Sunday, April 26, 2009

Underage Drinking

Youth Drinking: Risk Factors and Consequences

Despite a minimum legal drinking age of 21, many young people in the United States consume alcohol. Some abuse alcohol by drinking frequently or by binge drinking-often defined as having five or more drinks* in a row. A minority of youth may meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence. The progression of drinking from use to abuse to dependence is associated with biological and psychosocial factors. This Alcohol Alert examines some of these factors that put youth at risk for drinking and for alcohol-related problems and considers some of the consequences of their drinking.

Prevalence of Youth Drinking

Thirteen- to fifteen-year-olds are at high risk to begin drinking. According to results of an annual survey of students in 8th, 10th, and 12th grades, 26 percent of 8th graders, 40 percent of 10th graders, and 51 percent of 12th graders reported drinking alcohol within the past month. Binge drinking at least once during the 2 weeks before the survey was reported by 16 percent of 8th graders, 25 percent of 10th graders, and 30 percent of 12th graders.

Males report higher rates of daily drinking and binge drinking than females, but these differences are diminishing. White students report the highest levels of drinking, blacks report the lowest, and Hispanics fall between the two.

A survey focusing on the alcohol-related problems experienced by 4,390 high school seniors and dropouts found that within the preceding year, approximately 80 percent reported either getting "drunk," binge drinking, or drinking and driving. More than half said that drinking had caused them to feel sick, miss school or work, get arrested, or have a car crash.

Some adolescents who drink later abuse alcohol and may develop alcoholism. Although these conditions are defined for adults in the DSM, research suggests that separate diagnostic criteria may be needed for youth.

Drinking and Adolescent Development

While drinking may be a singular problem behavior for some, research suggests that for others it may be an expression of general adolescent turmoil that includes other problem behaviors and that these behaviors are linked to unconventionality, impulsiveness, and sensation seeking.

Binge drinking, often beginning around age 13, tends to increase during adolescence, peak in young adulthood (ages 18-22), then gradually decrease. In a 1994 national survey, binge drinking was reported by 28 percent of high school seniors, 41 percent of 21- to 22-year-olds, but only 25 percent of 31- to 32-year-olds. Individuals who increase their binge drinking from age 18 to 24 and those who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e.g. marriage, educational attainment, employment, and financial independence).

Risk Factors for Adolescent Alcohol Use, Abuse, and Dependence Genetic

Risk Factors - Animal studies and studies of twins and adoptees demonstrate that genetic factors influence an individual's vulnerability to alcoholism. Children of alcoholics are significantly more likely than children of nonalcoholics to initiate drinking during adolescence and to develop alcoholism, but the relative influences of environment and genetics have not been determined and vary among people.

Biological Markers - Brain waves elicited in response to specific stimuli (e.g. a light or sound) provide measures of brain activity that predict risk for alcoholism. P300, a wave that occurs about 300 milliseconds after a stimulus, is most frequently used in this research. A low P300 amplitude has been demonstrated in individuals with increased risk for alcoholism, especially sons of alcoholic fathers. P300 measures among 36 preadolescent boys were able to predict alcohol and other drug (AOD) use 4 years later, at an average age of 16.

Childhood Behavior - Children classified as "undercontrolled" (i.e. impulsive, restless, and distractible) at age 3 were twice as likely as those who were "inhibited" or "well-adjusted" to be diagnosed with alcohol dependence at age 21. Aggressiveness in children as young as ages 5-10 has been found to predict AOD use in adolescence. Childhood antisocial behavior is associated with alcohol-related problems in adolescence and alcohol abuse or dependence in adulthood.

Psychiatric Disorders - Among 12- to 16-year-olds, regular alcohol use has been significantly associated with conduct disorder; in one study, adolescents who reported higher levels of drinking were more likely to have conduct disorder.

Six-year-old to seventeen-year-old boys with attention deficit hyperactivity disorder (ADHD) who were also found to have weak social relationships had significantly higher rates of alcohol abuse and dependence 4 years later, compared with ADHD boys without social deficiencies and boys without ADHD.

