Alcohol, Trauma and Impaired Driving

3RD Edition, 2006

Alcohol, Trauma and Impaired Driving

3RD Edition, 2006

Prepared by: C. Bryant L. Gibbs E. Usprich L. Crosby S. Kettle C. Zahnleiter R. Solomon

Phone: (905) 829-8805 Toll-free in Canada: 1-800-665-MADD Fax: (905) 829-8860, E-mail: info@madd.ca 2010 Winston Park Drive, Suite 500 Oakville, Ontario L6H 5R7 www.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.

TABLE OF CONTENTS
INTRODUCTION ........................................................................................................................ 1 PART I: GENERAL INFORMATION ..................................................................................... 2
SELECTED ALCOHOL FACTS ........................................................................................................................................ 2 Canada .......................................................................................................................................................................................2 British Columbia........................................................................................................................................................................3 Ontario.......................................................................................................................................................................................3 United States..............................................................................................................................................................................3 United Kingdom ........................................................................................................................................................................4 Europe........................................................................................................................................................................................5 Australia ....................................................................................................................................................................................5 CONSUMPTION PATTERNS ............................................................................................................................................ 7 Canada .......................................................................................................................................................................................7 British Columbia........................................................................................................................................................................8 Ontario.......................................................................................................................................................................................8 United States..............................................................................................................................................................................9 United Kingdom ......................................................................................................................................................................10 Australia ..................................................................................................................................................................................11 ALCOHOL CONSUMPTION CHARTS.......................................................................................................................... 13 National Per Capita Alcohol Consumption In Litres, 2002 .....................................................................................................13 Alcohol Consumption Per Capita: Canada, 1988-2004..........................................................................................................13 Alcohol Consumption Per Capita: Provinces And Territories, 2004......................................................................................14 Binge Drinking Among Current Drinkers At Least Once In The Past Year, By Age: Canada, 2003 .....................................14 Binge Drinking Among Current Drinkers 12 Or More Times In The Past Year, By Age: Canada, 2003 ..............................15 Binge Drinking Among Current Drinkers In The Past Month, By Age: United States, 2003.................................................15 Type Of Alcohol Use By Gender, Among Persons 12 Or Older In The Past Month: United States, 2003............................16 Type Of Alcohol Use By Persons 12 Or Older In The Past Month: United States, 2003 .......................................................16 Binge Drinking Among Current Drinkers, By Age: United Kingdom, 2000/01 ....................................................................17 COSTS OF ALCOHOL USE ............................................................................................................................................. 18 Canada .....................................................................................................................................................................................18 British Columbia......................................................................................................................................................................18 United States............................................................................................................................................................................19 United Kingdom ......................................................................................................................................................................19 ALCOHOL COST CHARTS ............................................................................................................................................. 20 Direct Law Enforcement Costs Of Alcohol Use, In Millions: Canada, 1992..........................................................................20 Costs Of Alcohol Use, In Millions: Canada, 1992 ..................................................................................................................20 Estimated Cost Of Alcohol And Drug-Impaired Driving Crashes, In Millions: Canada, 2003..............................................21

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

ALCOHOL, DROWNING AND BOATING .................................................................................................................... 22 Canada .....................................................................................................................................................................................22 British Columbia......................................................................................................................................................................22 Ontario.....................................................................................................................................................................................22 United States............................................................................................................................................................................22 United Kingdom ......................................................................................................................................................................23 Europe......................................................................................................................................................................................23 ALCOHOL AND FALLS ................................................................................................................................................... 24 Canada .....................................................................................................................................................................................24 Ontario.....................................................................................................................................................................................24 United States............................................................................................................................................................................24 United Kingdom ......................................................................................................................................................................24 Europe......................................................................................................................................................................................25 ALCOHOL AND FIRES .................................................................................................................................................... 26 Canada .....................................................................................................................................................................................26 Ontario.....................................................................................................................................................................................26 United States............................................................................................................................................................................26 United Kingdom ......................................................................................................................................................................27 ALCOHOL AND THE WORKPLACE ............................................................................................................................ 28 Canada .....................................................................................................................................................................................28 Alberta .....................................................................................................................................................................................28 United States............................................................................................................................................................................28 United Kingdom ......................................................................................................................................................................30 New Zealand............................................................................................................................................................................30 ALCOHOL AND SPORTS ................................................................................................................................................ 31 Ontario.....................................................................................................................................................................................31 United States............................................................................................................................................................................31 ALCOHOL AND VIOLENCE........................................................................................................................................... 32 Canada .....................................................................................................................................................................................32 British Columbia......................................................................................................................................................................32 Ontario.....................................................................................................................................................................................33 United States............................................................................................................................................................................33 United Kingdom ......................................................................................................................................................................34 Australia ..................................................................................................................................................................................34 ALCOHOL AND SUICIDE ............................................................................................................................................... 36 Canada .....................................................................................................................................................................................36 British Columbia......................................................................................................................................................................36 United States............................................................................................................................................................................36 United Kingdom ......................................................................................................................................................................37 Europe......................................................................................................................................................................................37

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

CANADIAN TRAUMA DATA .......................................................................................................................................... 38 General ....................................................................................................................................................................................38 Children And Youth ................................................................................................................................................................38 Ontario.....................................................................................................................................................................................38 Aboriginal Peoples ..................................................................................................................................................................39 ALCOHOL AND DRUGS.................................................................................................................................................. 40 Canada .....................................................................................................................................................................................40 Atlantic Canada .......................................................................................................................................................................42 British Columbia......................................................................................................................................................................42 Ontario.....................................................................................................................................................................................42 Quebec.....................................................................................................................................................................................43 United States............................................................................................................................................................................43 United Kingdom ......................................................................................................................................................................45 Australia ..................................................................................................................................................................................45 Europe......................................................................................................................................................................................45 TRAUMA AND YOUTH CHARTS .................................................................................................................................. 46 Unintentional Trauma Death Among 15-19 Year Olds: Canada, 1997 ...................................................................................46 Intentional Trauma Death Among 15-19 Year Olds: Canada, 1997........................................................................................46 Unintentional Trauma Death Among 20-24 Year Olds: Canada, 1997 ...................................................................................47 Intentional Trauma Death Among 20-24 Year Olds: Canada, 1997........................................................................................47 ALCOHOL AND YOUTH CHARTS................................................................................................................................ 48 Relative Risk Of A Fatal Single-Vehicle Crash For Males, At Various BACs.......................................................................48 Percentage Of Alcohol-Related Crash Deaths, By Age Group: Canada, 2003 ......................................................................48 Percentage Of Alcohol-Related Traffic Deaths And Population, By Age Group: Canada, 2003...........................................49 Motor Vehicle Death Rates By Age Group, Per 100,000: Canada, 1997................................................................................49 Motor Vehicle Injury Rates By Age Group, Per 100,000: Canada, 1997................................................................................50 Deaths Per Billion Kilometres Travelled, By Age: Canada, 2001...........................................................................................50 Cumulative Estimate Of The Lives Saved In The United States By The Minimum Drinking Age Laws, 1975-2004 ...........51 Weekly And Monthly Heavy Drinking Among Current Drinkers: Canada, 2004 .................................................................51 Alcohol Consumption Among Current Drinkers On A Typical Drinking Day In The Past Year: Canada, 2004 ..................52 Percentage Of Current Drinkers Who Drank Hazardously In The Past Year: Canada, 2004..................................................52 Percentage Of Individuals Harmed By Drinking In The Past Year: Canada, 2004 ................................................................53

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

ALCOHOL AND PEDESTRIANS .................................................................................................................................... 54 Canada .....................................................................................................................................................................................54 British Columbia......................................................................................................................................................................54 United States............................................................................................................................................................................54 United Kingdom ......................................................................................................................................................................55 Sweden ....................................................................................................................................................................................55 Australia ..................................................................................................................................................................................55 ALCOHOL AND BICYCLISTS........................................................................................................................................ 56 Canada .....................................................................................................................................................................................56 Ontario.....................................................................................................................................................................................56 United States............................................................................................................................................................................56 United Kingdom ......................................................................................................................................................................57 ALCOHOL AND SNOWMOBILING .............................................................................................................................. 58 Canada .....................................................................................................................................................................................58 Ontario.....................................................................................................................................................................................58 United States............................................................................................................................................................................59 ALCOHOL AND ALL-TERRAIN VEHICLES (ATV)................................................................................................... 60 Canada .....................................................................................................................................................................................60 Ontario.....................................................................................................................................................................................60 ALCOHOL AND MOTORCYCLES ................................................................................................................................ 61 Canada .....................................................................................................................................................................................61 United States............................................................................................................................................................................61 United Kingdom ......................................................................................................................................................................62 ALCOHOL, DRUGS AND PILOTS ................................................................................................................................. 63 Canada .....................................................................................................................................................................................63 United States............................................................................................................................................................................63

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

CANADA ............................................................................................................................................................................. 64 Alcohol ....................................................................................................................................................................................64 Drugs .......................................................................................................................................................................................66 British Columbia......................................................................................................................................................................66 Ontario.....................................................................................................................................................................................66 Quebec.....................................................................................................................................................................................67 Other Provinces .......................................................................................................................................................................67 UNITED STATES............................................................................................................................................................... 68 Alcohol ....................................................................................................................................................................................68 Drugs .......................................................................................................................................................................................69 UNITED KINGDOM.......................................................................................................................................................... 71 Alcohol ....................................................................................................................................................................................71 Drugs .......................................................................................................................................................................................71 AUSTRALIA ....................................................................................................................................................................... 73 Alcohol ....................................................................................................................................................................................73 Drugs .......................................................................................................................................................................................74 NEW ZEALAND................................................................................................................................................................. 75 IMPAIRED DRIVING CHARTS ...................................................................................................................................... 76 Percentage Of Traffic Fatalities, By Road User Type: Selected OECD Countries, 1998 .......................................................76 Legal Impairment Among Fatally-Injured Drivers: Selected OECD Countries, 1997/98.......................................................76 Traffic Deaths Per Billion Kilometres Travelled: Selected OECD Countries, 2001 ..............................................................77 BAC Limits For Driving Worldwide.......................................................................................................................................77 Alcohol And Drug-Impaired Fatalities, Injuries And Property-Damage-Only (Pdo) Crashes: Canada, 1999-2003...............78 Percentage Of Fatal Crashes By Type Of Impairment: Canada, 2003 ....................................................................................78 BACs Of Alcohol-Positive Fatally-Injured Drivers: Canada, 1990 - 2002 .............................................................................79 Public Support For A Lower Criminal Code BAC Limit: Canada, 2005................................................................................80 Public Views On A .05% Criminal Code BAC Limit: Canada, 2005 .....................................................................................80 BACs For Males In Relation To Time, Weight And Standard Canadian Drinks ...................................................................81 BACs For Females In Relation To Time, Weight And Standard Canadian Drinks ...............................................................81 Annual Charges And Dispositions In Provincial And Territorial Courts: Cumulative Averages, 1994-1998 ........................82 Annual Convictions And Sentences In Canada: Cumulative Averages, 1994-1998 ..............................................................82 Americans Who Reported Driving Under The Influence Of Any Illicit Drug In The Past Year, By Age, 2003 ...................83 Americans Who Reported Driving Under The Influence Of Any Illicit Drug In The Past Year, By Age Group, 2003 ........83 Americans Who Reported Driving Under The Influence Of Alcohol In The Past Year, By Age, 2003 ................................84 Americans Who Reported Driving Under The Influence Of Alcohol In The Past Year, By Age Group, 2003.....................84

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INTRODUCTION*
This report has grown out of MADD Canadas ongoing public education and research projects. First, almost all of these initiatives are based, in part, on an understanding of the adverse consequences and costs of alcohol consumption. Second, many of the projects require that this type of information be marshalled, explained and documented. The more current, comprehensive and authoritative this information, the stronger the projects. This edition of the report is longer and broader in scope than its predecessors. For example, the materials on alcohol consumption and costs, alcohol and fires, and alcohol and the workplace have been expanded. We have also included information on alcohol and pilots as well as statistics on drug-impaired driving. The number of charts has been increased and we have placed them as close to the relevant text as possible. The primary purpose of this report is to provide a single, referenced source of current facts on alcohol-related trauma. While we have focused on Canada, data has also been included on the United States, the United Kingdom, Australia, and to a lesser extent Europe and New Zealand. More information has been included from other jurisdictions when that data was current and comprehensive, or when the Canadian data was not as detailed as we would have wanted. Although the international data must be used with caution, it provides a perspective in assessing how well Canada has fared in addressing certain alcohol-related problems. Whenever possible, we have relied on the most current and authoritative sources. Preference was given to articles from leading journals, review articles, government sources, and studies from well-recognized organizations, such as the National Highway Traffic Safety Administration, the Canadian Centre on Substance Abuse, the Centre for Addiction and Mental Health, and the Canadian Institute for Health Information. However, it is important to emphasize that we did not conduct a comprehensive review of the research literature, apply defined inclusion criteria, or undertake a systematic assessment of the relative quality of the research. Finally, we have not attempted to verify the findings that the various sources reported. Despite these limitations, this study should provide a useful resource for those interested in alcoholrelated trauma and impaired driving in Canada.

* The authors would like to acknowledge MADD Canada and the Centre for Addiction and Mental Health for providing the funding necessary to undertake this project. The project was also supported by grants from the Law Foundation of Ontario and AUTO 21, a member of the Networks of Centres of Excellence program. The authors would also like to thank Drs. N. Giesbrecht and R. Mann of the Centre for Addiction and Mental Health for reviewing the manuscript.

PART I: GENERAL INFORMATION

SELECTED ALCOHOL FACTS

CANADA It was estimated that 6,507 Canadians died in 1995 due to alcohol consumption. The largest number 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 in 1995. The greatest number of hospitalizations were for alcoholic psychosis, alcohol dependence syndrome or alcohol abuse (19,744 in total), non-motor vehicle accidents (19,412), and motor vehicle 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% of alcohol-related hospital admissions. These figures include victims who were killed or injured as a result of others intoxication (p. 1,674). Motor vehicle accidents accounted for 17.6% of alcohol-attributed deaths, but only 11.7% of hospital admissions (p. 1,674). In 1995, alcohol-related illnesses, accidents and intentional harms accounted for 3.1% of total mortality, 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-attributed deaths 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 and disease attributable to alcohol, tobacco and illicit drug use in Canada (2000) 162(12) CMAJ 1,669. 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 reported three 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.

In Canada, every litre increase in per capita alcohol consumption between 1950 and 1998 was accompanied 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 Addiction 883. Alcohol plays a role in pregnancy complications, such as miscarriages, still-born births, low birthweights, and premature births. Moreover, fetal alcohol spectrum disorder was the leading cause of preventable birth defects and developmental delay among Canadian children between 2002 and 2003. Research indicated that over 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: <http: //www.phac-aspc.gc.ca/dca-dea/publications/fasd-etcaf/framework_e.html>; and Statistics Canada, Births and Birth Rate, by Provinces and Territories (number of births) (Ottawa: Statistics Canada, 2005). Online: <http://www40.statcan.ca/l01/cst01/demo04a.htm>.

BRITISH COLUMBIA The provincial Vital Statistics Agency estimated that 1,689 British Columbians died as a result of alcohol consumption in 2000 (p. 13). Twelve percent of women drink during pregnancy, leading to between 200 and 320 babies being born 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 2000/01 were 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 constituted 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 average age of 42 for the non-alcohol-related hospitalizations (p. 3). Canadian Institute for Health Information (CIHI), Ontario Trauma Registry Bulletin: AlcoholRelated 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. This figure has not been below 103,247 since 1979. National Institute on Alcohol Abuse and Alcoholism (NIAAA), Number of Deaths and AgeAdjusted 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: <http:// www.niaaa.nih.gov/databases/armort01.txt>.

In 1997, unintentional injuries were the leading cause of death among Americans aged 1-34, and approximately one-third of these deaths were alcohol-related. Those who started drinking before the age of 21 were significantly more likely to suffer an unintentional injury while under the influence of alcohol sometime in their life than those who began drinking at or above the age of 21. R. Hingson et al., Age of Drinking Onset and Unintentional Injury Involvement After Drinking (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, affecting 25% 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 Interventions in Trauma Centres (1997) 42(2) The Journal of Trauma: Injury, Infection and Critical Care 299. More than one-third of Americans report that alcohol has caused trouble in their immediate family, which is the highest percentage response to this question in the more than 50 years it has been asked. F. Newport, More than a Third of Americans Report Drinking Has Caused Family Problems, (Washington D.C.: Gallup News Service, November 1999). Online: <http://www.gallup.com/ content/login.aspx?ci=3493>. An estimated 21.6 million Americans in 2003 were classified with substance dependence or abuse. 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 illicit drugs, 3.8 million were dependent on or abused only illicit drugs and 14.8 million were dependent on or abused only alcohol. Department of Health and Human Services, Overview of Findings from the 2003 National Survey on Drug Use and Health (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2003) at 7. Alcohol-related traffic deaths fell by 2.4% between 2003 and 2004. Nevertheless, alcohol-related crashes 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: <http://www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/T SF2004/809905.pdf>.

UNITED KINGDOM In 1996, there were approximately 75,000 years of life lost in England and Wales due to alcohol consumption. The main causes of alcohol-related mortality among 16-24 year olds were road traffic crashes, suicides and assaults. A. Britton and K. McPherson, Mortality in England and Wales attributable to current alcohol consumption (2001) 55 Journal of Epidemiology and Community Health 383.

