) in chronic users. Because of the higher metabolic rate for alcohol lower peak blood alcohol concentrations are achieved by chronic alcohol users than the average drinker when the same amount of alcohol is ingested. The second is functional tolerance in which there is an actual change in the organ or system's sensitivity to the drug. Studies have shown that chronic alcohol users can have twice the tolerance for alcohol as an average person. It is important to note however that even in light of these tolerance factors, it has been shown conclusively that even in heavy alcohol users functional impairment is clearly measurable at the blood alcohol concentration levels that are currently used for traffic law enforcement and safety sensitive job performance. Gender Differences As outlined above in the section on Body Weight and Body Type different body types coincide with different body water percentages. In general, but by no means in all cases, women tend to have a higher percentage of body fat and thus a lower percentage of body water. Therefore, in general, if a man and a woman of the same weight ingest the same amount of alcohol the woman will tend to achieve a higher alcohol concentration. This, of course, would not be true if the woman was very fit and the man was somewhat obese, but on average, this is the case. Furthermore, total body water tends to decrease with age, so an older person will also be more affected by the same amount of alcohol. According to the table below the differences in alcohol concentration due to average body composition differences based on gender would be between 16% and 10% depending on age. Average Total Body Water as a function of Sex and Age Age Male Female 18 to 40 61% 52% over 60 51% 46% Another gender based difference is in the elimination of alcohol. Although not explained, studies appear to show that women eliminate alcohol from their bodies at a rate 10% greater than that of men. 1995-2006 Intoximeters, Inc. Site Map Site Problems? Email Webmaster
|
DUI RECIDIVISMRelease Date: December NIH Guide: EFFECTIVENESS OF STRATEGIES FOR PREVENTING DUI RECIDIVISM EFFECTIVENESS OF STRATEGIES FOR PREVENTING DUI RECIDIVISMRelease Date: December 4, 1998PA NUMBER: PAS-99-023P.T.National Institute on Alcohol Abuse and AlcoholismNational Highway Traffic Safety Administration, Department of TransportationCenter for Substance Abuse Treatment, SAMHSAApplication Receipt Date: March 18, 1999; standard receipt dates thereafterPURPOSEThe purpose of this program announcement is to stimulate research that addressesthe problem of recidivism among people convicted of drinking and drivingoffenses. This includes individuals who are apprehended for driving under theinfluence (DUI), driving while intoxicated (DWI), or related offenses such asdriving after suspension for a DUI and violation of zero tolerance laws, and areeither convicted or otherwise sanctioned for such illegal behavior. Applicantswho respond to this program announcement are encouraged to develop researchapplications that design, develop, implement, and/or test interventions that havethe potential of preventing or reducing DUI recidivism. Such interventions maybe investigator initiated and implemented in collaboration with appropriatemembers of judicial, administrative, and policy-making bodies specifically totest or compare their efficacy in preventing or reducing DUI recidivism. Alternatively, the interventions to be studied may occur naturally in society aslaws, regulations, policies, and practices implemented by legally constitutedbodies and may be tested for their effectiveness by researchers who use theestablished methodologies of studying "natural experiments."Over the past 15 years, there has been a marked decrease in alcohol-relatedfatalities and in alcohol-impaired driving among the U.S. driving population asa whole. Research indicates that these reductions have resulted in part from theadoption and implementation of several laws by all or many States. These legalchanges include raising the minimum legal drinking age to 21 by all States,implementing administrative license revocation, increasing the severity andexpanding the types of sanctions for convicted DUI offenders, and reducinglegally acceptable BAC levels to .08 for drinking drivers. However, much remainsto be learned about the relative effectiveness of specific sanctions, singly andin combination, for violators of the aforementioned new laws. Of particularconcern is how to deal most effectively with persons with multiple DUI offenses. The goal of this program announcement is to expand research in this domain as ameans of building a firmer knowledge base to assist judges, prosecutors, andother decision makers in making choices among the various options available tothem in sanctioning DUI offenders.HEALTHY PEOPLE 2000The Public Health Service (PHS) is committed to achieving the health promotionand disease prevention objectives of "Healthy People 2000," a PHS-led nationalactivity for setting priority areas. This program announcement is related to thepriority areas of alcohol abuse reduction and alcoholism treatment. Potentialapplicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No.017-001-00474-0 or Summary Report: Stock No.017-001-00473-1) through theSuperintendent of