ALCOHOL IMPAIRMENT

See also: Alcohol Impairment Charts
See also: National Highway Safety Traffic Administration
See also : Vision
See also : Why you should never drink and drive Researchers liken driving drunk to driving at night with sunglasses on.

"New Nationwide Report Estimates That Roughly a Quarter of All Drivers in Some States Drove Under the influence of Alcohol in the Past Year" SAMHSA news release 04/23/2008. "A first-of-its kind national report reveals that 15.1 percent of the nation's drivers age 18 and older drove under the influence of alcohol at least once in the past year. The report says that in some states the levels are far higher--about one in four drivers. Driving under the influence ranged from a low of 9.5 percent in Utah, to highs of 26.4 percent in Wisconsin, 24.9 percent in North Dakota and 23.5 percent., , ,"

The ABC's of BAC: a guide to understanding blood alcohol concentration and impairment
This document has been updated and is available as a PDF. Do a Google search on the ABS's of BACs

"Alcohol metabolism, " ALCOHOL ALERT (1997), 35 PH 371. (Explains how alcohol is metabolized by the body and factors affecting this metabolism such as food, gender, medications, body weight, and so on.) Address: http://pubs.niaaa.nih.gov/publications/aa35.htm

AMA Policies on Alcohol (Impairment)
"Alcohol and the driver" JAMA 1986, 522-527l
Address: http://jama.jamanetwork.com/article.aspx?articleid=402698 you may have to paste this address in a browser

Blood Alcohol Content for general background information on this subject. Note information in Wikipedia should be verified by other sources.
http://en.wikipedia.org/wiki/Blood_alcohol_concentration

Blood Alcohol Content (BAC) contains an explanation of how alcohol is absorbed by the body. http://www.drinkinganddriving.org/Articles/blood-alcohol-content.html

Driver Characteristics at Various BACs 2000
Address: http://www.nhtsa.dot.gov/people/injury/research/pub/impaired_driving/BAC/

DWI Detection Guide
For the "Visual Detection of DWI Motorists" brochure, the researchers interviewed officers through out the United States to develop a list of more than 100 driving cues that predict blood alcohol concentrations above .08 percent. The list was reduced to 24 cues involving three field studies involving hundreds of officers and more than 12,000 enforcement stops. These are the major subject areas:
Problems Maintaining Proper Lane Position
Speed and Braking Problems
Vigilance Problems
Judgment Problems
http://www.nhtsa.dot.gov/staticfiles/nti/pdf/808677.pdf

Impaired-Driving Program Assessments: A Summary of Recommendations (1991 to 2003) by Darrell W. Johnson.
http://www.nhtsa.dot.gov/cars/rules/regrev/evaluate/809815.html

Impaired driving facts from the CDC
http://www.cdc.gov/Motorvehiclesafety/index.html

Effects of Blood Alcohol Concentration (BAC)
http://www.cdc.gov/motorvehiclesafety/impaired_driving/bac.html

Alcohol and Transportation Safety
Research has shown that even low blood alcohol concentration (BAC)1 impairs driving skills and increases crash risk. New information about BAC and impairment has led to policy changes, which have contributed to declines in alcohol-related crashes and fatalities. This Alcohol Alert examines some aspects of alcohol-induced impairment and reviews selected strategies designed to reduce alcohol-related crashes and repeat drinking-and-driving offenses.
Address: http://pubs.niaaa.nih.gov/publications/aa52.htm

Imaging and the Brain
http://pubs.niaaa.nih.gov/publications/aa47.htm)

Relative Risk Of Fatal Crash Involvement By BAC, Age, And Gender
"This study estimated age and sex specific relative risk of fatal crash involvement as a function of BAC based on logistic regression analyses of FARS combined with exposure data from The 1996 National Roadside Survey. Results showed that drivers with non-zero BACs below .10, and 16-20 year old male drivers below .08 BAC pose substantially elevated risk both to themselves and other road users."
http://www.nhtsa.dot.gov/People/injury/research/809-050pdf.pdf downloadable PDF.

A Review of the Literature on the Effects of Low Doses of Alcohol on Driving-Related Skills
by Herbert Moskowitz.
A review of the scientific literature of the effects of alcohol on driving related skills examined the lowest BAC at which impairment was reliably present, and the thresholds of impairment for several behavioral areas. Authors concluded that all drivers can be expected to experience impairment in some driving-related skills by 0.08 g/dl or less.
http://www.nhtsa.dot.gov/people/injury/research/pub/Hs809028/Title.htm

Bibliography

"Alcohol-related impairment," ALCOHOL ALERT (1994), 25 PH 351, July. ["The brain's control of eye movements is highly vulnerable to alcohol. In driving, the eyes must focus briefly on important objects in the visual field ant track them as they (and the vehicle) move. Low to moderate BACs (0.03 to 0.05 percent) interfere with voluntary eye movements, impairing the eye's ability to rapidly track a moving target. Steering is a complex psychomotor task in which alcohol effects on eye-to-hand reaction time are superimposed upon the visual effects described above. Significant impairment in steering ability may begin as low as approximately 0.035 percent BAC and rises as BAC increases. Research on the effects of alcohol on performance by both automobile and aircraft operators shows a narrowing of the attentional field beginning at approximately 0.04 percent BAC.]
http://pubs.niaaa.nih.gov/publications/aa25.htm

Allen, M. J.; Abrams, B. W.; Ginsburg, A. P.; Weintraub, L.; Forensic aspects of vision and highway safety, Boca Raton, Florida, Lawyers and Judges Publishing Company, 1996, pp. 269-271. (As soon as you start to drink, your blood alcohol concentrations, BAC, starts to rise. Driving impairment increases directly with BAC level. Goes on to quote Garriott about color and glare recovery, Brecher about binocular coordination, Moskowitz and visual tracking, and Newman and visual acuity.)

Avant, L. L. "Alcohol impairs visual presence/absence detection more for females than for males," PERCEPTION AND PSYCHOPHYSICS (1990), 48 (3): 285-290. (90 male and female subjects, BrAC, fasted given 3 levels of alcohol 0.0%, 0.5%, or 1.0%. Alcohol produced higher blood alcohol concentration (BAC) levels, and higher detection threshold durations, for females than for males. These results indicate that alcohol influences precortical visual processing and that the influence is greater for females than for males. The higher bioavailability of alcohol in women is likely due to less gastric oxidation of ethanol in women than in men.?)

Bartell, K.; Gross, C.; DiGuiseppi, C.; "Creation of a register on alcohol-imparied driving" INJURY PREVENTION (2006). http://injuryprevention.bmj.com/content/12/6/430.full.html To facilitate the identification of the best available evidence in the field of alcohol-impaired driving prevention, the Colorado Injury Control Research Center, in collaboration with the Cochrane Injuries Group, has begun to develop a register of controlled evaluations of interventions targeting drunk driving. This effort is being supported by the National Center for Injury Prevention and Control, part of the US Centers for Disease Control and Prevention.

Blanke, R.; Caplan, Y.; Chamberlain, R., et al.; "Drug concentrations and driving impairment," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (1985), 254: 2618-21. (Impairment of driving performance is, in the most general sense a failure to exercise the expected degree of prudence or control to ensure safe operation of the vehicle. Manifestations of such impairment are many; driving at a speed that is inappropriate to the flow of surrounding traffic, weaving within a lance of traffic or frequent lane changes, following cars too closely, failing to signal major changes of course, failing to observe traffic signs or signals, as well as many others. These are the sings of impairment that, when observed by law enforcement officers, merit investigation.)

"Blood Alcohol Concentration and Driving," ANNALS OF EMERGENCY MEDICINE (1997), 29 (6): 835. (A blood alcohol level of .08 % is per se evidence of driving while impaired and a BAC of .05 % is presumptive evidence of impaired driving.)

Blomberg, R., Moskowitz, H., Burns, M., Peck, R. & Fiorentino, D. (2005). "Crash risk of alcohol impaired driving". A case-control study was conducted in Long Beach, CA and Fort Lauderdale, FL to examine the relative crash risk associated with drivers' blood alcohol concentrations (BACs). Data were obtained for drivers involved in 2,871 crashes of all severity's. Two control drivers for each crash driver were sampled a week after the crash at the same location, on the same day of the week and at the same time of day.

For both groups of drivers, a research team recorded observations, administered a brief questionnaire and obtained breath specimens for BAC measurements. Of the 14,985 sampled drivers who were potentially available for testing, 91.7% of crash drivers and 97.9% of control drivers provided breath specimens. Relative risk models were generated with logistic regression techniques with and without covariates such as driver age, gender, marital status and ethnicity. The models without adjustment for the covariates show elevated relative risk beginning at 0.05 - 0.06% BACs with an accelerating increase in risk at BACs greater than 0.10%. With adjustment for covariates and bias due to missing data (non tested hit-and-run drivers, refusals, and incomplete responses), risk was elevated at a slightly lower BAC and the risk curve was steep. Statistically significant risk occurred at 0.04% BAC and small, non-significant elevations occurred at BACs closer to zero. Relative risk models were also produced for age groups and alcohol consumption levels.

