Categories of ’drunk’

By Anna Sandiford 13/04/2010 9

There has been much comment in the media and on Sciblogs about the effects (or not) of a lowering in drink driving “accidents” (although the Road traffic Police in England refer to them as ‘avoidable incidents’, because they are; there’s nothing accidental about them) as the result of a reduction in the NZ blood alcohol concentration from the current level of 80mg alcohol/100ml blood to 50.

Personally, I think that although a zero drink drive limit would not immediately and dramatically reduce the number of road traffic incidents in which alcohol is a factor, time would make its mark.  Drink driving is socially acceptable in New Zealand, more so than in other countries.  Kiwis drink hard and long.  Peer pressure in my age group (currently late 30s) that reduced drink driving in England and Wales during the 1980s and 1990s does not exist to the same degree here.

People drink and drive here because there is the general perception that the driver can  “calculate” what they can get away with drinking before they are over the limit.  By the time they are over the limit, they are in the Euphoria stage and, in my experience, mostly in the Excitement stage.  For reference, the following table demonstrates the descriptive stages of drunkenness and the associated blood alcohol concentration:

Blood alcohol concentration (mg/100 ml) Stage of Influence General signs/symptoms
10 — 50 Subclinical No obvious effect.  Observed behaviour appears nearly normal.
30 — 120 Euphoria Mild euphoria, sociability, talkativeness.  Increase in confidence; decrease in inhibitions.  Reduced attention and judgement.  Some sensory-motor impairment.  Reduced rate of information processing.
90 – 250 Excitement Impaired balance, reduction in co‑ordination leading to staggering or erratic gait, possible nausea, poor sensory perception, drowsiness.  Increase in reaction times.
180 – 300 Confusion Dizziness, ’drunkenness’, confusion, disorientation.  Apathy, increased drowsiness, lethargy.  Increase in pain threshold; vision disturbances.
250 – 400 Stupor Approaching loss of motor functions, inability to stand or walk as result of muscular in-coordination, “passing out”, incontinence.
350 – 500 Coma Unconsciousness, depressed or unresponsive reflexes.  Circulatory and respiratory depression.  Reduced temperature.  Approaching the health danger limit, possible death.
450+ Death Probable fatal limit due to respiratory paralysis

(adapted from Garriott J. ed. c2003. Medical-legal aspects of alcohol. Tuscon, USA: Lawyers & Judges Publishing Company, Inc. and Walls H., Brownlie A. 1985. Drink, Drugs and Driving. Sweet & Maxwell: London)

I don’t believe that anyone should be making a decision as to whether they can drive if they have gone beyond the Subclinical stage.  I realise that lowering the blood alcohol limit to 50 is the top end of Subclinical but the effects of alcohol vary within and between individuals, regardless of the limit stipulated by the law.  In that regard, alcohol is a unique drug – no other drug has a level stipulated in law for driving precisely because the effects of drugs are unpredictable and are complicated by mixing of drugs (including alcohol), people’s habituation and other factors.

Until the law changes to a much lower level than 80 or even 50, I will be happy to carry on doing blood, breath and urine alcohol calculations for drink driving cases because it is about what the law says.  Plus alcohol is a major contributor to so many other crimes in this country – it’s never going to go away.

9 Responses to “Categories of ’drunk’”

  • Now that table is what an infographic ought to be made from! (Imagine a series of cartoons of people getting progressively drunker.) Thanks for writing this.

  • Thank you, kind sir. One of the first times I saw this table it was accompanied by a series of cartoon men getting more drunk until eventually they were buried in a box under the ground… I still refer to this table when I calculate blood/breath/urine alcohol concentrations (obviously re-calculating the figures to represent the appropriate body fluid). It’s very useful

  • You don’t seem to get it Grant. Infographics that run in newspapers are aimed at PEOPLE, not SCIENTISTS. I wonder how many people when asked in a survey would be able to tell you what a blood alcohol concentration of 30 – 120 meant. Not many I suspect. On the other hand, I’m sure they’d be able to tell you what drinking 2 – 4 glasses of beer over a 2 hour period would mean to them.

  • Peter,

    I do get what you were trying to say; I tried to indicate that to you earlier in your thread.

    My focus is not the numerical value of the blood alcohol levels (I didn’t say it was; you are presuming it is). It’s on the effects—as I was saying in your thread—and people recognising them.

    When I wrote “the people I know” in your thread, almost all of the people happen to be thinking of are… non-scientists. Would I be correct in saying that you have assumed that I meant scientists because I am?