Documents, Government Printing Office, Washington, DC20402-9325 (Telephone: 202-512-1800).ELIGIBILITYApplications may be submitted by domestic and foreign, for-profit and non-profit,public and private organizations, such as universities, colleges, hospitals,laboratories, units of State and local governments, and eligible agencies of theFederal Government. Racial/ethnic minority individuals, women, and persons withdisabilities are encouraged to apply as Principal Investigators.MECHANISM OF SUPPORTThis research support may be obtained through applications for a regular researchproject grant (R01), small grant (R03), or exploratory/developmental grants(R21). R21 grants are limited to up to 2 years for up to $100,000 for directcosts per year. Applicants for Exploratory/Developmental Grants will need tocite the program announcement for Secondary Analysis of Existing Health ServicesData Sets (PA-97-066) in addition to this program announcement in theirapplication. Applicants may also submit Investigator-Initiated InteractiveResearch Project Grants (IRPG) under this program announcement. InteractiveResearch Project Grants require the coordinated submission of related regularresearch project grant applications from investigators who wish to collaborateon research. Further information on the IRPG mechanism is may be obtained in PA-96-001, which is available on the internet at http://www.nih.gov/grants/guide/pa-files/PA-96-001.html .Potential applicants for Exploratory/Developmental Grants may obtain copies ofthe specific announcements from the NIAAA Home Page at http://www.niaaa.nih.gov or from the Office of Scientific Affairs, NIAAA, 6000 Executive Boulevard, Suite409, MSC 7003, Bethesda, MD 20892-7003, telephone: 301-443-4375 or FAX301-443-6077. Further information on grant mechanisms and areas of researchinterest may be obtained from program staff listed under INQUIRIES.FUNDS AVAILABLEAt least $1,300,000 in total costs will be available for three to five awards inthe first year of awards. This level of support is dependent on receipt of applications of high scientific merit. The usual policies governing grantsadministration and management, including facilities and administrative costs,will apply. Funding beyond the first and subsequent years of the grant will becontingent upon satisfactory progress during the preceding years and availabilityof funds. The earliest possible award date is September 30, 1999.RESEARCH OBJECTIVESBackgroundIn spite of the decreasing prevalence of DUI, it remains a major alcohol-relatedproblem in the United States and the leading cause of death for persons betweenthe ages of 1 and 24. The extent of the problem is illustrated by the followingdata:o Of the 41,967 persons killed in traffic crashes in 1997, 16,189 (39 percent)died in alcohol-related crashes. This translates into one alcohol-related deathevery 32 minutes during 1997.o An additional 327,000 persons (about 10 percent of all those injured incrashes) received their injuries in alcohol-related crashes.o At some point in their lives, three in every 10 Americans will be involved inan alcohol-related crash.o About 1.5 million people were arrested in 1996 for driving under the influence(DUI) or driving while intoxicated (DWI).Drunk driving recidivism rates are high: approximately one-third of driversarrested or convicted of DWI each year are repeat offenders. A 1994 studypublished in the New England Journal of Medicine concluded that drivers involvedin alcohol-related fatal crashes were eight times more likely to have had DWIconvictions in the previous 5 years than drivers randomly selected from thegeneral population of licensed drivers. The National Highway Traffic SafetyAdministration (NHTSA) indicates that in 1996, about one in six drivers withpositive BAC levels who died in traffic crashes had been convicted of drivingwhile intoxicated during the three previous years. And a 1995 California studysuggests that 44 percent of drivers convicted of DUI in that State arereconvicted of DUI within 10 years.The magnitude of the DUI recidivism problem prompted NHTSA and NIAAA tocollaborate in sponsoring a series of working groups of judges, prosecutors, andalcohol researchers to discuss what is known about effective prevention andtreatment interventions for DUI offenders and to develop two guides for judges,prosecutors, and other relevant administrators to help them confront the problemof DUI offenders. A Guide to Sentencing DUI Offenders, published in 1996 by theDepartment of Transportation (DOT HS 808 365), discusses the sentencing process,factors influencing risk for recidivism, specific sanctions and remedies,rehabilitation options for offenders sentenced to treatment, compliance andreporting, and research needs. The second guide, Sentencing and Dispositions ofYouth DUI and Other Alcohol Offenses, (referred to below as the Youth Guide) iscurrently in press and focuses on youthful offenders. Because all States haveadopted laws making age 21 the minimum legal drinking age, sales to and purchase,possession, and consumption of alcohol by minors usually are illegal (althoughlaws and specific penalties vary among the States). For that reason, the YouthGuide has a broader focus of interest including laws and sanctions directed atalcohol-related offenses by