Are You Okay?

A variety of drinking tests: the good, the bad, and the silly.

Here’s a short, no-nonsense questionnaire that uses your weekly drinking habits to produce an at-a-glance comparison of how your intake stacks up against others your age and sex. For example, your result might say: “Only 4% of the adult male population drinks more than you say you drink.” Which is food for thought, at least. Join Together (sponsored by The Partnership at DrugFree.org and Boston University School of Public Health) provides this service.

Here is the Mayo Clinic alcohol use self-assessment test, which says with refreshing frankness: “This assessment can’t diagnose you with an alcohol use or abuse problem, but it can help you evaluate your drinking and understand whether you may benefit from seeking help.” Tends to be a bit stern on the drinks-per-day end of things, but otherwise it’s quite straightforward.

Then there is the venerable Michigan MAST Test, first offered in 1971, and revised regularly every since. It’s showing its age a bit as a clinical tool, but here is a link to the 22-question self-administered version: TEST

Iondesign’s Drink-O-Meter is a whimsical test that makes a sober point: “Why not take our test to calculate the state of your kidneys, wallet, and quantity of alcohol you have consumed over the years?” Why not? Well, maybe because you can’t HANDLE the truth: Test results give an estimate of the total number of drinks you have consumed, an estimate of how much money you’ve spent—and an estimate of the number of Ferraris you could have bought instead.

And finally, we have the amazing and ever-popular CAGE Test, so called for the system of naming and memorizing the questions. The CAGE test takes less than a minute, requires only paper and pencil, and can be graded by test takers themselves. It goes like this:

1. Have you ever felt the need to (C)ut down on your drinking?

2. Have you ever felt (A)nnoyed by someone criticizing your drinking?

3. Have you ever felt (G)uilty about your drinking?

4. Have you ever felt the need for a drink at the beginning of the day—an “(E)ye opener?

People who answer “yes” to two or more of these questions should seriously consider whether they are drinking in an alcoholic or abusive manner. Unfortunately, the CAGE test is considered to be an accurate diagnostic tool primarily in the case of adult white males.

Photo Credit: http://tokyotek.com

There’s No Agreement on DUIC: Driving Under the Influence of Cannabis

The ACLU squares off against law enforcement over how to measure marijuana impairment.

What’s your blood cannabis content? You don’t know, and neither does anybody else, without a fair bit of effort. There’s no device to blow into, no quick chemical field test. You’re impaired by marijuana if the officer says you’re impaired by marijuana, and in most states he or she will decide that matter by using a series of sobriety checks not dissimilar to the well-known alcohol exercises: standing on one foot, walking a line, having your eyeballs and blood pressure checked—and my personal favorite, a test of how well you can guess when 30 seconds is up. Time passes more slowly when you’re about to be arrested for drugs, I’m guessing, since it takes a little while for your life to pass before your eyes. Even the National Highway Traffic Safety Administration admits that it is “difficult to establish a relationship between a person's THC blood or plasma concentration and performance impairing effects. Concentrations of parent drug and metabolite are very dependent on pattern of use as well as dose."

The point is, observable indications of impairment, as they’re called, are really all that law enforcement currently has as a tool for policing the use by drivers of American’s second most popular drug. At one extreme end of the spectrum are the pot enthusiasts who argue that no amount of marijuana significantly impairs you behind the wheel. At the other end of the spectrum stand the zero-tolerance advocates: No amount of marijuana is safe, if you’re planning to get behind the wheel within the next several hours—or at any time during the rest of your life, as some anti-drug advocates seem to be saying.

And somewhere in between, according to the American Civil Liberties Union (ACLU) of Washington State, lies a possible compromise for gauging marijuana impairment. “Adding a science-based threshold for likely impairment to the mix and providing educational information that allows people to estimate their personal level of intoxication can be effective strategies for preventing impaired driving in the first place and improving public safety,” the  ACLU asserts.