A 1998 study found that 1 in 6 patients at Accident and Emergency (A&E) departments had alcohol-related injuries or problems. About half of the seriously-injured patients admitted via A&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 in 1990 to 33,345 in 1998 (p. 4). The total number of alcohol-related, non-fatal leisure accidents increased from 33,266 in 1990 to 71,050 in 1998 (p. 4). Between 1993 and 1998, the number of people who died each year due to the toxic effects of alcohol ranged from 127 to 166 (p. 5). Alcohol Concern, Factsheet 9: Alcohol and Accidents (London: Alcohol Concern, 2003). Online: <http://www.alcoholconcern.org.uk/files/20030819_152850_Alcohol%20and%20Accidents.pdf>.

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 Globe Magazine. Online: <http://www.ias.org.uk/publications/theglobe/99issue4/globe9904_p7.html>. 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 Related Burden 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 poisoning deaths 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 (an average of more than 4 standard drinks per day for men, and more than 2 standard drinks per day for 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 more likely to die from conditions related to long-term alcohol misuse. Alcohol-caused death rates among females decreased slowly but consistently between 1990 and 1997.

Alcohol-related death rates among males declined rapidly between 1990 and 1993, but showed little evidence of decline in the following years. During 1996/97, high-risk drinking was responsible for 72,302 hospitalizations and 403,795 hospital 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 and Hospitalizations in Australia, 1990-1997 (Perth: National Drug Research Institute, Curtin University, 1999) at 1 and 3.

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 per month. 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 were also more likely to drink at least once a week, have 5 or more drinks per occasion, and exceed the low-risk consumption guidelines (i.e. no more than 14 drinks per week for males or 9 drinks per week 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 common among 18-24 year olds than older Canadians. About 16.0% of past-year drinkers reported that their usual consumption pattern was to have 5 or more drinks at a sitting. This pattern of drinking was found to be more common among males than 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 those with a university degree and 89% of those in the highest income adequacy bracket had consumed 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 6,282 undergraduate 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 of the 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% reported using within the past 30 days. During the past month period, students who consumed alcohol reported drinking an average of 1.3 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% of past 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-campus locations (86% of the time). Students living on campus or off campus without family drank more often and more heavily than students living off campus with family.

Thirty-two percent of the students (37.6% of males and 27.5% of females) reported hazardous drinking as measured by scoring 8 or more on the 10-item Alcohol Use Disorder Identification Test (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 school year were having a hangover (53.4%), memory loss (25.4%), regretting their actions (24.5%), and missing 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 while driving (3.8%). The commonly reported harms resulting from other students drinking were study or sleep disruptions (32.9%), serious arguments or quarrels (17.3%), being assaulted (10%), and being sexually harassed (9.8%). E. Adlaf et al., Canadian Campus Survey, 2004, Executive Summary (Toronto: Centre for Addiction and Mental Health, 2005 at 1-8. Among Canadians aged 12 and over who reported drinking in 2000/01, 43.4% admitted binge drinking 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 on one 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 alcohol within 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 the population (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 Columbia drinkers (age 12 or older) were regular heavy drinkers (5 or more drinks per occasion, 12 or more 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 of grade-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 increased slightly from 56% in 1995 to 57.8% in 2005 (p. 21).

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-7 students (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 was defined as a pattern of drinking that increases the likelihood of future medical and physical problems. 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 more drinks 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 drugs during the past 12 months (p. 200). In 2005, 6% of Ontario students reported both alcohol problems and related psychological distress (e.g. symptoms of anxiety or depression) (p. viii). E. Adlaf and A. Paglia-Boak, Drug Use Among Ontario Students 1977 - 2005: Detailed Ontario Student Drug Use Findings (Toronto: Centre For Addiction and Mental Health, 2005). Online: <http://www.camh.net/pdf/OSDUS2005_DrugDetailed_final.pdf>.

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 past 30 days). Moreover, 6.8% reported being heavy drinkers (5 or more drinks per occasion at least 5 times in the past 30 days). The rate of binge drinking among 18-25 year olds was 41.6%. Among this age group, 15.1% of respondents 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 month before the survey (i.e. 7.2 million people). Department of Health and Human Services, Overview of Findings from the 2003 National Survey on Drug Use and Health (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004) at 4-5. A 2002 survey of adults (21 and older) found that 46% reported not drinking in the 30 days prior to 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, but consumed 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 old drinkers 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).

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 happy hours and drinking games, often target young drinkers and promote binge drinking (p. 3). Pacific Institute for Research and Evaluation, Drinking in America: Myths, Realities, and Prevention Policy (Washington: US Department of Justice, Office of Juvenile Justice and Delinquency 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 emergency medical 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, and 62% 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, and more 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 school students who do not (p. 4). Teen heavy drinkers and binge drinkers are more than twice as likely as non-drinkers to report that they deliberately try to hurt or kill themselves or think about hurting or killing themselves. A heavy drinker is defined as a person who reports binge drinking at least 5 times in the past 30 days (p. 3). Two-thirds of teens who are heavy drinkers also use at least one other illicit drug, compared to only 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 not drink (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: Americas Underage 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 more than 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 per week and women drank an average of 7.6 units (4.5 standard Canadian drinks) per week from 1998 to 2002 (p. 9). In 2001, beer accounted for 58% of the alcohol consumed, wine accounted for 25% and spirits accounted 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).

10

Institute of Alcohol Studies (IAS), Drinking in Great Britain (St. Ives: IAS, March 2005). Online: <http://www.ias.org.uk/factsheets/drinking-gb.pdf>. In 2002, 32% of females and approximately 45% of males aged 16-19 in the UK had a hazardous drinking pattern (drinking to the point where the individual is at risk of physical or psychological harm). 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 age except 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 the recommended maximum limits for adults (21 drinks per week for men and 14 drinks per week for women). Among 18-24 year olds, approximately 42% of men and 22% of women reported exceeding these limits (p. 12). A Liverpool hospital reported that children as young as 8 are being admitted with acute alcohol intoxication. 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 least once 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: <http://www.ias.org.uk/factsheets/young-people.pdf>.

AUSTRALIA A 1998 survey indicated that people who regularly drink at levels above the low risk for longterm harm accounted for 39% of the total alcohol consumed in Australia. Low-risk for long-term harm 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 longterm health problems, such as liver damage (p. 3). Fifty-one percent of alcohol consumption occurs in situations of medium or high risk of acute harms, such as traffic crashes, falls or violence. Medium risk is defined in terms of 7 or 8 drinks per occasion for males and 5 to 6 drinks for females. High risk is defined as 9 or more drinks per occasion 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 by 14-17 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 highrisk 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 in Australia, 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 9.03 litres in 1995/96. Nevertheless, Queensland, Western Australia and metropolitan areas in the Northern 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).

11

The trends in adult per capita consumption closely reflected the patterns in alcohol-related deaths and traffic crash injuries (p. 1). P. Catalano et al., National Alcohol Indicators Bulletin No. 4: Trends in Per Capita Alcohol Consumption in Australia, 1990/91-1998/99 (Perth: National Drug Research Institute, Curtin University, 2001).

12

ALCOHOL CONSUMPTION CHARTS

NATIONAL PER CAPITA ALCOHOL CONSUMPTION IN LITRES, 2002* France Luxembourg Ireland Hungary Czech Republic Portugal Denmark Spain United Kingdom Austria Switzerland Germany 14.8 14.7 14.3 13.4 11.9 11.5 11.2 11.2 11.1 11.0 10.8 10.4 Netherlands Australia Belgium New Zealand Finland Greece Italy United States Canada Sweden Iceland Norway 9.8 9.8 9.6 9.2 9.2 9.1 8.6 8.3 7.8 6.9 6.5 5.9

* Population aged 15 years and older Source: Organization for Economic Co-operation and Development (OECD), OECD Health Data 2005 (Paris: OECD, June 2005). Online: <http://www.oecd.org/document/ 16/0,2340,en_2649_34631_2085200_1_1_1_1,00.html>.

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

8

Litres

4 1988 1990 1992 1994 1996 1998 2000 2002 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 1998 (Ottawa: Brewers Association of Canada, July 1999) at 39; and Brewers Association of Canada, Annual Statistical Bulletin 2004 (Ottawa: Brewers Association of Canada, 2005) at 39.

13

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 THE PAST YEAR, BY AGE: CANADA, 2003
90 80 70 Percentage 60 50 40 30 20 10 0 15 - 19 20 - 24 25 - 34 35 - 44 45 - 54 55 - 64
* 5 or more drinks on a single occasion. Source: Statistics Canada, Frequency of Drinking 5 or More DrinksCanada, 2003 (Ottawa: Statistics Canada, 2003). Online: <http://www.statcan.ca/english/freepub/82-221XIE/00604/tables/html/2157_03.htm>.
Males Females

14

BINGE DRINKING* AMONG CURRENT DRINKERS 12 OR MORE TIMES IN THE PAST YEAR, BY AGE: CANADA, 2003
50

40

Percentage

30

Males
20

Females

10

0 15 - 19 20 - 24 25 - 34 35 - 44 45 - 54 55 - 64

* 5 or more drinks on a single occasion. Source: Statistics Canada, Frequency of Drinking 5 or More DrinksCanada, 2003 (Ottawa: Statistics Canada, 2003). Online: <http://www.statcan.ca/english/freepub/82-221XIE/00604/tables/html/2157_03.htm>.

BINGE DRINKING* AMONG CURRENT DRINKERS IN THE PAST MONTH, BY AGE: UNITED STATES, 2003
60 50 40 Percentage 30 20 10 0 12 - 17 18 - 25 26 or Older 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: Detailed Tables (Washington: US Department of Health and Human Services, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

15

TYPE OF ALCOHOL USE BY GENDER, AMONG PERSONS 12 OR OLDER IN THE PAST MONTH: UNITED STATES, 2003
70

60

50

40 Males 30 Females

20

10

0 Any Binge* Heavy**

* 5 or more drinks on a single occasion (4.7 standard Canadian drinks). ** 5 or more binge drinking occasions in the past 30 days. Source: Office of Applied Studies, 2003 National Survey on Drug Use & Health: Detailed Tables (Washington: US Department of Health and Human Services, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

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

No Use 21%

Heavy Use 7%

Any Use 49%

Binge Use 23%

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. Source: Office of Applied Studies, 2003 National Survey on Drug Use & Health: Detailed Tables (Washington: US Department of Health and Human Services, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

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

40 35 30 Percentages 25 20 15 10 5 0 16 - 24 24 - 55 45 - 64 65+ All * 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). Males Females

Source: Binge Drinking Costing Billions BBC News (19 September 2003). Online: <http://news.bbc.co.uk/1/hi/health/3121440.stm>.

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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 morbidity and premature mortality; $1.36 billion for law enforcement; and $1.30 billion in direct health care costs (p. 36). Police It was estimated that in 1992, 11.9% of all offences which officially came to police attention were related to alcohol (p. 48). Total policing expenditures in 1992 were estimated at $5.39 billion. The policing costs attributed to 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 in Canada (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 $3.1 billion (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 on Substance Abuse, 1996).

BRITISH COLUMBIA In 1992, the provinces annual alcohol-related costs were estimated to be: $179 million annually for health care; $143 million for law enforcement; $529 million for lost productivity due to morbidity, premature mortality and crime; and $93 million for fire damage, traffic accidents and other 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).

18

UNITED STATES In 2000, drivers with BACs of .10% and above were involved in an estimated 2,058,400 crashes that killed 12,892 and injured 448,630 people. Drivers with BACs between .080% and .099% were involved in an estimated 35,410 crashes that killed 1,097 and injured 20,150 people. Drivers with positive BACs below .08% were involved in an estimated 69,400 crashes that killed 2,664 and injured 43,730 people. Alcohol was a factor in 26% of the total crash costs. Alcohol-related crashes cost the American public 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 alcoholrelated crashes. The average alcohol-related fatality costs $3.5 million, which includes $1.1 million in monetary costs 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 in monetary 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 cost per 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 insurance payments. Reducing alcohol-related crashes by 10% would save $1.8 billion in insurance payments and loss adjustment expenses. National Highway Traffic Safety Administration, Impaired Driving in the United States. Online: <http://www.nhtsa.dot.gov/people/injury/alcohol/impaired-drivingusa/US.pdf>. Drivers and non-occupants with BACs of .10% or greater accounted for 75% of all alcoholinvolved crash costs (p. 2). The impact of alcohol involvement increases with injury severity. Alcohol-involved crashes accounted 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: <http://www.lhsc.isu.edu/OutsideLinks/ EconomicImpact-1.pdf >.

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: <http://www.strategy.gov.uk/downloads/ files/econ.pdf>.

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ALCOHOL COST CHARTS

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

Corrections, $389.3 Police, $665.4

Courts, $304.4

Total Law Enforcement Costs: $1,359.1 billion

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

$1,300.6 Direct Health Care $273.1 Other

$1,359.1 Direct Law Enforcement

Traffic Crash Damage

$482.8

$4,136.5 Productivity Losses

Total Costs: $7,552.1 billion

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

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ESTIMATED COST OF ALCOHOL AND DRUG-IMPAIRED DRIVING CRASHES, IN MILLIONS: CANADA, 2003
Fatal Number of Crashes Real Dollar Costs* Deferred Future Income** Willingness to Pay*** 1,048 $303 $1,063 $8,067 Personal Injury 50,707 $1,317 $1,242 $1,677 Property Damage Only 161,298 $263 $1,207 $1,207 Total 213,053 $1,883 $3,512 $10,951

* 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.

21

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 in each of the preceding 5 years. Between 1992 and 2001, alcohol was involved in 44% of preventable water-related deaths involving victims aged 18-49. From 1992 to 2001, alcohol was involved in 37% of boating deaths, 42% of recreational powerboating 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: <http://www.lifesaving.ca/content/english/pdf/NationalDrowningTrendsEng lish1992-2001.pdf>.

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 to 2001. 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 boating incidents, 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 in Ontario, 2004 edition (Toronto: Lifesaving Society, 2004) at 22. Online: <http://www.lifesaving society.com/PDF/98DrowningReport2004Edition.pdf>.

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

22

fourth most common cause of unintentional injury deaths for all ages and the third most common cause for 5-44 year olds (p. 85). Three literature reviews concluded that between 30% and 50% of adolescent and adult drowning victims had been drinking (p. 86). One study of non-boating fatalities indicated that having a positive BAC below .10%, increased the 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 (Totowa, NJ: Humana Press, 1995) 85. In 1998, 800 Americans died in recreational boating incidents. Data from four states with high testing 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 likely to die, and boaters with a BAC greater than .10% were 12 times more likely to die than boaters with a zero BAC (p. 2,978). G. Smith et al., Drinking and Recreational Boating Fatalities: A Population-Based CaseControl Study (2001) 286(23) JAMA 2,974. In 2003, the U.S. Coast Guard received reports of 5,438 recreational boating accidents, resulting in 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 Homeland Security, February 2003). Online: <http://www.uscgboating.org/statistics/Boating_Stat istics_2003.pdf>.

UNITED KINGDOM The Royal Life Saving Society has identified alcohol as the most common risk factor in drowning deaths (p. 3). In 1998, there were 79 alcohol-related drownings in the UK, representing 15% of total drownings. Males accounted for 90% of these alcohol-related drownings (p. 3). Alcohol Concern, Factsheet 9: Alcohol and Accidents (London: Alcohol Concern, 2001). Online: <http://www.alcoholconcern.org.uk/files/20030819_152850_Alcohol%20and%20Accidents.pdf>.

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 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.

23

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 vehicle accidents accounted for 22% of deaths, but only 13% of hospitalizations and 12% of hospital days. E. Single et al., Morbidity and Mortality Attributable to Alcohol, Tobacco, and Illicit Drug Use in 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 hospitalizations in 11 lead Ontario trauma hospitals. Of the 203 people hospitalized for falls in 2000/01 who were tested for alcohol, 34% had a positive 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 810.

UNITED STATES In 1990, falls were the second leading cause of accidental death in the United States, accounting for 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% of those injured in falls had been drinking. A review of other studies indicates that alcoholics are 3 to 16 times more likely to suffer a fatal fall than other members of the public. C. Cherpitel, The Epidemiology of Alcohol-Related Trauma (1992) 16(3) Alcohol Health and Research World 191 at 194.

UNITED KINGDOM A 1998 survey of emergency departments found that a quarter of facial injuries were linked to alcohol 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: <http://www.ias.org.uk/factsheets/crime.pdf>.

24

EUROPE An early Finnish emergency room study found that the risk of a fall was 3 times greater for people 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 of Alcohol 231.

25

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 Centre on 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 United Kingdom 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 74 years of age accounted for the largest number of fire deaths, but only 3% of these victims were impaired 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 of Alcohol to Fire Fatalities in Ontario (2003) 3(5) Topical Fire Research Series. Online: <http://w ww.usfa.fema.gov/downloads/pdf/tfrs/v3i5.pdf>. In 2004, more than 24,000 fires were reported to the Ontario Fire Marshals Office, accounting for $395 million in property damages. Fires also resulted in 761 injuries, more than 400 hospitalizations and 97 deaths. Preventable residential fires accounted for 77% of the deaths. Drug or alcohol impairment was involved in 29% of the deaths, and in 14% of the cases the person was asleep with no known impairment. Lit smoking materials were the largest single source of ignition in the preventable residential fire deaths. 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 were intoxicated at the time of death. Alcohol was most often a factor in fatal fires caused by cigarettes.