Whether anxiety and depression lead to or are consequences of alcohol abuse is unresolved. In a study of college freshmen, a DSM-III diagnosis of alcohol abuse or dependence was twice as likely among those with anxiety disorder as those without this disorder. In another study, college students diagnosed with alcohol abuse were almost four times as likely as students without alcohol abuse to have a major depressive disorder. In most of these cases, depression preceded alcohol abuse. In a study of adolescents in residential treatment for AOD dependence, 25 percent met the DSM-III-R criteria for depression, three times the rate reported for controls. In 43 percent of these cases, the onset of AOD dependence preceded the depression; in 35 percent, the depression occurred first; and in 22 percent, the disorders occurred simultaneously.

Suicidal Behavior - Alcohol use among adolescents has been associated with considering, planning, attempting, and completing suicide. In one study, 37 percent of eighth-grade females who drank heavily reported attempting suicide, compared with 11 percent who did not drink. Research does not indicate whether drinking causes suicidal behavior, only that the two behaviors are correlated.

Psychosocial Risk Factors - Parenting, Family Environment, and Peers. Parents' drinking behavior and favorable attitudes about drinking have been positively associated with adolescents' initiating and continuing drinking. Early initiation of drinking has been identified as an important risk factor for later alcohol-related problems. Children who were warned about alcohol by their parents and children who reported being closer to their parents were less likely to start drinking.

Lack of parental support, monitoring, and communication have been significantly related to frequency of drinking, heavy drinking, and drunkenness among adolescents. Harsh, inconsistent discipline and hostility or rejection toward children have also been found to significantly predict adolescent drinking and alcohol-related problems.

Peer drinking and peer acceptance of drinking have been associated with adolescent drinking. While both peer influences and parental influences are important, their relative impact on adolescent drinking is unclear.

Expectancies - Positive alcohol-related expectancies have been identified as risk factors for adolescent drinking. Positive expectancies about alcohol have been found to increase with age and to predict the onset of drinking and problem drinking among adolescents.

Trauma - Child abuse and other traumas have been proposed as risk factors for subsequent alcohol problems. Adolescents in treatment for alcohol abuse or dependence reported higher rates of physical abuse, sexual abuse, violent victimization, witnessing violence, and other traumas compared with controls. The adolescents in treatment were at least 6 times more likely than controls to have ever been abused physically and at least 18 times more likely to have ever been abused sexually. In most cases, the physical or sexual abuse preceded the alcohol use. Thirteen percent of the alcohol dependent adolescents had experienced posttraumatic stress disorder, compared with 10 percent of those who abused alcohol and 1 percent of controls.

Advertising - Research on the effects of alcohol advertising on adolescent alcohol-related beliefs and behaviors has been limited. While earlier studies measured the effects of exposure to advertising, more recent research has assessed the effects of alcohol advertising awareness on intentions to drink. In a study of fifth- and sixth-grade students' awareness, measured by the ability to identify products in commercials with the product name blocked out, awareness had a small but statistically significant relationship to positive expectancies about alcohol and to intention to drink as adults. This suggests that alcohol advertising may influence adolescents to be more favorably predisposed to drinking.

Consequences of Adolescent Alcohol Use

Drinking and Driving. Of the nearly 8,000 drivers ages 15-20 involved in fatal crashes in 1995, 20 percent had blood alcohol concentrations above zero. For more information about young drivers' increased crash risk and the factors that contribute to this risk, see Alcohol Alert No. 31: Drinking and Driving.

Sexual Behavior - Surveys of adolescents suggest that alcohol use is associated with risky sexual behavior and increased vulnerability to coercive sexual activity. Among adolescents surveyed in New Zealand, alcohol misuse was significantly associated with unprotected intercourse and sexual activity before age 16. Forty-four percent of sexually active Massachusetts teenagers said they were more likely to have sexual intercourse if they had been drinking, and 17 percent said they were less likely to use condoms after drinking.

