Driving Impairment by Alcohol and Drug

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1 Asian sian Center enter for Transportations Studiestudies Driving Impairment by Alcohol and Drug Road Safety Engineering Training June 2006 Why are road injuries important? Potential years of life lost Mortality Morbidity Long term injuries Lost productivity Costs Handicap International 2006 Costs Include: Medical cost Loss of productivity and future earnings Pain and suffering Delays to other traffic Vehicle insurance administration Crash investigation and reporting Alternate transport costs Other property damage costs Road Crashes in Developing Areas Limited research Little awareness of the contribution of road injuries to the burden of disease Responsibility for Road Injuries Uncertainty as to who should be responsible for road injuries Transport agencies or public health agencies? This is particularly the case in developing countries Can lead to no action Causes of Road Crashes Rarely caused by a single factor Road environment Road users Vehicles 1

2 Who is At Risk Young people Males People living in the rural areas Road users types (pedestrians, motorcyclists) Alcohol VS Road Crashes Leading cause of injury death in the world Rapidly growing problem in developing countries-but decreasing in developed countries Rapid urbanizations and motorization in developing countries will account for much of the rise Developing countries will account for this due to the lack of appropriate road engineering and lack of injury prevention programs Alcohol VS Road Crashes WHO has forecast that by the year 2020, road crashes will be the most common cause of premature death in the world 44% of road deaths in the world occur in the Asia/Pacific region Driving Under Influence (DUI) Alcohol and drugs adversely affect alertness, reaction time, quality of judgment, physical co ordinations the ability to handle a vehicle no longer exists. Most of the statistics reviewed that 90% of traffic crashes happened in night time,50% of them were found BAC and more than half had BAC shown illegally. Alcohol Sold in a wide variety of beverages Affects the body s central nervous system by Slow down the activity in the brain, depressant Slow down the whole body, including breathing and heart rate Alcohol, Impairment and Driving What everyone should know about Alcohol and Driving How many drinks make driving unsafe? Drivers can become unsafe with a blood alcohol reading as.05 (50 milligrams per 100 milliliters of blood.) For many people, this takes only two drinks. Here is a wallet card with a Blood Alcohol Chart. It can tell you whether it s wise to drive. It can save your life or someone else s 2

3 Alcohol, Impairment and Driving How many drinks make driving unsafe? Drinks * STOP NOW MAKE THIS YOUR LIMIT IMPAIRED ABOVE LEGAL LIMIT Blood Alcohol Content Chart Alcohol, Impairment and Driving How many drinks make driving unsafe? WARNING: Some drugs and medicine (e.g. cough syrups) can increase impairment levels by as such as five times. In this table, 1 drink = 12 oz. beer, or 1½ oz. liquor, or 5 oz. wine. The single most common cause of death among people age 16 to 30 is drinking driving accidents. Drinking drivers cost the people of millions each year in medical, insurance and justice system costs. Drinking and driving is a criminal offence. The penalties are high. Alcohol: Fact Alcohol oxidation at the rate of about 3/8 oz. (one drink) per hour for an average sized person (150 lbs.) 50mg% risk crash 2 times 100mg% risk crash 7 times 150mg% risk crash 25 times Black coffee, aspirin, cold showers and exercise may cause a person to be more alert but have no effect helping the body get rid of alcohol and its effects. Driving Under Influence (DUI) As concentrations of alcohol in the blood increase progressively, judgment is affected, reaction is slowed, coordination is impaired, a sense of false confidence may be developed, the field of vision is reduced, visual acuity is decreased, hearing is adversely affected, concentration becomes difficult, and speech and balance are eventually affected. Alcohol, Impairment and Driving Alcohol: Behavior vs driving performance Effects on the driver or equipment operator: slows the driver s reaction time distorts driver s perceptions increases confidence greatly reduces ability to concentrate decreases ability to coordinate appropriate reaction when driving greatly increases the risk of having a crash BAC (mg%) Feeling and behavior Not change Slower judgment, loss of concentration, blurred vision, nausea and vomiting Worse of judgment and more blurred vision Harder to change body activity, hard to decide and judge Performance Aggressive driving Poor physical co ordination (break, gear), prolong RT, worse 8% of performance worse 12% of performance poor muscle control, hard to control vehicle, worse 5% of performance 3