26

Studies indicate that alcoholics are 10 to 26 times more likely to die in fires than other members of 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 the average BAC among these victims was .19%. D. Barillo and R. Goode, Substance abuse in victims of fire (1996) 17(1) Journal of Burn Care and Rehabilitation 71. Alcohol has been implicated in more than half of fatal residential fires. Among the adult victims who were tested for alcohol, 53% had a BAC above .10%. In this study, of the 190 fatalities, 124 victims 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 alcohol or other drugs. Fourteen of the 48 deaths among those under 18 years of age occurred in situations in which there was no adult supervision. Seven young victims died in fires in which one or more of the surviving adults had been judged to be impaired by alcohol or other drugs. S. Marshall et al., Fatal Residential Fires: Who dies and who survives? (1998) 279 JAMA 1633 at 1634. Fires and burns are the fourth leading cause of accidental death in the United States, accounting for 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 in single-family homes and duplexes. Healthlink, Medical College of Wisconsin, Preventing Home Fires During the Holidays (December 2001). Online: <http://www.healthlink.mcw.edu/article/1008273330.html>.

UNITED KINGDOM A series of studies by the Department of Forensic Medicine at Glasgow University found that 50% 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 and Accidents (St. Ives: IAS, 1999). Online: <http://www.ias.org.uk/factsheets/medsoc4.htm>. 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 in up 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: <http://www.alcoholconcern.org.uk/files/20030819_152850_Alcohol%20and%20Accide nts.pdf>.

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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 by 35% 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 workplace problem 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 on Substance Abuse, 1998).

ALBERTA A 2002 survey found that 11% of Alberta workers reported using alcohol at work in the past 12 months (i.e. 184,118 workers). Eighty-one percent of Alberta employees reported consuming alcohol in the year prior to the survey. 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 Workplace 1992-2002 (Edmonton: AADAC, 2003). Online: <http://corp.aadac.com/content/corporate /research/alcohol_use_alberta_workplace_profile.pdf>.

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 low compared 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 positive BACs. 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 be linked to alcohol consumption and alcoholism. Alcohol is the most widely abused drug among working adults. In 1999, an estimated 6.2% of adults working full-time were heavy drinkers. Heavy drinkers were defined as individuals who consumed 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 drinks on at least one occasion in the past 30 days). Among employed adults, the highest rates of heavy drinking and current illicit drug use were reported 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 preparation workers, waiters, waitresses, and bartenders (19%); construction workers (14%); service occupations (13%); and transportation and material moving workers (10%). A 1995 U.S. Department of Health and Human Services report indicated that alcohol and drug abuse cost American businesses an estimated $81 billion a year in lost productivity $37 billion due to premature death and $44 billion due to illness. Eighty-six percent of these combined costs were attributable to alcohol. A 1991 study indicated that alcoholism is estimated to account for 500 million lost workdays annually. The same study indicated that current heavy drinkers (8%) were more likely to have changed employers 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 skipped one 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: <http://www.dol.gov/asp/programs/drugs/workingpartners/stats/wi. asp>. In 1992, 24% of workers surveyed in a large manufacturing plant reported drinking on the job at least once during the year before the survey. In a survey of 6,540 employees at 16 worksites representing a range of industries, 23% of upperlevel managers reported drinking during working hours in the previous month. In a 1999 study, drinking at work, problem drinking, and frequency of getting drunk in the past 30 days were positively associated with frequency of absenteeism, arriving late to work or leaving early, doing poor work, doing less work, and arguing with co-workers. In 1995, productivity losses attributable to alcohol were estimated at $119 billion. National Institute on Alcohol Abuse and Alcoholism (NIAAA), Alcohol Alert, Alcohol and the Workplace (Bethesda, MD.: NIAAA, 1999). Online: <http://www.niaaa.nih.gov/publications/ aa44.htm>. In a 1997 national survey, 6.6% of Americans employed in full-time jobs reported heavy drinking (5 or more drinks per occasion on 5 or more days in the past 30 days). In addition, 4.9% of parttime employees and 10.4% of unemployed workers reported heavy drinking. The highest rate of heavy drinking occurred among unemployed 26-34 year olds (12.2%). Sixty percent of alcohol-related work performance problems could be attributed to employees who were not alcohol-dependent, but who occasionally drank too much on a work night or drank during a weekday lunch. Twenty-one percent of workers reported being injured, put in danger, having to re-do work or cover for a co-worker, or needing to work harder due to another workers drinking. National Council on Alcoholism and Drug Dependence (NCADD), Alcohol and Other Drugs in the Workplace (New York: NCADD, 1999). Online: <http://www.ncadd.org/facts/workplace. html>.

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UNITED KINGDOM A 2001 study found that 60% of employers reported problems related to alcohol misuse and 27% reported problems related to drug misuse. It is estimated that up to 25% of workplace accidents are alcohol related. An employee may be at work, but underperform due to alcohol or drug use at lunchtime or during breaks, or due to recovering from the previous nights drinking or drug use. National Treatment Agency for Substance Misuse (NTA), Drugs and Alcohol in the Workplace (London: NTA, March 2004) at 3. Online: <http://www.nta.nhs.uk/publications/docs/Drug_and _Alcohol.pdf>. It is estimated that alcohol misuse is responsible for between 8 to 14 million days of lost work each year in England and Wales, with a cost to industry of approximately 600 million. Drinkers take four times as many days off as other employees. One-in-five industrial accidents is alcohol-related. Drink Sense, Alcohol and the Workplace. Online: <http://www.drinksense.org/factsheets/work place.htm>.

NEW ZEALAND It is estimated that 20% to 25% of occupational injuries involve intoxicated workers. Absenteeism is 2 to 3 times higher for employees who use drugs and alcohol. Accident Compensation Corporation, Drugs and Alcohol in the Workplace. Online: <http://ww w.acc.co.nz/wcm001/idcplg?IdcService=SS_GET_PAGE&ssDocName=WCM001921&ssSource NodeId=4249>.

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ALCOHOL AND SPORTS

ONTARIO Three hundred and ten people were hospitalized in Ontario for a major sports/recreational injury in 1999/00. Of the 116 patients who were tested for alcohol, 21% had a BAC over .08%. There were 428 hospitalizations due to cycling injuries from 1995/96 to 1999/00. Of the 134 patients who were tested for alcohol, 26% had a BAC over .08%. APOLNET-L, Sports & Recreational Injuries in Ontario. Online: <http://www.web.ca/~apolnet/ apolnet-l.bak/msg00172.html>.

UNITED STATES Alcohol was reported to be a contributing factor in 31 of 126 sports-related spinal cord injuries in Oklahoma among persons over 4 years of age. Diving was the leading cause of sports-related spinal cord injury from 1988 to 1994, accounting for 53 of the 142 cases. Males accounted for 91% of the diving-related spinal cord injuries. Alcohol was involved in 52% of these injuries among males. Injury Update: A Report to Oklahoma Injury Surveillance Participants, Sports-Related Spinal Cord Injuries, Oklahoma, 1988-1994 (September 1996). Online: <http://www.health.state.ok.us/ program/injury/updates/sportsci.html>.

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ALCOHOL AND VIOLENCE

CANADA A 2002 study found that 54% of offenders entering federal custody (2 years imprisonment or more) reported having been under the influence of a psychoactive substance when they committed the most serious crime on their current sentence. Twenty-four percent were under the influence of alcohol, 19% were under the influence of drugs, and 11% were under the influence of both. In total, 30% of federal inmates committed their most serious crime under at least the partial influence of drugs, and 38% committed their most serious crime under at least the partial influence of alcohol. Alcohol intoxication was a dominant characteristic in the various violent crimes committed by the federal inmates. Among assault offenders, 39% reported being under the influence of alcohol at the time of the crime, and 24% reported being under the influence of both drugs and alcohol. Among those convicted of homicide, 34% reported being under the influence of only alcohol, 7% reported being under the influence of only illicit drugs, and 21% reported being under the influence of both alcohol and illicit drugs. Federal inmates who reported not using either drugs or alcohol during a six-month period of freedom reported an average of 1.7 crimes a week. Those who used one or more substances without being dependent committed an average of 3.3 crimes a week. K. Pernanen et al., Proportions of Crimes Associated with Alcohol and Other Drugs in Canada (Ottawa: Canadian Centre on Substance Abuse, April 2002) Executive Summary pp. 5-11. Online: <http://www.ccsa.ca/pdf/ccsa009105-2002.pdf>. Rates of being a victim of spousal violence were 6 times higher for people whose partners drank heavily than for those whose partners did not drink or drank moderately. Heavy drinkers were defined as those who consumed 5 or more drinks on 5 or more occasions in the past month (p. 16). From 1979 to 1998, alcohol and/or drug abuse was reported in 39% of spousal homicide cases. Alcohol abuse was defined as having 5 or more drinks on 5 or more occasions per month (p. 41). Thirty-five percent of respondents whose partner had been violent in the past 5 years reported that their partner had been drinking at the time. Women (43%) were more likely than men (25%) to report that their partner had been drinking at the time of the incident (p.16). Statistics Canada: Canadian Centre for Justice Statistics 2000, Family Violence in Canada: A Statistical Profile 2000 (Ottawa: Statistics Canada, 2000). Online:<http://www.statcan.ca/english /freepub/85-224-XIE/0000085-224-XIE.pdf>.

BRITISH COLUMBIA In 2000, about half of the 4,944 spousal assaults reported in British Columbia were alcoholrelated. This proportion has not changed substantially since 1993 (p. 11). About 5% of parents of children under 12 said drinking was a source of tension or disagreement at home. Children in these families were being exposed to inappropriate consumption and are at increased risk of alcohol misuse themselves (p. 11). 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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ONTARIO Assaults accounted for 15% of the alcohol-related major injury hospitalizations from 1996/97 to 2000/01. Assaults were the third most common alcohol-related major injury, after traffic accidents and falls (p. 10). In 2000/01, all of the people hospitalized for alcohol-related assaults were male, and the average age of these patients was 29 (p. 10). 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 10.

UNITED STATES Alcohol consumption is closely associated with about half of all violent events. Both domestic and foreign studies conducted between 1951 and 1992 have found that alcohol is involved in 50% to 67% of homicides, 25% of serious assaults, and 25% of rapes. S. Martin, The epidemiology of alcohol-related interpersonal violence (1992) 16(3) Alcohol, Health & Research World 230. In 1996, corrections authorities supervised an estimated 5.3 million offenders a day. Nearly 2 million (36%) had been drinking at the time of the offence (p. vi). Among violent offenders in 1996, 41% of probationers, 41% of those in local jails, 38% of those in state prisons, and 20% of those in federal prisons were estimated to have been drinking when they committed the crime (p. vii). Between 1992 and 1995, there was an average of 11.1 million victims of violence each year. On average, 25% of victims were certain and an additional 37% believed that the offender had been drinking before the crime (p. 3). U.S. Department of Justice, Bureau of Justice Statistics, Alcohol and Crime (Washington: Bureau of Justice Statistics, 1998). Online: <http://www.ojp.gov/bjs/pub/pdf/ac.pdf>. Alcohol is the drug most likely to be present in rapes. Studies, when averaged, suggest that the perpetrator, victim or both had been drinking prior to approximately 50% of all rapes. Studies of rapists have found that more than 25% had used alcohol immediately preceding a rape. In general, alcohol involvement is considerably higher in date rapes than in other types of rapes. One study reported that 53% of perpetrators and 46% of victims had been drinking prior to reported campus date rapes. That study also found alcohol to be among the four strongest predictors of the likelihood of date rape. In another study, 68% of college women who had been raped or sexually intimidated reported that their male assailant had been drinking at the time. Studies of child abuse indicate that between 22% and 63% of cases involve alcohol. Studies of sexual molestation and incest indicate that alcohol is involved in 30% to 71% of cases. Partner battery studies indicate that alcohol is involved in 60% to 70% of the cases. J. Mosher, Like Pouring Gasoline on a Fire: Reducing Alcohols Role in Societal Violence (Revised version of a paper delivered at the 125th Annual Meeting of the American Public Health Association, Indianapolis, Indiana, November 9-13, 1997) at 5 and 6.

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UNITED KINGDOM One cohort study showed that male alcoholics were 15.23 times more likely to die from assaults than age-matched men in the general population (p. 573). Similarly, female alcoholics were 12.50 times more likely to die from assaults than age-matched women in the general population (p. 573). Males aged 16-24 have the highest rates of heavier drinking in Great Britain, and males aged 16-30 have the highest rates of violence victimization (p. 574). R. Norton and M. Morgan, The Role of Alcohol in Mortality and Morbidity from Interpersonal Violence (1989) 24(6) Alcohol & Alcoholism 565. A 1995 study found that alcohol was a factor in 60% to 70% of homicides, 75% of stabbings, 70% of beatings, and 50% of fights and domestic assaults (p. 2). Police Superintendents reported that alcohol was present in half of all crime. The National Association of Probation Officers found that 30% of probationers and 58% of prisoners had severe alcohol problems (p. 2). Various studies have found a strong association between alcohol-related violence and the concentration of licensed establishments in an area (pp. 7-8). The 2001/02 British Crime Survey found that 45% of domestic violence, 19% of muggings, 58% of stranger violence, and 51% of acquaintance violence were perpetrated by assailants under the influence of alcohol. Overall, 47% of assailants in violent incidents were described as being under the influence of alcohol (p. 3). In 1999, 32% of assault, 75% of robbery, 29% of criminal damage, 61% of breach of the peace, and 30% of vehicle theft arrestees tested positive for alcohol (p. 5). A 1998 survey of casualty (emergency) departments found that a quarter of facial injuries were linked to alcohol consumption. Approximately 18,000 young people are scarred for life each year as result of serious facial injuries caused by drunken assaults (p. 8). In England and Wales, approximately 70% of crime audits published in 1998 and 1999 identified alcohol as an issue, particularly in relation to public disorder (p. 1). A recent survey from 3 police force areas in England and Wales found that in 52% of all adult male-on-male homicides analyzed, either the victim or the offender had been drinking, often to excess (p. 5). In 2002, 45% of those accused in Scottish homicide cases were drunk at the time of the offence, an additional 15% were drunk and on drugs, and 10% were only on drugs (p. 5). Institute of Alcohol Studies (IAS), Alcohol and Crime (St. Ives: IAS, April 2005). Online: <http://www.ias.org.uk/factsheets/crime.pdf>.

AUSTRALIA Alcohol is a major contributing cause of violence in Australia. It was estimated that 47% of all perpetrators of assault and 43% of all victims of assault were intoxicated prior to the event. It was estimated that in 1997, alcohol-related violence resulted in 124 deaths, 4,381 years of life lost prematurely and 26,882 days of hospitalization. There was a consistently high level of alcohol-related violence in Australia during the 1990s. It was estimated that in 1998/99, 8,661 people were admitted to hospital as a result of alcoholcaused assaults (4.6 per 10,000 persons). Seventy-four percent of those admitted were male. Fifteen to thirty-four year olds were over-represented, accounting for 64% of these hospital admissions.

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An additional 62,534 serious alcohol-related assaults were reported to the police and still more were unreported. Rural areas of the Northern Territory, Western Australia, Queensland, and South Australia had markedly higher levels of hospital admissions for assault than urban regions. The Northern Territory consistently had the highest estimated rate of alcohol-caused assault hospitalizations and the highest rate of per capita alcohol consumption. In most jurisdictions, alcohol-related assaults reported by the police showed similar trends to alcohol-caused assault hospitalizations. Most jurisdictions showed relatively steady trends in alcohol-related violence from 1995/96 to 1998/99. However, the Northern Territory and Western Australia showed some evidence of increases in recent years. S. Matthews et al., National Alcohol Indicators Bulletin No. 5: Trends in Alcohol-Related Violence in Australia, 1991/92-1999/00 (Perth: National Drug Research Institute, Curtin University, 2002) at 1.

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ALCOHOL AND SUICIDE

CANADA Approximately 27% of all male suicides and 17% of all female suicides were attributed to alcohol in 1992. E. Single et al., The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada (2000) 162(12) CMAJ 1669 at 1670. In 1995, of the 6,503 deaths attributed to alcohol, 955 deaths (14.7%) resulted from suicide. 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 61. In 2001, 22 percent of youth aged 15 to 24 who died took their own life. Suicide is quickly approaching motor vehicle crashes as the leading cause of death among youth. Smartrisk, Ending Canadas Invisible Epidemic: A Strategy for Injury Prevention (Toronto: Smartrisk, 2005). Online: <http://www.timeforaction.ca>.

BRITISH COLUMBIA In a British Columbia study of deaths among those under 19 years of age, 34 of the 489 deaths between 1996 and 2000 resulted from suicide. Alcohol was mentioned in 71% of the suicide reports, and was present in 32% of the deceased. 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.

UNITED STATES A study of alcohol use and suicide in the United States between 1934 and 1987 found that when unemployment rates rose, so did per capita alcohol consumption and suicides (p. 459). Overall, a 1-litre per year increase in per capita alcohol consumption increased the suicide rate by about 3%. Among those under age 60, a 1-litre increase in per capita alcohol consumption increased the suicide rate by about 5%. When per capita alcohol consumption was approximately 10 litres per year, 26% of all suicides could be attributed to alcohol (p. 459). The effect of consumption on the suicide rate among women is similar to its effect on men (p. 460). It was suggested that alcohol consumption does not play a significant role in suicide among older people because alcohol use is lower among this group. Heavy drinking, often associated with suicide, is relatively uncommon among older people, probably because people who drink heavily are less likely to live past 60 years of age (p. 460). F. Caces and T. Harford, Time series analyses of alcohol consumption and suicide mortality in the United States, 1934-1987 (1998) 59 J. Stud. Alcohol 455.

