Alcohol, Trauma and Impaired Driving

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Alcohol, Trauma and

Impaired Driving3RD Edition, 2006

Alcohol, Trauma and

Impaired Driving


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Phone: (905) 829-8805

Toll-free in Canada: 1-800-665-MADD

Fax: (905) 829-8860, E-mail: [email protected]

2010 Winston Park Drive, Suite 500

Oakville, Ontario L6H 5R7www.madd.ca

For general information about addiction and

mental health, contact the R. Samuel McLaughlin

Addiction and Mental Health Information Centre

Ontario toll free: 1 800 463 6273

Toronto: 416 595 6111

or visit us at www.camh.net

This publication is a product of the partnership between

MADD Canada and the Centre for Addiction and Mental Health (CAMH).

These organizations have many publications on the effects of alcohol

and further information can be found on their respective websites.

Prepared by:

C. Bryant L. Crosby

L. Gibbs S. Kettle

E. Usprich C. ZahnleiterR. Solomon

Alcohol, Trauma and

Impaired Driving

3RD Edition,2006


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TABLE OF CONTENTS

INTRODUCTION........................................................................................................................1

PART I: GENERAL INFORMATION .....................................................................................2

SELECTEDALCOHOLFACTS........................................................................................................................................ 2Canada .......................................................................................................................................................................................British Columbia........................................................................................................................................................................Ontario.......................................................................................................................................................................................United States..............................................................................................................................................................................United Kingdom ........................................................................................................................................................................4Europe........................................................................................................................................................................................5Australia ....................................................................................................................................................................................

CONSUMPTIONPATTERNS............................................................................................................................................ 7Canada .......................................................................................................................................................................................British Columbia........................................................................................................................................................................Ontario.......................................................................................................................................................................................United States..............................................................................................................................................................................United Kingdom ......................................................................................................................................................................10Australia ..................................................................................................................................................................................1

ALCOHOLCONSUMPTIONCHARTS.......................................................................................................................... 13National Per Capita Alcohol Consumption In Litres, 2002.....................................................................................................1Alcohol Consumption Per Capita: Canada, 1988-2004 ..........................................................................................................1

Alcohol Consumption Per Capita: Provinces And Territories, 2004......................................................................................1Binge Drinking Among Current Drinkers At Least Once In The Past Year, By Age: Canada, 2003 .....................................1Binge Drinking Among Current Drinkers 12 Or More Times In The Past Year, By Age: Canada, 2003 ..............................1Binge Drinking Among Current Drinkers In The Past Month, By Age: United States, 2003.................................................1Type Of Alcohol Use By Gender, Among Persons 12 Or Older In The Past Month: United States, 2003............................1Type Of Alcohol Use By Persons 12 Or Older In The Past Month: United States, 2003 .......................................................16Binge Drinking Among Current Drinkers, By Age: United Kingdom, 2000/01....................................................................1

COSTSOFALCOHOLUSE ............................................................................................................................................. 1Canada .....................................................................................................................................................................................1British Columbia......................................................................................................................................................................1United States............................................................................................................................................................................1United Kingdom ......................................................................................................................................................................19

ALCOHOLCOSTCHARTS............................................................................................................................................. 20Direct Law Enforcement Costs Of Alcohol Use, In Millions: Canada, 1992 ..........................................................................2Costs Of Alcohol Use, In Millions: Canada, 1992 ..................................................................................................................2Estimated Cost Of Alcohol And Drug-Impaired Driving Crashes, In Millions: Canada, 2003..............................................2


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PART II: ALCOHOL AND TRAUMA ...................................................................................22

ALCOHOL,DROWNINGANDBOATING.................................................................................................................... 22Canada .....................................................................................................................................................................................22British Columbia......................................................................................................................................................................2

Ontario.....................................................................................................................................................................................2United States............................................................................................................................................................................22United Kingdom ......................................................................................................................................................................23Europe......................................................................................................................................................................................23

ALCOHOLANDFALLS................................................................................................................................................... 24Canada .....................................................................................................................................................................................24Ontario.....................................................................................................................................................................................24United States............................................................................................................................................................................24United Kingdom ......................................................................................................................................................................24Europe......................................................................................................................................................................................25

ALCOHOLANDFIRES .................................................................................................................................................... 26Canada .....................................................................................................................................................................................2Ontario.....................................................................................................................................................................................2United States............................................................................................................................................................................2United Kingdom ......................................................................................................................................................................27

ALCOHOLANDTHEWORKPLACE............................................................................................................................ 28Canada .....................................................................................................................................................................................2Alberta .....................................................................................................................................................................................2United States............................................................................................................................................................................2United Kingdom ......................................................................................................................................................................30

New Zealand............................................................................................................................................................................3

ALCOHOLANDSPORTS ................................................................................................................................................ 3Ontario.....................................................................................................................................................................................3United States............................................................................................................................................................................3

ALCOHOLANDVIOLENCE........................................................................................................................................... 32Canada .....................................................................................................................................................................................32British Columbia......................................................................................................................................................................3Ontario.....................................................................................................................................................................................3United States............................................................................................................................................................................3United Kingdom ......................................................................................................................................................................34Australia ..................................................................................................................................................................................34

ALCOHOLANDSUICIDE ............................................................................................................................................... 36Canada .....................................................................................................................................................................................3British Columbia......................................................................................................................................................................3United States............................................................................................................................................................................3United Kingdom ......................................................................................................................................................................37Europe......................................................................................................................................................................................37


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PART III: TRAUMA, YOUTH, ALCOHOL, AND DRUGS................................................38

CANADIANTRAUMADATA.......................................................................................................................................... 38General ....................................................................................................................................................................................3Children And Youth ................................................................................................................................................................3

Ontario.....................................................................................................................................................................................3Aboriginal Peoples ..................................................................................................................................................................3

ALCOHOLANDDRUGS.................................................................................................................................................. 40Canada .....................................................................................................................................................................................4Atlantic Canada .......................................................................................................................................................................42British Columbia......................................................................................................................................................................4Ontario.....................................................................................................................................................................................4Quebec.....................................................................................................................................................................................4United States............................................................................................................................................................................4United Kingdom ......................................................................................................................................................................4Australia ..................................................................................................................................................................................4

Europe......................................................................................................................................................................................45

TRAUMAANDYOUTHCHARTS .................................................................................................................................. 4Unintentional Trauma Death Among 15-19 Year Olds: Canada, 1997 ...................................................................................4Intentional Trauma Death Among 15-19 Year Olds: Canada, 1997........................................................................................4Unintentional Trauma Death Among 20-24 Year Olds: Canada, 1997 ...................................................................................4Intentional Trauma Death Among 20-24 Year Olds: Canada, 1997........................................................................................4

ALCOHOLANDYOUTHCHARTS................................................................................................................................ 48Relative Risk Of A Fatal Single-Vehicle Crash For Males, At Various BACs.......................................................................4Percentage Of Alcohol-Related Crash Deaths, By Age Group: Canada, 2003 ......................................................................4Percentage Of Alcohol-Related Traffic Deaths And Population, By Age Group: Canada, 2003...........................................4

Motor Vehicle Death Rates By Age Group, Per 100,000: Canada, 1997................................................................................4Motor Vehicle Injury Rates By Age Group, Per 100,000: Canada, 1997................................................................................5Deaths Per Billion Kilometres Travelled, By Age: Canada, 2001...........................................................................................5Cumulative Estimate Of The Lives Saved In The United States By The Minimum Drinking Age Laws, 1975-2004 ...........5Weekly And Monthly Heavy Drinking Among Current Drinkers: Canada, 2004 .................................................................5Alcohol Consumption Among Current Drinkers On A Typical Drinking Day In The Past Year: Canada, 2004 ..................5Percentage Of Current Drinkers Who Drank Hazardously In The Past Year: Canada, 2004 ..................................................5Percentage Of Individuals Harmed By Drinking In The Past Year: Canada, 2004 ................................................................5


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PART IV: TOPICS IN TRAFFIC TRAUMA......................................................................... 54

ALCOHOLANDPEDESTRIANS.................................................................................................................................... 54

