Correlates of Breath Alcohol Concentration Among Driving Under the Influence Program Clients in Southern California

• Author: Melanie Barker,Susan I. Woodruff,Natasia S. Courchesne,Conner M. Muth
• DOI: 10.1177/0022042618815688
• Date: 01 April 2019
• Published date: 01 April 2019
• Subject Matter: Articles

https://doi.org/10.1177/0022042618815688

Journal of Drug Issues

2019, Vol. 49(2) 279 –295

© The Author(s) 2018

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DOI: 10.1177/0022042618815688

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Article

Correlates of Breath Alcohol

Concentration Among Driving

Under the Influence Program

Clients in Southern California

Natasia S. Courchesne1,2, Conner M. Muth3, Melanie Barker4,

and Susan I. Woodruff1

Abstract

Understanding factors correlated with breath alcohol concentration (BrAC) at time of arrest

for driving under the influence (DUI) may lead to informed rehabilitation programs. This study

describes correlations between BrAC at time of arrest and sociodemographic, mental, and

physical health, and alcohol-related characteristics among clients in a large California DUI

Program. Client reported data (n = 17,282) were collected at an intake from 2009 to 2014.

BrACs ranged from 0.083% to 0.390%, with an average of 0.159% (SD = 0.051), almost twice

the legal limit in the state. Approximately 10.6% of the variance in BrAC was explained by 11

significant correlates. Two sociodemographic factors (age and race/ethnicity) as well as several

alcohol-related characteristics were related to higher BrAC levels, whereas comorbid mental

and physical health factors played less of a role. Factors associated with BrAC are complex and

warrant further investigation to identify causality and inform future interventions.

Keywords

BrAC, blood alcohol concentration, drunk driving, DUI, MAST, CAGE, alcohol use disorder

Introduction

Driving under the influence (DUI) of alcohol poses great risk to personal and public safety. In the

United States, 28 people die in an alcohol-related vehicle crash every day—that is, one person

every 51 min (National Highway Traffic Safety Administration, 2017). Although the last three

decades have seen drunk driving fatalities fall by a third, drunk driving is involved in one in three

crash deaths (Centers for Disease Control and Prevention [CDC], 2016). Death and damages

from alcohol-related vehicle crashes cost US$52 billion per year (CDC, 2016). Greater under-

standing of how to prevent these adverse outcomes is essential.

1San Diego State University, CA, USA

2University of California, San Diego, CA, USA

3Virginia Commonwealth University, Richmond, VA, USA

4County of San Diego DUI Program, San Diego, CA, USA

Corresponding Author:

Susan I. Woodruff, c/o 1722 Latour Ave, Brentwood, CA 94513, USA.

Email: swoodruff@sdsu.edu

815688JODXXX10.1177/0022042618815688Journal of Drug IssuesCourchesne et al.

research-article2018

280 Journal of Drug Issues 49(2)

In an effort to address this important public health concern, different strategies have been used

to mitigate risk (e.g., mandated interlocks, alcohol server education, mass media campaigns,

victim advocacy). Among the most common strategies, breathalyzers are used by law enforce-

ment to provide an indirect, noninvasive estimate of the percentage of alcohol in a driver’s blood

stream. These breath tests are the most widely used impaired-driving field test in the world; are

used during sobriety checkpoints, certain traffic violations, and at serious crashes; and are

accepted forensically (Pechansky et al., 2012). In the United States, drivers above the age of 21

who are stopped, and who test positive for a breath alcohol concentration (BrAC) of 0.08% or

higher may be arrested and charged with DUI. In 2015 alone, nearly 1.1 million drivers across

the United States were arrested for a DUI (U.S. Department of Justice, Federal Bureau of

Investigation, 2016). There are about 160,000 DUI arrests per year in California, with about 73%

resulting in a conviction (California Office of Traffic Safety, 2016). Those convicted of a DUI

may face driver’s license suspension, fees and fines, increased insurance premiums, court-man-

dated community service, and jail time. In addition, rehabilitation programs have been developed

and are court ordered in California. These programs require regular attendance and completion

of the program to avoid additional sanctions. More information about California’s DUI laws and

driving under the influence program (DUIP) enrollment can be found at https://www.dmv.org

/ca-california/automotive-law/dui.php.

Beyond consideration of the legal limit of 0.08% in most states, the level of intoxication (i.e.,

as measured by BrAC level) is also an important factor to consider, in that, there is a dose–

response relationship between decrements in cognitive function and risk of different types of

injury with increasing BrAC (Kuendig, Hasselberg, Laflamme, Daeppen, & Gmel, 2008;

Starkey & Charlton, 2014; Taylor et al., 2010). According to the National Institute on Alcohol

Abuse and Alcoholism (NIAAA), as blood alcohol increases, so does impairment and the risk

of alcohol-related crashes and fatalities (Hingson & Winter, 2003), with values between 0.06%

and 0.15% indicative of increased impairment, 0.16% to 0.30% indicative of severe impair-

ment, and 0.31% to 0.45% indicative of life-threatening risk (NIAAA, 2015). In recognition of

the increasing risk of increasingly high BrAC levels, many states have passed laws affording

greater drunk driving penalties (e.g., higher fines, lengthier license suspension) in instances

where the blood alcohol content (BAC) is above a certain level, for example, >15% (National

Conference of State Legislatures, 2016). The importance of level of BrAC is further justified

insofar as high intoxication levels predict increased DUI recidivism (Lapham, Skipper, Hunt, &

Chang, 2000; Marowitz, 1998). However, few studies have examined intoxication as a continu-

ous measure. When intoxication among drunk drivers and bar patrons has been measured as a

continuous variable, the levels included in analyses have been relatively low (Martin, Brechbiel,

Chaney, Cremeens-Matthews, & Vail-Smith, 2016), or limited in range (Hubicka, Källmén,

Hiltunen, & Bergman, 2010; Hubicka, Laurell, & Bergman, 2010). Studies that include BrAC

as a variable in its continuous, meaningful numerical scale could provide increased statistical

power, precision, and gains in information about individual differences (MacCallum, Zhang,

Preacher, & Rucker, 2002).

Greater understanding of DUIP client characteristics could lead to more effective rehabilita-

tion by tailoring programs to better serve clients (Hubicka et al., 2010), yet few studies have

described individuals’ characteristics as they relate to BrAC level upon arrest. A nationwide

roadside study in Brazil found that higher BrAC levels were associated with less education, being

above the age of 30, and binge drinking (Pechansky et al., 2012). A study conducted in Sweden

investigating age, sex, and BrAC of those arrested for a DUI over an 8-year period found that

higher BrACs were related to older age, although BrAC was not different by sex (Jones &

Holmgren, 2009). Other research has suggested that DUI clients have high rates of psychiatric

comorbidities (Driessen et al., 2008; Peller, Najavits, Nelson, LaBrie, & Shaffer, 2010) and par-

ticular personality characteristics (Hubicka, Källmén, Hiltunen, & Bergman, 2010). Hohman and