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Suicide is the 9th leading cause of death in the United States, and the 3rd leading cause of death among 15-24 year olds. Alcohol is associated with a high percentage of suicides between 18% and 66% of suicide victims have alcohol in their blood at the time of death. Drinkers are twice as likely as non-drinkers to commit suicide in the home. Those for whom drinking results in trouble at work are 6 times more likely than non-drinkers to commit suicide in the home. A recent study found that states with higher per capita spirits sales have higher suicide rates. The authors concluded that a 10% increase in spirits sales results in a 1.4% increase in a states suicide rate. One study suggests that alcohol may be a more significant factor in impulsive, as opposed to planned, suicides. Alcohol was found to be involved more frequently in suicides in which the victim left no suicide note, had not made a prior suicide attempt, and had no long-standing physical or mental condition to which the suicide could be related. Alcohol-Related Injury and Violence (ARIV), Alcohol and Suicide: Literature Review (1998). Online: <http://www.tf.org/tf/alcohol/ariv/reviews/revsuic5.html>. In 2000, 12-17 year olds who had used alcohol in the past year were approximately 2.25 times more likely to be at risk of suicide than those who did not (p. 2). US Department of Health and Human Services, National Household Survey on Drug Abuse Report: Substance Use and the Risk of Suicide Among Youths (Rockville, MD.: US Department of Health and Human Services, July 2002). Online: <http://www.oas.sam-hsa.gov/2k2/suicide/ suicide.pdf>.

UNITED KINGDOM Forty percent of men who try to kill themselves have had a long-standing alcohol problem. Seventy percent of those who succeed in killing themselves were drinking alcohol prior to their death. The Royal College of Psychiatrists (RCP), Alcohol and Depression (London: RCP, 2004) at 3. A 2001 UK study found that 40% of the people who committed suicide, and had been in contact with a mental health services organization within the preceding year, had a history of alcohol misuse. A Northern Ireland study found that the risk of suicide is 8 times greater among those who currently misuse or are dependent upon alcohol than among those without these characteristics. T. Foster, Dying for a Drink (2001) 323 British Medical Journal 817 at 818.

EUROPE According to a review of studies from several different European countries, a history of alcohol abuse and heavy drinking was present in 10% to 54% of suicides (p. 2). M. Ramstedt, Alcohol and suicide in 14 European countries - A comparative time series analysis (Stockholm: Centre for Social Research on Alcohol and Drugs, 2001). Online: <http://www.sofi. su.se/suicideecas1.PDF>.

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PART III: TRAUMA, YOUTH, ALCOHOL, AND DRUGS

CANADIAN TRAUMA DATA

GENERAL Injuries are the number one killer of Canadians under the age of 45 and overall the fourth leading cause of death in Canada. In 2002, 13,477 Canadians died of injuries. It was estimated that injuries cost Canadians $14.7 billion annually in health care costs ($3.9 billion) and lost productivity ($10.8 billion). The average cost per injury was estimated to be $4,800. Injuries constitute the third leading source of hospital costs. Motor vehicle crashes, falls and poisoning account for almost 70% of injury-related health care costs. Smartrisk, Ending Canadas Invisible Epidemic: A Strategy for Injury Prevention (Toronto: Smartrisk, 2005). Online: <http://www.timeforaction.ca>.

CHILDREN AND YOUTH In 2002, 414 children under the age of 15 died of injuries in Canada. For every death, it was estimated that 86 children were hospitalized. Most child injury deaths are completely preventable. In 2001, Canada had the 18th highest rate of child injury among 26 OECD nations. Canadas child injury rate is approximately double that of Sweden which had the lowest. In 2001, 1,595 youth aged 15-24 died of injuries in Canada. Injuries kill more 15-24 year olds than all other causes combined, accounting for over 70% of all youth deaths. Approximately 45% of youth deaths involved motor vehicle crashes, and nearly 40% of these traffic deaths are alcohol-related. Smartrisk, Ending Canadas Invisible Epidemic: A Strategy for Injury Prevention (Toronto: Smartrisk, 2005). Online: <http://www.timeforaction.ca>. ONTARIO In 2001-2002, 9,737 individuals under the age of 20 years old were hospitalized due to injuries. Males under 20 had a higher rate of injury hospitalization than females. Falls were the most common cause of injury hospitalization for children under 15. However, motor vehicle crashes were the most common cause for 15-19 year olds. Canadian Institute for Health Information (CIHI), Ontario Trauma Registry Analytic Bulletin September 2003: Injury Hospitalizations Among Children and Youth in Ontario, 2001-2002 (Toronto: CIHI, 2003).

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ABORIGINAL PEOPLES Injuries are the leading cause of death for Aboriginal children, youth and adults under the age of 44. Suicide and self-injury accounted for 38% of deaths among 10-19 year olds, and 23% of deaths among 20-44 year olds. The death rate from injuries among all Aboriginal males of all ages is more than double that of females (146.7 deaths per 100,000 males vs. 67.6 deaths per 100,000 females). Suicides, followed by motor vehicle crashes, are the leading causes of male injury deaths. Among females, motor vehicle crashes are the leading cause of injury death. Health Canada, A Statistical Profile on the Health of First Nations in Canada (Ottawa: Health Canada, 2003). Online <http://www.hc-sc.gc.ca/fnih-spni/pubs/gen/2003_stat_profil/7_mortality -mortalite-stat_e.html>.

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ALCOHOL AND DRUGS

CANADA In 1997, 40% of 16-19 year old drivers who were killed in crashes had been drinking. Among these drinking drivers, 75% had BACs over .08% and 44% had BACs above .15%. Sixteen year olds accounted for 7.2% of the fatally-injured teenage drinking drivers, and 19 year olds accounted for 46.9%. Similarly, 16 year olds accounted for only 9.2% of the seriouslyinjured drinking drivers, whereas 19 year olds accounted for 37.6%. The percentage of fatally-injured teenage drivers who were alcohol positive dropped by 7% between 1990 and 1997. However, during this period, the percentage of fatally-injured teenage drivers who had BACs above .08% increased from 26% to 31%. Males accounted for 87% of the fatally-injured and 89% of seriously-injured teenage drinking drivers. Eighty-eight percent of the alcohol-positive, fatally-injured male drivers had BACs above .08%. Fifty-five percent of teenage drinking drivers died and 49.4% were seriously injured in crashes on weekends. Seventy-four percent of teenage drinking drivers died and 86% were seriously injured in crashes at night. Teenage drinking drivers were more likely to be involved in single-vehicle crashes than older drinking drivers. Seventy-seven percent of teenage drinking drivers who died and 91% of those injured were involved in single-vehicle crashes. D. Mayhew and H. Simpson, Youth and Road Crashes: Reducing the Risks from Inexperience, Immaturity, and Alcohol (Ottawa: Traffic Injury Research Foundation, 1999) at 6 and 7. Young drivers are at a greater risk of being killed per kilometre driven than older drivers. In 2001, 16-19 year old drivers were 9 times more likely to die per kilometre driven than 35-44 and 45-54 year olds. Similarly, 20-24 year olds were more than 5 times more likely to die per kilometre driven than these older age groups. Transport Canada, Road Safety in Canada: An Overview (Ottawa: Transport Canada, 2004). Online: <http://www.tc.gc.ca/roadsafety/stats/overview/2004/menu.htm>. In 2003, alcohol was a factor in 40.4% of the traffic fatalities among 16-19 year olds, and 49.9% of the traffic fatalities among 20-25 year olds. Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>. The Canadian Addiction Survey reported that, among current drinkers, 15-24 year olds have the highest rates of: (i) weekly and monthly heavy drinking (5 or more drinks for males and 4 or more drinks for females on a single occasion) (p. 31); (ii) consuming 5 or more drinks on a typical drinking day during the past year (p. 29); (iii) drinking in excess of the low-risk drinking guidelines (no more than 14 drinks for males and 9 drinks for females per week, and no more than 2 drinks per day for males or females (p. 32); (iv) hazardous drinking, as measured by scoring 8 or more on the 10-item Alcohol Use Disorders Identification Test (AUDIT). (This test is primarily used to screen for alcohol problems in clinical practice.) (p. 42).

40

Fifteen to twenty-four year olds also had, by far, the highest rates of suffering at least one harm in the past year caused by their own drinking (p. 44). The most commonly-reported problems related to: physical health; friendship and social life; financial position; home life and marriage; and work, study and employment (p. 43). Eighteen to twenty-four year olds had the highest rates of suffering at least one harm in the past year caused by the drinking of others (p. 46). Fifteen to seventeen year olds were not surveyed on this issue. E. Adlaf et al., Canadian Addiction Survey: Detailed Report (Ottawa: Canadian Centre on Substance Abuse, 2005). The Canadian Campus Survey, conducted in spring 2004, included responses from 6,282 undergraduate 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 of the 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% reported using within the past 30 days. During the past month period, students who consumed alcohol reported drinking an average of 1.3 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% of past 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-campus locations (86% of the time). Students living on-campus or off-campus without family drank more often and more heavily than students living off-campus with family. Thirty-two percent of the students (37.6% of males and 27.5% of females) reported hazardous drinking as measured by scoring 8 or more on the 10-item Alcohol Use Disorder Identification Test (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 school year were having a hangover (53.4%), memory loss (25.4%), regretting their actions (24.5%), and missing 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 while driving (3.8%). The commonly reported harms resulting from other students drinking were study or sleep disruptions (32.9%), serious arguments or quarrels (17.3%), being assaulted (10%), and being sexually harassed (9.8%). E. Adlaf et al., Canadian Campus Survey, 2004, Executive Summary (Toronto: Centre for Addiction and Mental Health, 2005 at 1-8.

41

A study of specialized trauma hospitals (excluding Saskatchewan, Manitoba and the Territories) reported that 10-24 year olds accounted for 27% of alcohol-related trauma admissions in 2002/03. Over 30% of alcohol-related motor vehicle collision injuries involved Canadians under the age of 25. Provinces with a legal drinking age of 19 had a rate of alcohol-related major injury of 9 per 100,000 among 18 year olds. In provinces with a drinking age of 18, the comparable rate among 18 year olds was 15 per 100,000. Canadian Institute for Health Information (CIHI), More Than Half of All Alcohol-Related Severe Injuries Due to Motor Vehicle Collisions (Ottawa: CIHI, 2005).

ATLANTIC CANADA Almost 49% of grade 10 and 12 students in the Atlantic provinces reported using cannabis (p. 1028). Among cannabis users, 15.1% reported driving under the influence of the drug in the past year (p. 1029). The highest rates of driving under the influence of cannabis were among males, students who had used fake IDs to purchase alcohol, and students who had driven under the influence of alcohol (p. 1029). Relative to students who did not drive under the influence of alcohol, students who did were 6 times more likely to drive under the influence of cannabis (p. 1031). Students who drove under the influence of cannabis were twice as likely as cannabis-free students to report being in a collision. Moreover, it was not cannabis consumption per se that increased the risk of a collision, but rather its use just prior to driving (p. 1031). Nearly 12% of students reported driving under the influence of alcohol (p. 1029). M. Asbridge et al., Motor vehicle collision risk and driving under the influence of cannabis: evidence from adolescents in Atlantic Canada (2005) 37 Accid. Anal. and Prev. 1025.

BRITISH COLUMBIA Vehicle crashes were the leading cause of death among children and youth in 2003, accounting for 37% of all fatalities. In 2003, 83 youths aged 13-21 were killed in road crashes and over 11,600 were injured. Youth CounterAttack and Road Sense Society of B.C. (CARS BC), Statistics Overview (Richmond: CARS BC, 2003). Online: <http://www.carsbc.org/stats/index.php?PHPSESSID=c1f6b6 20c423d94843f5e62b8d276b37>.

ONTARIO In 2005, about 14% of licensed drivers in grades 10-12 reported driving within an hour of consuming two or more drinks. In 1977, the rate was 58%. Twenty percent of drivers in grades 10-12 reported driving within one hour of using cannabis during 2005. In 2005, 29% of students in grades 7-12 reported being a passenger in a vehicle driven by someone who had been drinking alcohol, and 22% reported being a passenger in a vehicle driven by someone who had been using drugs prior to driving. E. Adlaf and A. Paglia-Boak, Drug Use Among Ontario Students 1977-2005, Detailed Ontario Student Drug Use Findings (Toronto: Centre for Addiction and Mental Health, 2005) at vii. Online: <http://www.camh.net/pdf/OSDUS2005_DrugDetailed_final.pdf>.

42

QUEBEC A Quebec study found that 24.3% of 16-19 year old drivers and 22.4% of 20-24 year old drivers who provided samples (urine and/or saliva) in a nighttime roadside survey tested positive for cannabis. C. Dussault et al., The Contribution of Alcohol and Other Drugs Among Fatally Injured Drivers in Quebec: Some Preliminary Results, in D. Mayhew and C. Dussault, eds., Proceedings of the 16th International Conference of Alcohol, Drugs and Traffic Safety, 2002 (Montreal: Socit de lassurance automobile du Qubec, 2002) at 429. Online: <http://www.sa aq.gouv.qc.ca/t2002/actes/pdf/(16a).pdf>. A study of drivers fatally-injured between April 1, 1999 and December 31, 2002 found that 12.2% of the 16-24 year old drivers were positive for only drugs and that 24.8% were positive for only alcohol. An additional 14.9% of the drivers were positive for both drugs and alcohol. J. Bouchard and M. Brault, Link Between Driving Records and the Presence of Drugs and/or Alcohol in Fatally Injured Drivers, in P. Williams and A. Clayton, eds., Proceedings of the 17th International Conference on Alcohol, Drugs and Traffic Safety, 2004 (Glasgow: International Council on Alcohol, Drugs and Traffic Safety, 2004). Online: <http://www.x-cd.com/t2004/pdfs/ O28.pdf>.

UNITED STATES Although alcohol use is illegal for those under 21, approximately 44% of 8th graders, 64% of 10th graders, 77% of 12th graders, and 85% of college students have tried alcohol. Twenty percent of 8th graders, 42% of 10th graders, and 60% of 12th graders reported being drunk at least once in their lifetime. Six percent of 8th graders, 19% of 10th graders, and 33% of 12th graders reported being drunk during the 30 days immediately before the survey. Young males drink more heavily than females. For example, 49% of college males report having five or more drinks in a row during the past two weeks versus 38% of college females. By the end of grade 8, 30% of Americans have tried an illicit drug (if inhalants are included), and by the end of grade 12, 53% have done so. By their late 20s, 61% of Americans have tried an illicit drug, excluding inhalants. Moreover, 35% have tried an illicit drug other than marijuana. L. Johnston et al., Monitoring the Future: National Survey Results On Drug Use, 1975-2004, Volume I, Secondary School Students (Bethesda, MD: National Institute on Drug Abuse, 2005). Online: http://www.monitoringthefuture.org/pubs/monographs/vol1_2004.pdf>. Binge drinking (5 or more drinks on a single occasion) and particularly driving while intoxicated increased among 18-24 year old college students since 1998 (p. 273). While the college population increased 3% between 1998 and 2001, alcohol-related unintentional injury deaths increased 9% to over 1,700 (pp. 267 and 259). In 2001, nearly 600,000 (10.5%) college students were injured because of drinking, 474,000 (8%) had unprotected sexual intercourse as a result of drinking, and more than 696,000 (12%) were assaulted or hit by another drinking college student (p. 267). R. Hingson et al., Magnitude of Alcohol-Related Mortality And Morbidity Among U.S. College Students Ages 18-24: Changes from 1998-2001 (2005) 26 Annu. Rev. Public Health 259.

43

A 2000 study of the low and zero BAC laws for drivers under 21 found significant decreases in nighttime single-vehicle injury (NSVI) crashes in Maine (40%) and Oregon (35%). These states enacted low BAC limits for young drivers in the early 1980s and strengthened these laws in the mid-1990s. Florida, which introduced a .02% BAC limit for young drivers in 1997, had only a 5% decrease in NSVI crashes. Texas, which introduced a zero BAC limit in 1997, showed no decrease in NSVI crashes. The authors suggested that the effectiveness of these measures will increase as enforcement rates rise in Florida and Texas. J. Lacey, R. Jones and C. Wiliszowski, Zero Tolerance for Youth: Four States Experience (Washington: National Highway Traffic Safety Administration, 2000). In 2004, the crash rate per mile driven by 16-19 year olds was 4 times that of older drivers. Moreover, the crash rate of 16 year olds was twice that of 18-19 year olds. Among fatally-injured 16-17 year old passenger vehicle drivers, 18% of males and 10% of females had BACs at or above .08%. Among fatally-injured 18-19 year old drivers, 33% of males and 15% of females had BACs at or above .08%. In 2004, teenagers accounted for 10% of the population, but 13% of motor vehicle crash deaths. Insurance Institute for Highway Safety (IIHS), Fatality Facts 2004: Teenagers (Arlington, VA: IIHS, 2005). Online: <http://www.iihs.org/research/fatality_facts/pdfs/teenagers.pdf>. In 2002, motor vehicle crashes were the leading cause of death among 15-20 year olds (p. 1). In 2004, 3,620 drivers aged 15-20 were killed in crashes, and an additional 303,000 were injured (p. 1). Twenty-nine percent of the 15-20 year old fatally-injured drivers had been drinking, and 24% had a BAC of .08% or higher (pp. 2-3). The severity of the crashes increased with alcohol involvement. Five percent of 15-20 year old drivers involved in property-damage-only crashes, 5% of those involved in personal injury crashes, and 22% of those involved in fatal crashes had been drinking (p. 4). The number of 15-20 year old drivers involved in fatal crashes, who had a BAC at or above .08%, dropped by 5% between 1994 and 2004 (p. 4). In 2004, 26% of 15-20 year old male drivers involved in fatal crashes were alcohol-positive, compared to 12% of females (p. 4). Seventy-four percent of 15-20 year old alcohol-positive drivers, who were killed in passenger car crashes, were unrestrained (p. 4). National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data, Young Drivers (Washington, D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/ nrd-30/NCSA/TSF2004/809918.pdf>. Sixty-eight percent of the 2,355 children, who died in alcohol-related crashes between 1997 and 2002, were riding with drinking drivers. In 79% of the alcohol-related crashes in which a child was killed, at least one driver had a BAC over .08%. Of these crashes, 60% occurred between 6 a.m. and 9 p.m. Only 32% of children killed while riding with drinking drivers were restrained at the time of the crash. Morbidity and Mortality Weekly Report, Child Passenger Deaths Involving Drinking Drivers: United States, 1997-2002 (Atlanta: Centre for Disease Control and Prevention, 2004).