Risky Behavior and Victimization - Survey results from a nationally representative sample of 8th and 10th graders indicated that alcohol use was significantly associated with both risky behavior and victimization and that this relationship was strongest among the 8th-grade males, compared with other students.

Puberty and Bone Growth - High doses of alcohol have been found to delay puberty in female and male rats, and large quantities of alcohol consumed by young rats can slow bone growth and result in weaker bones. However, the implications of these findings for young people are not clear.

Prevention of Adolescent Alcohol Use

Measures to prevent adolescent alcohol use include policy interventions and community and educational programs. Alcohol Alert No. 34: Preventing Alcohol Abuse and Related Problems covers these topics in detail. See the National Institute on Alcohol Abuse and Alcoholism's (NIAAA's) World Wide Web site at h

*A standard drink is 12 grams of pure alcohol, which is equal to one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.

Full text of this publication is available on NIAAA's World Wide Web site at
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Out of State Drivers arrested in Texas for DWI

How Would a Conviction be treated by my "Home State"

If you are convicted in Texas, you may lose only your driving privileges in the state of Texas. However, Texas will report your conviction to your home state, and your home state will, in all likelihood, suspend your license for whatever period someone in your state would get if he/she were convicted in your state for DWI/DUI.

The Drivers License Compact require member states to report tickets received by motorist to the state where they received a license to drive so as to receive points and get an insurance hike. Also when a state suspends the license of a driver who is from out-of-state, the state where the motorist received a license to drive will also suspend their license. Texas is a member of the Compact, and will report any infractions to your "home state".

The only states that are not members are: Tennessee, Georgia, Massachusetts, Wisconsin and Michigan. However, Georgia, Michigan, Wisconsin will report tickets to your home state even though they are not members of the compact.

How other States treat Out of State matters

Colorado, Ohio, and Wisconsin do not assess points for out-of-state convictions. Colorado does not make an entry for out-of-state convictions such as speeding but convictions for offenses like DUI still count! Colorado will issue you a license if you qualify. New York, same rules apply as for Colorado except New York does apply points for moving violations in Ontario and Quebec. Michigan and Georgia will assess points for out-of-state tickets. Kentucky does not assess points for out-of-state speeding tickets but will for others. Vermont and North Carolina do not report tickets to your home state unless violation results in license suspension. North Carolina will not assess points for out-of-state tickets unless the violation, if committed in North Carolina would result in a suspension. Kansas, Wyoming, Minnesota, Arizona, Iowa, and South Dakota will not put speeding tickets on record unless it is 10 or more mph over the limit. If the violation was committed by an out-of-state motorist, the violation may still be reported to the home state which can result in points being assessed. South Dakota will not assess points for speeding tickets. This may change since the repeal of the 55 mph National Speed Limit.

About the Non-Resident Violator Compact

The Non-Resident Violator Compact requires member states to suspend the drivers license of those who get traffic tickets for moving violations in other states and fail to pay them. The compact is not supposed to include non-moving violations such as expired inspection stickers, equipment violations such as window tinting or parking violations. A member state may choose to voluntarily suspend a license of a person who does not pay an out-of-state ticket for an equipment violation such as loud exhaust.
Out of State Drivers arrested in Texas for DWISocialTwist Tell-a-Friend

Blood Alcohol Content

Blood alcohol content or blood alcohol concentration (abbreviated BAC) is the concentration of alcohol in a person's blood. BAC is most commonly used as a metric of intoxication for legal or medical purposes. It is usually measured in terms of mass per volume, but can also be measured in terms of mass per mass. Blood alcohol concentration is given in many different units and notations, but they are all relatively synonymous with each other numerically.

The number of drinks consumed is a poor measure of BAC, largely because of variations in weight, sex, and body fat. However, it is generally accepted that the consumption from sober of one standard drink of alcohol (e.g. 14 grams (17.74 ml) ethanol content by U.S. standard) will increase the average person's BAC roughly 0.02% to 0.05% and would return to 0% about 1.5 to 3 hours later (at a dissipation rate of around 0.015% per hour).