persons under age 21, including DUI.Preparing the guides has made abundantly clear to NIAAA and NHTSA that theexisting knowledge base regarding the effectiveness of specific sanctions for DUIoffenders provides limited guidance for judges and other decision makers whodaily must choose among the available options. For that reason, these twoagencies, as well as the Center for Substance Abuse Treatment (CSAT), whichserved in an advisory role in the preparation of the Guides and which has astrong interest in the effectiveness of interventions with DUI offenders, arejointly inviting the research community to propose new studies that can helpaddress the fundamental unanswered questions about the outcomes and effectivenessof various sanctions singly and in combination, and which populations and underwhat conditions the interventions are most effective.Applicants should justify their choice of interventions for study based onrelevant theories of behavior change for individuals and, where possible, onexisting data suggesting positive intervention effects. Applicants shouldexplain why the chosen intervention should be expected to prevent DUI recidivism. Applicants also may propose small-scale feasibility or pilot studies as a preludeto later designing more complex intervention research.Possible Interventions for StudyIn the field of alcohol-problem prevention research, a popular way ofconceptualizing interventions is to distinguish between universal, selective, andindicated approaches in terms of certain characteristics of the target group. This typology takes into account the breadth of the target group, its risk ofhaving the disorder or problem of concern, and the benefit/cost ratio ofcommitting resources to its prevention in that particular target group. Universal approaches target entire populations or subpopulations without regardto risk; selective strategies target subgroups known to be at higher than averagerisk; and indicated interventions target persons with individual risk factorsthat require more immediate intervention.Since the objective of this research endeavor is to prevent DUI recidivism, thecritical target population is that group of people who have already been arrestedor apprehended for committing DUI, and the proposed interventions must showpromise of preventing (or reducing) their drinking, their driving, or thecombination of these behaviors. The risk of recidivism varies across theheterogeneous DUI offender population, depending on such factors as the frequencyof driving after drinking, number of prior DUI offenses, and the offender's age,sex, ethnicity, and history of alcohol-related problems. Specific subpopulationsmay be the focus of a proposed study. Of particular interest are persistent DUIoffenders who pose an especially difficult problem for both public safety and thecourts, and thus are a highly desirable focus of proposed research to reducerecidivism.Several factors known to facilitate reduction of recidivism across the spectrumof DUI offenders also should be considered, including consistency, certainty, andcoordination of sanctions. In addition, it is important that such legallyprescribed policies as mandated screening for alcohol and other drug problems andother mandatory sanctions be fully and consistently implemented; that sanctionsbe made increasingly severe for repeat offenders; that courts, evaluators,probation officers, and treatment providers be integrated into a coordinatedsystem to ensure compliance with the sentence, since failure to address non-compliance greatly undermines the effectiveness of a sanction and the authorityof the court.Sanctions imposed on DUI offenders may have several objectives. Theysimultaneously seek to 1) protect the road-using public, 2) hold the offenderaccountable to the victim and/or the community, and 3) provide education and/ortreatment to the offender through a combination of retribution, general andspecific deterrence, incapacitation, rehabilitation, and restorative justice. Thus, a combination of sanctions often is needed to achieve these goals. It isimportant to note, however, that the goal of this program of research is tomeasure the effectiveness of sanctions on recidivism. For this reason,investigators should not focus on the general deterrent effect on the drivingpublic of the countermeasure being studied. However, sanctions that are veryeffective in reducing recidivism may also have a general deterrent effect if theyare highly publicized.A number of specific intervention options identified in the Guide to SentencingDUI Offenders and the Youth Guide might be rigorously evaluated with variouspopulations in a jurisdiction in which they currently are being used. Alternatively, the sanctions may be deliberately implemented so as to facilitatesystematic evaluation in jurisdictions where they are not currently being used.Many of the sanctions identified in the guides have been assessed only with adultpopulations or have included such small samples of youth that their effectivenesswith this population has not been determined.Offender SanctionsOffenders most frequently are sentenced to jail terms (including weekenddetention), probation (with a wide range of conditions of probation), fines, andcourt-mandated license suspension/revocation. Each of these sanctions