44

UNITED KINGDOM In 2002, 17-19 year olds and 20-24 year olds accounted for 9% and 21%, respectively of all drink-drive accidents among car drivers. Seventeen to nineteen year olds and 20-24 year olds had the highest rates of both drink-drive crashes per 100,000 licensed drivers and per 100 million miles driven. Institute of Alcohol Studies (IAS), Drinking and Driving (St. Ives: IAS, 2005) at 6.

AUSTRALIA Fifteen to twenty-four olds account for about 52% of the alcohol-related serious road injuries in Australia (excluding Victoria). T. Chikritzhs et al., National Alcohol Indicators Bulletin No. 2: Trends in Alcohol-Related Road Injury in Australia, 1990-1997 (Perth: National Drug Research Institute, Curtin University, 2000). Online: <http://www.ndri.curtin.edu.au/pdfs/naip/naip007.pdf>. Between 1993 and 2002, an estimated 2,643 young people (aged 15-24) died from alcoholattributable injury and disease caused by risky or high-risk drinking. Between 1993/1994 and 2001/2002, over 100,000 young people were hospitalized for alcoholattributable injury and disease. The most common causes of alcohol-attributable deaths for young people were road injury, suicide and violence. Young males were 4 times more likely to die from an alcohol-attributable cause than young females. T. Chikritzhs et al., National Alcohol Indicators Bulletin No. 6: Trends in Youth Alcohol Consumption and Related Harms in Australian Jurisdictions, 1990-2002 (Perth: National Drug Research Institute, Curtin University, 2004). Online: <http://www.ndri.curtin.edu.au/pdfs/naip /naip006.pdf>.

Between 1993 and 2002, an estimated 501 underage drinkers (aged 14-17) died from alcoholattributable injury and disease caused by risky or high-risk drinking. Over 3,300 14-17 year olds were hospitalized for alcohol-attributable injury and disease in 1999/ 2000. Teenage males were 3.5 times more likely than teenage females to die from alcohol-attributable injury. The number of alcohol-attributable deaths among 14-17 year olds has declined steadily since 1990. T. Chikritzhs et al., National Alcohol Indicators Bulletin No. 7: Under-aged Drinking Among 1417 Year Olds and Related Harms in Australia (Perth: National Drug Research Institute, Curtin University, November 2004). Online: <http://www.ndri.curtin.edu.au/pdfs/naip/naip007.pdf>.

EUROPE 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 Related Burden of Mortality in Young People in Established Market Economies of Europe (2001) 7(3) European Addiction Research 148.

45

TRAUMA AND YOUTH CHARTS

UNINTENTIONAL TRAUMA DEATH AMONG 15-19 YEAR OLDS: CANADA, 1997*

5.1%

Drownings Falls

2.5% 73.3% Motor Vehicle 19.1% Other

*Males dominated all categories of unintentional trauma death: motor vehicle (67.8%); drownings (77.8%); falls (84.6%); and other causes (79.2%). Source: Health Canada, Canadian Injury Data, Mortality 1997 and Hospitalizations 1996-97 (Ottawa: Health Canada: 1999). Online: <http://www.phac-aspc.gc.ca/injury-bles/cid98-dbc98>.

INTENTIONAL TRAUMA DEATH AMONG 15-19 YEAR OLDS: CANADA, 1997*

87% Suicide

10% Violence 3%
Other

*Males dominated all categories of intentional trauma death: suicide (79.3%); violence (76.7%); and other causes (66.7%). Source: Health Canada, Canadian Injury Data, Mortality 1997 and Hospitalizations 1996-97 (Ottawa: Health Canada: 1999). Online: <http://www.phac-aspc.gc.ca/injury-bles/cid98-dbc98>.

46

UNINTENTIONAL TRAUMA DEATH AMONG 20-24 YEAR OLDS: CANADA, 1997*

7.1% 65.7% Motor Vehicle

Drownings

4.5% Falls

22.7% Other

*Males dominated all categories of unintentional trauma death: motor vehicle (74.5%); drownings (92.5%); falls (92.0%); and other causes (86.6%). Source: Health Canada, Canadian Injury Data, Mortality 1997 and Hospitalizations 1996-97 (Ottawa: Health Canada: 1999). Online: <http://www.phac-aspc.gc.ca/injury-bles/cid98-dbc98>.

INTENTIONAL TRAUMA DEATH AMONG 20-24 YEAR OLDS: CANADA, 1997*

14.1% Violence 82.8% Suicide 3.1%

Other

*Males dominated all categories of intentional trauma death: suicide (87.7%); violence (74.0%); and other causes (81.8%). Source: Health Canada, Canadian Injury Data, Mortality 1997 and Hospitalizations 1996-97 (Ottawa: Health Canada: 1999). Online: <http://www.phac-aspc.gc.ca/injury-bles/cid98-dbc98>.

47

ALCOHOL AND YOUTH CHARTS

RELATIVE RISK OF A FATAL SINGLE-VEHICLE CRASH FOR MALES, AT VARIOUS BACS .02% - .049% Age 16-20 Age 21-34 Age 35+ 5 3 3 .05% - .079% 17 7 6 .08% - .099% 52 13 11 .10% - .149% 241 37 29 .15% + 15,560 573 382

Source: P. Zador, S. Krawchuk and R. Voas, Alcohol-Related Relative Risk of Driver Fatalities and Driver Involvement in Fatal Crashes in Relation to Driver Age and Gender: An Update Using 1996 Data (2000) 61 J. Stud. Alcohol 387 at 392.

PERCENTAGE OF ALCOHOL-RELATED CRASH DEATHS, BY AGE GROUP: CANADA, 2003

60

50

40

Percentage

30

20

10

<16

16 - 19

20 - 25

26 - 35

36 - 45

46 - 55

>55

Source: Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf at 14.

48

PERCENTAGE OF ALCOHOL-RELATED TRAFFIC DEATHS AND POPULATION, BY AGE GROUP: CANADA, 2003
25 20

Percentage

15 10 5 0
2.1 20.1 12 8.3 5.4 21.6 13.9 20.7 16.7 13 14.5 10.5 21.7

19.6

<16

16 - 19

20 - 25

26 - 35

36 - 45

46 - 55

>55

% of Alcohol-Related Fatalities

% of Population

Sources: Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: http://ccmta.ca/english/pdf/alcohol_crash03_e.pdf>. Statistics Canada, Table 051-0001 Estimates of population, by age group and sex, Canada, provinces and territories, annual (Persons) (Ottawa: Statistics Canada, 2003).

MOTOR VEHICLE DEATH RATES BY AGE GROUP, PER 100,000: CANADA, 1997
20

Deaths per 100,000

15

10

0 15 - 19 20 - 24 25 - 34 35 - 44 45 - 54 55 - 64

Source: D. Mayhew and H. Simpson, Youth and Road Crashes: Reducing the Risks from Inexperience, Immaturity and Alcohol (Ottawa: Traffic Injury Research Foundation, 1999) at 6.

49

MOTOR VEHICLE INJURY RATES BY AGE GROUP, PER 100,000: CANADA, 1997

1600 1400 Injuries per 100,000 1200 1000 800 600 400 200 0 15 - 19 20 - 24 25 - 34 35 - 44 45 - 54 55 - 64

Source: D. Mayhew and H. Simpson, Youth and Road Crashes: Reducing the Risks from Inexperience, Immaturity and Alcohol (Ottawa: Traffic Injury Research Foundation, 1999) at 7.

DEATHS PER BILLION KILOMETRES TRAVELLED, BY AGE: CANADA, 2001

30 25 Number of Deaths 20 20 15 10 5 0 16 - 19 20 - 24 25 - 34 6 3 35 - 44 3 45 - 54 4 55 - 64 16 27

5 65 - 74 >75

Source: Transport Canada, Road Safety in Canada: An Overview (Ottawa: Transport Canada, March 2004). Online: <http://www.tc.gc.ca/roadsafety/stats/overview/2004/menu.htm>.

50

25,000

CUMULATIVE ESTIMATE OF THE LIVES SAVED IN THE UNITED STATES BY THE MINIMUM DRINKING AGE LAWS, 1975-2004

20,000 Estimated Lives Saved

15,000

10,000

15,667
5,000

18,220

20,043

21,892

23,733

0 1975-95 1998 2000 2002 2004

Source: National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data, Young Drivers, (Washington D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/TSF2004/809918.pdf> at 5.

WEEKLY AND MONTHLY HEAVY DRINKING* AMONG CURRENT DRINKERS: CANADA, 2004 Age Group 15 17 18 19 20 24 25 34 35 44 45 54 All (15 75+) Weekly 7.6 % 16.1 % 14.9 % 6.5 % 5.3 % 6.0 % 6.2 % Monthly 35.7 % 51.8 % 47.0 % 30.4 % 24.2 % 22.0 % 25.5 %

* Males consuming 5 or more drinks and females consuming 4 or more drinks on a single occasion. Source: E. Adlaf et al., Canadian Addiction Survey: Detailed Report (Ottawa: Canadian Centre on Substance Abuse, 2005) at 31.

51

ALCOHOL CONSUMPTION AMONG CURRENT DRINKERS ON A TYPICAL DRINKING DAY IN THE PAST YEAR: CANADA, 2004 Age Group 15 17 18 19 20 24 25 34 35 44 45 54 All (15 75+) 1 - 2 Drinks 38.3 % 34.0 % 38.4 % 54.5 % 66.1 % 67.6 % 63.7 % 3 - 4 Drinks 32.9 % 23.5 % 30.0 % 23.4 % 19.9 % 19.2 % 20.2 % 5+ Drinks 28.8 % 42.5 % 31.6 % 22.0 % 14.0 % 13.2 % 16.0 %

Source: E. Adlaf et al., Canadian Addiction Survey: Detailed Report (Ottawa: Canadian Centre on Substance Abuse, 2005) at 29.

PERCENTAGE OF CURRENT DRINKERS WHO DRANK HAZARDOUSLY* IN THE PAST YEAR: CANADA, 2004
45 40 35 30

Percentage

25 20 15 10 5 0 15 - 17 18 - 19 20 - 24 25 - 34 35 - 44 45 - 54 All Ages

* Scoring 8 or more on the Alcohol Use Disorder Identification Test (AUDIT), which is an indicator of high-risk drinking. Source: E. Adlaf et al., Canadian Addiction Survey: Detailed Report (Ottawa: Canadian Centre on Substance Abuse, 2005) at 42.

52

PERCENTAGE OF INDIVIDUALS HARMED BY DRINKING IN THE PAST YEAR: CANADA, 2004 Age Group 15 17 18 19 20 24 25 34 35 44 45 54 55 64 65 74 75+ All (15 75+) Harmed by Own Drinking Harmed by Others Drinking

} } } }

Not surveyed 21.8 % 62.6 % 58.3 % 7.8 % 5.9 % 2.8 % 8.8 % 41.9 % 32.7 % 30.4 % 24.8 % 14.9 % 5.4 % 32.7 %

Source: E. Adlaf et al., Canadian Addiction Survey: Detailed Report (Ottawa: Canadian Centre on Substance Abuse, 2005) at 44 and 46.

53

PART IV: TOPICS IN TRAFFIC TRAUMA

ALCOHOL AND PEDESTRIANS

CANADA During 2003, 57% of the 458 fatally-injured pedestrians were tested for alcohol. Of those tested, 39.1% had been drinking and 25.7% had a BAC over .16%. However, 82.6% of fatally-injured 16-19 year old pedestrians and 41.3% of fatally-injured 20-25 year old pedestrians had been drinking. The 16-19 and 20-25 year age groups accounted for 23% and 12%, respectively of the total number of alcohol-positive, fatally-injured pedestrians. Males accounted for 77.0% of the fatally-injured pedestrians who had been drinking and 75.3% of the fatally-injured pedestrians with BACs over .08%. It should be noted that males accounted for 62.7% of the pedestrians who were killed. Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>.

BRITISH COLUMBIA Among non-child pedestrian fatalities, 30% had BACs greater than .08% and 24% had BACs greater than .15%. Fatalities among impaired pedestrians are more likely to take place in business, commercial and rural areas, and less likely to occur in residential areas. At the time of the collision, 36% of the impaired pedestrians were crossing a street with no signal or crosswalk, compared to 26.4% of non-impaired pedestrians. R. Wilson and M. Fang, Alcohol and Drug Impaired Pedestrians Killed or Injured in Motor Vehicle Collisions, in H. Laurell and F. Schlyter eds., Proceedings of the 15th International Conference on Alcohol, Drugs and Traffic Safety, 2000 (Stockholm: International Council on Alcohol, Drugs and Traffic Safety, 2000). Online: <http://www.icadts.org/proceedings/2000/ica dts2000-086.pdf>.

UNITED STATES In 2004, 4,641 pedestrians were killed and 68,000 were injured in traffic crashes in the United States a decrease of 15% from 1994. On average, one pedestrian was killed every 113 minutes, and one was injured every 8 minutes (p. 1). Males accounted for 69% of the pedestrian fatalities (p. 1). Nineteen percent of all 5-9 year olds killed in crashes were pedestrians (p. 1). Alcohol involvement, either for the driver or the pedestrian, was reported in 47% of crashes resulting in pedestrian fatalities. Among the fatally-injured pedestrians, 34% had BACs of .08% or higher, and an additional 4% had BACs of .01% - .07%. Of the drivers involved, 13% had BACs of .08% or greater and an additional 1% had BACs of .01% - .07%. In 6% of the crashes, both the driver and the pedestrian had BACs of .08% or higher (p. 4). National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data,

54

Pedestrians (Washington, D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/nrd -30/NCSA/TSF2004/809913.pdf>.

In 2004, 54% of pedestrians aged 16 and older who were killed in nighttime motor vehicle crashes had BACs of .08% or higher. Insurance Institute for Highway Safety, Fatality Facts 2004: Pedestrians (Arlington, VA: IIHS, 2005). Online: <http://www.iihs.org/research/fatality_facts/pdfs/pedestrians.pdf>.

UNITED KINGDOM Between 1985/89 and 1995/99, the proportion of alcohol-positive pedestrian fatalities among 1619 year olds increased from 59% to 78% for males, and from 38% to 50% for females. Between 1995 and 1999, the percentage of fatally-injured pedestrians who tested positive for alcohol increased from 40% to 48%. The percentage of fatally-injured pedestrians with BACs over .08% increased from 31% to 39%. M. Keigan and R. Tunbridge, The Incidence of Alcohol in Fatally-injured Adult Pedestrians (Berkshire, UK: TRL Limited, 2003). Online: <http://www.trl.co.uk/static/dtlr/pdfs/TRL579.pdf>.

In 2002, 48% of fatally-injured pedestrians aged 16 and older had positive BACs, 42% had BACs above .08%, and 34% had BACs above .15%. Institute of Alcohol Studies (IAS), Drinking and Driving (St. Ives: IAS, 2005) at 4.

SWEDEN An investigation of 286 fatally-injured pedestrians, who were autopsied between 1977 and 1995, indicated that 19% were positive for alcohol and the median BAC concentration was .16%. The proportion of alcohol-positive victims did not change significantly during the period. M. Ostrom and A. Eriksson, Pedestrian Fatalities and Alcohol (2001) 33 Accid. Anal. and Prev. 173 at 173 and 174.

AUSTRALIA Between 1998 and 2002, 70% of fatally-injured male pedestrians aged 15-54 had BACs over .05%, and 58% had BACs over .15%. Australian Transport Safety Bureau (ATSB), Monograph 14: Male Pedestrian Fatalities (Canberra: ATSB, 2003). Online: <http://www.atsb.gov.au/road/mgraph/mgraph14/mono 14.pdf>.

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ALCOHOL AND BICYCLISTS

CANADA Between 1987 and 1999, 24.7% of fatally-injured cyclists had positive BACs. Of these alcoholpositive cyclists, 81.5% had BACs of .08% or greater. Among 36-55 year olds, 31.9% of fatally-injured cyclists had positive BACs . D. Beirness, Alcohol Involvement in Recreational Vehicle Operator Fatalities in Canada, in D. Mayhew and C. Dussault eds., Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, 2002 (Montreal: Socit de lassurance automobile du Qubec, 2002). Online: <http://www.saaq.gouv.qc.ca/t2002/actes/pdf/(27a).pdf>.