Canada .....................................................................................................................................................................................54British Columbia......................................................................................................................................................................54United States............................................................................................................................................................................54United Kingdom ......................................................................................................................................................................5Sweden ....................................................................................................................................................................................5Australia ..................................................................................................................................................................................5

ALCOHOLANDBICYCLISTS........................................................................................................................................ 56Canada .....................................................................................................................................................................................5Ontario.....................................................................................................................................................................................5United States............................................................................................................................................................................5United Kingdom ......................................................................................................................................................................57

ALCOHOLANDSNOWMOBILING .............................................................................................................................. 5Canada .....................................................................................................................................................................................5Ontario.....................................................................................................................................................................................5United States............................................................................................................................................................................5

ALCOHOLANDALL-TERRAINVEHICLES(ATV)................................................................................................... 60Canada .....................................................................................................................................................................................6Ontario.....................................................................................................................................................................................6

ALCOHOLANDMOTORCYCLES ................................................................................................................................ 6Canada .....................................................................................................................................................................................6United States............................................................................................................................................................................6United Kingdom ......................................................................................................................................................................62

ALCOHOL,DRUGSANDPILOTS ................................................................................................................................. 63Canada .....................................................................................................................................................................................6United States............................................................................................................................................................................6


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PART V: IMPAIRED DRIVING .............................................................................................64

CANADA ............................................................................................................................................................................. 64

Alcohol ....................................................................................................................................................................................64Drugs .......................................................................................................................................................................................6British Columbia......................................................................................................................................................................6Ontario.....................................................................................................................................................................................6Quebec.....................................................................................................................................................................................6Other Provinces .......................................................................................................................................................................6

UNITEDSTATES............................................................................................................................................................... 68Alcohol ....................................................................................................................................................................................6Drugs .......................................................................................................................................................................................6

UNITEDKINGDOM.......................................................................................................................................................... 7

Alcohol ....................................................................................................................................................................................7Drugs .......................................................................................................................................................................................7

AUSTRALIA....................................................................................................................................................................... 73Alcohol ....................................................................................................................................................................................7Drugs .......................................................................................................................................................................................7

NEWZEALAND................................................................................................................................................................. 75

IMPAIREDDRIVINGCHARTS...................................................................................................................................... 76Percentage Of Traffic Fatalities, By Road User Type: Selected OECD Countries, 1998 .......................................................76

Legal Impairment Among Fatally-Injured Drivers: Selected OECD Countries, 1997/98.......................................................76Traffic Deaths Per Billion Kilometres Travelled: Selected OECD Countries, 2001 ..............................................................7BAC Limits For Driving Worldwide.......................................................................................................................................7Alcohol And Drug-Impaired Fatalities, Injuries And Property-Damage-Only (Pdo) Crashes: Canada, 1999-2003...............7Percentage Of Fatal Crashes By Type Of Impairment: Canada, 2003 ....................................................................................7BACs Of Alcohol-Positive Fatally-Injured Drivers: Canada, 1990 - 2002 .............................................................................79Public Support For A LowerCriminal Code BAC Limit: Canada, 2005................................................................................8Public Views On A .05% Criminal Code BAC Limit: Canada, 2005.....................................................................................8BACs For Males In Relation To Time, Weight And Standard Canadian Drinks ...................................................................8BACs For Females In Relation To Time, Weight And Standard Canadian Drinks ...............................................................8Annual Charges And Dispositions In Provincial And Territorial Courts: Cumulative Averages, 1994-1998 ........................82Annual Convictions And Sentences In Canada: Cumulative Averages, 1994-1998 ..............................................................8Americans Who Reported Driving Under The Influence Of Any Illicit Drug In The Past Year, By Age, 2003 ...................8

Americans Who Reported Driving Under The Influence Of Any Illicit Drug In The Past Year, By Age Group, 2003........83Americans Who Reported Driving Under The Influence Of Alcohol In The Past Year, By Age, 2003................................84Americans Who Reported Driving Under The Influence Of Alcohol In The Past Year, By Age Group, 2003.....................84


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PART I: GENERAL INFORMATION

SELECTED ALCOHOL FACTS

CANADA

It was estimated that 6,507 Canadians died in 1995 due to alcohol consumption. The largestnumber of alcohol-related deaths stemmed from impaired-driving accidents (p. 1,673).

It was estimated that 82,014 Canadians were admitted to hospital because of alcohol misuse in1995. The greatest number of hospitalizations were for alcoholic psychosis, alcohol dependencesyndrome or alcohol abuse (19,744 in total), non-motor vehicle accidents (19,412), and motorvehicle accidents (9,591) (pp. 1,673-4).

It was estimated that in 1995, 1,144 motor vehicle fatalities were attributable to alcohol (p.1,672).

Non-motor vehicle accidents accounted for 12.2% of alcohol-related deaths, but 23.7% ofalcohol-related hospital admissions. These figures include victims who were killed or injured as aresult of others intoxication (p. 1,674).

Motor vehicle accidents accounted for 17.6% of alcohol-attributed deaths, but only 11.7% ofhospital admissions (p. 1,674).

In 1995, alcohol-related illnesses, accidents and intentional harms accounted for 3.1% of totalmortality, 5.4% of total years of potential life lost, and 2.7% of hospital admissions in Canada (p.1,674).

Less than one-fifth (18.5%) of alcohol-related deaths in 1995 were due to chronic conditions.Accidents and other acute causes accounted for nearly half (47.1%) of all alcohol-attributeddeaths and well over half (107,554 or 62.5%) of potential years of life lost (p. 1,675).

E. Single et al., The relative risks and etiologic fractions of different causes of death anddisease attributable to alcohol, tobacco and illicit drug use in Canada (2000) 162(12) CMAJ1,669.

In 1995/96, 349 men and 193 women per 100,000 were hospitalized in Canada due to alcohol. Alcohol-attributed hospitalizations accounted for 3.9% (51,765) of all hospitalizations for men

and 1.6% (29,181) of all hospitalizations for women.

Accidental falls (16,720), alcohol dependence syndrome (11,709) and motor vehicle accidents(9,378) accounted for almost half of all alcohol-attributed hospitalizations.

E. Single et al, Canadian Profile: Alcohol, Tobacco and Other Drugs (Toronto: Canadian Centre

on Substance Abuse and Centre for Addiction and Mental Health, 1999) at 28.

In a 2002 survey of Canadians aged 15 and older, symptoms of alcohol dependence were reportedthree times more often (2.6%) than symptoms of illicit drug dependence (0.8%).

Alcohol dependency was reported by 7% of Canadians (excluding the territories) aged 15-24,compared to 2% of those aged 25-64.

Statistics Canada, Canadian Community Health Survey: Mental Health and Well Being (Ottawa:Statistics Canada, 2004). Cat. No. 82-617-XIE.


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In Canada, every litre increase in per capita alcohol consumption between 1950 and 1998 wasaccompanied by an increase in accident mortality of 5.9 males and 1.9 females per 100,000.

O-J. Skog, Alcohol consumption and fatal accidents in Canada, 1950-98 (2003) 98 Addiction883.

Alcohol plays a role in pregnancy complications, such as miscarriages, still-born births, lowbirthweights, and premature births.

Moreover, fetal alcohol spectrum disorder was the leading cause of preventable birth defects anddevelopmental delay among Canadian children between 2002 and 2003. Research indicated thatover 2,700 children were born with this disorder each year.

Ministry of Health, Public Health Agency of Canada,Fetal Alcohol Spectrum Disorder (FASD):A Framework for Action (Ottawa: Public Health Agency of Canada, 2003). Online: ; and Statistics Can-ada, Births and Birth Rate, by Provinces and Territories (number of births) (Ottawa: StatisticsCanada, 2005). Online: .

BRITISH COLUMBIA

The provincial Vital Statistics Agency estimated that 1,689 British Columbians died as a result ofalcohol consumption in 2000 (p. 13).

Twelve percent of women drink during pregnancy, leading to between 200 and 320 babies beingborn each year in British Columbia with either full or partial fetal alcohol syndrome (p. 9).