4 Alcohol Consequences of Alcohol BAC (mg%) Loss of responsibility, euphoria,hard to stand and speak,slurred speech Loss of balance in walking, loss of inhibitions and loss of concentration, emotional, confuse, dizziness, temporary relief from pain Slower motion, worse coordination, unconscious Coma, death Feeling and behavior Performance loss of balance and coordination, worse 33% of performance Loss of confidence to drive, more aggressive driving, sway left or right Driving un-mindfulness automatically, highest risk Liver: fatty liver, hepatitis, cirrhosis Heart: arrhythmia, congestive heart failure Esophagus: chronic irritation Pancreas Cancer Violence Motor vehicle Injuries Driving Under Influence (DUI) Driving Under Influence (DUI) Different people are affected differently by alcohol. The difference may be due to body size and weight, drinking experience, presence of food in the stomach, time interval between drinks and the amount of water in the drinks. Tests to determine the amount of alcohol in the body include breath and urine tests and analysis of concentration of alcohol in the blood. Fairclough and Graham(1999) found that under full sleep driving with BAC 70mg%,driving performance will worse for 4 times. and under sleep deprivation 4 hrs with BAC 70mg%, then performance will worse for 15 times. Alcohol, Impairment and Driving Alcohol, Impairment and Driving How to get home safely? Make arrangements to ride home with a sober driver before you go out. Use your judgment while you still have it. Don t drink and drive Don t ride with a drinking driver. If you see a drinking driver, call the police. 10%-15% of all drinking driving convictions comes from public calls. Breath analyzer 4

5 Alcohol, Impairment and Driving Saturday, February 21, 2004 Willy gets off lightly after DUI arrest Breath analyzer Road Crashes in Thailand Road crashes leading cause of death for people aged in Thailand Road injuries and deaths cost Thailand over $213million US in lost economic productivity, hospital and property costs Trend is increasing Causes of Crashes in Thailand Inappropriate of Crashes in Thailand Poor condition of vehicles Truck overloading Inadequate training and licensing of drivers Broad mix of vehicles on the road- high proportion of trucks and buses mixed with motorcycles and pedestrians Drug and alcohol Alcohol and Road Crashes Skill become impaired even after low levels of alcohol consumption Studies show at 0.05 mg% there is significant impairment Some skills are even impaired at 0.01 mg% The risk of a fatal crash increases as blood alcohol concentration increases Factors that Influence Alcohol- Impairment Alcohol tolerance: Repreated performance on certain tasks while under the influence of alcohol can make a person less sensitive to impairement Problems occur however during unexpected situations 5

6 Factors that Influence Alcohol- Impairment Age Young drivers are at particular risk (17-25 Years Sleep deprivation Drowsiness can increase crash risk and blood alcohol concentrations of 0.01 mg% can increase drowsiness Alcohol Morbidity in Thailand Alcohol is a significant risk factor in the development of hypertension in urban areas Risk factor for oesophageal cancer in Southern Thailand Alcohol Crashes in Thailand Penalties for Drink Driving in Thailand 44 % of road injuries seeking emergency services in public hospitals had a blood alcohol concentration of 0.1 mg% or more 1994 law enacted setting legal blood alcohol limit at 0.05 mg% Fine up to $250 US 3 Months Jail Or Both Few Laws Restricting Alcohol Availability in Thailand Prohibition of alcohol sale 24 hours before the end of election day Closure of bars and nightclubs before 2 am Raising Awareness Not until 1997 when an active public education program undertaken at national level To raise awareness against drink driving To support enforcement 6

7 Raising Awareness Enforcement Multiple channels used: Road side posters Stickers on the back of vehicles Radio and television spots Public announcements Newspaper articles 1998, highly visible sobriety check points consisting of 17 police officers set up on a rotating basis around Bangkok from 1 am- 4am Drug and Road Crashes Drug and Road Crashes Much less is known about drugs and road crashes Number of drugs have been shown to impair performance on driving-related tasks Includes both licit and illicit drugs Why drugs may not be causal Australian Studies Alcohol also often detected Poly drug use Drug may have been used days earlier but the drug is still detectable in the blood or urine sample Behavioral effects of cannabis may end but inactive metabolites may be detected days or weeks later Drugs other than alcohol have been detected in a substantial proportion of crash-involved drivers But this does not show that drugs were a causal factor in the crash 7

8 Non-medical use of Psychotherapeutics among yrs old : Types of Drugs Alcohol Prescription drugs Over-the-Counter Drugs Illegal/Illicit Drugs Stimulants and Depressants Stimulants Effect that they have on the central nervous system Stimulants generally increase alertness and energy Depressants generally slow down the body activity Hallucinogens can alter perceptions and cause hallucinations Amphetamine Ecstasy Cocaine Caffeine Nicotine Depressants Amphetamine (Stimulant) Alcohol Cannabis Heroin Opium Tranquilizers Speed, Goey, Whizze, Ice, Uppers, Go,Zip, Dexies Ya Ba or Crazy Pill Commonly known as speed Usually white, beige or yellow powder but are also sold as tablets/ liquid/ capsules/ crystal like form Used to treat sleep disorders, attention deficit disorder, appetite control, Parkinson s disease 8