In 2003, 28% of fatally-injured bicyclists had been drinking, and among these 57.1% had BACs over .08%. Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>.
ONTARIO Of the 428 hospitalizations due to cycling from 1995/96 to 1999/00, 31% had a positive BAC. In these cases, 26% had a BAC greater than .08%. Canadian Institute for Health Information (CIHI), Ontario Trauma Registry Bulletin: Hospitalization due to Major Sports and Recreational Injuries in Ontario, 1999-2000 (Toronto: CIHI, 2001). Online: <http://secure.cihi.ca/cihiweb/en/downloads/bl_otr31jul2001_e.pdf>.

UNITED STATES In 2004, 725 cyclists were killed and 41,000 were injured in traffic crashes (p. 1). Males accounted for 87% of the fatally-injured cyclists (p. 2). Cyclists accounted for 13% of all non-motorist traffic fatalities in 2004 (p. 1). In 28% of the fatal crashes, either the driver or the cyclist had a BAC of .08% or higher. BACs of .01% to .07% were reported in an additional 6% of the fatal crashes (p. 2). Twenty-four percent of cyclists killed had a positive BAC, and 20% had a BAC of .08% or higher (p. 2). National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data, Pedalcyclists (Washington, D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/nr d-30/NCSA/TSF2004/809912.pdf>. In 2004, 83% of fatally-injured bicyclists were not wearing helmets. Insurance Institute for Highway Safety (IIHS), Fatality Facts 2004: Bicycles (Arlington, VA: IIHS, 2005). Online: <http://www.iihs.org/research/fatality_facts/pdfs/bicycles.pdf>.

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UNITED KINGDOM In 2002, 22% of all fatally-injured cyclists aged 16 and older had positive BACs, 7% had BACs over .08%, and 4% had BACs over .15%. Institute of Alcohol Studies (IAS), Drinking and Driving (St. Ives: IAS, 2005) at 4.

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ALCOHOL AND SNOWMOBILING

CANADA Between 1987 and 1999, 743 people died while snowmobiling in Canada. Among those fatally injured, 71.2% had positive BACs, 17.9% had BACs between .081% and .15%, and 38.8% had BACs of .15% or greater. Fatally-injured snowmobile drivers are 2.47 times more likely to be alcohol positive than alcohol negative. D. Beirness, Alcohol Involvement in Snowmobile Operator Fatalities in Canada, in D. Mayhew and C. Dussault eds., Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, 2002 (Montreal: Socit de lassurance automobile du Qubec, 2002). Online: <http://www.saaq.gouv.qc.ca/t2002/actes/pdf/(27a).pdf>.

In 2003, 65.2% of fatally-injured snowmobile operators had been drinking and of these, 79.1% had BACs over the legal limit. Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>.

ONTARIO During the 2000/01 snowmobile season, 36 people died in snowmobiling fatalities within OPP jurisdiction. Alcohol was a factor in 40% of these incidents. Between 1997/98 and 2001/02, an average of 25 people died in snowmobile crashes. On average, 48.4% of these deaths were alcohol-related. J. McDonnell, C. Hughes and L. Lee-Davidson, Ontario Provincial Police Specialized Patrols: Trails and Waterways Enforcement, Snowmobile All-Terrain Vehicle Vessel Enforcement (S.A.V.E.) Teams, in D. Mayhew and C. Dussault eds., Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, 2002 (Montreal: Socit de lassurance automobile du Qubec, 2002). Online: <http://www.saaq.gouv.qc.ca/t2002/ actes/pdf/(00a).pdf>.

Between 1997 and 2001, alcohol was involved in 63% of snowmobiling fatalities. Among the alcohol-positive fatalities, the average BAC was .13% and 33% had a BAC above .08%. Ninety-four percent of people who drowned while snowmobiling were not wearing a personal floatation device or suit. Lifesaving Society, The Drowning Report: A profile of drownings and water-related deaths in Ontario: 2004 Edition (Ottawa: Lifesaving Society, 2004). Online: <http://www.lifesavingsociety .com/PDF/98DrowningReport2004Edition.pdf> at 3 and 22.
Snowmobiling is the leading cause of severe injuries due to winter sport and recreation activities. In 2002/03, there were approximately 393 snowmobile-related injuries requiring hospitalization. More than 80% of those hospitalized were male. Approximately 11% of hospitalized snowmobilers were under 16 years of age. Smartrisk, Off-Road Vehicle Injuries (November, 2005) 2(9) Ontario Injury Compass.

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UNITED STATES There were a total of 28 snowmobile fatalities during the 2002/03 winter season in Vermont, New Hampshire and Maine. This was the highest annual total in the past 12 seasons. Twenty of the deceased were tested for alcohol and of these, 5 had BACs at or above .08%. Center For Disease Control and Prevention (CDC), Snowmobile Fatalities Maine, New Hampshire and Vermont, 2002-2003 (Atlanta: CDC, 2003). Online: <www.cdc.gov/mmwr/preview/ mmwrhtml/mm5250a1.htm>.

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ALCOHOL AND ALL-TERRAIN VEHICLES (ATV)

CANADA ATV crashes in Canada claimed 255 lives from 1987 to 1999. Among those tested, 55.7% had positive BACs, 13.3% had BACs between .081% and .150%, and 31.4% had BACs above .150%. Among ATV driver fatalities, 35.2% of 16-20 year olds, 61.5% of 21-25 year olds, and 73.2% of 26-35 year olds tested positive for alcohol. D. Beirness, Alcohol Involvement in Recreational Vehicle Operator Fatalities in Canada, in D. Mayhew and C. Dussault eds., Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, 2002 (Montreal: Socit de lassurance automobile du Qubec, 2002). Online: <http://www.saaq.gouv.qc.ca/t2002/actes/pdf(27a).pdf>.

In 2003, 56.6% of fatally-injured ATV drivers had been drinking and of these, 76.7% had BACs over .08%. Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>.

The number of people hospitalized due to ATV injuries climbed almost 50% from 1,693 in 1996/97 to 2,535 in 2000/01. In 2000/01, 5-19 year olds accounted for 36% of all ATV injuries. Among the ATV-related severe injury admissions in 2001/02, 26% tested positive for alcohol. ATV injuries are now the third most common cause of severe sports and recreation injuries, after cycling and snowmobiling. Canadian Institute For Health Information (CIHI), ATV Injuries Resulting in Hospitalization on the Rise (Ottawa: CIHI, February 2003). Online: <http://secure.cihi.ca/cihiweb/dispPage.jsp?c w_page=media_05feb2003_e>.
ONTARIO All-terrain vehicles are the second leading cause of severe injuries due to winter sport and recreation activities. In 2002/03, there were approximately 462 ATV-related injuries requiring hospitalization. More than 80% of those hospitalized were male. Approximately 22% of those hospitalized for ATV injuries were under 16 years of age. Smartrisk, Off-Road Vehicle Injuries (November, 2005) 2(9) Ontario Injury Compass.

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ALCOHOL AND MOTORCYCLES

CANADA Vulnerable road users (pedestrians, bicyclists and motorcycle/moped riders) consistently account for approximately 20% of road users killed or seriously injured annually. Between 1993 and 1997, motorcyclists under the age of 20 accounted for slightly more than 19% of total motorcyclist fatalities and slightly more than 22% of those seriously injured. These figures are about double those of similarly-aged motor vehicle drivers. The percentage of fatally-injured motorcyclists who were legally impaired decreased steadily, from 42.4% in 1993, to 26.5% in 1997. Transport Canada, Canadas Road Safety Targets to 2010 (Ottawa: Minister of Public Works and Government Services, March 2001). Online: <http://www.tc.gc.ca/roadsafety/tp/tp13736/ pdf/CRS_Target.pdf>.

In 2003, 38 motorcycle drivers died in alcohol-related crashes in Canada. Among fatally-injured motorcycle drivers who were tested for alcohol, 28.6% had been drinking and of these, 71.1% had BACs over the legal limit. Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>.

UNITED STATES In 2004, 4,008 motorcyclists were killed in the United States, an 8% increase from 2003. An additional 76,000 motorcyclists were injured, a 14% increase from 2003 (p. 1). Motorcyclists are about 32 times more likely to die and 6 times more likely to be injured per mile travelled than passenger car occupants (p. 3). Thirty-six percent of motorcyclists involved in fatal crashes were speeding, approximately twice the rate of car or light truck drivers (p. 4). Among motorcyclists involved in fatal crashes, 24% did not have a valid licence, which is twice the rate of car drivers (p. 4). Among fatally-injured motorcycle drivers in 2004, 6% had BACs between .01% and .07%, and 28% had BACs of .08% or higher (p. 5). Twenty-seven percent of motorcyclists, 22% of passenger car drivers, 21% of light truck drivers, and 1% of large truck drivers involved in fatal crashes had BACs at or above .08% (p. 5). Of fatally-injured motorcyclists, 39% of 35-39 year olds, 38% of 40-44 year olds, and 34% of 4549 year olds had BACs at or above .08% (p. 5). Motorcyclists killed in nighttime crashes were 3 times more likely to have BACs at or above .08% than those killed during the day (42% and 13%, respectively) (p. 5). Only 41% of the fatally-injured motorcyclists with BACs at or above .08% were reportedly wearing helmets (p. 6). National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data, Motorcycles (Washington, D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/nrd -30/ NCSA/TSF2004/809908.pdf>.

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UNITED KINGDOM In 2002, 27% of fatally-injured motorcycle riders aged 16 and over had positive BACs, 11% had BACs above .08%, and 6% had BACs above .15%. Institute of Alcohol Studies (IAS), Drinking and Driving (St. Ives: IAS, 2005) at 4.

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ALCOHOL, DRUGS AND PILOTS

CANADA In one study, 10 licensed pilots were given a marijuana joint containing 19 mg. of THC, a relatively small amount. Twenty-four hours after smoking the joint, they were tested in a flight simulator. All 10 pilots made errors in landing, and one missed the runway completely. Canadian Police Association, Submission to the Senate Special Committee on Illegal Drugs, May 2001. Online: <http://www.drugwatch.org/Canadian%20Police%20Testimony.htm>. In 1995, 15 fatal air-space transport accidents were attributable to alcohol. 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 61.

UNITED STATES Between 1985 and 2000 in Maryland, New Mexico and North Carolina, 1,642 general aviation crashes occurred, and 313 pilots were killed. BAC information was available for 233 of the fatally-injured pilots. Of these pilots, 11% had positive BACs and 6% had BACs exceeding the legal limit for flying (.04%). The mean BAC was .075%, with a standard deviation of .064%. Illicit drugs were found in two pilots with positive BACs, and in one pilot with a negative BAC. G. Li et al., Characteristics of alcohol-related fatal general aviation crashes (2005) 37 Accid. Anal. and Prev. 143.

A study of crashes between 1994 and 2000 indicated that 3.4% of the pilots had a conviction for an alcohol-related traffic offence. A prior impaired driving conviction was associated with a 43% increased risk of crash involvement. G. Li et al., Driving-while-intoxicated history as a risk marker for general aviation pilots (2005) 37 Accid. Anal. and Prev. 179.

Under FAA rules, pilots are prohibited from flying with a BAC of .02% or above, and are considered legally intoxicated at a BAC of .04%. Pilots are also prohibited from consuming alcohol eight hours prior to flying. Between 2000 and 2003, 22 pilots tested positive for alcohol through random testing. Thirty-eight pilots tested positive for alcohol through reasonable suspicion checks, and 146 pilots tested positive for drugs through random testing. Checks and follow-up examinations led to the revocation or suspension of the licences of 230 pilots in 2000, and 220 in 2001. B. Sweedler, Flying High Alcohol Impaired Airline Pilots How Big is the Problem and What are the Countermeasures?, in P. Williams and A. Clayton eds., Proceedings of the 17th International Conference on Alcohol, Drugs and Traffic Safety, 2004 (Glasgow, UK: International Council on Alcohol, Drugs and Traffic Safety, 2004). Online: <http://www.x-cd.com/t2004/ pdfs/WS2-6.pdf>.

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PART V: IMPAIRED DRIVING

CANADA

ALCOHOL In 1999, 2,969 road users were killed in Canada and another 17,500 were seriously injured in traffic collisions. Alcohol was a factor in more than 1,200 of the fatalities (about 40%) and more than 3,600 of the serious injuries (about 21%). Canadian Council of Motor Transport Administrators, Road Safety Vision 2010 The 2000 Update (Ottawa: Minister of Public Works and Government Services, 2002) at 10. Online: <http:// www.tc.gc.ca/roadsafety/vision/2000/menu.htm>.

In 2001, 38% of the fatally-injured drivers who were tested had been drinking and of these, almost 85% had BACs over .08%. Road Safety in Canada: An Overview (Ottawa: Transport Canada, 2004). Online: <http://www. tc.gc.ca/road safety/stats/overview/2004/pdf/overview.pdf>.

In 2004, police reported about 79,000 impaired driving incidents. Between 1994 and 2004, the number of people charged with an impaired driving offence, per 100,000 population decreased 33.5%. Statistics Canada, Uniform Crime Reporting Survey (Ottawa: Canadian Centre for Justice Statistics, 2005).

During 2003, 3,124 people died in motor vehicle collisions (p. 5). In 2003, 38.3% of the fatally-injured car drivers, who were tested, had positive BACs. This constitutes a 8.3% increase from 1999. Twenty-six percent of these drivers had BACs of between .081% and .16%, and 57% had BACs over .16% (p. 18). Of the fatally-injured motorcycle drivers, who were tested, 28.6% had positive BACs and of these almost 71% had BACs of over .08% (p. 17). Males accounted for 86.8% of the alcohol-positive, fatally-injured drivers and 85.8% of fatallyinjured drivers who were legally impaired (p. 20). Of the fatally-injured bicyclists, who were tested, 28% had been drinking. Among this group, 57.1% had BACs over .08% (p. 25). Among fatally-injured snowmobile drivers, who were tested, 65.2% were alcohol positive. Of these, 79.1% had BACs over .08% (p. 25). Traffic Injury Research Foundation of Canada (TIRF), The Alcohol-Crash Problem in Canada: 2003 (Ottawa: TIRF, 2005). Online: <http://www.ccmta.ca/english/pdf/alcohol_crash03_e.pdf>.

In 2003, alcohol and/or drugs were involved in 1,257 fatalities, 74,181 injuries, and 161,299 property-damage-only crashes involving 245,174 damaged vehicles (p. 10). The total financial and social costs of these losses were estimated to be as high as $10.95 billion (p. 12). 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).

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In 1997, 1 in every 278.6 licensed drivers in Canada was charged with an impaired driving offence. By 2003, the charge rate had fallen to 1 in every 345.6 licensed drivers. In contrast, 1 in every 135 licensed drivers in the United States was charged with an impaired driving offence in 2003. Thus, Canadas charge rate for impaired driving in 2003 was only 39% of the American rate. Transport Canada, Canadian Motor Vehicle Traffic Collision Statistics, 2003 (Ottawa: Minister of Transport, 2004), Cat. No. T45-3/2003; and National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data, Alcohol (Washington, D.C.: NHTSA, 2005) at 2; and Statistics Canada, Uniform Crime Reporting Survey (Ottawa: Canadian Centre for Justice Statistics, 2005). A study in the Moncton area found that the number of suspended drivers stopped at four checkpoints was 57% of the expected total, if all suspended drivers had continued to drive as much as they did prior to the suspension. In other words, the suspensions only reduced the incidence of driving among suspended drivers by 43%. Suspended drivers made up only 3.5% of the total drivers in New Brunswick, but were involved in 8% of the fatal crashes. Suspended drivers tended to drive most often between midnight and 6:00 a.m. The average number of kilometres driven per week prior to the suspension was 333 for first offenders and 337 for repeat offenders. The average self-reported number of kilometres driven per week during the suspension was 44 for first offenders and 75 for repeat offenders. Thirty-two percent of first-time offenders and 35% of repeat offenders admitted driving during their suspension period. Ninety percent of the suspended drivers stopped by the police produced an apparently valid driving permit, even though the law requires them to surrender their permits when suspended. J. Malenfant et al., A study to measure the incidence of driving under suspension in the Greater Moncton Area (2002) 34 (4) Accid. Anal. and Prev. 439. Online: <http://scholarsportal .info/pdflinks/05052214492000807.pdf>. A study of 6,067 drivers admitted to British Columbia hospitals for crash injuries between January 1, 1992 and March 31, 2000 found that only one-third were administered a blood-alcohol test (p. 2). Among the 1,697 tested drivers, 47.1% had been drinking. Of the alcohol-positive drivers, 22.5% had BACs of between .01% and .08%, and 77.5% had BACs above .08%. The mean BAC of the alcohol-positive drivers was .156% (p. 5). The police listed alcohol as a contributing factor in 31.7% of all of the injury cases, and in 70.5% of the cases in which the drivers BAC was subsequently found to exceed .08%. Nevertheless, only 11% (68 out of 619) of the drivers with BACs above .08% were convicted of an impaired driving offence. Less than 4% received a 90-day administrative licence prohibition, and 10.7% were given a 24-hour roadside prohibition (p. 7). R. Purssell et al., Proportion of injured alcohol-impaired drivers subsequently convicted of an impaired driving criminal code offence in British Columbia (2004) 6(2) CJEM. Online: <http: //www.caep.ca/004.cjem-jcmu/004-00.cjem/vol-6.2004/v62.080-8.htm>.

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DRUGS It was estimated that in 2003, 27.45% of traffic fatalities involved alcohol, 9.15% involved alcohol and drugs, and 3.66% involved drugs alone. In 2003, 13.71% of crash injuries involved only alcohol, 4.57% involved alcohol and drugs, and 1.83% involved drugs alone. 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).