may varywidely in length or amount, as well as the conditions of supervision and may bethe subject of assessment under specific conditions or with particularsubpopulations.o Based on studies available through 1995, the Guide to Sentencing DUI Offendersconcludes that jail may be effective as a general deterrent, but it appears tobe no more effective as a specific deterrent for reducing DUI recidivism thanother sanctions, and it is far more costly. Moreover, mandatory jail sentencesmay so overload the court and correctional system that the implementation of jailsentences actually is curtailed. Nevertheless, incarceration may be the mostappropriate and/or effective sanction with certain offenders.o Weekend interventions programs provide opportunities to assess the offender'salcohol and other drug problems, permit individualized treatment plans, and allowoffenders to remain on the job. One study suggests that repeat offenders in suchprograms have lower recidivism rates than those sentenced to jail or givensuspended sentences and fines. However, more research is needed.o Detention in facilities dedicated to DUI offenders incapacitates high-riskoffenders for various lengths of time and may offer opportunities forrehabilitation services, but research on the impact of detention combined withtreatment programs is very limited.o Probation is not a single program or strategy; rather, the conditions ofprobation vary widely. Moreover, there is little data on the effectiveness ofparticular programs of varying length and scope as conditions of probation. Research might explore the short and longer-term outcomes with DUI offenders ofeach of the following sanctions or combinations of them as a condition ofprobation: intensive probation, home detention, electronic monitoring, licenseor vehicle restrictions, fines and/or community service, and attendance at victimimpact panels or at Alcoholics Anonymous. For example, a NHTSA study found thatrecidivism rates one year after sentencing were 33 percent lower for theexperimental subjects sentenced to home detention and electronic monitoring (6percent) than for those of individuals in a control group (4 percent). However,the effectiveness of most other conditions of probation, both through theprobationary period and beyond it, and the extent of compliance with theseconditions, have not been carefully assessed.o Since offenders often fail to comply with all the terms of their sentence,investigators may explore the costs and benefits of implementing variousmechanisms to increase compliance with sanctions. These might compare scheduledmeetings with the sentencing judge; increased phone monitoring by probationofficers, and brief incarceration for even minor infractions.o Based on findings that suggest drug courts have been effective in reducing therecidivism rates of drug offenders, it would be useful to test and evaluate thedrug court model with DUI offenders.Administrative Licensing ActionsThe courts share responsibility for managing DUI offenders with State departmentsof motor vehicles (DMVs). DMV agencies maintain critical records and haveadministrative power to suspend a driver's license and vehicle registration andto determine when a suspended offender is eligible for reinstatement. Althoughadministrative license suspension (ALS) and revocation (ALR) are civil actions,they have been found to be among the most effective in reducing DUI recidivism. In contrast, judicial license suspension is a post-conviction action ordered bythe court.o Studies of administrative license suspension clearly indicate that it iseffective in reducing DUI recidivism and the risk of crash involvement amongdrinking drivers. Optimal suspension periods appear to be between 12 and 18months, but suspension periods tend to be shorter, in part, because it isbelieved that suspension has a negative impact on a driver's employment andfamily welfare. Although some research suggests that job loss is not a majorproblem, it continues to be a significant factor in persuading courts not toimpose license restrictions as a sanction. The length and impact of thissanction merits further rigorous study.o Researchers might assess the effectiveness of various civil remedies or court-based sanctions for driving after suspension, which is a serious offense thatoccurs frequently, but appears to be addressed inconsistently.Vehicle-related SanctionsSeveral recent studies suggest that efforts to reduce illegal driving byconvicted alcohol-impaired drivers through vehicle impoundment, license plateimpoundment and tagging, and/or use of alcohol ignition interlocks may all beeffective, both during and after the sanction period. While there is a growingbody of research on ignition interlocks, research on other vehicle restrictionsis limited; thus, investigators might usefully explore the effectiveness of othervehicle sanctions during and after the sanction period.o Recent data on the effectiveness of vehicle impoundment suggests thatrecidivism and crashes can be reduced for suspended license offenders. Data onvehicle forfeiture are limited and might be further studied, particularly theconditions under which this intervention can be effective. For example, whetherforfeiture is equally effective with all groups of offenders and the optimalduration