Brick, John; Carpenter, John A.; "The identification of alcohol intoxication by police," ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (2001), 25 (6): 850-855. Drinkers were accurately targeted to low (0.08-0.09%), medium (o.11-0.13%), and high (0.15-16%) blood alcohol concentrations (BACs). At lower BACs, most police officers were unable to identify whether or not targets had been drinking. Raters were "pretty sure" that targets in the 0.15-0.16% range had been drinking and "not sure" whether or not they should be served another drink or drive a car. Conclusions: the ability of raters to reliably identify target drinkers who were too intoxicated to drive safely was not obtained until the BACs were relatively high. The results suggest that prevention measures must focus on improving behavioral observations made of potential drunk drivers.

Brick, John, "Facts on driving while intoxicated", Fact Sheet No. 5 (2), Center for Alcohol Studies, 1996. "Traffic accidents account for more deaths of individuals between age 6 and 33 than any other type of accident. Although many factors contribute to highway accidents including highway and vehicle design, traffic volume, driver characteristics (e.g., experience, personality), and the mechanical function of the motor vehicle, the single most significant predictor of an accident is the driver's state of sobriety. More is known about the relationship between alcohol intoxication and driving than about driving and any other drug. While people of all types and backgrounds drink and drive, the most consistent profile for drivers arrested for driving under the influence of alcohol is that they tend to be men, 20-40 years of age with some history of problem drinking. About twice as many men than women are involved in fatal motor vehicle accidents when the blood alcohol level is greater than .10%. On closed-course driving tests, at BACs of about .06%-.09%, variability in lane position and brake use increased and steering ability decreased. Using a driving simulator approach, it has been found that at BACs approaching .10%, there are increases in braking (up to 45%), and gear changing and steering errors. In some laboratory tests, alcohol produces impairment on complex tests when blood levels are as low as about .02%. Epidemiological data indicate that the risk for an accident begins to increase at blood alcohol levels above .05% so that at .08% the risk of an accident is about 5 times greater than when sober.

Brookhuis, K. A.; de Waard, D.; "The Use of psychophysiology to assess driver status," ERGONOMICS (1993): 36 (3): 1099-110. [20 subjects completed an on-the-road driving experiment, consisting of two different tests on two separate days. A two-part test was administered with while subjects were under the influence of alcohol (BrAC < = 0.05%); a four-part test was administered without alcohol consisting of 2.5 h driving test under vigilance conditions on a quiet highway. The Changes in relevant physiological parameters, such as ECG and EEG, reflected changes in driver status and predicted driving impairment. Impairment of driving performance was measured in a standard driving test (SD lateral position and SD steering wheel movements) and in recently developed car-following test (reaction to speed changes of a leading car) in the Netherlands.]

Burns, M.; Moskowitz, H.; "Methods for estimating expected blood alcohol concentration," U. S. Department of Transportation, National Highway Traffic Safety Administration, Washington, D. C.; 1980, 88. (BAC were measured in people by sex, number of drinks, and fasted state.)

CENTER FOR ALCOHOL STUDIES, Rutgers University - alcohol resources database
http://www.rci.rutgers.edu/~cas2/

Chamberlain, E.; Solomon, R.; "The case for 0.05% criminal law blood alcohol concentration limit for driving", INJURY PREVENTION (2002), 8:1-17, suppl3.iii.1. Canada established its current 0.08% "Criminal Code" blood alcohol concentration (BAC) limit for drivers in 1969. At the time, this was a substantial improvement, as it established a per se BAC limit under the criminal law and required impaired driving suspects to provide breath samples. However, in the more than three decades that have followed, breath testing instruments have become more accurate, public attitudes toward impaired driving have hardened, and scientific research as established that impairment begins at levels below 0.08%. In response, the international trend was and continues to be to reduce per se BAC limits to 0.05% or lower. The legal limit is reported to be 0.05% in numerous countries, including Argentina, Australia, Austria, Belgium, Bulgaria, Croatia, Denmark, Finland, France, Germany, Greece, Iceland, Israel, Italy, Macedonia, the Netherlands, Norway, Portugal, Slovenia, and Spain. Russia and Sweden have legal limits of 0.02% and Poland has a limit of 0.03%. Finally, the official limit is reported to be 0.00% in the Czech Republic,Hungary, Malaysia, Romania, Saudi Arabia, and Turkey, while Japan's limit is 0.00% in practice.

Clifasefi, Seema, L.; Takarangi, Melanie K. T.; Bergman, Jonah S.; "Blind drunk : the effects of alcohol on attentional blindness", APPLIED COGNITIVE PSYCHOLOGY (2006), 20: 697-704. (47 subjects aged 21 to 35) Alcohol consumption is a major contributor to road accidents. The authors know that even sober drivers can fail to detect unexpected salient objects that appear in their visual fields, a phenomenon know as inattentional blindness. The authors were interested in whether these visual errors become more or less likely when subjects are under the influence of alcohol or just think that they are drunk. Subjects were told half of our subjects that they had received alcohol, and half that they had received a placebo. This information was either true or false. The experiment involved giving subjects 10 minutes to consume beverages which either contained alcohol or did not to achieve .04 BAL. The subjects then watched 25 seconds of a video clip showing two teems of three people playing with a ball and were instructed to count the ball passes. Part way through the video clip, an individual dressed in a gorilla suit appeared on the screen, walked directly through the players, beat its chest and then walked away. Subjects who were mildly intoxicated were twice as likely to miss seeing the gorilla, even though it had screen time of over a third of the video. Intoxicated subjects (regardless of what they were told) were more likely to show 'blindness' to an unexpected object in their visual field. This finding has practical implications for human performance issues such as driving and eyewitness memory, and theoretical implications for visual cognition.

**"Computing a BAC estimate," U. S. Department of Transportation, National Highway Traffic Safety Administration, October, 1994, 6 pages. Search this title in Google to find the PDF which is cached. Search setup: "(Computing a BAC estimate) October 1994" (Interestingly the U. S. Department of Transportation espouses BAC estimates using Widmarks.)

Dawson, D.; Reid, K.; "Fatigue, alcohol and performance impairment (letter); NATURE (1997), July 17, 388 (6639): 235.

Di Maio, V. J. M.; Garriott, J. C.; "How valid is the 0.10 percent alcohol level as an indicator of intoxication?" PATHOLOGIST (1985), March: 33-35. (A number of researchers has shown that consistent impairment of reaction responses occurs at blood alcohol concentrations in excess of 0.07%. When either visual or tracking functions were combined, with more complex situation in which there are simultaneous visual and tracking response, impairment of performance occurred at low alcohol concentrations. This impairment in complex situations is concerned with the interference of the ability of the brain to process large quantities of information from more than one source at a time. Alcohol impairs driving performance because driving requires the division of attention between a visual search and recognition task and tracking test. Significant impairment begins to appear at blood alcohol concentrations of 0.05%. Reduction of the BAC to 0.05% can be justified on a scientific basis.)

"Drinking and driving," ALCOHOL ALERT (1996), 31, PH 362, January. ["The many skills involved in driving are not all impaired at the same BACs (3). For example, a driver's ability to divide attention between two or more sources of visual information can be impaired by BACs of 0.02 percent or lower (3-5). However, it is not until BACs of 0.05 percent or more are reached that impairment occurs consistently in eye movements, glare resistance, visual perceptions, reaction time, certain types of steering tasks, information processing, and other aspects of psychomotor performance.]

Easdon, C. M.; Vogel-Sprott, M.; "Drug free behavioral history affects social drinkers' tolerance to a challenge dose of alcohol," JOURNAL OF STUDIES ON ALCOHOL (1996), 57 (6): 591-7. (The results of the present research showed that a history of drug-free training under environmentally induced impairment reduced the impairing effect of a challenge dose of alcohol. Performance under alcohol represents a different condition, and much research shows that informative feedback during drugged performance is a powerful factor that enhances tolerance to alcohol-induced impairment, (Vogel-Sprott, 1992). The findings are consistent with the hypothesis of acquired behavioral compensation for impairment, and show that drug-free training under conditions that impair performance many enhance tolerance to alcohol-induced impairment.)

Fell, J. C.; "Drinking and driving in America,"ALCOHOL HEALTH AND RESEARCH WORLD (1990), 14 (1): 18-25. (Over 60 percent of nighttime, weekend, and single vehicle crashes involve a driver, pedestrian, or a bicyclist with a positive BAC (BAC > 0.01). Alcohol is involved in approximately 80 percent of fatal crashes that occur between 8 p.m. and 4 a.m. on any night of the week.)

Fell, James C; Voas, Robert B.; "The effectiveness of reducing illegal blood alcohol concentration (BAC) Limits for driving: evidence for lowering the limit to .05 BAC in Canada"; Pacific Institute for Research & Evaluation, May, 2003, 40p. "The purpose of this scientific review is to provide a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration (BAC) for driving and providing a case for enacting a .05 BAC Criminal Code limit in Canada.

The international trend continues to be to reduce illegal criminal per se limits to .05 BAC or lower. The illegal limits is .05 BAC in numerous countries including: Australia, Austria, Belgium, Bulgaria, Croatia, Denmark, Finland, France, Germany, Greece, Israel, Italy, the Netherlands, Portugal, South Africa, Spain, and Turkey. Russia, Sweden and Norway have a limit of .02 BAC and Poland recently went to l03 BAC. Several countries have reported studies indicating that lowering the illegal per se limit from .08 BAC to .05 BAC reduces alcohol-related fatalities.