9 Ecstasy (Stimulant) E, Bickies, Pills, Vitamins, XTC, Eccies, Love drug, Disco biscuits, MDMA Stimulant with hallucinogenic properties Small, colored tablets/ capsules with stamped shapes or brands Effects 4-6 hours if swallowed, and less if injected/ snorted Temporarily exaggerate feelings of well-being, happiness, euphoria, confidence and energy Distorts sensations of sight, sound and touch Cocaine (Stimulant) Coke, Charlie, Snow, White Lady, Freebase, Crack, Rock, C Speeds up activity of certain chemicals in the brain/ some effects of an anesthetic Usually white power Usually smoked Effect from a few minutes/ few hours, depending on how it is used Effects include exaggerated feelings or alertness, confidence and energy Heroin (Depressant) Opium (Depressant) Hammer, Smack Affects CNS by slowing down the whole body, including breathing and heart rate, and can result in death from overdose Usually white to brownish crystalline powder Effects usually last 2-4 hr Cause temporary feelings of well-being, pain relief, slower heart rate, shallow breathing, nausea and vomiting Used in Morphine, pethidine, codeine Used predominantly for pain relief Methadone used in the treatment of opiate addiction Effect on respiratory problems, dry mouth, visual disturbances Tranquilizers (Depressant) Tranquilizers and Prescriptions Major/ minor tranquilizers: sleepers, benzodiazepines or sleeping tablets Used to treat anxiety, insomnia and muscle spasms Also severe mental disorders Effect can last 5-24 hr dependent on short/ long acting Effects from benzodiazepines and tranquilizers can include temporary relief of pain sedation, and mental disorder Health care professional need to caution patients of the potential for driving impairment (and the operation of equipment) 9

10 Tranquillizers and Road Crashes Significant increase in crash risk Risk is highest in the first 4 weeks after start High risk when withdrawing Appropriately prescribed, may be safer to drive while taking tranquilizer than without Problems arise with multiple drug use with alcohol LSD and Magic Mushrooms (Hallucinogens) Acid, Trips Alter perceptions and cause hallucinations (Seeing or hearing something that is not there) Small pieces of absorbent paper, decorated with designs such as smiley faces and cartoons, sugar cubes, small squares of gelatin, or in capsule/ tablet/ liquid form Effects within min and may last 6-24 hr Can intense distorted sensory experiences Experiences can be frightening and unpredictable PCP (Phencyclidine-Hallucinogen) Also known as Angel Dust,mintwheet Similar to an anesthetic Removes the sensation of pain, but not touch and pressure Effect on the body unpredictable May cause behavior typical of stimulant or hallucinogenic drugs Euphoria, relaxation, increased strength, anxiety, panic, hallucination Poly Drug Use When more than one drug is taken at a time Fore example, alcohol in conjunction with cannabis Can include alcohol, prescription, and/or illicit drugs Stimulants when combined with other stimulants greatly increase the associated side effects, causing a greater false sense of confidence and risk-taking behavior Poly Drug Use and Road crashes Cannabis (Depressant) Depressant combined with another depressant dangerously increases the associated side effects, drastically slowing reaction times and distorting the driver s perception Hallucinogens when combined with any drug can be very unpredictable and dangerous- can cause visual distortion, including perceptions of speed and distance, and greatly limit the accuracy of actions when driving Poly drug driving greatly increases your chances of having a crash Grass, mull, pot, dope, weed, leaf, THC (Tetrahydrocanabinol) Depressant that can also have hallucinogenic properties Marijuana is a dried greenish-brown leaf or flower from the cannabis plant Effects up to 5 hours Cannabis can cause temporary feelings of well-being, loss of inhibitions, loss of concentration and increased appetite 10

11 Cannabis and Road Crashes A legal limit for cannabis during driving A dose dependent impairment of driving skills with cannabis Also evidence for compensatory behavior Decreased speed and keep an increased distance from the car in front Though this less apparent with high doses Source: UK's Transport Research Laboratory (TRL):2000 Cannabis and Road Crashes Main point to note: Cannabis appears to impair driving skills, but to a lesser extent than alcohol If If you want to drink. Please be at HOME!!! THANK YOU 11

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