of different vehicle-related sanctions are unclear.o Vehicle tagging (the placement of a sticker over portions of the license plateindicating that the owner has a suspended driver's license) appeared to reducetraffic violations and crashes when it was implemented in Oregon. Furtherexamination of this administrative approach would be valuable.Treatment and Rehabilitation OptionsThe research literature on the treatment of alcoholism is largely silent on thespecific treatment needs and most effective approaches for the subcategory ofpersons who enter the treatment system as a result of a court order followingapprehension and/or conviction for DUI. It is unknown, for example, whethertreatment programs found to have been effective with voluntary patients (e.g.,cognitive behavioral therapy) also are effective with those ordered by the courtto enter them. A meta-analysis of 225 intervention/treatment programs for DUIoffenders (including educational programs and well as self-help, outpatient, andinpatient treatment programs), indicated that such programs could reducerecidivism by 7 to 9 percent. For many first offenders, the shock of beingarrested and exposure to offender education classes may have been sufficient todeter further DUI. Nevertheless, the content, format, and number of educationalmaterials probably varied widely and was not rigorously assessed. Sincerecidivists tend to exhibit higher rates of alcoholism and more alcohol-relatedproblems than first-time DUI offenders, treatment interventions in a criminaljustice setting with the recidivist population also merit further examination. Other treatment-related research questions include how to sustain abstinence andprevent relapse with various groups of DUI offenders following treatment interventions.o Educational programs may include didactic lectures on the medical and legalconsequences of drinking or DUI, discussions that more actively involveoffenders, and/or video presentations. One study found that for non-alcoholic DUIoffenders, education reduced recidivism somewhat more than did fines alone. Itis unclear, however, what program content is most effective and what period ofinvolvement is most effective in reducing recidivism.o Data on treatment effectiveness is limited but suggests that recidivism maybe reduced among DUI problem drinkers if they are required to participate for atleast a year in an intensive treatment program that involves weekly therapysessions and bi-weekly individual interviews with either a therapist or probationofficer. Project MATCH found that alcohol dependent (but not necessarily DUIoffender) clients treated in both inpatient and outpatient sites were equallylikely to reduce their drinking in response to three treatments (cognitive-behavioral therapy, motivational enhancement therapy, and twelve-stepfacilitation). The effectiveness of these treatment regimes under conditions ofcourt coercion with the DUI offender population might be usefully explored.o Research findings are mixed, and further study is needed concerning theeffectiveness of diversion programs where prosecution is deferred while theoffenders undergo long-term treatment. Similarly, studies might be undertakenthat test the effects of deferred prosecution following informal probation andcommunity service, or other such conditions.o Alcoholics Anonymous (AA) is the most popular self-help group for alcoholics. However, it is not clear how AA can be used most effectively as an interventionstrategy for DUI offenders.An additional challenge to the court and to researchers is how to integrate thethree sanction areas-- license suspension, alcohol education and treatment, andpunitive sanctions such as jail -- that currently are used to manage DUIoffenders. Combining treatment with incarceration or brief interventions withcourt processing and screening, for example, may be occurring and should beevaluated.Specific Issues for Youth-Focused ResearchIn the absence of tested adolescent-specific interventions, many of the sanctionsidentified above (whether age-appropriate or not) have been applied to youthfulDUI offenders as well as adults but have not been rigorously evaluated with ayouthful population. In addition, there is a need to develop and testinterventions specifically tailored to the developmental and social needs ofadolescents. These may be novel approaches (as long as theoretically orempirically justified), or investigators may modify common adult interventionsto make them age-appropriate. Researchers should note, however, that there arespecial challenges and research issues that arise in addressing youthful DUIoffenders. Some are related to the fact that their special age status permitsmany alcohol-related cases involving youth to be handled by the juvenile court. It is not known, for example, whether the court to which a youth's alcohol-related offense is referred (traffic, juvenile, criminal or family court) resultsin different sanctions and whether these, in turn, result in different complianceand recidivism rates. Other questions are related to the implementation andoutcomes of special laws that apply only to youth. These include zero tolerancelaws requiring that they have no measurable BAC level when driving or risk lossof driving privileges. Further uncertainties revolve