Abstract
Driving is increasing across the world and road traffic accidents are a major cause of serious injuries and fatalities. The link between alcohol consumption and impaired driving has long been established and has led to legislation in many countries, with enforcement of legal limits based on blood alcohol concentration levels. Alcohol hangover research is an emerging field with a range of laboratory and naturalistic studies now clearly demonstrating the significant impairments that can result from hangover, even when alcohol levels are measured at or close to zero the day following a social drinking occasion. Driving is a commonplace activity but requires competency with a range of complex and potentially demanding tasks. Driving impaired can have serious consequences, including death and serious injury. There have been only limited alcohol hangover driving studies. The studies presented examined the consequences of alcohol hangover with a driving simulator contrasting a group with zero residual alcohol (N = 26) next day and another with residual alcohol (N = 26) assessed with breathalyzer in the morning before undertaking a 20 min commute to work. All participants completed a morning drive after a night without alcohol consumption and another after a night of social drinking. The driving scenarios were relatively demanding including traffic and pedestrians, traffic lights and other potential hazards in a mixed rural and urban journey. Subjective hangover and workload were assessed in addition to a range of driving performance variables, including divided attention, steering control and driving violations. Analyses contrasted driving in the no alcohol condition with the residual alcohol condition. The combined groups data (N = 52) was contrasted with the zero and residual alcohol groups. Significant contrasts were found for a range of driving measures, including divided attention, vehicle control, and driving violations as well as perceived workload. The pattern of impairment was broadly similar across both groups, indicating that whether or not residual alcohol was present, consistent driving impairment was seen. The relatively high number of significant variables may reflect the increased cognitive demand of the 20 min commute drive including busy and complex urban environments. This was also reflected in the significant increase in perceived workload recorded across the 6 dimensions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Associations between subjective measures and driving performance with hangover suggested a potential lack of awareness of impairment, though were limited in number. The overall findings indicate that the levels of impairment seen reflect those seen with alcohol impaired driving, even when breath alcohol is zero.
Highlights
Road traffic accidents are a leading cause of mortality, with around 1.35 million deaths recorded worldwide in 2016, ranked in the top 10 causes of mortality, the leading cause of death for 5–29 year olds, and with up to 35% of road accident deaths estimated as being alcohol related [1]
Alcohol hangover is the most commonly experienced consequence of alcohol consumption [12] and is defined as the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero [13,14]
Driving assessments made under more challenging conditions have found significant impairment in driving control at blood alcohol concentration as low as 0.02%–0.03% BAC [3,22], and it has been shown that driving distractions can produce a two-fold increase in alcohol induced driving impairment [4]
Summary
Road traffic accidents are a leading cause of mortality, with around 1.35 million deaths recorded worldwide in 2016, ranked in the top 10 causes of mortality, the leading cause of death for 5–29 year olds, and with up to 35% of road accident deaths estimated as being alcohol related [1]. The neurocognitive and psychomotor effects of alcohol hangover have been demonstrated in both laboratory and field studies [18,19], showing significant levels of impaired function on a range of tasks and impacting mood and subjective state in some but not all studies. The one hour (100 km) on-road highway driving test is considered the ‘gold standard’ of driving assessments and has been the basis of a large body of research in the Netherlands examining the impact of acute dosing as well as residual effects of a range of psychoactive compounds including alcohol [20]. The one hour driving test is undertaken in a relatively undemanding driving environment for a competent driver, such as a highway or motorway setting with an identified and clearly marked driving lane and without oncoming traffic. Driving assessments made under more challenging conditions have found significant impairment in driving control at blood alcohol concentration as low as 0.02%–0.03% BAC [3,22], and it has been shown that driving distractions can produce a two-fold increase in alcohol induced driving impairment [4]
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