P. Kendall,Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer(British Columbia: Ministry of Health Planning, 2002).

ONTARIO

A study of 11 lead trauma hospitals found that 29% of major injury hospitalizations in 2000/01were alcohol-related. In these cases, the patients mean blood-alcohol concentration (BAC) was

.15% (p. 3). Eighty-six percent of major injury cases involved males. The 19-29 year old age group con-

stituted the largest proportion of patients (37%) (pp. 3 and 5).

The leading causes of alcohol-related major injury hospitalizations were motor vehicle crashes(54%), falls (16%) and assaults (14%) (p. 8).

The average age of the patients in the alcohol-related cases was 36. This is lower than the averageage of 42 for the non-alcohol-related hospitalizations (p. 3).

Canadian Institute for Health Information (CIHI), Ontario Trauma Registry Bulletin: Alcohol-Related Major Injury Hospitalizations in Ontario,2000/2001 (Toronto: CIHI, 2002).

UNITED STATES

In 1996, 110,640 deaths were attributable to alcohol consumption in the United States. Thisfigure has not been below 103,247 since 1979.

National Institute on Alcohol Abuse and Alcoholism (NIAAA), Number of Deaths and Age-Adjusted Death Rates per 100,000 Population for Categories of Alcohol-Related (A-R) Mortality,

United States and States, 1979-96 (Bethesda, MD: NIAAA, September 1996). Online: .


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In 1997, unintentional injuries were the leading cause of death among Americans aged 1-34, andapproximately one-third of these deaths were alcohol-related.

Those who started drinking before the age of 21 were significantly more likely to suffer anunintentional injury while under the influence of alcohol sometime in their life than those whobegan drinking at or above the age of 21.

R. Hingson et al., Age of Drinking Onset and Unintentional Injury Involvement After Drink-

ing (2000) 284 JAMA 1527.

The risk of trauma death is 2.5 to 8 times higher among alcohol abusers than the general public.Patients with an alcohol problem are nearly 5 times more likely to die in motor vehicle crashes,16 times more likely to die in falls, and 10 times more likely to become fire or burn victims.

Alcoholism is by far the most common underlying health problem in trauma victims, affecting25% to 40% of patients, compared with a 2% to 5% incidence for other co-morbidities.

C. Dunn, D. Donovan and L. Gentillelo, Practical Guidelines for Performing Alcohol Inter-ventions in Trauma Centres (1997) 42(2) The Journal of Trauma: Injury, Infection andCritical Care 299.

More than one-third of Americans report that alcohol has caused trouble in their immediatefamily, which is the highest percentage response to this question in the more than 50 years it hasbeen asked.

F. Newport, More than a Third of Americans Report Drinking Has Caused Family Problems,(Washington D.C.: Gallup News Service, November 1999). Online: .

An estimated 21.6 million Americans in 2003 were classified with substance dependence orabuse. This constitutes 9.1% of the total population aged 12 or older.

Of these, 3.1 million were classified with dependence on or abuse of both alcohol and illicitdrugs, 3.8 million were dependent on or abused only illicit drugs and 14.8 million were dependenton or abused only alcohol.

Department of Health and Human Services, Overview of Findings from the 2003 National Surveyon Drug Use and Health (Rockville, MD: Substance Abuse and Mental Health Services Admin-istration, 2003) at 7.

Alcohol-related traffic deaths fell by 2.4% between 2003 and 2004. Nevertheless, alcohol-relatedcrashes accounted for 39% of traffic deaths and 7% of all crashes in 2004 (p. 1).

National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data,Alcohol (Washington, D.C.: NHTSA, 2005). Online: .

UNITED KINGDOM

In 1996, there were approximately 75,000 years of life lost in England and Wales due to alcoholconsumption. The main causes of alcohol-related mortality among 16-24 year olds were roadtraffic crashes, suicides and assaults.

A. Britton and K. McPherson, Mortality in England and Wales attributable to current alcoholconsumption (2001) 55 Journal of Epidemiology and Community Health 383.


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A 1998 study found that 1 in 6 patients at Accident and Emergency (A&E) departments hadalcohol-related injuries or problems. About half of the seriously-injured patients admitted viaA&E departments had an alcohol-related injury (p. 1).

The number of alcohol-related, non-fatal home accidents in the UK increased from 13,262 in1990 to 33,345 in 1998 (p. 4).

The total number of alcohol-related, non-fatal leisure accidents increased from 33,266 in 1990 to71,050 in 1998 (p. 4).

Between 1993 and 1998, the number of people who died each year due to the toxic effects ofalcohol ranged from 127 to 166 (p. 5).

Alcohol Concern,Factsheet 9: Alcohol and Accidents (London: Alcohol Concern, 2003). Online:.

EUROPE In the 1990s, between 40% and 60% of all deaths resulting from intentional and unintentional

injury were attributable to alcohol consumption.Institute of Alcohol Studies, European Alcohol Action Plan 2000-2005 (1999) 4 The GlobeMagazine. Online:.

In 1999, more than 8,000 people aged 15-29 died in Western Europe due to alcohol. Young males had a higher rate of alcohol-attributable death (12.8%) than females (8.3%).J. Rehm et al., Average Volume of Alcohol Consumption, Drinking Patterns and RelatedBurden of Mortality in Young People in Established Market Economies of Europe (2001) 7(3)European Addiction Research 148.

A 2001 study indicated that alcohol plays a very significant role in accidental falls, drownings,fires, and poisonings in northern Europe, particularly among males. This is consistent with studies

on Finnish males, which found that 31% of fatal falls, 63% of drownings, and 33% of poisoningdeaths were alcohol-related.O-J. Skog, Alcohol consumption and mortality rates from traffic accidents, accidental falls,and other accidents in 14 European countries (2001) 96 (Supp. I) Addiction S49 at S55.

AUSTRALIA

During 1997, 3,290 Australians died from injury and disease caused by high-risk drinking (anaverage of more than 4 standard drinks per day for men, and more than 2 standard drinks per dayfor women). Most of these alcohol-related deaths resulted from strokes, alcoholic liver cirrhosis,

road injuries, suicide, or alcohol dependence. Males accounted for 70% of these deaths. On average, each person who died prematurely from an alcohol-caused condition lost 19 years of

life.

Younger people were more likely to die from bouts of intoxication, while older people were morelikely to die from conditions related to long-term alcohol misuse.

Alcohol-caused death rates among females decreased slowly but consistently between 1990 and1997.


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Alcohol-related death rates among males declined rapidly between 1990 and 1993, but showedlittle evidence of decline in the following years.

During 1996/97, high-risk drinking was responsible for 72,302 hospitalizations and 403,795hospital bed-days in Australia.

Aboriginal populations had higher rates of alcohol-caused death than non-Aboriginal populations.T. Chikritzhs et al., National Alcohol Indicators Bulletin No. 1: Alcohol-Caused Deaths andHospitalizations in Australia, 1990-1997 (Perth: National Drug Research Institute, CurtinUniversity, 1999) at 1 and 3.


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CONSUMPTION PATTERNS

CANADA

Alcohol is the most commonly used psychoactive substance in Canada (p. 22). The 2004 Canadian Addiction Survey found that nearly 80% of Canadians aged 15 years or older

had consumed alcohol in the past year (p. 20).

Of those respondents who were drinkers, 44% reported drinking once a week and nearly 10%drank four or more times per week (p. 20).

One in four drinkers reported heavy drinking (5 or more drinks per occasion) at least once permonth. About 6.2% of past-year drinkers engaged in heavy drinking at least once a week (p. 20).

The rate of past-year drinking was higher among males (82%) than females (76%). Males werealso more likely to drink at least once a week, have 5 or more drinks per occasion, and exceed thelow-risk consumption guidelines (i.e. no more than 14 drinks per week for males or 9 drinks perweek for females, and no more than 2 drinks per day) (p. 20).

Heavy drinking and drinking in excess of the low-risk consumption guidelines was more commonamong 18-24 year olds than older Canadians.

About 16.0% of past-year drinkers reported that their usual consumption pattern was to have 5 ormore drinks at a sitting. This pattern of drinking was found to be more common among malesthan females (23.2% vs. 8.8%). It was particularly high among 15-24 year olds, peaking at 42.5%among 18-19 year olds (p. 23).