around the role andresponsibility of parents for minor children and how best to involve them in thesanctioning process.o There are now more than 280 teen courts operating in 31 States. These aredesigned to hold offenders accountable for their actions while freeing courtdockets. Individual programs have conducted internal evaluations of theireffectiveness, but there has been no standardized overall evaluation of teencourts.o License suspension and revocation may be particularly effective among youthsince the driver's license is an especially prized possession among them. Studies of license actions among youth might usefully explore the optimum periodof license suspension and revocation among young people, which may differ fromthat of adults due to zero tolerance laws.o The evidence is mixed regarding the effects of community service on recidivismor crashes among adult DUI offenders. It has not been evaluated among youthfuloffenders but may be particularly appropriate as a form of restorative justicefor youth given their limited ability to pay financial restitution and lowerlikelihood of need for alcohol treatment. Other forms of restorative justicethat merit further systematic evaluation particularly among youth include victim-offender mediation, attendance at victim impact panels, and emergency departmentvisitation.o The potential involvement of parents in the youth sanctioning process and theeffects of their involvement merit study. For example, does their attendance atcourt proceedings, in parenting skills classes, or in restitution programs withtheir children reduce the recidivism of youthful offenders?Methodological Issues and Outcome MeasuresTo assess the efficacy of interventions and the effectiveness of interventionprograms for DUI offenders, researchers may propose experimental or quasi-experimental study designs, as well as secondary analyses of existing data setsthat permit tests of the effectiveness of sanctions but where the data have notbeen fully or appropriately exploited. The selection of interventions fortesting should be theory-driven whenever possible. Formal theories postulatingmechanisms of change from a particular intervention may be drawn frommultidisciplinary sources such as the behavioral, biomedical, developmental,and/or social sciences. For example, Jessor's problem behavior theory, Bandura'ssocial learning theory and Prochaska and DeClemente's stages of change theory maybe useful.Research to establish the efficacy of an intervention must include appropriatecomparison groups. The single most powerful procedure available to provideunbiased comparison groups is the random assignment of subjects to experimentaland control conditions. While courts have often opposed randomization asantithetical to individualized sentencing, many judges appreciate the need forrandomization and its justice were the alternative sentences appear to be ofequivalent severity and their relative effectiveness is unknown. Similarly, aproposed intervention that cannot be assigned to all eligible offenders due toresource limitations may use randomization to offer all eligible offenders anequal opportunity to enter the program or obtain the treatment.Proposals that use quasi-experimental designs, including natural experiments thatuse time-series analyses, are also welcome. Whatever the chosen methodologicaldesign and analysis plan, they must be justified in terms of theirappropriateness for the task at hand. Applicants must defend their choice ofmethods in terms of their scientific credibility, but pragmatic considerationsmay also be relevant. For example, randomization may not be acceptable toauthorities in the particular judicial system in which the proposed study willtake place; or the law may mandate that a new naturally occurring interventionthat the applicant proposes to evaluate must be universally applied, forcing theinvestigator to seek appropriate controls elsewhere. Where randomization isproposed, applicants must be able to justify "treatment indifference" from anethical perspective -- i.e., that the intervention to be tested has not beenproven to be superior (or inferior) to the alternative intervention(s). Otherwise, it may be unethical to propose randomization.Researchers also should address potential problems of (a) self selection and (b)sample attrition, as well as assure (c) sufficient statistical power to detectdifferences in intervention efficacy or effectiveness when they really exist. Even where the principal investigator has strong methodological skills, it maybe advisable to include among the research team an expert in study design and/orstatistics.Since the purpose of this program announcement is to stimulate research oninterventions to prevent or reduce DUI recidivism, outcome measures (orendpoints) must be relevant to this objective. Direct evidence of recidivism mayinclude alcohol-related crashes, and reconvictions, rearrests, or new citationsfor DUI. Because offender self-reports of violations would in many instancesconstitute an admission of illegal behavior that could lead to additionalsanctions, self reports are likely to produce biased and unreliable data. Ifused as an outcome measure, they should be augmented with corroborativeinformation from collaterals or archival data.With respect to