Effects of Alcohol at Different Levels

Unless a person has developed a high tolerance for alcohol, a BAC rating of 0.20% represents very serious intoxication (most first-time drinkers would be unconscious by about 0.15%), and 0.35%–0.40% represents potentially fatal alcohol poisoning. 0.40% is the accepted LD50, the dose that is lethal for 50% of adult humans. However, there have been cases of people surviving and even remaining conscious at BACs above 0.40%.

Units of measurement

There are several different units in use around the world for defining blood alcohol concentration. Each is defined as either a mass of alcohol per volume of blood or a mass of alcohol per mass of blood (never a volume per volume). 1 milliliter of blood is approximately equivalent to 1 gram of blood, 1.06 grams to be exact. Because of this, units by volume are similar but not identical to units by mass.

Legal limits

For purposes of law enforcement, BAC is used to define intoxication and provides a rough measure of impairment. Although degree of impairment may vary among individuals with the same BAC, BAC can be measured objectively and is therefore legally useful and difficult to contest in court. Most countries disallow operation of motor vehicles and heavy machinery above prescribed levels of BAC. Operation of boats and aircraft are also regulated.

The alcohol level at which a person is considered to be legally impaired varies by country. The list below gives limits by country. These are typically BAC (blood alcohol content) limits for the operation of a vehicle.
0.00% - Czech Republic, Hungary, Romania, Saudi Arabia, Slovakia, United Arab Emirates
0.02% - Brazil, Estonia, Poland, Sweden, Norway
0.03% - India (note: In the State of Kerala, since of late, it is illegal to even have a sip and drive)[8], Japan[9], Russia
0.04% - Lithuania
0.05% - Argentina (0.02% for motorbikes, 0.00% for truck/taxi/bus drivers), Australia (0.02% for Australian Capital Territory learner, probationary & convicted DUI drivers, 0.00% for learner drivers, provisional/probationary drivers (regardless of age) and DUI drivers), Austria, Belgium, British Columbia, Manitoba (0.05% is a 24-hour suspension and a fine, 0.08% is a D.U.I. charge)(0.00% for drivers with class G1 or G2 licenses in Ontario, or class 7 or 5P in the Northwest Territories, or drivers with a under the Graduated License System in Manitoba, and Alberta, or class 7 or 7L in British Columbia), Bulgaria, Costa Rica, Croatia, Denmark, Finland, France, Germany (0.00% for learner drivers, all drivers 18-21 and newly licensed drivers of any age for first two years of licence), Greece, Iceland, Israel, Italy, Latvia, Luxembourg, Netherlands (0.02% for drivers in their first five years after gaining a driving license), Portugal, Republic of Macedonia, Serbia, Slovenia (0.00% for drivers in their first two years after gaining a drivers licence), South Africa, Spain (0.015% for drivers in their first two years after gaining a driving licence), Switzerland, Thailand, Turkey
0.08% - Canada, Malaysia, Malta, Mexico, New Zealand (0.03% for drivers under 20), Ireland, Singapore, United Kingdom (0.02% for operators of aeroplanes), United States

For further information on U.S. laws, see Alcohol laws of the United States by state (0.01% for operators of common carriers, such as buses, 0.04% for pilots, Federal Aviation Regulations within eight hours of consumption).

Test assumptions

Blood alcohol tests assume the individual being tested is average in various ways. For example, on average the ratio of BAC to breath alcohol content (the partition ratio) is 2100 to 1. In other words, there are 2100 parts of alcohol in the blood for every part in the breath. However, the actual ratio in any given individual can vary from 1300:1 to 3100:1, or even more widely. This ratio varies not only from person to person, but within one person from moment to moment. Thus a person with a true blood alcohol level of .08 but a partition ratio of 1700:1 at the time of testing would have a .10 reading on a Breathalyzer calibrated for the average 2100:1 ratio.

A similar assumption is made in urinalysis. When urine is analyzed for alcohol, the assumption is that there are 1.3 parts of alcohol in the urine for every 1 part in the blood, even though the actual ratio can vary greatly.