Past-year drinking increased with level of education and income. Eighty-four percent of thosewith a university degree and 89% of those in the highest income adequacy bracket hadconsumed at least one drink in the past year (p. 22).

Canadian Centre on Substance Abuse (CCSA), Canadian Addiction Survey: Detailed Report(Ottawa: CCSA, 2005).

The Canadian Campus Survey, conducted in spring 2004, included responses from 6,282undergraduate students in 40 universities across Canada.

A significant majority of the respondents (64%) were women. Responses were based on experience over the past 12 months (March/April, 2003 to

March/April, 2004), the past month (March, 2004 to April, 2004), and since the beginning ofthe school year (September, 2003 to April, 2004).

Only 17.3% of respondents lived on campus, 40.4% lived off campus without family and 41.1%lived off campus with family.

Approximately 86% of students reported using alcohol within the past year and 77% reportedusing within the past 30 days.

During the past month period, students who consumed alcohol reported drinking an average of1.3 times and 6.4 drinks per week. Males reported drinking significantly more frequently than

women (1.7 times vs. 1 time per week) and more heavily (8.9 vs. 4.5 drinks per week). Forty-one percent of past month drinkers reported consuming 5 or more drinks on a single

occasion at least twice in this period (49.9% of males and 34.2% of females). Moreover, 17.3% ofpast month drinkers reported consuming 8 or more drinks on a single occasion at least twice(25.9% of males and 10.6% of females).

College students were most likely to drink on weekends (75% of the time) and at off-campuslocations (86% of the time).

Students living on campus or off campus without family drank more often and more heavily thanstudents living off campus with family.


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Thirty-two percent of the students (37.6% of males and 27.5% of females) reported hazardousdrinking as measured by scoring 8 or more on the 10-item Alcohol Use Disorder IdentificationTest (AUDIT) (This test is primarily used for screening alcohol problems in clinical practice).

Almost 44% of students reported at least one indicator of harmful drinking, such as feeling guilty,experiencing memory loss or an injury, or having other people concerned about their drinking.

Almost 32% reported at least one indicator of dependent drinking, such as being unable to stop,failing to perform everyday activities or needing a drink first thing in the morning.

The most commonly reported harms experienced by students since the beginning of the schoolyear were having a hangover (53.4%), memory loss (25.4%), regretting their actions (24.5%), andmissing classes due to a hangover (18.8%).

The hazardous alcohol-related behaviours included having unplanned sexual relations (14.1%),driving a car after drinking too much (7.4%), having unsafe sex (6.0%), and drinking whiledriving (3.8%).

The commonly reported harms resulting from other students drinking were study or sleepdisruptions (32.9%), serious arguments or quarrels (17.3%), being assaulted (10%), and beingsexually harassed (9.8%).

E. Adlaf et al., Canadian Campus Survey, 2004, Executive Summary (Toronto: Centre forAddiction and Mental Health, 2005 at 1-8.

Among Canadians aged 12 and over who reported drinking in 2000/01, 43.4% admitted bingedrinking in the last year (5 or more drinks on one occasion).

Among current drinkers, 20-24 year olds had the highest rates of reported binge drinking (67.8%)in the past 12 months.

Canadian Institute For Health Information (CIHI), Frequency of drinking 5 or more drinks onone occasion in the last 12 months, by age group and sex, household population aged 12 and over

who are current drinkers, Canada, 2000/01 (Toronto: CIHI, 2002). Cat. No. 82-221-XIE.

BRITISH COLUMBIA

A 1999 study of British Columbia youth showed that by age 13, 44% reported consuming alcoholwithin the last year. This percentage rose to 80% by age 17 (p. 8).

In 1999, British Columbia (56%) was second only to Quebec (57%) in the proportion of thepopulation (age 12 and older) that reported regular drinking (at least one drink each month) (p.7).

According to the 1998/99 National Population Health Survey, nearly 20% of British Columbiadrinkers (age 12 or older) were regular heavy drinkers (5 or more drinks per occasion, 12 ormore times per year) (p. 10).

An estimated 1,689 British Columbians died as a result of alcohol consumption in 2000 (p. 13). Among high school students who drink, the rate of binge drinking increased from 36% in 1992 to

44% in 1998 (p. 10).P. Kendall,Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer

(British Columbia: Ministry of Health Planning, 2002).

ONTARIO

In 2005, 62% of all high school students reported drinking in the past year. Thirty-one percent ofgrade-7 students reported using alcohol in the past year, and this percentage rose to about 82%among grade-11 and 12 students (p. vi).

The percentage of students in grades 7, 9 and 11 who reported drinking in the past year increasedslightly from 56% in 1995 to 57.8% in 2005 (p. 21).


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In 2005, 10% of all high school students consumed alcohol weekly (p. vi). Overall, 23% of students reported binge drinking in the 4 weeks prior to the survey (p. vi). About 5% of drinkers reported binge drinking 4 or more times in the month prior to the survey (p.

vii).

Heavy drinking increased significantly with grade: binge drinking was lowest among grade-7students (3.4%) and highest among grade-12 students (42.5%) (p. i).

Drinking at hazardous levels was reported by nearly 16% of students. Hazardous drinking wasdefined as a pattern of drinking that increases the likelihood of future medical and physicalproblems. Hazardous drinking was more common among males (18%) than females (14%) (p.vii).

In 2005, almost 14% of all drivers in grades 10-12 drove within an hour of consuming 2 or moredrinks during the past 12 months (p. vii). Males were more likely than females to drink and drive(17.7% vs. 8.5%) (p. 190).

In 2005, 0.7% of students reported having been in a treatment program for alcohol or other drugsduring the past 12 months (p. 200).

In 2005, 6% of Ontario students reported both alcohol problems and related psychologicaldistress (e.g. symptoms of anxiety or depression) (p. viii).

E. Adlaf and A. Paglia-Boak, Drug Use Among Ontario Students 1977 - 2005: Detailed OntarioStudent Drug Use Findings (Toronto: Centre For Addiction and Mental Health, 2005). Online:.

UNITED STATES

A national survey estimated that 50% of Americans over the age of 12 consumed alcohol in 2003.An estimated 22.6% reported binge drinking (5 or more drinks on at least one occasion in the past30 days). Moreover, 6.8% reported being heavy drinkers (5 or more drinks per occasion at least 5times in the past 30 days).

The rate of binge drinking among 18-25 year olds was 41.6%. Among this age group, 15.1% ofrespondents also reported heavy drinking. The survey estimates that 13.6% of those 12 and over drove under the influence of alcohol at least

once in 2003 (i.e. 32.3 million people).

Twenty-nine percent of 12-20 year olds reported drinking in the month before the survey (i.e.10.9 million people). Moreover, 19.2% of this age group reported binge drinking in the monthbefore the survey (i.e. 7.2 million people).

Department of Health and Human Services, Overview of Findings from the 2003 National Surveyon Drug Use and Health (Rockville, MD: Substance Abuse and Mental Health ServicesAdministration, 2004) at 4-5.

A 2002 survey of adults (21 and older) found that 46% reported not drinking in the 30 days priorto the survey, and 26% reported drinking once a week or less (p. 1).

Binge drinkers (5 or more drinks per occasion) constituted 23% of the adult population, butconsumed 76% of the alcohol (p. 2).

Half of 12-14 year old drinkers, 65% of 15-17 year old drinkers, and 72% of 18-20 year olddrinkers reported drinking 5 or more drinks in a sitting in the month prior to the survey (p. 3).

Young binge drinkers accounted for the vast majority of the alcohol consumed by their age group.Binge drinkers were responsible for 91% of the alcohol consumed by 12-14 year olds, and 96%of the alcohol consumed by 18-20 year olds (p. 3).


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In 2002, underage drinkers consumed about 11% of the alcohol purchased in the United States (p.3).

Americans face $4 billion worth of alcohol marketing each year. Price promotions, such as happyhours and drinking games, often target young drinkers and promote binge drinking (p. 3).

Pacific Institute for Research and Evaluation, Drinking in America: Myths, Realities, andPrevention Policy (Washington: US Department of Justice, Office of Juvenile Justice and Delin-

quency Prevention, 2002).