Laboratory studies indicate that impairment in critical driving functions begins at low BACs and that most subjects are significantly impaired at .05 BAC with regard to visual acuity, vigilance, drowsiness, psychomotor skills, and information processing compared to their performance at .00 BAC. The relative risk of being involved in a fatal crash as a drivers is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. Leading medical, crash prevention, public health and traffic safety organization in the world support BAC limits at .05 BAC or lower.

Fell, James; Voas, Robert; "Evidence for lowering the BAC Limit to .05", JOURNAL OF SAFETY OF RESEARCH (from ICADETS newsletter). "Fourteen states indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5-16% reductions in alcohol-related crashes, fatalities, or injuries. Several studies indicate that lowering the illegal per se limit from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving function begins at low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. There is strong evidence in the literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately save lives. The authors conclude that this critical review supports the adoption of lower illegal BAC limits for driving"

Fillmore, Mark T.; Vogel-Sprott, M.; "Behavioral impairment under alcohol: cognitive and pharmacokinetic factors," ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (1998) 22 (7): 1476-1482.

Fillmore, Mark T.; Blackburn, Jaime; "Compensating for alcohol-induced impairment: alcohol expectancies and behavioral disinhibition," (2002), 63: 237-246. Social drinker (N=48) practice a stop-signal choice reaction (RT) task that measured their speed of responding and their ability to inhibit responses to stop signals. The findings demonstrate that an alcohol expectancy can reduce impairment of one aspect of performance under the drug while increasing its impairing effect on another. The study contributes to a growing body of research that highlights the importance of understanding interactions between the expected and pharmacological effects of alcohol.

Finnigan, F.; Hammersley, R.; "The Effects of alcohol on performance," In: Smith, A. P.; Jones, D. M., eds.; , New York, NY, Academic Press, c1992, p.73-126. [The authors explain methodological problems: measurement of baseline performance; use between subject- designs; use sufficient numbers of subjects (authors believe there should be more than 15 subjects); insure that subjects cannot tell when they are consuming alcohol; include placebo alcohol conditions in the design; and measure achieved blood or breath alcohol level; measure performance and BAL over time; show some agreement abut which measure of psychomotor performance are fundamental for alcohol research; more statistical sophistication should be employed in interpreting results; some study of the relevance to everyday live--"we need to know the extent to which people can and do control their dose and hence their impairment."]

Fisher, Honey R.; Simpson, Robert I.; Bhushan, M. Kapur; "Calculation of blood alcohol concentration (BAC) by sex, weight, number of drinks and time," CANADIAN JOURNAL OF PUBLIC HEALTH (1987), 78, September/October : 300-304. "The behavioral signs of intoxication, including slurred speech, loss of coordination, and clumsiness, would indicate cutting off service, even if a patron's BAC was below the 80 mg% limit. Again, it must be remembered that as a person's tolerance to alcohol increases, there may be fewer outward behavioral signs of intoxication, even though the BAC level may be greater than 80 mg%," (Fisher, 1987).

Garriott, J. C.; "Pharmacology of ethyl alcohol," In: Garriott, J., ed.; Medicolegal Aspects of Alcohol Determination in Biological Specimens, Littleton, MA, PSG Publishing Company, Inc., c1988, 36-54. (Colors, vision, light, and impairment, etc., pyloric sphincter.)

Garriott, J. C.; "Pharmacology and toxicology of ethyl alcohol", In: Garriott, James C., ed.; Medicolegal aspects of alcohol, 3rd ed. Lawyers & Judges Publishing Company, Inc., c1996, pp. 44-46, 526p.(A review of research on alcohol impairment and driving--of 177 studies, 158 reported impairment of one or more behavioral skills at one or more BAC's, study by Moskowitz and Robinson.

Gengo, R. M.: Gagos, C.; Straley, C.; Manning, C.; "Pharmacodynamics of ethanol: effects of performance and judgment," JOURNAL OF CLINICAL PHARMACOLOGY (1990), 30 (8): 748-754. (20 subjects' self rated degrees of impairment of various est. BAC (BrAC) were influenced by whether alcohol concentrations were rising or falling. Subjective impairment ratings were greater while alcohol concentrations were increasing compared to the same Est. BAC occurring during falling alcohol concentrations. Disparities between self rated degree of impairment and decrements in test performance were greatest 1.0 hour after peak Est. BAC and maximum decrements in test performance. The delay in subjects' ability to accurately rate their impairment relative to peak Est. BAC may be contributing factor to motorists choosing to drive while their performance is still impaired. "There was no difference in response to ethanol that could be demonstrated comparing performance during rising with performance during declining Est. BAC." P. 752. Our data support the present assumptions by the medico-legal community that equal impairment of psychomotor function occurs regardless of increasing or decreasing ethanol concentration," p. 754)

Giguire, W.; "Impairment caused by moderate blood alcohol levels in a closed course: preliminary demonstration," In: Alcohol, Drugs and Traffic Safety, San Juan, Puerto Rico, 1985,: 529-543. (Driving impairment and BrAC.)

Grossman, David C.; Mueller, Beth A.; Kenaston, Tricia; Salzberg, Philip; Cooper, William; Jurkovich, Gregory J.; "The validity of police assessment of driver intoxication in motor vehicle crashes leading to hospitalization", ACCIDENT ANALYSIS AND PREVENTION (1996), 28 (4): 435-442. A total of 1336 subjects had both a recorded BAC and a police sobriety assessment. Seventy percent of subjects were male and 79% under the age of 35 years. Overall, 40% of all subjects were judged by police to have been impaired, based on the scene sobriety assessment. Among all drivers, the field assessment had a sensitivity of 91%, a specificity of 90% and a predictive value positive of 85%. After excluding the 419 drivers which as breath testing as part of their assessment, the field assessment had a sensitivity of 74% and a specificity of 97%. The sensitivity of the field assessment did not vary appreciably by gender but was lower among older drivers, and higher among severely injured drivers and those involved in weekend and nighttime crashes. Police officers in this sample appear to recognize drunk driving with a high degree of accuracy when investigating crashes in which the driver is transported to a trauma center.

Harris, Douglas H., "Visual detection of driving while intoxicated", HUMAN FACTORS (1980), 22 (6): 725-732. Visual cures were identified and procedures were developed to enhance on-the-road detection of driving while intoxicated (DWI) by police officers. Related research was reviewed; police officers with demonstrated effectiveness in DWI detection were interviewed; DWI arrest reports were analyzed; and a study was conducted to determine the frequency of occurrence and relative discriminability of visual cues. Based on the results, a DWI detection guide was developed and verified in a field study involving a sample of 10 law enforcement agencies located throughout the United States. Use of the guide was accompanied by a statically significant 12% overall increase in DWI arrest rate.

Hedlund, J. H.; "If they didn't drink, would they crash anyway?--The role of alcohol in traffic Crashes," ALCOHOL, DRUGS, AND DRIVING (1994), 10 (2): 115-125. (Crash data shows that many crash-involved drivers have alcohol in their blood. In the US in 1992, an estimated 29% of drivers in fatal crashes had some measurable alcohol. Extensive research shows that alcohol impairs driving-related tasks such as divided attention, comprehension, reaction time, and coordination. In addition, several studies show directly that drivers with alcohol in their blood have a greater crash risk than drivers at similar times and places without alcohol. This evidence has been sufficient for most jurisdictions throughout the world to make it illegal to drive with a blood alcohol content (BAC) exceeding some specified level (typically ranging from 0.05 to 0.10 Each of the three methods gives clear evidence that alcohol increases crash risk. The first finds that crash risk increases rapidly as BACs rise above 0.05-0.07, for drivers of all drinking frequencies. The second finds that crash responsibility increases as BAC increases for crash-involved drivers. And the third finds measures to reduce drinking and driving that have in fact reduced all crashes. These strongly suggest that reduced drinking and driving does indeed reduce crashes.)

Hernandez-Collados, A.; Sanchez-Turet, M.; Sanchez-Sastre, J.; "Different cognitive effects in the increasing and decreasing limb of the metabolic curve of ethanol," MEDICAL SCIENCE RESEARCH (1998), 26: 173-175. (20 men and 19 women, single dose of ethanol 1 g/kg, BrAC, mean BAC of 0.24 g/l, subjects performance decreased significantly during absorption. This impairment was related to perceptual motor and visual memory processes. In the elimination phase, at a mean BAC or 0.47 g/l, there was no decrease in performance. We may conclude that behavior was different in the ascending and descending phases. Very low alcohol doses, much lower than that legally permitted for drivers in various countries, produce a marked impairment over a period of time after ingestion of alcohol.)

Hernandez-Collados, A.; Rodamilans, M.; Sanchez-Turet, M.; "Influence of acetaldehyde on cognitive performance shortly after ingesting ethanol," MEDICAL SCIENCE RESEARCH (1997), 25: 593-96. (20 males, 19 females, BrAC 1 g kg-1 of alcohol and perceptive-motor and cognitive impairment tests were deteriorated.)

Hingson, R.; Howland, J.; "Alcohol, injury, and legal controls: some complex interactions," LAW, MEDICINE, AND HEALTH CARE (1989), 17 )1): 58-68. (The evidence that drinking is associated with increased risk for vehicular injury and death is substantial. Laboratory and field studies demonstrate that alcohol impairs sensory and motor skills required for safe driving.)