Breath alcohol testing further assumes that the test is post-absorptive—that is, that the absorption of alcohol in the subject's body is complete. If the subject is still actively absorbing alcohol, his body has not reached a state of equilibrium where the concentration of alcohol is uniform throughout the body. Most forensic alcohol experts reject test results during this period as the amounts of alcohol in the breath will not accurately reflect a true concentration in the blood.

Metabolism and excretion

Alcohol is removed from the bloodstream by a combination of metabolism, excretion, and evaporation. The relative proportion disposed of in each way varies from person to person, but typically about 92 to 98% is metabolised, 1 to 3% is excreted in urine, and 1 to 5% evaporates through the breath. A very small proportion (less than 0.5%) is also excreted in the sweat, tears, etc. Excretion into urine typically begins after about 40 minutes, whereas metabolisation commences as soon as the alcohol is absorbed, and even before alcohol levels have risen in the brain. (In fact, in some males, alcohol dehydrogenase levels in the stomach are high enough that some metabolization occurs even before the alcohol is absorbed.)

Alcohol is metabolised mainly by the group of six enzymes collectively called alcohol dehydrogenase. These convert the ethanol into acetaldehyde (an intermediate that is actually more toxic than ethanol). The enzyme acetaldehyde dehydrogenase then converts the acetaldehyde into non-toxic Acetyl-CoA.

Many physiologically active materials are removed from the bloodstream (whether by metabolism or excretion) at a rate proportional to the current concentration, so that they exhibit exponential decay with a characteristic halflife (see pharmacokinetics). This is not true for alcohol, however. Typical doses of alcohol actually saturate the enzymes' capacity, so that alcohol is removed from the bloodstream at an approximately constant rate. This rate varies considerably between individuals; experienced male drinkers with a high body mass may process up to 30 grams (38 mL) per hour, but a more typical figure is 10 grams (12.7 mL) per hour. Persons below the age of 25, women, persons of certain ethnicities, and persons with liver disease may process alcohol more slowly. Many East Asians (e.g. about half of Japanese) have impaired acetaldehyde dehydrogenase; this causes acetaldehyde levels to peak higher, producing more severe hangovers and other effects such as flushing and tachycardia. Conversely, members of certain ethnicities that traditionally did not brew alcoholic beverages have lower levels of alcohol dehydrogenases and thus "sober up" very slowly, but reach lower aldehyde concentrations and have milder hangovers. Rate of detoxification of alcohol can also be slowed by certain drugs which interfere with the action of alcohol dehydrogenases, notably aspirin, furfural (which may be found in fusel oil), fumes of certain solvents, many heavy metals, and some pyrazole compounds. Also suspected of having this effect are cimetidine (Tagamet), ranitidine (Zantac), and acetaminophen (Tylenol) (paracetamol).

Currently, the only known substance that can increase the rate of metabolism of alcohol is fructose. The effect can vary significantly from person to person, but a 100g dose of fructose has been shown to increase alcohol metabolism by an average of 80%.

Alcohol ingestion can be slowed by ingesting alcohol on a full stomach. Spreading the total absorption of alcohol over a greater period of time decreases the maximum alcohol level, decreasing the hangover effect. Thus, drinking on a full stomach or drinking while ingesting drugs which slow the release of acetaldehyde, will reduce the maximum blood levels of this substance, and decrease the hangover. Alcohol in non-carbonated beverages is absorbed more slowly than alcohol in carbonated drinks.

Retrograde extrapolation

Retrograde extrapolation is the mathematical process by which someone's blood alcohol concentration at the time of driving is estimated by projecting backwards from a later chemical test. This involves estimating the absorption and elimination of alcohol in the interim between driving and testing. The rate of elimination in the average person is commonly estimated at .015 to .020 percent per hour, although again this can vary from person to person and in a given person from one moment to another. Metabolism can be affected by numerous factors, including such things as body temperature, the type of alcoholic beverage consumed, and the amount and type of food consumed.