Underage drinkers consume 20% of the alcohol sold in the United States (p. i). In 1999, underage drinkers accounted for up to $22.5 billion of the $116 billion spent on alcohol

(p. ii).

Alcohol was a major contributing factor in the three leading causes of teen death accidents,homicides and suicides (p. ii).

The financial costs of underage drinking approached $53 billion in accidents, drownings, burns,violent crimes, suicide attempts, fetal alcohol syndrome, alcohol poisonings, and emergencymedical care (p. ii).

Approximately 3.3 million 12-17 year old students start drinking each year (p. 2).

Forty-one percent of grade-9 students, 50% of grade-10 students, 51% of grade-11 students, and62% of grade-12 students currently use alcohol (p. 2).

In 1999, 41.6% of grade-12 students reported binge drinking at least once in the last 30 days, andmore than 5 million teenagers reported binge drinking at least once a month (p. 3).

High school students who use alcohol are 5 times more likely to drop out than high schoolstudents who do not (p. 4).

Teen heavy drinkers and binge drinkers are more than twice as likely as non-drinkers to reportthat they deliberately try to hurt or kill themselves or think about hurting or killing themselves. Aheavy drinker is defined as a person who reports binge drinking at least 5 times in the past 30days (p. 3).

Two-thirds of teens who are heavy drinkers also use at least one other illicit drug, compared toonly 5.5% of teens who do not drink (p. 4).

Teen heavy drinkers are 12 times more likely to be on juvenile probation than teens who do notdrink (19% vs. 1.5%) (p. 4). The reported rates of current alcohol use (m. 40.2% vs. f. 41%) and binge drinking (m. 21.7% vs.

f. 20.2%) are very similar among male and female grade-9 students (p. 3).The National Center on Addiction and Substance Abuse (CASA), Teen Tipplers: AmericasUnderage Drinking Epidemic (New York: CASA, 2003).

UNITED KINGDOM

In 2003, those over 14 years of age consumed an average of 11.34 litres of alcohol, which is morethan double the average consumption in 1956 (5.07 litres) (p. 2).

Men reported drinking an average of 17.2 units (10.2 standard Canadian drinks) of alcohol perweek and women drank an average of 7.6 units (4.5 standard Canadian drinks) per week from1998 to 2002 (p. 9).

In 2001, beer accounted for 58% of the alcohol consumed, wine accounted for 25% and spiritsaccounted for 17% (p. 12).

Two-thirds of the alcohol was consumed on licensed premises (p. 13). In 2000, over 33.5 billion was spent on alcohol in the UK, which amounts to 5.4% of all

consumer expenditures (p. 13).


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Institute of Alcohol Studies (IAS), Drinking in Great Britain (St. Ives: IAS, March 2005).Online: .

In 2002, 32% of females and approximately 45% of males aged 16-19 in the UK had a hazardousdrinking pattern (drinking to the point where the individual is at risk of physical or psychologicalharm). For men, hazardous drinking peaked in the 20-24 age group, with 62% reporting such

drinking (pp. 1-2). A 2004 study found that between 1988 and 2002 the percentage of 11-15 year old English pupils

who drank in the past week increased from 20% to 24%. The percentage increased for each ageexcept 11 year olds. Moreover, the amount consumed by the 11-15 year age group doubled.Forty-five percent of 15 year olds reported drinking within the past week (p. 4).

Over 5% of 14-15 year olds and almost 10% of 15-16 year olds reported exceeding therecommended maximum limits for adults (21 drinks per week for men and 14 drinks per week forwomen). Among 18-24 year olds, approximately 42% of men and 22% of women reportedexceeding these limits (p. 12).

A Liverpool hospital reported that children as young as 8 are being admitted with acute alcoholintoxication. While 20 children were treated in 1986, this figure rose to 200 by 1996 (p. 12).

Approximately half of the 15-16 year olds reported drinking 5 or more drinks in a row at leastonce in the previous month, and 40% reported having been drunk by the age of 13 (p. 13).

Institute of Alcohol Studies (IAS), Young People and Alcohol(St. Ives: IAS, May 2005). Online:.

AUSTRALIA

A 1998 survey indicated that people who regularly drink at levels above the low risk for long-term harm accounted for 39% of the total alcohol consumed in Australia. Low-risk for long-termharm was defined as up to 28 drinks for men and 14 drinks for women per week (20.8 and 10.4

standard Canadian drinks) (pp. 2-3). Due to their drinking, about 9% of male and female drinkers are at a medium to high risk of long-

term health problems, such as liver damage (p. 3).

Fifty-one percent of alcohol consumption occurs in situations of medium or high risk of acuteharms, such as traffic crashes, falls or violence. Medium risk is defined in terms of 7 or 8 drinksper occasion for males and 5 to 6 drinks for females. High risk is defined as 9 or more drinks peroccasion for males and 7 or more drinks for females (p. 3).

Drinking at a medium or high risk of acute harm accounts for 71% of the alcohol consumed by14-17 year olds and 66% of the alcohol consumed by 18-24 year olds (p. 3).

Forty-six percent of male and 32.5% of female drinkers consumed alcohol at a medium or high-risk of acute harm at least once a month in the past year. Seventy-nine percent of males and 52%of females 18-24 years old drank at these levels at least once a month in the past year (p. 4).

P. Heale et al., National Alcohol Indicators Bulletin No. 3: Patterns of Alcohol Consumption inAustralia, 1998 (Perth: National Drug Research Institute, Curtin University, 2000).

Adult (aged 15 and older) per capita alcohol consumption fell from 9.70 litres in 1991/92 to 9.03litres in 1995/96. Nevertheless, Queensland, Western Australia and metropolitan areas in theNorthern Territory showed increasing consumption (p. 4).

Per capita consumption was consistently highest in the Northern Territory (1995/96 13.6 litres)and rural areas, and lowest in Victoria (1995/96 7.5 litres) (p. 4).


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The trends in adult per capita consumption closely reflected the patterns in alcohol-related deathsand traffic crash injuries (p. 1).

P. Catalano et al., National Alcohol Indicators Bulletin No. 4: Trends in Per Capita AlcoholConsumption in Australia, 1990/91-1998/99 (Perth: National Drug Research Institute, CurtinUniversity, 2001).


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ALCOHOL CONSUMPTION CHARTS

NATIONAL PER CAPITA ALCOHOL CONSUMPTION IN LITRES, 2002*

France 14.8 Netherlands 9.8

Luxembourg 14.7 Australia 9.8

Ireland 14.3 Belgium 9.6Hungary 13.4 New Zealand 9.2

Czech Republic 11.9 Finland 9.2

Portugal 11.5 Greece 9.1

Denmark 11.2 Italy 8.6

Spain 11.2 United States 8.3

United Kingdom 11.1 Canada 7.8

Austria 11.0 Sweden 6.9

Switzerland 10.8 Iceland 6.5

Germany 10.4 Norway 5.9

* Population aged 15 years and older

Source: Organization for Economic Co-operation and Development (OECD), OECD HealthData 2005 (Paris: OECD, June 2005). Online: .

ALCOHOL CONSUMPTION* PER CAPITA**:CANADA, 1988-2004

4

5

6

7

8

1988 1990 1992 1994 1996 1998 2000 2002 2004

L

itres

* Not including alcohol brought across the border, or home or assisted beer and wine production.** Based on total population.

Source: Brewers Association of Canada,Annual Statistical Bulletin 1998 (Ottawa: Brewers Association ofCanada, July 1999) at 39; and Brewers Association of Canada,Annual Statistical Bulletin 2004

(Ottawa: Brewers Association of Canada, 2005) at 39.


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ALCOHOL CONSUMPTION* PER CAPITA**:PROVINCES AND TERRITORIES, 2004

* Not including alcohol brought across the border, or home or assisted beer and wine production.** Based on total population.

Source: Brewers Association of Canada,Annual Statistical Bulletin 2004 (Ottawa:Brewers Association of Canada, 2005) at 39-63.