Hingson, R. W.; Heeren, T.; Winter, M. R.; "Preventing impaired driving," ALCOHOL RESEARCH AND HEALTH (1999), 23 (1): 1999. "Although moderate drinking does not necessarily increase a person's blood alcohol concentration (BAC) to the level at which diving is legally prohibited in the United States, any drinking can impair driving tasks. In addition to laws establishing lower legal BAC limits for driver, legislative approaches for reducing alcohol-impaired driving include imposing sanctions for drinking and driving and restricting alcohol's availability."

Hingson, R.; "Prevention of alcohol-impaired driving," ALCOHOL HEALTH AND RESEARCH WORLD (1993), 17 (1): 28-34.

Hingson, R.; McGovern, T.; Howland, J.; Heeren, T.; Winter, M.; Zakocs, R.; "Reducing alcohol-impaired driving in Massachusetts: the saving lives program", AMERICAN JOURNAL OF PUBLIC HEALTH, (1996), 86 (6): 791-797.

Jones, A. W.; "Evidence-based survey of the elimination rates of ethanol from blood with applications in forensic casework", FORENSIC SCIENCE INTERNATIONAL (2010), 200 (1-3: 1-20. "Reliable information about the elimination rate of alcohol (ethanol) from blood is often needed in forensic science and legal medicine when alcohol-related crimes, such as drunken driving or drug-related sexual assault are investigated. A blood sample for forensic analysis might not be taken until several hours after an offense was committed. The courts usually want to know the suspect's blood-alcohol concentration (BAC) at some earlier time, such as the time of driving. Making these back calculations or retrograde extrapolations of BAC in criminal cases has many proponents and critics. Ethanol is eliminated from the body mainly by oxidative metabolism inn the liver by Class I isoenzymes of alcohol dehydrogenase (ADH). Ethanol is an example of a drug for which the Michaelis-Menten pharmacokinetic model applies and the Michaelis constant (k(m)) for Class I ADH is at BAC of 2-10mg/100mL. This means that the enzyme is saturated with substrate after the first few drinks and that zero-order kinetics is adequate to describe the declining phase of the BAC profile in most forensic situations (BAC >20 mg/100mL) After drinking on an empty stomach, the elimination rate of ethanol from blood falls within the range 10-15 mg/l00mL/h. In non-fasted subjects the rate of elimination tends to be in the rage 15-20mg/100mL/h. In alcoholics during detoxification, because activity of microsomal enzyme (CYP2E1) is boosted, the ethanol elimination rate might be 25-35 mg/100mL/h. the slope of the BAC declining phase is slightly steeper in women compared with men, which seems to be related to gender difference in liver weight in relation to lean body mass. The present evidence-based review suggests that the physiological range of ethanol elimination rates from blood if from 10 to 35mg/100mL/h. In moderate drinkers 15 mg/100mL/h remains a good average value for the population, whereas in apprehended drivers 19 mg/100mL/h is more appropriate, since many of these individuals are binge drinkers or alcoholics. In preparing this article, a large number of peer-reviewed publications were scrutinized. Only those meeting certain standards in experimental design, dose of alcohol and blood-sampling protocol use used. The results presented can hopefully serve as best-practice guidelines when question arise in criminal and civil litigation about the elimination rate of ethanol from blood in humans.

Johnston, I. R.; "The Role of alcohol in road crashes," ERGONOMICS (1982), 25: 941-946. (Fifty percent of the alcohol-related crashes occurred on curves compared with only 36% of the 'sober' crashes. In negotiating a curve, two behaviors are critical: an accurate estimation of the degree of curvature to enable appropriate speed selection and precise tracking of the curve path. It is a conventional divided attention-task and alcohol is known to seriously impair timesharing ability. Making the reasonable assumption that impaired drivers will devote relatively more attention to their short-term steering task it is likely to be their perception of the relevant cues to curvature that will suffer, resulting in in an inappropriate curve entry speed which in turn will exacerbate the demands placed on steering control.)

Jones, A. W.; "Are a blood alcohol concentration of 256 mg/dl and minimal signs of impairment reliable indicators of alcohol dependence?" MEDICINE, SCIENCE AND THE LAW (1994), 34 (3): 265-270.

Jones, A. W.; "Pharmacokinetics of ethanol in saliva: comparison with blood and breath alcohol profiles, subject feelings of intoxication, and diminished performance," CLINICAL CHEMISTRY (1993), 39 (9): 1837-1844. (21 men who were given 0,68 g/kg body weight. Near the time of obtaining body fluids (breath, blood, saliva) subjects estimated their feelings of intoxication, [body sway, roving ocular movements (ROM), hand tremor, and positional alcohol nystagmus (PAN) were quantitatively recorded. The concentration time profiles of ethanol in the blood, bread and saliva agreed well with in individuals, but large variations occurred between subjects. Standing steadiness and hand steadiness were highest at the time of reaching the peak concentrations of ethanol in the body. PAN was evident in most subjects between 60 and 102 min after the start of drinking, ROM appeared mainly during the postabsortptive phase between 120-420 min. BAC threshold were between 500 and 700 mg/L (50-70 mg/dL) when with diminished performance and recovered to baseline values. BrAC was analyzed at 2100:1. Tests began at 9:00 am on an empty stomach meal was served 5 hours after drinking started. Maximum impairment coincided with the time of reaching the peak concentrations of ethanol. On reaching the postpeak phase, the degree of impairment rapidly diminished.)

Khanna, Jatinder M.; LeBlanc, A. Eugene; Mayer, Joel A.; "Alcohol pharmacokinetics and forensic issues: a commentary", In: K. E. Crow, R. D. Batt (Eds.); Human metabolism of alcohol, volume I: Pharmacokinetics, medicolegal aspects and general interest; CRC Press (1989), 214p. (59-70). "As pharmacologists, we would recognize that it is possible for a person to have consumed significant amounts of alcohol and to be on the rising phase of the BAC curve, such that within a few minutes of the end of drinking there are no signs of intoxication, but these appear later on while driving a car."

Koelega, H. S.; "Alcohol and vigilance performance: a review," PSYCHOPHARMACOLOGY (1995), 118: 233-249. [The capacity to divide and sustain attentions is already impaired at BAC levels of 0.02-0.03% (Moskowitz and Robinson, 1987). Further, alcohol effects appear to some extent to be time-dependent, and are greatest during periods of sleepiness (the early afternoon and after midnight). There is sufficient evidence from the literature indicating that the BAC standard for driving should be lowered to 0.02% for driving after midnight and for special risk groups (young and less experienced drivers).

Koelega, H. S.; " Effects of caffeine, nicotine and alcohol in vigilance performance," In: J. Snel and M. M. Lorist, Eds.; Nicotine, caffeine and social drinking: behavior and brain function, Amsterdam, The Netherlands, Harwood, 1998, 473p. (pp. 363-373). (There are considerable individual differences in the metabolism of alcohol, in time to achieve the peak BAC [usually 30-90 min] and in the rate of elimination. Usually, BAC and performance are non-concordant, that is peak BAC and peak impairment of performance often take place at different points of time. Effects of alcohol on vigilance performance were reviewed by Keolega (1995)). Of 38 alcohol-placebo comparisons, an effect of alcohol on level of performance was noted in 50% of the cases, which increased to about 70% when small-sized samples (n<15)were eliminated.)

Linnoila, M.; Stapleton, J. M.; Lister, R.; Guthrie, S.; Eckardt, M.; "Effects of alcohol on accident risk," PATHOLOGIST (1986), August: 36-41. (Ethanol has multiple adverse effects on central nervous system functions. Such functions must be intact for the safe operation of a motor vehicle in traffic. Thus, it is not surprising that the consumption of ethanol is associated with increased risk of accidents. This increment in accident risk becomes evident in epidemiological studies at BACs between 50 and 80 mg/dL. Laboratory studies have demonstrated ethanol-induced impairments of skilled performance starting at BACs of the order of 25 to 30 mg/dL.)

Lund, A. K.; Wolfe, A. C.; "Changes in the incidence of alcohol-impaired driving in the United States, 1973-1986," JOURNAL OF STUDIES ON ALCOHOL (1991), 52 94): 293-301. (Studies of motor vehicle fatality data have indicated alcohol involvement in fatal crashes has declined since 1980 this study determined that the data for late-night weekend crashes was 3.1% with BAC above 0.10% compared to 1973 and 4.9%.)

Mack, C. M.; " Alcohol-induced impairment of central nervous system function: behavioral skills involved in driving," JOURNAL OF STUDIES ON ALCOHOL (1985), Suppl. 10, July: 109-116.

Manno, Barbara R, Manno, Joseph E.; "Epidemiologic basis or alcohol-induced psychomotor performance impairment (PMPI)," In: Garriott, James C., ed.; Medicolegal aspects of alcohol, 3rd ed. Lawyers & Judges Publishing Company, Inc., c1996, 526p.

Manno, Joseph E., Manno, Barbara R, ; "Experimental basis or alcohol-induced psychomotor performance impairment (PMPI)," In: Garriott, James C., ed.; Medicolegal aspects of alcohol, 3rd ed. Lawyers & Judges Publishing Company, Inc., c1996, 526p.

Maylor, E. A.; Rabbit, P. M. A.; "Alcohol, reaction time and memory: a meta-analysis," BRITISH JOURNAL OF PSYCHOLOGY (1993), 84: 301-17. (Alcohol appears to have a general linear effect on information processing, rather than specific effects on a subset of stages. It is concluded that the results are consistent with a reduced processing resources hypothesis for the impairment with alcohol.)