reducing DUI recidivism and alcohol-involved traffic crashes,mediating and moderating variables may affect the outcome. Both program inputs(e.g., more intense monitoring) and program outputs (e.g., increased perceptionof the risk of sanctions for drinking and driving) may contribute to suchintermediate changes as reduced drinking or modified driving behaviors. Increating intervention programs, researchers need to identify and model theanticipated mediating and moderating factors that are likely to contribute tointermediate and more distal changes in the outcome measures. Such factors mayinclude dispositional and personality characteristics (e.g., sensation-seeking),offender perceptions of risk of apprehension for violating the sanction andactual enforcement mechanisms, and integrity of the delivery of the intervention(e.g., whether the education program is delivered as described by the provider). While the DUI outcome is the ultimate measure of program effectiveness,explanatory models of the change process, measures of program implementation andintegrity, and data identifying the sociodemographic and personalitycharacteristics of the study population are essential elements in the cumulativeprocess of understanding program success or failure and linkages between theintervention processes and their outcomes.The complexity of the problem and difficulties in establishing new programs forstudy suggest that some investigators may prefer to design feasibility studies. These might address such issues as how best to operationalize interventions foruse in specific real-world legal or jurisdictional environments; the feasibility,costs, and relative effectiveness of having different types of individuals in acommunity (e.g., professionals, paraprofessionals, or community-based volunteerswho receive special training) perform offender screening or act as probationofficers; or constructing or adapting protocols for use among culturally diverseor youthful populations.Given the complex nature of the specific research problem and the desirabilityof implementing a true experimental design if possible, collaborative effortsbetween researchers and justice system practitioners are strongly encouraged. For example, researchers with expertise in alcohol treatment, criminal justice,and traffic safety research may wish to collaborate with criminal justice systempractitioners including judges, treatment providers, and/or probation departmentpersonnel to maximize the competence of the study team investigating differentaspects of the common topic.INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTSIt is the policy of the NIH that women and members of minority groups and theirsubpopulations must be included in all NIH supported biomedical and behavioralresearch projects involving human subjects, unless a clear and compellingrationale and justification is provided that inclusion is inappropriate withrespect to the health of the subjects or the purpose of the research. Thispolicy results from the NIH Revitalization Act of 1993 (Section 492B of PublicLaw 103-43).All investigators proposing research involving human subjects should read the"NIH Guidelines for Inclusion of Women and Minorities as Subjects in ClinicalResearch," which have been published in the Federal Register of March 20, 1994(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Volume 23,Number 11, March 18, 1994.Investigators also may obtain copies of the policy from the program staff listedunder INQUIRIES. Program staff may also provide additional relevant informationconcerning the policy.INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTSIt is the policy of NIH that children (e.g., individuals under the age of 21)must be included in all human subjects research, conducted or supported by theNIH, unless there are scientific and ethical reasons not to include them. Thispolicy applies to all initial (Type 1) applications submitted for receipt datesafter October 1, 1998.All investigators proposing research involving human subjects should read the"NIH Policy and Guidelines on the Inclusion of Children as Participants inresearch Involving Human Subjects" that was published in the NIH Guide for Grantsand Contracts, March 6, 1998, and is available a the following URL address: http://www.nih.gov./grants/guide/notice-files/not98-024.html Investigators also may obtain copies of these policies from the program stafflisted under INQUIRIES. Program staff may also provide additional relevantinformation concerning the policy.APPLICATION PROCEDURESApplications are to be submitted on the grant application form PHS 398 (rev.4/98) and will be accepted on March 18, 1999 and on the standard applicationreceipt dates each year thereafter. Application kits are available at mostinstitutional offices of sponsored research and may be obtained from the Divisionof Extramural Outreach and Information Resources, National Institutes of Health,6701 Rockledge Drive, MSC 7710, Bethesda, MD 20892-7910, telephone 301-435-0714,Email: grantsinfo@nih.gov .The title and number of the program announcement must be typed on line 2 of theface page of the application form and the YES box must be marked.The completed original application and five legible copies must be sent ordelivered to:CENTER FOR SCIENTIFIC REVIEWNATIONAL