BINGE DRINKING* AMONG CURRENT DRINKERS AT LEAST ONCE IN THEPAST YEAR, BY AGE: CANADA, 2003

0

10

20

30

40

50

60

70

80

90

15 - 19 20 - 24 25 - 34 35 - 44 45 - 54 55 - 64

Percentage

Males

Females

* 5 or more drinks on a single occasion.

Source: Statistics Canada, Frequency of Drinking 5 or More DrinksCanada, 2003 (Ottawa:Statistics Canada, 2003). Online: .


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BINGE DRINKING* AMONG CURRENT DRINKERS 12 OR MORE TIMES INTHE PAST YEAR, BY AGE: CANADA, 2003

0

10

20

30

40

50

15 - 19 20 - 24 25 - 34 35 - 44 45 - 54 55 - 64

Percentage

Males

Females

* 5 or more drinks on a single occasion.

Source: Statistics Canada, Frequency of Drinking 5 or More DrinksCanada, 2003 (Ottawa:Statistics Canada, 2003). Online: .

BINGE DRINKING* AMONG CURRENT DRINKERS IN THE PAST MONTH,BY AGE: UNITED STATES, 2003

0

10

20

30

40

50

60

12 - 17 18 - 25 26 or Older

Percentage

Males

Females

* 5 or more drinks on a single occasion (4.7 standard Canadian drinks)

Source: Office of Applied Studies,2003 National Survey on Drug Use & Health: DetailedTables (Washington: US Department of Health and Human Services, 2004). Online:

.


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0

10

20

30

40

50

60

70

Any Binge* Heavy**

Males

Females

TYPE OF ALCOHOL USE BY GENDER, AMONG PERSONS 12 OR OLDERIN THE PAST MONTH: UNITED STATES, 2003

* 5 or more drinks on a single occasion (4.7 standard Canadian drinks).** 5 or more binge drinking occasions in the past 30 days.


.

TYPE OF ALCOHOL USE BY PERSONS 12 OR OLDER IN THEPAST MONTH: UNITED STATES, 2003

Binge Use

23%

Heavy Use

7%Any Use

49%

No Use

21%

Binge use: 5 or more drinks on a single occasion (4.7 standard Canadian drinks).

Heavy use: 5 or more binge drinking occasions in the past 30 days.


.


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* 8 or more drinks for men and 6 or more drinks for women on a single day

(5.1 and 3.6 standard Canadian drinks).

BINGE DRINKING* AMONG CURRENT DRINKERS,BY AGE: UNITED KINGDOM, 2000/01

Source: Binge Drinking Costing BillionsBBC News (19 September 2003).Online: .

0

5

10

15

20

25

30

35

40

16 - 24 24 - 55 45 - 64 65+ All

Percentages

Males

Females


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COSTS OF ALCOHOL USE

CANADA

Total Economic Costs In 1992, alcohol accounted for more than $7.5 billion in costs, or $265 per capita. This represents

41% of the total costs of substance abuse (p. 36).

The largest economic costs of alcohol were: $4.14 billion for lost productivity due to morbidityand premature mortality; $1.36 billion for law enforcement; and $1.30 billion in direct health carecosts (p. 36).

Police

It was estimated that in 1992, 11.9% of all offences which officially came to police attention wererelated to alcohol (p. 48).

Total policing expenditures in 1992 were estimated at $5.39 billion. The policing costs attributedto alcohol were estimated to be $665.4 million (p. 49).

Fire Damage

In 1992, fire damage to property, excluding forest fires, totalled more than $1.24 billion inCanada (p. 50). The loss attributed to alcohol-related fires was $35.2 million (p. 50).

Motor Vehicle Property Damage

In 1992, private and commercial motor vehicle property damage claims were estimated to be $3.1billion (p. 50).

It was estimated that alcohol contributed to 15.8% of these claims, or $482.8 million (p. 50).E. Single et al., The Costs of Substance Abuse in Canada (Ottawa: Canadian Centre onSubstance Abuse, 1996).

BRITISH COLUMBIA

In 1992, the provinces annual alcohol-related costs were estimated to be: $179 million annuallyfor health care; $143 million for law enforcement; $529 million for lost productivity due tomorbidity, premature mortality and crime; and $93 million for fire damage, traffic accidents andother direct costs (p. 16).

The total annual cost of alcohol consumption in B.C. was $944 million in 1992. This amounts to$272 per capita, the third highest per capita cost in Canada, behind Alta. ($285) and P.E.I. ($283)(p. 16).

The net income of the British Columbia Liquor Distribution Branch was $642 million in 2000/01(p. 15).

P. Kendall,Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer

(British Columbia: Ministry of Health Planning, 2002).


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UNITED STATES

In 2000, drivers with BACs of .10% and above were involved in an estimated 2,058,400 crashesthat killed 12,892 and injured 448,630 people.

Drivers with BACs between .080% and .099% were involved in an estimated 35,410 crashes thatkilled 1,097 and injured 20,150 people.

Drivers with positive BACs below .08% were involved in an estimated 69,400 crashes that killed2,664 and injured 43,730 people.

Alcohol was a factor in 26% of the total crash costs. Alcohol-related crashes cost the Americanpublic an estimated $114.3 billion in 2000 ($51.1 billion in monetary costs and an estimated$63.2 billion in quality of life losses).

People other than the drinking driver were required to bear $71.6 billion in costs due to alcohol-related crashes.

The average alcohol-related fatality costs $3.5 million, which includes $1.1 million in monetarycosts and $2.4 million in quality of life losses.

The estimated cost per injured survivor of an alcohol-related crash averaged $99,000 ($49,000 inmonetary costs and $50,000 in quality of life losses).

Crash costs averaged $5.80 for every mile driven by a driver with a BAC of .10% and above, and$2.50 for every mile driven by a driver with a BAC between .080% and .099%. The crash costper mile of a driver with a BAC of zero was $0.10.

Alcohol-related crashes accounted for an estimated 18% of the $103 billion in US auto insurancepayments. Reducing alcohol-related crashes by 10% would save $1.8 billion in insurancepayments and loss adjustment expenses.

National Highway Traffic Safety Administration, Impaired Driving in the United States. Online:.

Drivers and non-occupants with BACs of .10% or greater accounted for 75% of all alcohol-involved crash costs (p. 2).

The impact of alcohol involvement increases with injury severity. Alcohol-involved crashesaccounted for 10% of property-damage-only crash costs, 21% of non-fatal injury costs and 46%of fatal injury costs (p. 2).

L. Blincoe et al., The Economic Impact of Motor Vehicle Crashes: 2000 (Washington: National

Highway Traffic Safety Administration, 2001). Online: .

UNITED KINGDOM

In 1999, the cost of misusing alcohol in England and Wales was estimated to be 18.5-20 billion(p. 59).

Alcohol-related healthcare costs were estimated to be 1.3-1.6 billion (p. 26). An estimated 4.7 billion was attributable to human and emotional costs (p. 57). Alcohol-related productivity losses were estimated to be: 1.2-1.8 billion for absenteeism; 2.4

billion for premature death; and 2 billion for unemployment (p. 59).United Kingdom, Prime Ministers Strategy Unit, Alcohol Misuse, How Much Does It Cost?(London: Cabinet Office, September 2003). Online: .


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ALCOHOL COST CHARTS

DIRECT LAW ENFORCEMENT COSTS OF ALCOHOL USE, IN MILLIONS: CANADA, 1992

Courts, $304.4

Corrections, $389.3

Police, $665.4

Source: E. Single et al., The Costs of Substance Abuse in Canada (Ottawa: Canadian

Centre on Substance Abuse, 1996) at Table 4.

COSTS OF ALCOHOL USE, IN MILLIONS: CANADA, 1992

$273.1

Other

Traffic Crash

Damage

$1,359.1

Direct

Law

Enforcement

$1,300.6

Direct Health

Care

$4,136.5Productivity Losses

Source: E. Single et al., The Costs of Substance Abuse in Canada (Ottawa: CanadianCentre on Substance Abuse, 1996) at Table 4.