Maylor, E. A.; Rabbit, P. M. A.; "Effects of practice and alcohol on performance of a perceptual-motor task," THE QUARTERLY JOURNAL OF EXPERIMENTAL PSYCHOLOGY (1987), 39A: 777-795. (40 male and 40 female subjects, BrAC. The results demonstrated that: (1) results improved with practice; (2) with alcohol, 0.8 mg/kg body weight, subjects were more variable and less accurate; (3) improvement with alcohol was greater that without alcohol, but as performance was impaired by alcohol, there was greater scope for improvement; (4) those who practiced with alcohol still improved when switched to no alcohol late in practice; and (5) alcohol had the same effect early and late in practice.)

McKnight, A. James; Langston, Elizabeth A.; Marques, Paul R.; Tippetts, A. Scott; "Estimating blood alcohol level from observable signs", ACCIDENT ANALYSIS AND PREVENTION (1997), 29 (2): 247-255. Researchers first observed and recorded signs of change in behavior and physical appearance among dosed drinkers in small social groups (n=149). Signs were grouped into impairment levels corresponding to three broad categories of blood alcohol concentration (BAC): <0.04% (no signal), 0.04%-0.08%, and >0.08%. Next, drinkers were then classified into judged impairment level by guests observing small numbers in social groups (n=333), hosts observing large numbers in social groups (n=480), and servers observing patrons in public establishments (n+436). A random half of the observers in each setting were given instructional guidance in the relationship of signs to impairment level. Results showed all observers to exceed change in their classifications of drinker impairment, with observations in the small social groups being significantly more accurate than those in the other two groups. A beneficial instructional guidance effects was significant for the social groups, with the greatest benefit found in detecting those over 0.04% in the small groups. The authors conclude that, while most people are fairly accurate in judging alcohol impairment, their accuracy is greatest and guidance most effective in detecting the presence rather than degree of impairment and when attention can be concentrated upon a few drinkers at a time.

Mills, K. C.; Bisgrove, E. Z.; "Cognitive impairment and perceived risk from alcohol: laboratory, self-report and field assessments" JOURNAL OF STUDIES ON ALCOHOL (1993), 44 (1): 26-46. (40 males aged 24-52 were given ethanol and tested four times, four different days, on divided attention. Results show that heavy drinkers are more likely to hold elevated estimates of their ability to compensate for the effects of drinking. After the study, heavy drinkers also had more optimistic attitudes about effects of driving and drinking.)

Mills, K. C.; Parkman, K. M.; Spruill, S. E.; "A PC-based software test for measuring alcohol and drug effects in human subjects," ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (1996), 20 (9): 1582-91. (BrAC with 24 subjects with significant falling and rising impairment effects on eye movements, eye-hand coordination, color, etc.)

Mitchell, N. C.; "Alcohol induced impairment of central nervous system function: behavioral skills involved in driving," JOURNAL OF STUDIES ON ALCOHOL (1985), Suppl 10, 109-116. (Review of alcohol and its effects on perception, attention, sensorimotor coordination, and cognitive function. Impairment is dose related but not identical or strictly linear for all behaviors. Alcohol-related impairment of behavior skills that require cognitive functioning is greatest for those tasks that require cognitive functioning; simple perception alone is least affected. Impairment of cognitive functioning, which includes information processing and decision making under conditions of divided attention, is evident at BALs above 50 mg/dl and is markedly affected above 100 mg/dl.)

Moskowitz, H.; "Attention tasks as skills performance measures of drug effects," BRITISH JOURNAL OF CLINICAL PHARMACOLOGY (1984), 18: 51S-61S. (This paper examined and reviewed the effects of drugs on tow major components of cognitive perceptual performance, concentrated attention or vigilance and divided attention. It is demonstrated that these two types of attention tasks are differentially affected by various drugs, so that sometimes one and sometimes the other of these tasks is impaired. Various experimental paradigms to investigate these two attention functions are presented. It is demonstrated that attention tasks are frequently highly sensitive to drug effects, suggesting the importance of examining these functions when investigating the effects of drugs on performance.)

Moskowitz, H.; DePry, D.; "Differential effect of alcohol on auditory vigilance and divided-attention tasks," QUARTERLY JOURNAL OF STUDIES ON ALCOHOL ( 1968), 29: 54-63. (10 subjects. The results support the reports the Gruner, Ludwig and Domer that alcohol disrupts the ability of the brain to monitor simultaneously two channels of information; they found a 16% impairment at a 0.075% blood alcohol level, almost the same impairment found in this study, and also reported a performance deficit at blood alcohol levels as low as 0.025%.)

Moskowitz, H.; Robinson, C.; "Driving-related skills impairment at low blood alcohol levels", In: Noordzij, P. C., et al. (eds.) ALCOHOL, DRUGS, AND TRAFFIC SAFETY: proceeding of the 10th International conference on Alcohol Drugs and Traffic Safety, Amsterdam, 1987, 79-86. (Review 178 studies of impairment literature.)

Moskowitz, H.; Burns, M. M,; Williams, A. F.; "Skills performance at low blood alcohol levels," JOURNAL OF STUDIES ON ALCOHOL (1985), 46 (6): 482-485. (10 men, BrAC, and divided attention and tracking. All response variable singly show evidence of impairment at the lowest BAL tested at 0.02 and increasing impairment with increasing BAL. Clearly, the divided-attention tasks was the more sensitive of the two tasks, which probably reflects the greater susceptibility of complex tasks to alcohol effects. Moreover, the divided-attention task combining tracking and visual search components is more directly compatible to demands of actual driving situations.)

Naranjo, C. A.; Bremner, K. E.; "Behavioral correlates of alcohol intoxication," ADDICTION (1993, 88 (1): 25-35. (Adverse social consequences related to alcohol intoxication include impaired driving, acts of aggression and violence towards self and others, and various types of accidents. The observation that [positive BAC is inversely related to using a seat belt may be one factor increasing the risk of serious injury or fatality in a motor vehicle accident. alcohol is more frequently involved in fatal crashes and fatal pedestrian accidents at night than during the day, and on weekends rather than on weekdays. Alcohol impairs information-processing abilities crucial to driving at blood concentrations as low as 0.015%, Howat et al. recommended lowering the legal BAC limit to 0.05%.)

Nawrot, M,; Nordstrom, B.; Olson, A.; "Disruption of eye movements by ethanol intoxication affects perception of depth from motion parallax", PSYCHOLOGICAL SCIENCE (2004), 15 (4): 858-65. "Motion parallax, the ability to recover depth from retinal motion generated by observer translation, is important for visual depth perception. Recent work indicates that the perception of depth from motion parallax relies on the slow eye movement system. It is well known that ethanol intoxication reduces the gain of this system, and this produces the horizontal gaze nystagmus that law enforcement's field sobriety test is intended to reveal. The current study demonstrates that because of its influence on the slow eye movement system, ethanol intoxication impairs the perception of depth from motion parallax. Thresholds in a motion parallax task were significantly increased by acute ethanol intoxication, whereas thresholds for an identical test relying on binocular disparity were unaffected. Perhaps a failure of motion parallax plays a role in alcohol-related driving accidents; because of the effects of alcohol on eye movements, intoxicated drivers may have inaccurate or inadequate information for judging the relative depth of obstacles from motion parallax."

Nau, P. A.; Van Houten, R.; Rolider, A.; Jonah, B. A.; "The Failure of feedback on alcohol impairment to reduce impaired driving," JOURNAL OF APPLIED BEHAVIOR ANALYSIS (1993), 26 (3): 361-7. (In a public drinking establishment, patrons received cards to guide them to pace their drinking to stay under the legal limit, individual feedback on BAC (BrAC tests given), and posted group feedback on the percentage of patrons driving while impaired the preceding week was introduced in two taverns. The addition of a brief intensive police enforcement program directed at impaired driving produced a short-term reduction in impaired driving.)

Nichols, J. M.; Martin, F.; "The Effect of heavy social drinking on recall and event-related potentials," JOURNAL OF STUDIES ON ALCOHOL (1996), 57: 125-135. (HSD heavy social drinker is defined as who drank more and 200 gm per week, or 20 standard drinks per week which included one session in which at least 100 mg or 10 standard drinks were consumed. 28 subjects half social heavy drinkers given lorazepam-ativan and placebo. Results indicate heavy social drinkers have an impairment in their information-processing ability in the presence of an acute inhibitory agent.)

Nichols, J. M.; Martin, F.; "Social drinking, memory, and information processing" In: J. Snel and M. M. Lorist, Eds.; Nicotine, caffeine and social drinking: behavior and brain function, Amsterdam, The Netherlands, Harwood, 1998, 473p. (315-330pp. ). (When alcohol is consumed at levels which are regarded as socially acceptable, especially when large amounts of alcohol are consumed in one sitting, recent research indicates that impaired information processing and memory deficits may result.)

Nicholson, M. E.; Andre, J. T.; Tyrrell, R. A.; Wang, M.; Liebowitz, H.; "Effects of moderate dose of alcohol on visual contrast sensitivity for stationary and moving targets," JOURNAL OF STUDIES ON ALCOHOL (1995), 56: 261-66. (BrAC of 8 subjects, 4 double blind sessions. Most states currently prohibit driving with BACs of 0.08-.010%, the present data indicate reliable visual impairment at approximately half of that level.)