    As an aside, in reply to your remark about scientists, allow me a friendly poke back: perhaps journalists aren’t people? 🙂 I’m kidding but the point is, playing the label game goes all ways. Scientists are people too. (And so are journalists.) Comparing “people” v. “scientists” is not a good look, especially around here 😉

    I realise you probably mean viewed looking at the issue scientifically, as opposed to scientists, the people, but I still think you deserve a poke for writing that 😉

    My focus is on when you might not be fit to drive, not some academic thing about measurements. I’m guessing that you are mixing up what I am saying for myself personally and what I have said about the issue in general.

    Of course, counting drinks per hour provides a “rule of thumb”. That’s obvious and I’m fine about it. I think you’d agree it’s only a rule of thumb and is affected by how much the person ate, their size, and so on. (Bet most people are on the generous side with there estimates on how much they have drunk too, esp. once they’d had a few!)

    You could achieve a similar end by looking at effects (the outcome, rather than the input as it were). They’re just different ways to the same point.

    I agree with Anna that “trying to self-judge” is hard; it seems to me that there’s a bit of a catch-22 that once you’re past sub-clinical you can’t easily self-judge accurately; if anything you’d suspect people over-estimate their capacity.

    That said I would also suspect that it’s why you see the different curves in the different age groups on the ‘crash risk’ plot in the Herald example you showed. The majority of older people may have developed a more cautious and refined judgement over time. (Which is not to say that everyone has; graphs of averages are deceptive that way.)

    In my experience most people over a long time develop a better, or at least more cautious, judgement of when they’ve had enough. People (well, most people!) become more self-aware as they get older. I’m not saying it’s the best way, just that’s what in my experience is what people do. (Anecdotal, not evidenced, obviously.) This generally won’t work on younger people; it’s a corollary of what I’m saying here.

    For younger people, I think they’re hard to reach. For one thing, you can’t “preach” to them and advertising that looks like “preaching” probably gets dismissed.

    I have some ideas for solutions for younger people that I might write about later if I find time. I can’t say this are definitive any sort of way; but they’re at least some ideas.

  • “I still think you deserve a poke for writing that ;-)” I knew that would get you going!! I agree with Anna too, self-judging is hard, but people in general need some sort of measure to go by which is why the standard drinks per hour for the average sized man and woman is an important measure to get right and to get out to the public.

  • I knew that would get you going!!

    Actually it didn’t. I do get a bit frumpy about others assuming what I’m thinking though, especially if they use the assumption to make me to be holding a position I don’t.

    “but […]”

    This isn’t counter to what I’ve been writing about in the way you seem to think.

    It’s a measure you can use, and with the obvious caveats it’s useful to get out there; I never said otherwise, but it’s not the only approach or the only element involved. There is a bit more subtlety to this IMHO.

    Let me try explain.

    I felt that the infographics related to the drink driving limit and not the effect. I thought the latter was the fundamental issue. You are saying the relationship of amount to effect is what matters, as I did earlier. (Correct?)

    The infographics you presented aren’t doing that. They’re relating amounts to the “rule of law”, not the effect, which was my original point and the one I’m still making.

    The number of drinks per hour is just a crude stand-in for the blood alcohol level. I was not trying to suggest that the blood alcohol should be presented in it’s place. I was trying to say that what’s missing is relating the measure of amount to effect.

    If anything—leaving aside different age groups, etc.—I believe the amount needs to be related to both the rule of law and the effect, so that people can see why the rule of law should be altered.

    The infographics don’t do that. They presume the people are able to “map” amount to effect, yet as Anna pointed (and you and I agree) people aren’t good at that.

    (I’m beginning to wish I’d written this as a blog post!)

  • Grant, how exactly do you propose to get people to understand the effects of drinking and therefore adjust their drinking accordingly? The Government has been trying to scare us into submission with graphic ads for years and it hasn’t worked in the same way that threatening people with death row hasn’t stopped murders in Texas or anti-obesity ads haven’t stopped the obesity epidemic. That is why we have these rules of law. It is the only thing that people really understand. Its really just a matter of how much we are willing to take, which goes to the arbitrary nature of it all that MacDoctor disagrees with.

  • I have to go to a meeting, but you’re still not getting it right and with all respect you’re not addressing what I’ve written. I’ll reply later.

  • Okay, I’m intrigued to hear from you what you think a better way to illustrate this in a mainstream media graphic aimed at consumers would be…