Total Law Enforcement Costs:$1,359.1 billion

Total Costs: $7,552.1 billion

$482.8


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ESTIMATED COST OF ALCOHOL AND DRUG-IMPAIRED DRIVINGCRASHES, IN MILLIONS: CANADA, 2003

* Includes vehicle repairs, medical costs and insurance payouts.** Includes real dollar costs, plus lost days of work, reduced employment opportunities, and reduced life span.*** Refers to what society would be willing to pay to avoid the crash.

Source: G. Mercer,Estimating the Presence of Alcohol and Drug Impairment in Traffic Crashes and their Costs to

Canadians 1999 to 2003 (Vancouver: Applied Research and Evaluation Services, 2005) at 10 and 12.

FatalPersonalInjury

PropertyDamage Only

Total

Number of Crashes 1,048 50,707 161,298 213,053

Real Dollar Costs* $303 $1,317 $263 $1,883

Deferred Future Income** $1,063 $1,242 $1,207 $3,512

Willingness to Pay*** $8,067 $1,677 $1,207 $10,951


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PART II: ALCOHOL AND TRAUMA

ALCOHOL, DROWNING AND BOATING

CANADA

Drowning is the third leading cause of unintentional death for Canadians under 60 years of age,exceeded only by motor vehicle accidents and poisoning.

In 2001, there were 431 drownings in Canada. Canadian water-related deaths had decreased ineach of the preceding 5 years.

Between 1992 and 2001, alcohol was involved in 44% of preventable water-related deaths in-volving victims aged 18-49.

From 1992 to 2001, alcohol was involved in 37% of boating deaths, 42% of recreational power-boating deaths, 47% of drownings involving canoers, and 54% of snowmobile-related drownings.

Lifesaving Society, National Drowning Trends Report 1992-2001 (Ottawa: Lifesaving Society,2005) at 1. Online: .

BRITISH COLUMBIA

Alcohol was present in one-third of drownings among those under 19 years of age.J. Greschner and W. Mitic, Alcohols Role in the Deaths of BC Children and Youth (2002)93(3) Canadian Journal of Public Health 173 at 174.

ONTARIO

Alcohol consumption was involved in 39% of the preventable water-related deaths from 1997 to2001. Fifty percent of adult male and 24% of adult female water-related deaths involved alcohol.

Alcohol was involved in 75% of the fatal incidents after dark. The number of water-related deaths involving alcohol increased to 58 in 2001, up 12% from 2000. From 1997 to 2001, the average BAC in fatal alcohol-related incidents was .177%. The average

BACs for boating and snowmobile drowning victims were .152% and .130%, respectively.

From 1997 to 2001, 24% of all Ontario drowning victims, 25% of drowning victims in boatingincidents, and 33% of drowning victims in snowmobiling incidents had BACs above .08%.

Coroners cite alcohol as the second most frequent factor in preventable water-related deaths.Lifesaving Society, The Drowning Report: A Profile of Drownings and Water-Related Deaths inOntario, 2004 edition (Toronto: Lifesaving Society, 2004) at 22. Online: .

UNITED STATES

In 1991, there were 4,600 drowning deaths in the United States, including 924 boating deaths.Although drowning deaths have decreased substantially over recent decades, they constitute the


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fourth most common cause of unintentional injury deaths for all ages and the third most commoncause for 5-44 year olds (p. 85).

Three literature reviews concluded that between 30% and 50% of adolescent and adult drowningvictims had been drinking (p. 86).

One study of non-boating fatalities indicated that having a positive BAC below .10%, increasedthe risk of drowning fourfold (p. 88).

Studies suggest that between 25% and 50% of boaters drink while on their boats (p. 94).J. Howland et al., Alcohol as a Risk Factor for Drowning and Other Aquatic Injuries, in R.Watson ed., Drug and Alcohol Abuse Reviews, Volume 7: Alcohol, Cocaine and Accidents (To-towa, NJ: Humana Press, 1995) 85.

In 1998, 800 Americans died in recreational boating incidents. Data from four states with hightesting rates indicated that 51% of people involved in boating fatalities had BACs of at least.04%, and 30% had BACs above .10% (p. 2,974).

A 2001 study found that boaters with a BAC between .01% and .05% were 2.8 times more likelyto die, and boaters with a BAC greater than .10% were 12 times more likely to die than boaterswith a zero BAC (p. 2,978).

G. Smith et al., Drinking and Recreational Boating Fatalities: A Population-Based Case-Control Study (2001) 286(23) JAMA 2,974.

In 2003, the U.S. Coast Guard received reports of 5,438 recreational boating accidents, resultingin 703 fatalities and 3,888 injuries (p. 5).

Alcohol was involved in 630 boating accidents, up from 602 in the previous year (p. 36). Alcohol was involved in 31% of all boating fatalities in 2003, down 8% from 2002 (p. 6).United States Coast Guard, Boating Statistics 2003 (Washington: US Department of Home-land Security, February 2003). Online: .

UNITED KINGDOM

The Royal Life Saving Society has identified alcohol as the most common risk factor in drowningdeaths (p. 3).

In 1998, there were 79 alcohol-related drownings in the UK, representing 15% of totaldrownings. Males accounted for 90% of these alcohol-related drownings (p. 3).

Alcohol Concern,Factsheet 9: Alcohol and Accidents (London: Alcohol Concern, 2001). Online:.

EUROPE

Alcohol plays a very significant role in drownings in northern Europe, particularly among males.This is consistent with studies on Finnish males, which found that 63% of drowning deaths werealcohol-related.

O-J. Skog, Alcohol consumption and mortality rates from traffic accidents, accidental falls,and other accidents in 14 European countries (2001) 96 (Supp. I) Addiction S49 at S55.


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ALCOHOL AND FALLS

CANADA While accidental falls accounted for only 6% (408) of alcohol-related deaths in 1992, they

accounted for 20% of hospitalizations and 27% of hospital days. In contrast, motor vehicleaccidents accounted for 22% of deaths, but only 13% of hospitalizations and 12% of hospitaldays.

E. Single et al., Morbidity and Mortality Attributable to Alcohol, Tobacco, and Illicit Drug Usein Canada (1999) 89(3) American Journal of Public Health 385 at 386.

ONTARIO

From 1996/97 to 2000/01, falls accounted for 16% of the alcohol-related major injury hospital-izations in 11 lead Ontario trauma hospitals.

Of the 203 people hospitalized for falls in 2000/01 who were tested for alcohol, 34% had apositive BAC and 27% had a BAC above .08%.Canadian Institute for Health Information (CIHI), Ontario Trauma Registry Bulletin July 2002:Alcohol-Related Major Injury Hospitalizations in Ontario, 2000/2001 (Toronto: CIHI, 2002) at 8-10.

UNITED STATES

In 1990, falls were the second leading cause of accidental death in the United States, accountingfor more than 12,000 fatalities. Falls also accounted for 60% of accidental injuries.

A review of the relevant studies indicates that an average of 28% of the people killed and 30% ofthose injured in falls had been drinking.

A review of other studies indicates that alcoholics are 3 to 16 times more likely to suffer a fatalfall than other members of the public.

C. Cherpitel, The Epidemiology of Alcohol-Related Trauma (1992) 16(3) Alcohol Health andResearch World 191 at 194.

UNITED KINGDOM

A 1998 survey of emergency departments found that a quarter of facial injuries were linked toalcohol consumption, with the most common causes being falls (40%) and assaults (25%) (p. 8).

Institute of Alcohol Studies (IAS), Alcohol and Crime (St. Ives: IAS, April 2005). Online:.


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EUROPE

An early Finnish emergency room study found that the risk of a fall was 3 times greater forpeople with a BAC of between .10% and .15%, and 60 times greater for people with a BAC of.16% or higher, than for those with a BAC of .05% or less.

R. Honkanen et al., The role of alcohol in accidental falls (1983) 44(2) Journal of Studies ofAlcohol 231.


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ALCOHOL AND FIRES

CANADA In 1995, of the 6,503 deaths attributed to alcohol, 106 (about 2%) deaths resulted from fire.*E. Single et al., Canadian Profile: Alcohol, Tobacco and Other Drugs (Toronto: Canadian Centreon Substance Abuse and Centre for Addiction and Mental Health, 1999) at 61.