INSTITUTES OF HEALTH6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710BETHESDA, MD 20892-7710BETHESDA, MD 20817 (for express/courier service)REVIEW CONSIDERATIONSApplications that are complete will be evaluated for scientific and technicalmerit by an appropriate peer review group convened in accordance with thestandard NIH peer review procedures. As part of the initial merit review, allapplications will receive a written critique and undergo a process in which onlythose applications deemed to have the highest scientific merit, generally the tophalf of the applications under review, will be discussed, assigned a priorityscore, and receive a second level review by the appropriate national advisorycouncil.Review CriteriaThe goals of NIH-supported research are to advance our understanding ofbiological systems, improve the control of disease, and enhance health. Thereviewers will comment on the following aspects of the application in theirwritten critiques in order to judge the likelihood that the proposed researchwill have a substantial impact on the pursuit of these goals. Each of thesecriteria will be addressed and considered by the reviewers in assigning theoverall score, weighting them as appropriate for each application. Note that theapplication does not need to be strong in all categories to be judged likely tohave a major scientific impact and thus to deserve a high priority score. Forexample, an investigator may propose to carry out important work that by itsnature is not innovative but is essential to move a field forward.Significance: Does this study address an important problem? If the aims of theapplication are achieved, how will scientific knowledge be advanced? What willbe the effect of these studies on the concepts or methods that drive this field?Approach: Are the conceptual framework, design, methods, and analyses adequatelydeveloped, well-integrated, and appropriate to the aims of the project? Does theapplicant acknowledge potential problem areas and consider alternative tactics?Innovation: Does the project employ novel concepts, approaches or methods? Arethe aims original and innovative? Does the project challenge existing paradigmsor develop new methodologies or technologies?Investigator: Is the investigator appropriately trained and well-suited to carryout this work? Is the work proposed appropriate to the experience level of theprincipal investigator and other researchers (if any)?Environment: Does the scientific environment in which the work will be donecontribute to the probability of success? Do the proposed experiments takeadvantage of unique features of the scientific environment or employ usefulcollaborative arrangements? Is there evidence of institutional support?Budget: Is the requested budget and estimation of time to completion of theproject appropriate for the proposed research?In addition, plans for the recruitment and retention of subjects will beevaluated as will the adequacy of plans to include both genders, minorities andtheir subgroups, and children as appropriate for the scientific goal of theresearch.The initial review group will also examine the provisions for the protection ofhuman subjects and the safety of the research environment.AWARD CRITERIAApplications will be considered for funding on the basis of the overallscientific and technical merit of the application as determined by peer review,programmatic needs and balance, and the availability of funds.INQUIRIESInquiries concerning this program announcement are encouraged. The opportunityto clarify any issues or questions from potential applicants is welcome.Inquiries regarding programmatic issues may be directed to:Susan E. Martin, Ph.D.Division of Clinical and Prevention ResearchNational Institute on Alcohol Abuse and Alcoholism6000 Executive Boulevard MSC 7003Bethesda, MD 20892-7003Telephone: (301) 443-8767FAX: (301) 443-8774Email: smartin@willco.niaaa.nih.gov Direct inquiries regarding fiscal matters to:Edward EllisGrants Management BranchNational Institute on Alcohol Abuse and Alcoholism6000 Executive Boulevard MSC 7003Bethesda, MD 20892-7003Telephone: (301) 443-4706FAX: (301) 443-3891Email: eellis@willco.niaaa.nih.gov AUTHORITY AND REGULATIONSThis program is described in the Catalog of Federal Domestic Assistance, No.93.273. Awards are made under the authorization of the Public Health ServiceAct, Sections 301 and 464H, and administered under the PHS policies and FederalRegulations at Title 42 CFR Part 52 and 45 CFR Part 74 or 45 CFR Part 95, asapplicable. This program is not subject to the intergovernmental reviewrequirements of Executive Order 12372 or Health Systems Agency Review.The Public Health Service (PHS) strongly encourages all grant recipients toprovide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smokingin certain facilities (or in some cases, any portion of a facility) in whichregular or routine education, library, day care, health care or early childhooddevelopment services are provided to children. This is consistent with the PHSmission to protect and advance the physical and mental health of the Americanpeople. Return to Volume Index Return to NIH Guide Main Index Department of Health and Human Services National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892
|
DUI / DWI, Drinking 