In a 2002 survey, 17.7% of drivers reported driving within 2 hours of using a prescribed medication, over-the-counter remedy, marijuana, or other illicit drug during the past 12 months. These results suggest that an estimated 3.7 million Canadian drove after taking some medication or drug that could potentially affect their ability to drive safely. The most common drugs used were over-the-counter medications (15.9%), prescription drugs (2.3%), marijuana (1.5%), and other illegal drugs (0.9%). Young males were most likely to report using marijuana and other illegal drugs. While 86% of the drivers were aware that a conviction for impaired driving results in a criminal record, 66% erroneously believed that the penalties for drug-impaired driving were less severe than those for alcohol-impaired driving. In fact, the penalties are identical. Over 80% of drivers agreed that drivers suspected of being under the influence of drugs should be required to participate in physical coordination testing for drug impairment. However, only about 70% of drivers agreed that all drivers involved in a serious collision or suspected of drug impairment should be required to provide a blood sample. D. Beirness, H. Simpson and K. Desmond, The Road Safety Monitor 2002: Drugs and Driving (Ottawa: Traffic Injury Research Foundation, 2003). Online: <http://www.trafficinjury researc h.com/whatNew/newsItemPDFs/RSM_02_Drugs_and_ Driving.pdf>.

BRITISH COLUMBIA A study of blood samples from 227 fatally-injured drivers found that 37% were positive for only alcohol, 9% were positive for only drugs, and 11% were positive for both alcohol and drugs. Thus, 48% of the deceased drivers were alcohol positive, and their mean BAC was .164%. The most commonly found drugs were cannabis (13%), diazepam (5%), and cocaine (4%). G. Mercer and W. Jeffery, Alcohol, Drugs and Impairment in Fatal Traffic Accidents in British Columbia (1995) 27 Accid. Anal. and Prev. 335. In 1999, there were 2,228 alcohol-related collisions, resulting in 3,407 injuries and 96 fatalities. P. Kendall, Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer (Victoria: Office of the Provincial Health Officer, 2002).

ONTARIO In 1996 and 1997 surveys, 1.9% of all respondents reported driving within an hour of cannabis use in the past 12 months (3% of males and 0.8% of females). Young drivers had the highest rates of driving within an hour of cannabis use (9.3% of 18-19 year olds, 5% of 20-24 year olds, 2.1% of 25-34 year olds, and 1.6% of 35-44 year olds) (p. 261). Among cannabis users, 22.8% reported driving within an hour of use (p. 262).

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Forty-seven percent of those who reported driving within an hour of cannabis use also reported driving within an hour of having 2 or more drinks (p. 263). G. Walsh and R. Mann, On the High Road: Driving Under the Influence of Cannabis in Ontario (1999) 90 C.J.P.H. 260.

In a 2002 survey of licensed drivers 18 years of age and older, 2.9% (the equivalent of over 200,000) reported driving within an hour of using cannabis in the past year. Centre for Addiction and Mental Health (CAMH), CAMH Population Studies eBulletin: Cannabis Use and Driving Among Ontario Adults (Toronto: CAMH, May/June 2003).

QUEBEC A study of drivers fatally-injured between April 1, 1999 and December 31, 2002 found that, of those tested, 46.4% had consumed alcohol, drugs or a combination of both. (21.7% were positive for alcohol alone, 11.7% were positive for alcohol and drugs, and 13% were positive for drugs alone) Among the alcohol-positive drivers, 85% had BACs above .08%. The drugs most commonly detected among the deceased drivers were: cannabis (13.1%); benzodiazepines (9.2%); cocaine (4.7%); opiates (1.3%); PCP (0.5%); amphetamines (0.4%); and barbiturates (0.4%). Males aged 16-34 were over-represented among deceased drivers who were positive for illegal drugs, whereas drivers aged 55 and above were over-represented among deceased drivers who were positive for legal drugs. Seatbelts were not worn by 48% of drivers who had consumed both alcohol and drugs, 37.6% who had consumed alcohol alone, and 27.9% who had consumed drugs alone. In Quebec, seatbelt use among the general driving population is over 90%. J. Bouchard and M. Brault, Link Between Driving Records and the Presence of Drugs and/or Alcohol in Fatally Injured Drivers, in P. Williams and A. Clayton eds., Proceedings of the 17th International Conference on Alcohol, Drugs and Traffic Safety, 2004 (Glasgow, UK: International Council on Alcohol, Drugs and Traffic Safety, 2004).

OTHER PROVINCES In Saskatchewan, the percentage of deceased drivers who tested positive for drugs rose from 5.7% in 2000 to 38.3% in 2002. In Manitoba, the percentage of deceased drivers who tested positive for drugs was 23.5% in 2000 and 28.8% in 2002. The comparable figures for Nova Scotia were 15.8% and 20.8%. D. Mayhew et al., Drugs Among Fatally Injured Drivers: 2000-2002 (Ottawa: Traffic Injury Research Foundation, 2004) at 5.

In 2002, 26% of high school students with a drivers licence in Nova Scotia reported that they had, on at least one occasion in the past year, driven a motor vehicle within an hour of having used cannabis. Addiction Services, Nova Scotia Department of Health and Dalhousie University, Nova Scotia Student Drug Use 2002 (Halifax: Nova Scotia Department of Health, 2002).

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UNITED STATES

ALCOHOL Drivers with poor driving records had higher rates of impaired driving than drivers with fewer traffic convictions. Of 254 drivers in a remedial program, 11.4% had been convicted of impaired driving. This is 5 times the rate of impaired driving convictions among the general driving population. D. Donovan, R. Umlauf and P. Salzberg, Bad Drivers: Identification of a Target Group for Alcohol-Related Prevention and Early Intervention (1990) 51(2) J. Stud. Alcohol 136 at 138.

In 2000, drivers with a BAC of .10% or greater were involved in over 2 million crashes that killed 12,892 and injured 448,630. Drivers with BACs between .08% and .09% were involved in an estimated 35,410 crashes that killed 1,097 and injured 20,150. Drivers with positive BACs below .08% were involved in an estimated 69,400 crashes that killed 2,664 and injured 43,730. National Highway and Traffic Safety Administration (NHTSA), Impaired Driving in the United States. Online: <www.nhtsa.dot.gov/people/injury/alcohol/impaired_driving_pg2/us.htm>.

A 2003 survey found that an estimated 13.6% of persons aged 12 or older reported driving under the influence of alcohol in the past year. About 9.7% of 16-17 year olds, 20.1% of 18-20 year olds, and 28.7% of 21-25 year olds reported driving under the influence of alcohol. The percentage of people who reported driving under the influence of alcohol then declined steadily with age. Males were nearly twice as likely as females to report driving under the influence of alcohol. Department of Health and Human Services, Overview of Findings From the 2003 National Survey on Drug Use and Health (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004) at 15.

In 2004, there were 16,694 alcohol-related traffic fatalities, which was a decrease of 2.4% from 2003 and 4% from 1994 (p. 1). In 2004, there was an average of 1 alcohol-related traffic fatality every 31 minutes (p. 1). Alcohol was involved in 39% of fatal crashes and 7% of all crashes (p. 1). Eighty-six percent of the alcohol-related fatalities occurred in crashes in which at least one driver or non-occupant had a BAC at or above .08% (p. 1). An estimated 248,000 persons were injured in alcohol-related crashes in 2004, which is an average of 1 person approximately every 2 minutes (p. 2). Approximately 1.4 million drivers were arrested in 2003 for driving under the influence of alcohol or narcotics. Thus, there was 1 impaired driver arrested for every 135 licensed drivers in the United States (p. 2). In 2004, the rate of alcohol involvement in fatal crashes was 60% at night and only 18% during the day (18%) (p. 3). The percentage of drivers in fatal crashes with BACs at or above .08% was: 17% for 16-20 year olds; 32% for 21-24 year olds; 27% for 25-34 year olds; and 23% for 35-44 year olds (p. 5). Twenty-seven percent of motorcycle operators, 22% of passenger car drivers, 21% of light truck drivers, and 1% of large truck drivers in fatal crashes had BACs at or above .08% (p. 5). National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data,

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Alcohol (Washington, D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/T SF2004/809905.pdf>.

In 2004, speeding-related crashes claimed 13,192 lives, and speeding was a contributing factor in 30% of all fatal crashes (p. 1). Males aged 15-20 had the highest rates (38%) of speeding in fatal crashes, followed by males aged 21-24 (35%) (p. 2). Forty percent of drivers with BACs of .08% or higher in fatal crashes were speeding, compared to only 15% of sober drivers in fatal crashes (p. 2). Forty-nine percent of 21-24 year old speeding drivers in fatal crashes had BACs of .08% or higher, compared to 25% of non-speeding drivers (p. 2). Between midnight and 3:00 a.m., 77% of speeding drivers in fatal crashes had been drinking (p. 3). Only 48% of speeding passenger car drivers under 21 in fatal crashes were wearing seatbelts (p. 5). In 2004, 21% of speeding drivers in fatal crashes did not have a valid licence, compared to 10% of the non-speeding drivers (p. 5). National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts, 2004 Data, Speeding (Washington, D.C.: NHTSA, 2005). Online: <http://www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/ TSF2004/809915.pdf>.

A 1997 study in California found that, during the times examined, 8.8% of the drivers on the roads had a suspended or revoked licence, and 3.3% had no licence record. Thus, over 12% of the drivers were driving illegally. Relative to the amount of driving that they did, suspended and revoked drivers were 3.7 times more likely to be in a fatal crash than licensed drivers. Moreover, unlicensed drivers were overrepresented in fatal crashes by a factor of 4.9 to 1. D. DeYoung, R. Peck and C. Helander, Estimating the Exposure and Fatal Crash Rates of Suspended/Revoked or Unlicensed Drivers in California (1997) 29 Accid. Anal. and Prev. 17 at 22.

Twenty percent of fatal crashes in the United States between 1993 and 1999 involved at least one driver who was suspended or did not otherwise have a valid licence. R. Scopatz et al., Unlicensed To Kill, The Sequel (Washington: AAA Foundation for Traffic Safety, 2003) at 55. It was estimated that 75% of drivers with suspended or revoked licences continue to drive (p. III1). The police judged less than 30% of fatally-injured drivers with valid licences to be alcoholpositive. However, they judged almost 50% of fatally-injured unlicensed drivers, 55% of fatallyinjured cancelled and suspended drivers, and almost 75% of fatally-injured drivers with revoked licences to be alcohol-positive (p. III-4). T. Neuman et al., Guidance for Implementation of the AASHTO Strategic Highway Safety Plan (Washington: Transportation Research Board, 2003).

DRUGS In 2002 almost 11 million people or 5% of the population aged 12 or older reported driving under the influence of an illicit drug during the past year. Ten percent or more of each age from 17 to 25 reported driving under the influence of a drug with 21 year olds reporting the highest rate of such conduct (18%). Only 3% of those aged 26 and older reported driving under the influence of a drug.

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Of the over 35 million persons aged 12 or older who reported using illicit drugs in the past year, 31% had driven under the influence of illegal drugs. Males aged 12 or older (6%) were twice as likely as females (3%) to report driving under the influence of illegal drugs. Unemployed adults aged 26 to 49 were more likely to report driving under the influence of illegal drugs in the past year, than full or part-time workers in the same age group. Department of Health and Human Services, Results from the 2002 National Survey on Drug Use and Health: National Findings (Rockville, MD: Substance Abuse and Mental Health Services Ad-ministration, 2003). Online: <http://www.oas.samhsa.gov/nhsda/2k2nsduh/Overview/2k2 Overview.htm#chap2>

In 2002 and 2003, 17% of 16-20 year olds reported driving under the influence of alcohol in the past year, 13.5% reported driving under the influence of an illicit drug, and 8.3% drove under the combined influence of alcohol and an illicit drug. Department of Health and Human Services, Driving Under the Influence (DUI) among Young Persons (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004). Online: <http://www.oas.samhsa.gov/2k4/youthDUI/youthDUI.htm>.

In 2002 and 2003, 15.7% of drivers aged 21 or older reported driving under the influence of alcohol in the past year, 4.3% reported driving under the influence of an illicit drug and 3% reported driving under the combined influence of alcohol and an illegal drug. Department of Health and Human Services, Driving Under the Influence (DUI) among Adult Drivers (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005). Online: <http://www.oas.samhsa.gov/2k5/DUI/DUI.htm>.

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UNITED KINGDOM

ALCOHOL Drinking and driving, and alcohol-related deaths and injuries fell significantly between the early 1980s and 1999. However, since 2000 casualties have been rising, and provisional figures indicated that alcohol-related deaths and injuries in 2002 were at the highest level since 1990 (p. 1). In 2002, 11% of motorcycle riders, 23% of other vehicle drivers, 7% of cyclists, and 42% of pedestrians who were killed in traffic crashes had BACs above .08% (p. 4). In total, approximately 20% of road deaths were alcohol-related (p. 1). Seventeen to twenty-four year old car drivers had, by far, the highest rates of alcohol-related injury crashes both per 100,000 licensed drivers and per 100 million miles driven (p. 6). Ninety percent of the convicted drinking drivers were males and 52% were under the age of 33. Approximately half of the offenders had BACs in excess of .150%, and about 12% will be convicted of a second impaired driving offence within 10 years (p. 4). About half of the drivers and riders killed during the hours of 10:00 p.m. and 4:00 a.m. have BACs above the legal limit (.08%). On Friday and Saturday nights, this proportion rises to 60%. Institute of Alcohol Studies (IAS), Drinking and Driving (St. Ives: IAS, 2005). Online: <http:// www.ias.org.uk/factsheets/drink-driving.pdf>.

In a 2002 survey, 44% of all drivers reported driving after drinking in the previous year. Moreover, 12% had driven when they believed they were over the limit. Men were nearly 3 times as likely to report driving while over the limit than women. Seventy-two percent of the drivers who admitted to driving while over the limit did so only once or twice in the previous year. However, 18% admitted driving over the limit once or more a month. Young men were the most likely to drive when they believed they were over the limit. Twenty-six percent of 16-29 year olds admitted to driving while over the limit in the previous year. Thirteen percent of all respondents (drivers and non-drivers) had been a passenger when they thought the driver was over the limit in the previous year. Home Office, Drink-driving: prevalence and attitudes in England and Wales 2002: Findings (London: Research, Development and Statistics Directorate, 2005) at 1-2.

DRUGS A 2002 government report indicated that alcohol or drugs were detected in 48.8% of fatallyinjured road users. Alcohol alone was detected in 24.7% of the deaths, medicinal or illicit drugs alone were found in 17.2% of the deaths, and both alcohol and drugs were found in 6.8% of the deaths. Between 1992 and 2002, while there was a small decrease in alcohol-related traffic deaths, drugrelated traffic deaths have increased almost threefold. A higher incidence of illicit drugs were found in men, and a higher incidence of medicinal drugs were found in women. The Institute of Alcohol Studies (IAS), Time to call time on the governments drink-drive strategy (St. Ives: IAS). Online: <http://www.ias.org.uk/publications/alert/02issue1/alert02issue1.pdf>.

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The number of people killed in traffic crashes who were positive for illegal drugs has increased sixfold since 1988. Three percent of motorists admitted getting into a car, within the past 12 months, when they knew the driver was under the influence of cannabis or marijuana. One percent admitted doing so when they knew the driver was under the influence of harder drugs, such as ecstasy, cocaine or amphetamines. Nearly one-quarter of motorists admitted that they would always or sometimes drive, even if they knew that the medicines they were taking could impair their driving ability. RAC, Report on Motoring 2003, Drink, Drugs and Driving: Report Summary. Online: <http://ww w.rac.co.uk/web/racworld/issues/report_on_motoring_03/drink_drugs>.

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AUSTRALIA

ALCOHOL It was estimated that high-risk drinking caused 418 road fatalities and 7,789 hospitalizations in 1997. The average cost of a single road fatality or hospitalization has been estimated to be about $750,000 and $132,000, respectively. The total cost of traffic fatalities and injuries in 1997 was over $1.3 billion. Between 1990 and 1997, 31% of all driver and pedestrian deaths were estimated to be alcoholrelated. An estimated 28% of driver and pedestrian fatalities involved BACs above .10%, and 23% involved BACs above .15%. Between 1990 and 1997,. National rates of alcohol-related road deaths and serious injuries declined between 1990 and 1996, broadly following changes in per capita alcohol consumption. Most of these reductions occurred between 1990 and 1992. Most jurisdictions followed the national trend. Only Western Australia had higher levels of alcohol-related road injuries by 1997. Males accounted for 70% of those seriously injured in alcohol-related crashes, but only 56% of those seriously injured in non-alcohol crashes. The average age of alcohol-related crash victims was 27.5. Over half of these crash victims were between the ages of 15 and 24. The Northern Territory had, by far, the highest percentage (71%) of alcohol-related driver and pedestrian fatalities. T. Chikritzhs et al., National Alcohol Indicators Bulletin No. 2: Trends in Alcohol-Related Road Injury in Australia, 1990-1997 (Perth: National Drug Research Institute, Curtin University, 2000). Online: <http://www.ndri.curtin.edu.au/pdfs/naip/naip007.pdf>.