*This estimate of alcohol-related fire deaths is far lower than comparable American and UnitedKingdom estimates.

ONTARIO

Between 1995 and 2001, 901 Ontarians died from fire-related injuries, and 175 victims (19%)were impaired by alcohol (p. 2).

Nearly 70% of the alcohol-related fire victims were between the ages of 25 and 54. Those over 74years of age accounted for the largest number of fire deaths, but only 3% of these victims wereimpaired by alcohol (p. 4).

Men accounted for 78% of the 175 alcohol-related fire deaths (p. 4). None of the 101 fire victims under 15 years of age were impaired. However, some of these young

victims died in multiple fatality fires in which an adult was impaired (p. 4).US Fire Administration (USFA)/National Fire Data Center, Case Study: Contribution ofAlcohol to Fire Fatalities in Ontario(2003) 3(5)Topical Fire Research Series. Online: .

In 2004, more than 24,000 fires were reported to the Ontario Fire Marshals Office, accountingfor $395 million in property damages.

Fires also resulted in 761 injuries, more than 400 hospitalizations and 97 deaths. Preventableresidential fires accounted for 77% of the deaths.

Drug or alcohol impairment was involved in 29% of the deaths, and in 14% of the cases theperson was asleep with no known impairment.

Lit smoking materials were the largest single source of ignition in the preventable residential firedeaths.

Smartrisk, Fire-Related Injuries (October, 2005) 2(8) Ontario Injury Compass.

UNITED STATES Fires and burns were the fourth leading cause of accidental death in the United States, accounting

for more than 4,000 fatalities in 1990.

A review of studies on alcohol-related fires indicated that 33% to 61% of burn fatalities, and 22%to 27% of non-fatal burn injuries involved alcohol.

Another review of relevant studies estimated that approximately 50% of fire victims wereintoxicated at the time of death. Alcohol was most often a factor in fatal fires caused bycigarettes.


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Studies indicate that alcoholics are 10 to 26 times more likely to die in fires than other membersof the public.

C. Cherpitel, The Epidemiology of Alcohol-Related Trauma (1992) 16(3) Alcohol Health &Research World 191 at 194.

A New Jersey study found that 29.5% of people who died in fires had been drinking, and that theaverage BAC among these victims was .19%.

D. Barillo and R. Goode, Substance abuse in victims of fire (1996) 17(1) Journal of Burn Careand Rehabilitation 71.

Alcohol has been implicated in more than half of fatal residential fires. Among the adult victimswho were tested for alcohol, 53% had a BAC above .10%. In this study, of the 190 fatalities, 124victims were male and 78 victims were home alone.

Those most likely to die were children under 5 years old, those 64 years of age or older,individuals who were physically or cognitively disabled, and those who were impaired by alcoholor other drugs.

Fourteen of the 48 deaths among those under 18 years of age occurred in situations in which therewas no adult supervision.

Seven young victims died in fires in which one or more of the surviving adults had been judged tobe impaired by alcohol or other drugs.

S. Marshall et al., Fatal Residential Fires: Who dies and who survives? (1998) 279 JAMA1633 at 1634.

Fires and burns are the fourth leading cause of accidental death in the United States, accountingfor at least 5,000 deaths and 1.4 million injuries a year.

Alcohol contributes to about 40% of residential fire deaths, approximately 85% of which occur insingle-family homes and duplexes.

Healthlink, Medical College of Wisconsin, Preventing Home Fires During the Holidays (Dec-ember 2001). Online: .

UNITED KINGDOM

A series of studies by the Department of Forensic Medicine at Glasgow University found that50% of those killed in fires had a raised BAC. Moreover, in a high proportion of these cases,the victims BAC was high enough to have impaired escape.

Institute of Alcohol Studies (IAS), Alcohol as a Medical and Social Problem Alcohol andAccidents (St. Ives: IAS, 1999). Online: .

A British study found alcohol to be a contributing factor in 39% of fire deaths (p. 1). A 1994 study found that alcohol is the single most important factor in burns and is implicated inup to 65% of cases where people are admitted to hospital or die from burns (p. 3).Alcohol Concern,Factsheet 9: Alcohol and Accidents (London: Alcohol Concern, August 2003).Online: .


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ALCOHOL AND THE WORKPLACE

CANADA Twenty-two percent of Canadians report using alcohol on the job (p. 7). Alcohol impairment is a major cause of unemployment, absenteeism and workplace accidents (p.

9).

The most frequent workplace alcohol problems were absenteeism (cited as often a problem by35% of enterprises); impaired performance (36%); lateness (33%); and reduced motivation (29%)(p. 9).

Workers who misuse alcohol and drugs tend to leave their jobs, voluntarily or involuntarily,sooner than other workers (p. 14).

Lower-status workers, young people and males are most likely to experience a workplaceproblem due to alcohol or other drug use (p. 8).

Illicit drug users are more likely to engage in disruptive behaviour, such as spreading rumours,intentionally doing poor work, pilfering, and vandalism (p. 18).

Annual productivity losses in Canada due to alcohol use have been estimated to be $4.1 billion (p.24).

E. Single, Substance Abuse and the Workplace in Canada (Toronto: Canadian Centre onSubstance Abuse, 1998).

ALBERTA

A 2002 survey found that 11% of Alberta workers reported using alcohol at work in the past 12months (i.e. 184,118 workers).

Eighty-one percent of Alberta employees reported consuming alcohol in the year prior to thesurvey.

The industries reporting the highest prevalence of alcohol use were utilities, forestry/mining,public administration, and finance/insurance/real estate.

Alberta Alcohol and Drug Abuse Commission (AADAC), Alcohol Use and the Alberta Work-place 1992-2002 (Edmonton: AADAC, 2003).Online: .

UNITED STATES

Studies of alcohol-related work injuries have found that injury rates vary greatly by industry.However, the proportion of individuals with positive BACs in work-related accidents is lowcompared to other types of accidental injuries in the United States.

In a study of work-related fatalities, it was estimated that 15% of tested workers had positiveBACs.

A review of emergency room studies of work injuries indicated that an average of 4% (range 1%-16%) involved alcohol.

C. Cherpitel, The Epidemiology of Alcohol-Related Trauma (1992) 16(3) Alcohol Health &Research World 191 at 194-95.


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A 1989 study found that up to 40% of industrial fatalities and 47% of industrial injuries could belinked to alcohol consumption and alcoholism.

Alcohol is the most widely abused drug among working adults. In 1999, an estimated 6.2% ofadults working full-time were heavy drinkers. Heavy drinkers were defined as individuals whoconsumed 5 or more drinks per occasion at least 5 times in the past 30 days.

Thirty-eight percent of workers aged 18-25 were reported to be binge drinkers (5 or more drinkson at least one occasion in the past 30 days).

Among employed adults, the highest rates of heavy drinking and current illicit drug use werereported by 18-25 year old white males, who had less than a high school education.

The highest rates of heavy drinking and current illicit drug use were reported by: food preparationworkers, waiters, waitresses, and bartenders (19%); construction workers (14%); service occu-pations (13%); and transportation and material moving workers (10%).

A 1995 U.S. Department of Health and Human Services report indicated that alcohol and drugabuse cost American businesses an estimated $81 billion a year in lost productivity $37 billiondue to premature death and $44 billion due to illness. Eighty-six percent of these combined costswere attributable to alcohol.

A 1991 study indicated that alcoholism is estimated to account for 500 million lost workdaysannually.

The same study indicated that current heavy drinkers (8%) were more likely to have changedemployers 3 or more times in the past year, than those who were not heavy drinkers (4.4%).

This study also reported that current heavy drinkers (11.3%) were more likely to have skippedone or more work days in the past month, than those who were not heavy drinkers (5.1%).

Working Partners for an Alcohol and Drug Free Workplace, Small Business Workplace Kit,Facts and Figures. Online: .

In 1992, 24% of workers surveyed in a large manufacturing plant reported drinking on the job atleast once during the year before the survey.

In a survey of 6,540 employees at 16 worksites representing a range of industries, 23% of upper-level managers reported drinking during working hours in the p

Alcohol, Trauma and Impaired Driving

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