Nicholson, M. E.; Wang, M., Airhinenbuwa, C. O.; Mahoney, B. S.; Christina, R.; Mahoney, D. W.; "Variability in behavioral impairment involved in the rising and falling BAC curve," JOURNAL OF STUDIES ON ALCOHOL (1992), 53: 349-356. (BrAC).

Oscar-Berman, M.; Shagrin, B.; Evert, D. L.; Esptein, C.; "Impairments of brain and behavior: the neurological effects of alcohol: alcohol's effect on organ function," ALCOHOL HEALTH AND RESEARCH WORLD (1997), 21 (1): 65-66. (Heavy alcohol consumption can impair the brain and other components of the nervous system. Neurological effects can include impaired perception, learning and memory, as well as changes in personality and emotions.)

Philips, D., et. al; "The relationship between serious injury and blood alcohol concentration(BAC) in fatal motor vehicle accidents: BAC = 0.01% is associated with significantly more dangerous accidents than BAC = 0.00%," ADDICTION, June 20, 2011. Researchers at the University of California San Diego, studied 1, 495,667 people who were involved in fatal car crashes from 1994 through 2008. The study comes from the Fatality Analysis Reporting System (FARS) which reports on the blood-alcohol content of drivers in increments of 0.01. he FARS report comes from every U. S. county, all days of the the week and all times of the day. David Phillips, a sociologist a the the university, found that blood-alcohol levels far below the legal limit for drunken driving of 0.08 were linked to serious injury and death in auto crashes. Accidents are 36.6 percent more severe even when alcohol was barely detectable in a driver's blood, Phillips wrote in his published study. Even with a BAC of 0.01, there are 4.33 serious injuries for every non-serious injury verses 3.17 for sober drivers, he stated. The details of the FARS data revealed three main reasons that even low alcohol levels in drivers are linked to more serious injuries: impaired drivers are more likely to speed, they are less likely to use a seat belt, and they are more likely to be the driver of the striking vehicle. . .For example the more the driver has to drink, the greater the speed of the vehicle. The researchers recommend that the current legal limit of 0.08 for driving under the influence be lowered even further, pointing out that the legal limit in Germany is 0.05; in Japan, 3.03; and Sweden, 0.02.

Pihl, R. O.; Paylan, S. S.; Gentes-Hawn, A.; Hoaken, P. N.; "Alcohol affects executive cognitive functioning differently on the ascending versus descending limb of the blood alcohol concentration curve", ALCOHOLISM, CLINICAL AND EXPERIMENTAL RESEARCH (2003), 27 (5): 773-9. (The intoxicated volunteers showed cognitive impairment on both limbs of the blood alcohol curve, but the descending limb group showed even greater deficits, especially in spatial functioning. Cognitive function deficits can seriously affect behavior, making you more aggressive and argumentative. The essence of behavioral control is soluble in alcohol for many people. The results support the conclusion that alcohol negatively affects cognitive performance and has a differential effect on the descending versus ascending limb of the blood alcohol concentration curve. The latter fining may have important ramifications relating to the detrimental consequences of alcohol intoxication.) 41 college age males.

Pishkin, V.; Lawrence, B. E.; Bourne, L. E.; "Cognitive and elctro-physiologic parameters during ascending and descending limbs of blood alcohol curve," ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (1983), 7: 76-81. (40 men aged 21-30, and peak BrAC in the range of 0.08-0.10. Major findings were: cognitive performance was impaired by alcohol ingestion; autonomic arousal was significantly greater after alcohol than after placebo; number and amplitude of skin response were greater on the ascending than on the descending limb; the anticipated effects of failure on cognitive performance were ameliorated by alcohol; and differential effects of alcohol on the psychophysiological parameters were demonstrated.)

Quinlan, Kyran P.; Brewer, Robert D.; Siegel, Paul; Sleet, David A.; Mokdad, Ali H.; Shults, Ruth A.; Flowers, Nicole, Alcohol -impaired driving among U. S. adults, 1993-2002, AMERICAN JOURNAL OF PREVENTATIVE MEDICINE (2005) 28 (4):346-350. After a decline of alcohol-impaired driving throughout most of the 1990s, a new study shows that driving while intoxicated has increased significantly and researchers believe it is linked to an increase in binge drinking. Motor vehicle accidents are the leading cause of death in the United States for people between the ages of 1 and 34. Thirty percent of Americans will be involved in an alcohol-related crash in their lifetimes. Such accidents cause damages worth more than $50 billion a year. People who reported binge drinking were 13 times more likely to report driving while alcohol impaired. Most binge drinkers reported that they often consume far more than five drinks per binge drinking episode.

Roth, T.; Roehrs, T.; "Alcohol-induced sleepiness and memory function,: ALCOHOL HEALTH AND RESEARCH RESEARCH WORLD (1995), 19 (2): 130-8. (A review of the literature. Alcohol induced sleepiness may have memory-impairing effects. Evidence supporting this hypothesis comes from sleep deprivation studies in healthy people, studies of patients with sleep disorders, studies of drugs with sedative effects, and studies of the interaction between alcohol's sedative and performance-disruptive effects.)

Roth, T.; Roehrs, T. A.; Moskowitz, H.; "Issues in drug-related performance impairment," CLINICAL THERAPEUTICS (1992), 14 (5): 654-666; discussion 653. (A review of the literature. Performance impairment associated with alcohol, drugs and medical disorders is of increasing concern to clinicians. Understanding and assessing performance impairment associated with a particular drug or condition is complex and requires careful, critical evaluation of the literature. Awareness of the issues involved enhances the ability of the clinician to assess risks for a given patient and of a give medical therapy. Important study variables are described that should be considered when evaluating literature related to impairment performance. The clinical relevance of performance studies is also discussed.)

Russell, R. M.; Carney, E. A.; Feiock, K.; Garrett, M.; Karwoski, P.; "Acute ethanol administration causes transient impairment of blue-yellow color vision," ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (1980), 4 (4): 396-399. (14 alcoholic subjects and 12 nonalcoholic subjects, breath and blood analysis. The acute administration of ethanol to alcoholics and normal subjects transiently resulted in poorer color discrimination in all spectra but with significantly more errors in the blue-yellow versus the red-green color range. Thus, ethanol appears to act as a toxin to inner retinal layers, which could account for the higher incidence of tritanopia found among alcoholics. Damage to the cell layer or optic nerve mainly results in a reduction of red-green color sense.)

Samber, Sharon; "BAC: understanding how drinking affects you" September 4, 1997, NCADI.

Sarkar, Sheila, "Cost and life saving estimates on volunteer based safe rides program for intoxicated drivers, January to March, 2002", California Institute of Transportation Safety, 2002. This study shows the Designated Driver Association of San Diego and Sacramento program to have saved $130,698,837 in life savings and deterred 534 intoxicated drivers from getting behind the wheel. Findings include: of the 517 participants, 40% were females who consumed an average of 6.5 drinks in 4.5 hours; 60% males who consumed 8.6 drinks in 5 hours; over 60% of the drivers were aged 25 or younger; males consumed more drinks and spent more time drinking than females; females had higher BAC levels (0.139%) than males (.128%) when both locations are combined and when looking at San Diego alone (males=0.134% and females = 0.152%); and over 30% of the participants were students.

Schneider, U.; Dietrich, D. E.; Sternemann, U.; Seeland, I.; Gielsdorf, D.; Huber, T. J.; Becker, H. Emrich, H. M.; " Reduced binocular depth inversion in patients with alcoholism," ALCOHOL AND ALCOHOLISM (1998), 33 (2): 168-172. (50 subjects. The binocular depth inversion scores were highly elevated in the severely intoxicated patients group and in the group with moderate withdrawal symptoms without carbamazepine treatment, in comparison to the healthy volunteers. The data demonstrate a strong impairment of binocular depth inversion in moderate alcohol withdrawal an during severe alcohol intoxication. This supports the view that these states may be accompanied by a disorganization of the interaction between sensory input and top-down component.)

Shores, R. E., Voas, R. B.; et al.; "MADD rates the states: a media advocacy event to advance the agenda against alcohol-impaired driving." PUBLIC HEALTH REPORTS (1995), 110 (3): 240-6.

Slater MD ; Long M ; Ford VL; "Alcohol, illegal drugs, violent crime, and traffic-related and other unintended injuries in U.S. local and national news", JOURNAL OF STUDIES ON ALCOHOL (2006), 67(6): 904-10. "This study seeks to establish the extent to which media coverage acknowledges alcohol 's contribution to violent crime as well as to motor vehicle injuries and other injury incidents. METHOD: The study content-analyzes a unique sample, closely approximating national representativeness, of local and national television news, local newspapers, and national magazines randomly sampled during a 2-year period. RESULTS: Alcohol's role in violent crime and, to a lesser extent, in motor vehicle and other injury incidents is underreported relative to available estimates regarding alcohol-attributable fractions. Relative frequency of various news frames for coverage of alcohol and illegal drugs and differences in coverage of alcohol and illegal drugs as a function of the type of story and news medium are described. CONCLUSIONS: The underreporting in the United States of alcohol's contribution to serious and fatal injury from these causes may reduce public perceptions of alcohol-related risks, potentially influencing behavior, including public support of alcohol-control policies. This provides an opportunity for media-advocacy approaches to improve public health content of news coverage."