Analysis of 1997 crash data in New South Wales indicated that alcohol was involved in 20% of fatal crashes and 5% of all crashes (p. 4). Compared to sober drivers involved in fatal crashes, alcohol-positive drivers were three times as likely to have been speeding, twice as likely to have not been using a protective device (seatbelt or helmet), and seven times as likely to have been both speeding and not using a protective device (p. 5). Between 1995 and 1999, almost 50% of fatal alcohol-related crashes occurred on weekends (including public holidays) (p. 7). Seventy-one percent of drinking drivers involved in fatal crashes were males, under 40 years of age. Among this age group, 55% were 25 years old or younger, and 45% were 26-39. Among the female drinking drivers under 40, 40% were 25 years old or younger, and 60% were 26-39 years old (p. 11). Roads and Traffic Authority of New South Wales, Drink Driving: Problem Definition and Countermeasure Summary (Roads and Traffic Authority, 2000). Online: <http://www.rta.nsw. gov.au/roadsafety/downloads/pdcsum.pdf>.

Between 1992 and 2000, alcohol-involvement in road crashes fluctuated between 20% and 30%. The number of drivers and riders killed in road crashes in Australia fell from 1989 to 1992, but has remained relatively constant since that time. Males accounted for 87% of alcohol-positive drivers involved in fatal crashes in 1999.

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N. Haworth and I. Johnston, Why Isnt the Involvement of Alcohol in Road Crashes in Australia Lower?, in P. Williams and A. Clayton eds., Proceedings of the 17th International Conference on Alcohol, Drugs and Traffic Safety, 2004 (Glasgow: International Council on Alcohol, Drugs and Safety, 2004). Online: <http://www.x-cd.com/t2004/pdfs/O107.pdf>.

DRUGS A study of drivers fatally-injured in Victoria, West Australia and New South Wales between 1990 and 1993 found that 49% were positive for alcohol and/or drugs. Alcohol was detected in 36% of the cases and drugs were detected in 22%. In 13% of the fatalities only drugs were found, and in 9% of the cases the driver was positive for both drugs and alcohol. The most common illegal drugs found were cannabis (10.5%), stimulants (3.3%), benzodiazepines (3.2%), and opiates (3.2%). O. Drummer, Drugs and Accident Risk in Fatally-Injured Drivers, Proceedings of the 13th International Conference on Alcohol, Drugs and Traffic Safety, 1995 (Adelaide: International Council on Alcohol, Drugs and Traffic Safety, 1995). Online: <http://casr.adelaide.edu .au/T95/paper/s16p6.html>.

The most commonly found drugs among crash victims taken to a major Melbourne trauma hospital were cannabis (36%), benzodiazepines (14%), amphetamines (12%), opioids (10%), and cocaine (2%). J. Gerostamoulos et al., Drug Prevalence in Road Trauma Victims in Victoria; in D. Mayhew and C. Dussault eds., Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, 2002 (Montreal: Socit de lassurance automobile du Qubec, 2002). Online: <http://www.saaq.gouv.qc.ca/t2002/actes/pdf/(17a).pdf>.

A study of Queensland university students found that 15% reported driving under the influence of a drug within the past 12 months. The most commonly used drugs: marijuana (13%); speed (6%); heroin (1%); ecstasy (3%); LSD (2%); benzodiazepines (2%); and cocaine (1%). Twenty percent of the males and 13% of females reported driving under the influence of a drug, in the past 12 months. Thirteen percent of 18-21 year olds, 18% of 22-36 year olds, and 10% of those over 36 reported driving under the influence of a drug in the past 12 months. J. Davey, T. Davey, and P. Obst, Drug and Drink Driving by University Students: An Exploration of the Influence of Attitudes (2005) 6 Traffic Injury Prevention 44 at 47-48.

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NEW ZEALAND

In 2003, drinking and driving contributed to 124 fatal crashes, 370 serious injury crashes and 859 minor injury crashes. During 2003, drinking and driving contributed to 141 deaths, 555 serious injuries and 1,398 minor injuries. Thirty-one percent of all road deaths were alcohol-related. The social cost of alcohol-related crashes was about $760 million. Over 80% of drivers with excess BACs involved in fatal crashes were male. Between 2001 and 2003, the combination of alcohol and speed contributed to 19% of the fatal crashes. Alcohol alone contributed to an additional 12% of the fatal crashes, and speed alone contributed to 16%. Therefore, alcohol and/or speed were factors in 47% of all fatal crashes. Land Transport Safety Authority (New Zealand), Drinking and Driving Statistics, Wellington, NZ: Land Transport Safety Authority, 2005). Online: <http://www.landtransport.govt.nz/resear ch/drink.html>.

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IMPAIRED DRIVING CHARTS

PERCENTAGE OF TRAFFIC FATALITIES, BY ROAD USER TYPE: SELECTED OECD COUNTRIES, 1998 Country Pedestrians % Cyclists % Motorcycle/ Moped Riders % 9.8 14.6 15.4 18.3 13.1 10.3 15.5 13.0 5.8 6.3 18.9 12.5 5.6 Motor Vehicle Occupants % 66.3 54.3 56.3 40.7 65.6 69.1 56.0 64.9 77.4 64.8 62.0 64.5 79.7

Sweden United Kingdom Switzerland Japan Norway Australia Netherlands Germany Canada Finland Italy Austria United States

13.0 26.5 20.4 28.3 14.2 18.1 10.3 13.9 14.1 15.5 13.4 17.1 12.8

10.9 4.6 7.9 12.6 7.1 2.5 18.2 8.2 2.7 13.5 5.8 5.9 1.9

Source: Transport Canada, Canadas Road Safety Targets to 2010 (Ottawa: Minister of Public Works and Government Services, 2001) at 3. Online: <http://www.tc.gc.ca/ roadsafety/tp/tp13736/pdf/CRS_Target.pdf>.

LEGAL IMPAIRMENT AMONG FATALLY-INJURED DRIVERS: SELECTED OECD COUNTRIES, 1997/98

35

Percentage Legally Impaired

30 25 20 15 10 5 0 Japan (.05%) Netherlands (.05%) Germany (.05%) Sweden (.02%) U.K. (.08%) Finland (.05%) U.S.* (.08% / .10%) Canada (.08%)

*At the time, the criminal BAC limit was .08% in 15 American states and .10% in 33 states. Source: Transport Canada, Canadas Road Safety Targets to 2010 (Ottawa: Minister of Public Works and Government Services, 2001) at 7. Online: <http://www.tc.gc.ca/ roadsafety/tp/tp13736/pdf/CRS_Target.pdf>.

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TRAFFIC DEATHS PER BILLION KILOMETRES TRAVELLED: SELECTED OECD COUNTRIES, 2001 Country Traffic Deaths Per Billion Kilometres

Great Britain Sweden Netherlands Norway Canada Finland Switzerland Australia Denmark United States

7.28 7.80 7.81 8.25 8.94 9.09 9.09 9.13 9.22 9.40

Source: Transport Canada, Road Safety in Canada: An Overview (Ottawa: Transport Canada, March 2004). Online: <http://www.tc.gc.ca/roadsafety/stats/overview/2004/menu.htm>.

BAC (mg/ml) 0

BAC LIMITS FOR DRIVING WORLDWIDE* Countries

0.1 0.4

0.5

0.6 0.7 0.8

Armenia, Azerbaijan, Bahrain, Croatia, Czech Republic, Ethiopia, Hungary, Jordan, Nepal, Pakistan, Romania, Saudi Arabia, Slovak Republic, and United Arab Emirates. Albania, Algeria, China, Estonia, Georgia, India, Japan, Lithuania, Moldova, Mongolia, Norway, Poland, Russia, Sweden, and Turkmenistan. Argentina, Australia, Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Cambodia, Costa Rica, Denmark, El Salvador, Estonia, Finland, France, Germany, Greece, Iceland, Israel, Italy, Kyrgyzstan, Latvia, Macedonia, Monaco, the Netherlands, Peru, Philippines, Portugal, Serbia, Slovenia, South Africa, South Korea, Spain, Switzerland, Taiwan, Thailand, Turkey, and Venezuela. Bolivia, Ecuador, and Honduras. Botswana, Brazil, Canada, Ghana, Guatemala, Ireland, Jamaica, Kenya, Luxembourg, Malaysia, Malta, Mexico, New Zealand, Nicaragua, Paraguay, Singapore, Uganda, United Kingdom, United States, and Zimbabwe.

*There are inconsistencies in the reported BAC limits for some countries. Sources: International Center For Alcohol Policies (ICAP), Blood Alcohol Concentration Limits Worldwide (Washington, D.C.: ICAP, 2005); E. Wren, Drunk Driving Blood Alcohol Limits Worldwide (New York: Drive and Stay Alive, Inc., 2005); and Eurocare, Drinking and Driving in Europe: A Report to the European Union (St. Ives: Eurocare, 2003).

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ALCOHOL AND DRUG-IMPAIRED FATALITIES, INJURIES AND PROPERTY-DAMAGE-ONLY (PDO) CRASHES: CANADA, 1999-2003 Year Fatalities Injuries PDO Crashes*

1999 2000 2001 2002 2003 Average

1,247 1,176 1,213 1,161 1,257 1,211

73,579 69,362 71,536 68,470 74,181 71,431

159,990 150,824 155,606 148,881 161,299 155,320

* The author estimated that an average of 1.52 vehicles were damaged in each PDO 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.

PERCENTAGE OF FATAL CRASHES BY TYPE OF IMPAIRMENT: CANADA, 2003

Alcohol & Drugs, 23% Drugs, 9% Alcohol, 68%

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 5.

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BACS OF ALCOHOL-POSITIVE FATALLY-INJURED DRIVERS: CANADA, 1990 - 2002 Year Total No. of BACPositive Drivers The Number and Percentage of Drivers With BACs at: .01% - .08% .81% - .15% .151% + 155 (20%) 159 (20%) 483 (60%) 127 (16%) 168 (21%) 490 (62%) 126 (17%) 165 (22%) 471 (62%) 115 (15%) 162 (22%) 472 (63%) 127 (18%) 143 (20%) 433 (62%) 129 (18%) 143 (20%) 430 (62%) 97 (16%) 133 (22%) 368 (62%) 108 (19%) 122 (21%) 346 (60%) 90 (16%) 136 (24%) 333 (60%) 90 (18%) 110 (22%) 299 (60%) 91 (18%) 118 (23%) 304 (59%) 80 (15%) 123 (23%) 321 (61%) 87 (17%) 133 (26%)* 291 (57%)** 88 (16%) 141 (26%)* 309 (58%)**

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

787 785 762 749 703 702 598 576 559 499 513 525 511 538

* Drivers with BACs of .81% - .160%. ** Drivers with BACs greater than .161%. Sources: Data from Transport Canada; and the Traffic Injury Research Foundation.

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PUBLIC SUPPORT FOR A LOWER CRIMINAL CODE BAC LIMIT: CANADA, 2005
Oppose Strongly 5.2% Oppose 8.7%

Support 16.9%

Other 13.6%

Strongly Support 55.6%

Source: SES Research Incorporated, MADD (Canada) National Poll November 2005, (Ottawa: SES, 2005).

PUBLIC VIEWS ON A .05% CRIMINAL CODE BAC LIMIT: CANADA, 2005

Limit About Right 32.0% 7.9% Limit Too High 51.6% 8.5% Unsure
Limit Too Low

Source: SES Research Incorporated, MADD (Canada) National Poll November 2005, (Ottawa: SES, 2005).

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BACS FOR MALES IN RELATION TO TIME, WEIGHT AND STANDARD CANADIAN DRINKS*
Standard Drinks 2 3 4 5 6 7 8 170 lbs .0185% .0428% .0671% .0913% .1156% .1398% .1641% 2 hours 185 lbs .0146% .0369% .0592% .0815% .1038% .1261% .1484% 200 lbs .0112% .0319% .0525% .0731% .0937% .1144% .1350% 170 lbs .0035% .0278% .0521% .0763% .1006% .1248% .1491% 3 hours 185 lbs .000% .0219% .0442% .0665% .0888% .1111% .1334% 200 lbs .000% .0169% .0375% .0581% .0787% .0994% .1200% 170 lbs .000% .0128% .0371% .0613% .0856% .1098% .1341% 4 hours 185 lbs .000% .0069% .0292% .0515% .0738% .0961% .1184% 200 lbs .000% .0019% .0225% .0431% .0637% .0844% .1050%

Likely criminal threshold under the proposed .05% law. Likely criminal threshold under the current .08% law. * Based on 13.46 grams of alcohol, and a metabolism rate of a .015% decrease in BAC per hour. Source: R. Solomon and E. Chamberlain, Calculating BACs for Dummies: The Real-World Significance of Canadas 0.08% Criminal BAC Limit for Driving (2003) 8(2) Canadian Criminal Law Review at 224.

BACS FOR FEMALES IN RELATION TO TIME, WEIGHT AND STANDARD CANADIAN DRINKS*
Standard Drinks 2 3 4 5 6 7 120 lbs .0514% .0921% .1328% .1734% .2141% .2548% 2 hours 130 lbs .0451% .0827% .1202% .1578% .1953% .2329% 140 lbs .0398% .0746% .1095% .1444% .1793% .2141% 120 lbs .0364% .0771% .1178% .1584% .1991% .2398% 3 hours 130 lbs .0301% .0677% .1052% .1428% .1803% .2179% 140 lbs .0248% .0596% .0945% .1294% .1643% .1991% 120 lbs .0214% .0621% .1028% .1434% .1841% .2248% 4 hours 130 lbs .0151% .0527% .0902% .1278% .1653% .2029% 140 lbs .0098% .0446% .0795% .1144% .1493% .1841%

Likely criminal threshold under the proposed .05% law. Likely criminal threshold under the current .08% law. * Based on 13.46 grams of alcohol, and a metabolism rate of a .015% decrease in BAC per hour. Source: R. Solomon and E. Chamberlain, Calculating BACs for Dummies: The Real-World Significance of Canadas 0.08% Criminal BAC Limit for Driving (2003) 8(2) Canadian Criminal Law Review at 225.

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ANNUAL CHARGES AND DISPOSITIONS IN PROVINCIAL AND TERRITORIAL COURTS: CUMULATIVE AVERAGES, 1994-1998 Dispositions Offence (Criminal Code, section) No. of Charges Stay/ Withdrawal 61% Acquittals 4% Guilty 31% Transferred* 0 Other** 5%

Impaired Driving (s. 253(a)) Driving with a BAC over .08% (s. 253(b)) Impaired Driving Causing Death (s.255(3)) Impaired Driving Causing Bodily Harm (s. 255(2)) Failing to Provide Samples (s.254(5)) Driving While Disqualified (s. 259(4))

55,705 53,745 193 1,365 6,450 8,207

33% 43% 45% 36% 21%

3% 3% 3% 4% 0

61% 23% 33% 56% 74%

0 28% 16% 1% 1%

3% 3% 3% 3% 4%

* Transferred to a superior court. ** Includes acquittals due to not guilty by reason of mental disorder, and charges waived out of the province. Source: E. Chamberlain and R. Solomon, Rating the Provinces: The 2000 Report (Toronto: MADD Canada, 2000).

ANNUAL CONVICTIONS AND SENTENCES* IN CANADA: CUMULATIVE AVERAGES, 1994-1998

Charge (Criminal Code Section) Impaired Driving Causing Death (s.255(3)) Impaired Driving Causing Bodily Harm (s. 255(2)) No. of Charges No. of Convictions Prison 193 1,365 45 445 90% 76% Probation 6% 13% Sentences Fine 2% 9% Other 1% 1% Unknown 1% 1%

* If more than one sentence was imposed, such as prison and a fine, only the most serious sentence was recorded. Source: E. Chamberlain and R. Solomon, Rating the Provinces: The 2000 Report (Toronto: MADD Canada, 2000).

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AMERICANS WHO REPORTED DRIVING UNDER THE INFLUENCE OF ANY ILLICIT DRUG IN THE PAST YEAR, BY AGE, 2003
18 16 14 12 Percent 10 8 6 4 2 0 14 15 16 17 18 19 20 21 22 23 24 25
Source: Department of Health and Human Services, Results from the 2003 National Survey on Drug Use and Health: National Findings (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

AMERICANS WHO REPORTED DRIVING UNDER THE INFLUENCE OF ANY ILLICIT DRUG IN THE PAST YEAR, BY AGE GROUP, 2003

10 9 8 7 Percent 6 5 4 3 2 1 0 26 29 30 34 35 39 40 44 45 49 50 54
Source: Department of Health and Human Services, Results from the 2003 National Survey on Drug Use and Health: National Findings (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

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AMERICANS WHO REPORTED DRIVING UNDER THE INFLUENCE OF ALCOHOL IN THE PAST YEAR, BY AGE, 2003
35 30 25 Percent 20 15 10 5 0 14 15 16 17 18 19 20 21 22 23 24 25

Source: Department of Health and Human Services, Results from the 2003 National Survey on Drug Use and Health: National Findings (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

AMERICANS WHO REPORTED DRIVING UNDER THE INFLUENCE OF ALCOHOL IN THE PAST YEAR, BY AGE GROUP, 2003
25 20 15 10 5 0 26 29 30 34 35 39 40 44 45 49 50 54
Source: Department of Health and Human Services, Results from the 2003 National Survey on Drug Use and Health: National Findings (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004). Online: <http://www.oas.samhsa.gov/nhsda/2k3nsduh/appg.htm>.

Percent

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Phone: (905) 829-8805 Toll-free in Canada: 1-800-665-MADD Fax: (905) 829-8860, E-mail: info@madd.ca 2010 Winston Park Drive, Suite 500 Oakville, Ontario L6H 5R7 www.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