The ACLU favors the so-called Pennsylvania Model, which sets that state’s legal limit for cannabis in whole blood at 5 nanograms per milliliter (ng/mL). Why 5, and not some other number? Because a legal cut-off of 5 ng/mL is also what the National Organizaton for the Reform of Marijuana Laws (NORML) recommends, based in turn on an analysis of scientific studies of marijuana’s effect on driving skills. Specifically, NORML recommends a limit in the range of 3.5-5.0 ng/mL, which the group says will “clearly separate unimpaired drivers with residual THC concentrations of 0-2 ng/mL from drivers who consumed cannabis within the last hour or so.” Levels under that range tend to indicate that the driver smoked at least 1 to 3 hours ago. Anyone testing over that range, says NORML is “likely to be impaired.”

But it’s not quite that simple, of course. First, you have to rule out a whole roster of cannabis metabolites that stay in the system for days or weeks, but have no impact on driving skills. And the metabolism of cannabinoid by-products varies so widely from person to person (this is just beginning to be understood scientifically), that the results of testing are not foolproof. The iron law of metabolic diversity makes that claim unlikely. Moreover, there is currently no reliable way of testing blood in the field for THC concentrations. But there will be. Introducing the Vantix Biosensor, a device that looks, ironically, like a portable vaporizer for marijuana. Open your mouth, please, as the officer politely swabs the inside of your cheek with a plastic wand, and inserts the wand in the handheld machine. Sensors on a microchip react with telltale antibodies, and you test positive for cocaine, or marijuana, or, soon, synthetic marijuana. Or perhaps it will be some other company’s device. But rest assured it is being looked upon as a growth market.

And then there is, as the ACLU points out, the wrong way to go about it: zero tolerance. At least 11 states have now set the requisite cut-off level for illegal drugs at zero. That may raise a cheer in certain quarters of the anti-drug movement, but it is a decision “based not in science but on convenience,” says the ACLU. It establishes a crime wholly “divorced from impairment” behind the wheel. Put simply, zero tolerance “does not differentiate between a dangerously incapacitated driver and an individual who may have smoked the past Monday but was pulled over as a sober ‘designated driver’ on Saturday night.” Furthermore, “even a statute excluding cannabis metabolites but criminalizing trace amounts of THC” could result in the arrest of drivers several days after they last smoked pot. It’s pretty simple, really. “If science dictates that the presence of a trace amount of cannabis or a cannabis metabolite in an individual’s blood has NO ‘influence’ on his capacity to drive, it should not constitute per se evidence of ‘driving under the influence.’” But toxicologist Marilyn Huestis, at the National Institute on Drug Abuse, disagrees. She believes that there is no safe level of marijuana consumption, where driving is concerned. Paul Armentano, deputy director for NORML, scoffs at that, telling the Los Angeles Times that individual states “are not setting a standard based on impairment, but one similar to saying that if you have one sip of alcohol you are too drunk to drive for the next week.”

 One abiding problem is that for car accidents, it’s not necessarily a pure play. Alcohol mixed with one or more additional drugs is common, and if it’s difficult to set limits for alcohol and marijuana alone, imagine the permutations involved in creating legal limits for a combination of both. A 2007 survey of experimental studies, published in Addiction by a group of researchers in six countries, concluded that a rule of thumb police might want to consider is based on the finding that “a THC concentration in the serum of 7–10 ng/ml is correlated with an impairment comparable to that caused by a blood alcohol concentration (BAC) of 0.05%. Thus, a suitable numerical limit for THC in serum may fall in that range.” Considering that we allow drivers to exhibit blood alcohol limits as high as 0.08, NORML’s 5 ng/mL limit looks downright conservative.

There’s no simple solution. Maybe that’s because cannabis is not a simple drug. We’re still teasing apart its effects, and nailing down the particulars of driving under the influence of cannabis is one of them. As Jeffrey P. Michael of the National Highway Traffic Safety Adminstration refreshingly disclosed to the Los Angeles Times, “We don’t know what level of marijuana impairs a driver.” But they are trying to find out. A federal study in Virginia intends to round up more than 7,000 blood samples by showing up at the scene of car accidents and asking drivers to provide random, anonymous  samples to compare with control samples.

Other studies of a similar nature are underway. Driving under the influence of drugs could become as common a criminal charge as classic DUIs and DWIs.

Photo credit: http://www.janisian.com/

Feel Lucky, Drunk?

Sobering stats on alcohol-impaired driving.