Sonderstrom, C. A.; Birschbach, J. M. Dischlinger, P. C.; "Injured drivers and alcohol use: culpability, convictions, and pre- and pot-crash driving history," THE JOURNAL OF TRAUMA (1990), 30 (10): 1208-1214. (Driving histories of [ n=58] of injured impaired [BAC> 08 mg/dl] compared with unimpaired [n=92]. The data suggests that injury protects from legal prosecution and does not alter impaired driving practices.)

Starmer, G. A.; "Effects of low to moderate does of ethanol on human driving-related performance," In: K. E. Crow, R. D. Batt (Eds.); Human metabolism of alcohol, volume I: Pharmacokinetics, medicolegal aspects and general interest; CRC Press (1989), 214p.

Steele, C. M.; Josephs, R. A.; "Alcohol myopia: its prized and dangerous effects," AMERICAN PSYCHOLOGIST (1990), 45 (8): 921-933. (This article explains how alcohol make social responses more extreme, enhances important self-evaluations, and relieves anxiety and depression, effects that underlie both the social destructiveness of alcohol and the reinforcing effects that make it addictive. The theories are based on alcohol's impairment of perception and thought--the myopia it causes--rather than the ability of alcohol's pharmacology to directly cause specific reactions or on expectations associated with alcohol's use. Three conclusions are offered: alcohol make social behaviors more extreme by blocking a form of response conflict; the same process can inflate self-evaluations; alcohol myopia, in compilations with distracting activity, can reliably reduce anxiety and depression in all drinkers by making it difficult to allocate attention to the thoughts that provoke these states.)

Steele, C. M.: Southwick, L.; Pagano, R.; "Drinking your troubles away: the role of activity in mediating alcohol's reduction of psychological stress," JOURNAL OF ABNORMAL PSYCHOLOGY (1986), 95 (2): 173-180. (The results are discussed in terms of their implication that alcohol's reduction of psychological stress stems largely from its impairment of cognitive processes that, in conjunction with distracting activity, blocks out stress-inducing thoughts.)

Steele, C. M.; Josephs, R. A.; "Drinking your troubles away II: an attention-allocation model of alcohol's effect on psychological stress," JOURNAL OF ABNORMAL PSYCHOLOGY (1988), 97 (2): 196-205. (These results are discussed as (a) supporting the role of cognitive impairment and attention allocation in mediating alcohol's anxiety-reducing effects, (b) clarifying conditions under which alcohol can increase anxiety, and (c) demonstrating the importance of activity in mediating the variability of alcohol's tension-reducing effects.)

Stein, A. C.; Allen, R. W.; "The Effects of alcohol on driver decision making and risk taking," In: Noordzij, P. C.; Roszbach, R., eds.; Alcohol, Drugs and Traffic Safety--T86, c1987, p. 177-181. (This paper reports on a study designed to investigate the effects of alcohol on driver decision making and risk taking. It has been a commonly held belief that alcohol makes drivers more willing to take risks and less cautious in their decision making. Anecdotal evidence points to drivers under the influence of alcohol running red lights, speeding, and generally driving in a reckless manner. Alcohol has been involved in 50% of the traffic fatalities in the U. S., alcohol increases the severity of injury in a crash, Levine and colleagues categories effects according to abilities or tasks behavioral factors required for task performance. They found sensory-perceptual tasks seemed to be the most impaired, found increased psychological refractory period delays, impaired short term memory, increased reaction time under uncertainty, and increased eye fixation time while driving. He also found divided attention tasks are impaired by alcohol at very low levels (0.17-0.8) promil w/v. 26 male subjects, BAC 0.1.)

Sugarman, R. C.; Cozad, C. P.; Zavala, A.; "Alcohol-induced degradation of performance on simulated driving tasks," Society of Automotive Engineers, International Automotive Engineering Congress, Detroit, MI, January 8-12, 1973. (Breath alcohol study of simulated driving tasks found impairment. "The task most reliably degraded by intoxication was maintenance of lane position, followed by reaction to the red light and speed maintenance, in that order." The effects of alcohol are more during the intoxicating phase than the sobering-up phase.)

Sullivan, J. B.; Hauptman, M.; Bronstein, A. C.; "Lack of observable intoxication in humans with high plasma alcohol concentrations," JOURNAL OF FORENSIC SCIENCES (1987), 32 (6) : 1660-1665. "The difficulty of recognizing intoxication using gross observation alone is evident from this investigation and others. At plasma concentrations well in excess of 100 mg/dL, experienced alcohol drinkers may not appear intoxicated to very experienced observers. However, this appearance of sobriety does not translate to safe operation of a motor vehicle or complex machinery, in which case very low plasma concentrations produce impaired performance."

Thurman, Q.; "Drunk driving research and innovation . . .," SOCIAL SCIENCE RESEARCH (1993), 22 (3): 245-264. (These data suggest that key components of decisions to drink and drive include the extent of the driver's behavioral impairment, the availability of drunk-driving alternatives, weather condition, the number of miles that have to be driven after drinking, the legal consequences of drunk driving (in terms of jail sentences and license revocations), the community response to drunk driving, where drinking occurs, fines that might be issued, the use of traffic roadblocks, and the driver's familiarity with roads that must be driven after a drinking event. The analysis of drunk driving experiences, suggesting that those persons most experienced with drunk driving tend to rate legal sanctions as more important in judgments to drinking and drive than those person who typically refrain from drunk driving.)

Tupler, L. A.; Hege, S.; Ellinwood, E. H.; "Alcohol pharmacodynamics in young-elderly adults contrasted with young and middle-aged subjects," PSYCHOPHARMACOLOGY (1995), 118 (4): 460-70. (8 subjects in 3 age groups, BAC, both young and elderly individuals pose approximately equal risk of driving impairment, at least as measured by these tasks. Young subjects under the highest level of intoxication actually exhibited performance superior to that of elderly subjects under the base line conditions. Small samples.)

Vogel-Sprott, M.; "Acute recovery and tolerance to low doses of alcohol: differences in cognitive and motor skill performance," PSYCHOPHARMACOLOGY (1979), 61: 287-291. (Two groups of male social drinkers [10 subjects] were given low doses of alcohol four times and trained on pursuit rotor and decoding tasks and BrAC was tested on both the ascending and descending BrAC curve. After peak BrAC was reached acute recovery was evident in coding at a falling BrAC where PR remained impaired. These differences in impairment between tasks on the two limbs of the BAC curve suggested that conflicting evidence on the sensitivity of various tasks to alcohol effects may be obtained when studies examine task performance without respect to the limb of the BAC curve. Coding and tolerance were affected by repeated exposure. It was suggested that the phenomena of acute recovery and tolerance may be positively correlated, and different for different types of tasks.)

Vogel-Sprott, M.;: Kartechner, W.; McConnell, D.; "Consequences of behavior influence the effect of alcohol," JOURNAL OF SUBSTANCE ABUSE (1989), 1 (4): 369-79. (Behavioral effects of an acute dose of alcohol intensify while blood alcohol concentrations (BAC) rises, and abate while BAC declines. Elimination processes during this latter phase cannot totally explain this reduction, because the effects typically diminish more rapidly than the declining BAC. More recent research also demonstrates that the behavioral effect at a give rising BAC is greater than that observed at the same BAC on the declining limb of the alcohol curve. Four groups of male social drinkers were tested on a complex psychomotor tasks and then performed it 20 time after drinking a dose of alcohol. Group C received money contingent on the display of non impaired performance. Group I received information, Group R received money randomly, and N received no out come under the drug. A briefer duration of impairment, faster recovery at higher BACs, and less impairment during declining alcohol level was displayed by group C. The findings imply that the learned expectations of some valuable consequence for drug compensatory performance enhances behavioral tolerance to single and repeated doses of alcohol. BrAC)

Vogel-Sprott, M., Fillmore, M. T.; "Impairment and recovery under repeated doses of alcohol: effects of response-outcomes," PHARMACOLOGY BIOCHEMISTRY AND BEHAVIOR (1993), 45: 59-63. (36 males, 3 repeated doses of alcohol impairment is govern by two processes: response-outcome associations that determine the amount of impairment displayed under a dose and some adaptive process that determines the rate of recovery with time during exposure to a dose.)

Vogel-Sprott, M.," Is behavioral tolerance learned?" ALCOHOL HEALTH AND RESEARCH WORLD (1997), 21 (2): 161-9. (Studies conducted on alcoholism suggest that the behavioral tolerance of social drinkers towards alcoholism is developed through repeated exposure. The drinkers perceived expectations of society and the expected consequences of their antisocial actions modify their behavior. The term "tolerance" refers to the reduction in the intensity of the effect of alcohol, or other drugs, over the course of repeated use. These observations accord with the notion that apparent sobriety after drinking or an "ability to handle one's liquor", (i. e. exhibit tolerance to alcohol's behavioral effects) may be a useful pathological diagnostic symptom (American Psychiatric Association 1994). People likely to acquire tolerance to alcohol's behavioral effects in drinking situations where reliable cues, such as liquor bottles, signal alcohol availability. Research indicates that when alcohol is expected and received a social drinker may demonstrate behavioral tolerance while performing one task but not another. Other research suggests that technique commonly referred to as "mental rehearsal" can build tolerance as an alternative to actually performing a task after drinking alcohol. The techniques, often applied to improve motor skills in sports, involves imagining task performance before putting it into practice. Subjects in the cited studies drank repeated doses of alcohol and either mentally rehearsed a task with an imaginary reward for sober performance or actually practiced the task and received a reward for sober performance. After the treatments concluded and all groups performed the tasks after drinking alcohol, both the mental rehearsal and the task-practice groups displayed complete tolerance (i. e., no impairment) under the influence of alcohol.)