In an increasing number of states, laws have been enacted to facilitate this speculative task: the BAC at the time of driving is legally presumed to be the same as when later tested. There are usually time limits put on this presumption, commonly two or three hours, and the defendant is permitted to offer evidence to rebut this presumption.

Forward extrapolation can also be attempted. If the amount of alcohol consumed is known, along with such variables as the weight and sex of the subject and period and rate of consumption, the blood alcohol level can be estimated by extrapolating forward. Although subject to the same infirmities as retrograde extrapolation—guessing based upon averages and unknown variables—this can be relevant in estimating BAC when driving and/or corroborating or contradicting the results of a later chemical test.

Blood alcohol content calculation

BAC can be roughly estimated using a mathematical approach. While a mathematical BAC estimation is not as accurate as a breathalyzer, it can be useful for calculating a BAC level that is not currently testable, or a level that may be present in the future. While there are several ways to calculate a BAC, one of the most effective ways is to simply measure the total amount of alcohol consumed divided by the total amount of water in the body—effectively giving the percent alcohol per volume water in the blood.

The total water weight of an individual can be calculated by multiplying his or her body weight by their percent water. For example, a 150 pound woman would have a total amount of water of 73.5 pounds (150 x .49). For easiest calculations, this weight should be in kilograms, which can be easily converted by dividing the total pounds by 2.205. 73.5 pounds of water is equivalent to 33.3 kilograms of water. 33.3 kilograms of water is equivalent to 33,300 mL of water (1 L of water has a mass of 1 kg, and 1 L = 1000 mL).

Gender plays an important role in the total amount of water that a person has. In general, men have a higher percent of water per pound (58%) than women (49%). This fact alone strongly contributes to the generalization that men require more alcohol than women to achieve the same BAC level. Additionally, men are, on average, heavier than women. The more water a person has, the more alcohol is required to achieve the same alcohol:blood ratio, or BAC level. Further, studies have shown that women's alcohol metabolism varies from that of men due to such biochemical factors as different levels of alcohol dehydrogenase (the enzyme which breaks down alcohol) and the effects of oral contraceptives.

It is not strictly accurate to say that the water content of a person alone is responsible for the dissolution of alcohol within the body, because alcohol does dissolve in fatty tissue as well. When it does, a certain amount of alcohol is temporarily taken out of the blood and briefly stored in the fat. For this reason, most calculations of alcohol to body mass simply use the weight of the individual, and not specifically his water content.
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Driving While Intoxicated

Driving while intoxicated is the act of operating and/or driving a motor vehicle while under the influence of alcohol and/or drugs to the degree that mental and motor skills are impaired. It is illegal in all jurisdictions within the U.S. The specific criminal offense is usually called driving under the influence (of alcohol and/or other drugs, DUI), and in some states driving while intoxicated (DWI), operating while impaired (OWI), or operating a vehicle under the influence (OVI). Such laws may also apply to boating or piloting aircraft.

In the United States the National Highway Traffic Safety Administration (NHTSA) estimates that 17,941 people died in 2006 in "alcohol-related" collisions, representing 40 percent of total traffic deaths in the US. Over 500,000 people were injured in alcohol-related accidents in the US in 2003. NHTSA defines fatal collisions as "alcohol-related" if they believe the driver, a passenger, or an occupant of the vehicle (such as a pedestrian or pedalcyclist) had a blood alcohol content (BAC) of 0.01 or greater. NHTSA defines nonfatal collisions as "alcohol-related" if the accident report indicates evidence of alcohol present. NHTSA specifically notes that "alcohol-related" does not necessarily mean a driver or nonoccupant was tested for alcohol and that the term does not indicate a collision or fatality was caused by the presence of alcohol. On average, about 60 percent of the BAC values are missing or unknown. To analyze what they believe is the complete data, statisticians simulate BAC information. Drivers with a BAC of 0.10 are 6 to 12 times more likely to get into a fatal crash or injury then drivers with no alcohol.