Somewhere just before the stages veteran drinkers sometimes refer to as “bulletproof” and “invisible” comes a stage known as, “Can I drive home drunk, and avoid arrest?”

In the small town where I live, the college kids have it lucky: They can park their cars at the afterparty, and walk, or rather weave, to their respective domiciles, leaving a trail of frustrated cops parked in squad cars, waiting for fresh meat to slide drunkenly behind the wheel.  Not much point in breathalyzing pedestrians. 

Summer is approaching, and with it, new opportunities for drunk driving. Your chances of safely driving home drunk, without arrest, are 49 out of 50, according to figures from the AAA Foundation for Public Safety. Roughly 1 in 50 drunk drivers gets arrested while driving. However, considering the stiff penalties associated with DUI and DWI-type offenses, are those odds really good enough to take the risk?

Consider a few additional numbers from the Centers for Disease Control and Prevention (CDC): The annual cost of drunk-driving crashes is somewhere in the neighborhood of $51 billion. Every day, 32 people in the United States die in crashes that involve an alcohol-impaired driver.  This results in a truly appalling number: 1 in 45, or 1 death due to drunk driving every 45 minutes--all day, every day.  Almost one-third of all traffic-related deaths in the U.S. each year. That is the true cost, the daily dice throws, caused by being drunk behind the wheel.

But there is another set of equally appalling numbers, relating to that 1 in 50 figure we started with. In 2008, over 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics--less than one percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year. The CDC estimates that 2.5 million parents drive under the influence of alcohol each year. Drunk drivers involved in fatal crashes were eight times more likely to have a prior conviction for DWI than were drivers with no alcohol.

Oh yes, and here is another number you should remember: 0.08 per cent.  That is the blood-alcohol content limit in all 50 states, at this writing.  According to the CDC, fatal alcohol-related crashes have dropped by 7 per cent since the adoption of the 0.08 standard.

Photo Credit: http://letsfightalcoholism.wordpress.com/

States Unleash New Ignition Lock Laws

The brave new world of DUI enforcement.

Starting this month, drivers convicted of driving while intoxicated in at least six new states will face a hi-tech hurdle to repeat offenses: ignition interlocks. After a high profile national campaign, Mothers Against Drunk Driving and other organizations convinced several state legislatures to pass laws mandating the dashboard installation of small ignition interlock device activated by a breathalyzer.

“It’s amazingly inconvenient, “ David Malham of the Illinois MADD group told Associated Press. “But the flip side of the inconvenience is death.”

Will high technology really help keep drunk drivers off the streets and highways? Malham, quoted in the Chicago Tribune, insisted that “it’s not about changing human nature, it’s about science interfering and preventing reckless behavior.” Maltham also said he is looking forward to technology that will be able to sniff a car’s interior, scan the eyes of drivers, and test sweat on the steering wheel before allowing the driver to turn the key.

In addition to Illinois, states that passed laws requiring the use of ignition locks for drunken driving convictions of varying degrees include Nebraska, Colorado, Washington, and Alaska. Other states with similar but unevenly enforced laws on the books include South Carolina, Arizona, New Mexico, and Louisiana.

Illinois is attempting to work around the program’s most obvious flaws—the convicted drinker could drive someone else’s car, or get someone else to blow into the breath-monitoring device—by instituting heavy penalties for non-compliance if the driver is caught cheating.

Lined up in opposition to ignition lock legislation, thus far, is the American Beverage Institute, a lobby group for restaurant owners. In the AP article, the Institute’s Sarah Longwell objected to the fact that states might decide to apply the laws to people other than repeat offenders—to anyone who, on any given night, blows a 0.08 or a 0.10, the common denominators of alcohol intoxication in most states.

Sounding a bit more like the National Rifle Association (NRA) than perhaps it intended, the Beverage Institute offered a dire vision of a slippery slope: “We foresee a country in which you’re no longer able to have a glass of wine, drink a beer at a ball game or enjoy a champagne toast at a wedding. There will be a de facto zero tolerance policy imposed on people by their cars.”

My modest prediction: A tangle of state lawsuits and questions over civil liberties, the more so since many of the laws are first-pass efforts and subject to interpretation.

Photo Credit: HTB

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