Volkow, N.; Wang, G.; Doria, J. J.; "Monitoring the brain's response to alcohol with positron emission tomography," ALCOHOL HEALTH AND RESEARCH WORLD (1995), 19 (4); 396-300. (Researchers have used PET measurement of blood flow and energy metabolism to identify brain regions affected by alcohol and to investigate mechanisms of alcohol-induced cognitive and behavioral impairment. PET can detect early functional deficits in the brain before structural changes can be detected. Pet students have shown that alcohol withdrawal changes regional brain metabolism in alcoholics in the absence of neurological or psychological impairment. PET has also document gradual recovery of cognitive functions with continued abstinence.)

Warren, R. G.; Lie,I.; "Visual functions and acute ingestion of alcohol", OPHTHALMIC AND PHYSIOLOGICAL OPTICS (1996), 16 (6): 460-466. (22 males subjects, BrAC) Visual acuity and refraction were only significantly affected at the 0.1 percent BrAC level. Contrast sensitivity, stereoacuity and binocular vision were affected at both 0.05 percent and 0.1 percent BrAC concentrations. Only the higher spatial frequencies of contrast sensitivity were affected. These results confirm previous findings on the detrimental effects of alcohol upon oculomotor control, showing a considerable decrease in both positive relative convergence and negative relative convergence.

"Why you should never drink and drive", Buddy T., About.com.
25 years of research has shown that some impairment begins for both males and females even after one drink.

.02 BAC Level
At the .02 blood alcohol concentration level, experiments have demonstrated that people exhibit some loss of judgment, begin to relax and feel good. But tests have also shown that drivers at the .02 level experience a decline in visual functions, affecting their ability to track a moving object, and experience a decline in the ability to perform two tasks at the same time.

These changes may be very subtle and barely noticeable to the person who has had only one drink, but in an emergency situation while behind the wheel of a vehicle, they could cause the driver to react (or not react) as they would without having had a drink.

.05 BAC Level
At the .05 BAC level, people begin to exhibit exaggerated behavior, experience loss of small-muscle control -- such as being able to focus their eyes quickly -- have impaired judgment, lowered alertness and a release of inhibition.

If someone with a BAC level of .05 gets behind the wheel, they would be operating the vehicle with reduce coordination, a future diminished ability to track moving objects, more difficulty in steering and a markedly reduced response in emergency situations.

.08 BAC Level
When someone drinking is approaching the borderline of legal intoxication, studies show that he or she has poor muscle coordination -- affecting their balance, speech, vision, reaction time and hearing -- find it more difficult to detect danger, and exhibit impaired judgment, self-control, reasoning ability and memory. http://alcoholism.about.com/od/dui/a/impaired.htm

Wieczorek, W.; Mirand, A.; Callahan, C.; "Perception of the risk of arrest for drinking and driving," CRIMINAL JUSTICE AND BEHAVIOR (1994), 21 (3): 312-24. (Examined the relationships among drinking measures, drinking and driving variables, and the perception of the risk of being arrested for driving while impaired by alcohol (DWI). Random-digit dialing, 453 drivers aged 18 and older who drank alcoholic beverages in the last 12 months. These results suggest that DWI prevention efforts need to be directed at specific groups and that for some groups, such as heavier drinkers (more than five drinks on one occasion), efforts other than deterrence are needed.)

Williams, Allan; Farmer, C. M.; JOURNAL OF INJURY PREVENTION(2005), 11 (1). This study looked at fatal motor vehicle crash deaths in the United States by time of day, day of week, month, and season. It was found that on average, motor vehicle crashes in the United States result in more than 100 deaths per day, but there is much day-to-day variability. During 1986-2002 the single day fatality count ranged from a low of 45 to a high of 252. More crash death occur in summer and fall months, than winter and spring, largely due to increased travel. July 4 (Independence Day) has more crash deaths on average than any other day of the year, with a relatively high number of deaths involving alcohol. January 1 (New Year's Day) has more pedestrian crash deaths on average, plus it had the fifth largest number of deaths per day overall, also due to alcohol impairment. On other days the high numbers of deaths re likely due to increases in holiday or recreational travel. It was concluded that every day of the year results in many crash deaths, but certain days sand out as particularly risky. The temporal and geographic spread of crash deaths as well as the view of driving as a routine task, inures the public to this continuing problem. Innovative strategies are needed both to raise awareness and to work toward a solution.

Williams, A. F., McCartt, A. T. and Ferguson, S. A. 2006. "Hardcore drinking drivers and other contributors to the alcohol-impaired driving problem: need for a comprehensive approach.' Arlington, VA: Insurance Institute for Highway Safety. Who qualifies as a "hard-core drinking driver"? The term was coined to refer to people who repeatedly drive while impaired and are resistant to changing their behavior despite previous sanctions, treatments, or education. The underlying premise is that many, if not most, of these people are problem drinkers.9 The term is not precisely defined, although two criteria commonly used to identify hard-core drinking drivers are prior alcohol-impaired driving convictions and very high BACs (0.15 percent or higher) at the time of arrest for alcohol-impaired driving. Hard-core drinking drivers have drawn extra attention in recent years as policymakers have tried to renew progress against alcohol-impaired driving. The concept of hard-to-change chronic heavy drinking drivers ignores many who account for a large portion of alcohol-impaired driving crashes. These include drivers who drink heavily on occasion and drivers who drink at more moderate levels that elevate crash risk. Some countermeasures aimed at the hard-core group have been effective in reducing recidivism, but attention and resources also need to be given to general deterrent initiatives (e.g. sobriety checkpoints, administrative license suspension).

Wilson, R. J.; "Convicted impaired drivers and high-risk drivers: how similar are they?", JOURNAL OF STUDIES ON ALCOHOL (1992), 53 (4): 335-44. (Replication of Donovan (1980) study. Results suggest some of the deviance attributed to high-risk divers by Donovan may have been exaggerated by confounding with age. Secondly, the heterogeneity within the DWI and high-risk driving populations appears to outweigh their differences.)

Wilson, R. J.; Mann, R. E. (eds.); Drinking and Driving: Advances in Research and Prevention, New York, Guilford Press, 1990, 224p. (UNDERSTANDING THE IMPAIRED DRIVER --Jessor and Jessor a clustering of problem behaviors associated with personality states and traits like risk-taking orientation and distress.)

Wilson, R. J.; "Identifying impaired drivers," JOURNAL OF STUDIES ON ALCOHOL (1985), 46 (6): 531-537. ("Results of the survey analyses indicate that, as a group, those who drive impaired are distinguishable from those who drive after drinking moderate amounts of alcohol along a number of dimensions including drinking habits, driving behavior, peer influence and attitudes toward drinking-driving. The tendency to drive while impaired may be just one manifestation of a broader constellation of high-risk or irresponsible behaviors.")

Woerle S ; Roeber J ; Landen MG; "Prevalence of alcohol dependence among excessive drinkers in New Mexico", ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (2007), 31(2): 293-8. Conclusions: "16.5% of New Mexico adults had at least 1 type of excessive drinking, only 1.8% of all adults met the criteria for alcohol dependence. Furthermore, only a minority of those who reported binge drinking, heavy drinking , or alcohol-impaired driving met the criteria for alcohol dependence. This suggests that most alcohol problems in New Mexico are likely due to excessive drinking among persons who are not alcohol dependent. The adverse health and social consequences associated with excessive drinking are not limited to those who are alcohol dependent, but extend to a broader range of problem drinkers across the population."

Zador, P. L., Krawchuk, S. A., Voas, R. B.; "Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data," JOURNAL OF STUDIES ON ALCOHOL (2000), 61:387-395. The relative risk of involvement in a fatal vehicle crash increased steadily with increasing driver BAC in every age/gender group among both fatally injured and surviving drivers. Among 16-20 year old male drivers, a BAC increase of 0.02% was estimated to more than double the relative risk of fatal single-vehicle crash injury. At the midpoint of the 0.08%-0.10% BAC range, the relative risk of a fatal single-vehicle crash injury varied b between 11.r (drivers 35 and older and 51.9 (male drivers, 16-20). With only very few exceptions, older drivers had lower risk of being fatally injured in a single-vehicle crash than younger drivers, ad did women compared with men in the same age range. When comparable results largely confirmed existing prior estimates. Conclusions: This is the first study that systematically estimated relative risk for drink-drivers with BACs between 0.08% and 0.10% (these relative risk estimates apply to BAC range midpoints at 0.09%.) The results clearly show that drivers with a BAC under 0.l0% pose highly elevated risk both to themselves and to other road users.

Zador, P. L.; Lund, A. K.; Fields, M.; Weinberg, K.; "Fatal crash involvement and laws against alcohol-impaired driving," JOURNAL OF PUBLIC HEALTH POLICY (1989), Winter: 467-485. (Information on the effect of per se laws, RID, MADD to reduce drunk driving have made an effect. Crash data by time of day, day of week is included.

updated 12/08/16