BackgroundAlcohol-impaired driving is a critical factor leading to traffic crashes worldwide. Since decades, researchers from the developed nations have been investigating the effects of alcohol intoxication on their drivers. However, alcohol effects on the drivers of developing counties remain understudied. The extent of alcohol impairment may vary among the drivers of developed and developing nations due to the differences in drivers’ physiology, driving conditions, drinking habits, policy enforcement and driving attitude. MethodsThis study examined the effects of different Blood Alcohol Concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%) on 75 licensed Indian drivers (56 males and 19 females) with the help of a fixed-base driving simulator. Subjects completed driving simulations for all the BAC levels in a driving environment representing heterogeneous traffic conditions. Performance measures included longitudinal and lateral driving control indicators (obtained from simulator) along with the self-reported physiological changes in the drivers (obtained from questionnaire) with varying BAC levels. ResultsMean speed was the only performance measure significantly affected at 0.03% BAC. At 0.05% BAC, mean speed and mean steering wheel angle were the two significantly impaired measures. At 0.08% BAC, all the driving performance measures showed significant impairment except steering wheel angle variability. Physiological characteristics of drivers deteriorated with rising BAC levels. ConclusionsAlcohol significantly impaired the physiology of Indian drivers resulting in impairment in their driving performance. Mean speed was the only performance measure significantly affected by all the BAC levels, making it a suitable parameter to detect the alcohol-impaired state of the drivers.