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AlcoholAbsorption,Distribution&Elimination
Alcoholabsorption,distributionandeliminationaresimultaneousprocessesthatcommenceupon
consumption.
Absorptionisthepassageofalcoholintotheblood.Distributionisthetemporaryplacementofalcohol
intovariousbodytissues.Eliminationistheremovalofalcoholfromthebody.Diffusionisthemethod
ofpassageofalcoholthroughcellmembranesandisgovernedbyconcentrationdifferencesoneither
sideofthecellwall.
UsetheBloodAlcoholCalculatortoestimateyourbloodalcohollevelatagiventime.

Bloodalcoholconcentration
Abloodalcoholconcentration(BAC)orbloodalcohollevel(BAL)reflectstheamountofalcoholin
thebody.Food,typeandquantityofbeverage,weight,sex,andrateofeliminationdeterminetheBAC
aftertheconsumptionofalcohol.TheBACisameasureofthedifferencebetweentheratesof
absorptionandelimination.ThechangeinBACwithtimemaybedescribedgraphicallyasa"blood
alcoholcurve,"wheretheabsorptionphaseisrepresentedbyarisinglineandtheeliminationphasebya
fallingline.

Alcoholabsorption
Alcoholisabsorbedfromthestomachandsmallintestinebydiffusion.Mostabsorptionoccursfromthe
smallintestineduetoitslargesurfaceareaandrichbloodsupply.Therateofabsorptionvarieswiththe
emptyingtimeofthestomach.Generally,thehigherthealcoholconcentrationofthebeverage,the
fastertherateofabsorption.However,aboveacertainconcentration,therateofabsorptionmay
decreaseduetothedelayedpassageofalcoholfromthestomachintothesmallintestine.
Themaximumabsorptionrateisobtainedwiththeconsumptionofanalcoholicbeveragecontaining
approximately2025%(byvolumeorv/v)alcoholsolutiononanemptystomach.Theabsorptionrate
maybelesswhenalcoholisconsumedwithfoodorwhena40%(v/v)alcoholsolutionisconsumedon
anemptystomach.Theratemayalsoslowdownwhenhighfluidvolume/lowalcoholcontent
beverages,suchasbeer,areconsumed.

Normalsocialdrinking
Fornormalsocialtypedrinking,thehighestBACisusuallyachievedwithin30minutesafter
completionofconsumption,thoughitcouldtakeaslongas60minutes.Whenlargeamountsofalcohol
areconsumedoverashorttimeinterval,orwhenalargequantityoffoodiseatenwiththealcohol,the
absorptionphasemaynotbecompleteforuptotwo(2)hoursafterlastconsumption.

TwohourBACplateau
Inothersituations,asubjectmaydevelopaplateau,wherethebloodalcoholleveldoesnotchangefor
uptotwohours.Whenthisoccurstherateofabsorptionisequaltotherateofeliminationandhencethe
bloodalcoholconcentrationdoesnotchange.Aftertwohours,therateofeliminationwillexceedthe
rateofabsorptionandthebloodalcohollevelwillbegintodecrease.
Onceintheblood,alcoholiscarriedthroughoutthebody.Thealcoholdiffusesintotissuesandfluids
accordingtotheirwatercontent.Duringtheabsorptionphase,theBACofarterialbloodisgreaterthan
theBACofvenousblood.Arteriescarrybloodtoatissue,andveinsremovebloodfromthetissue.At
equilibrium,wherethetissuehasabsorbedaproportionatequantityofalcohol,theBACofarterial
bloodisequaltotheBACofvenousblood.

WeightandsexaffectBAC
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Aperson'sweightandsexdeterminethetotalvolumeofbodywaterandconsequentlytheBAC
obtaineduponconsumptionofaparticularquantityofalcohol.Generally,themoreapersonweighs,the
largerthevolumeofbodywaterandthelowertheBACobtainedfromtheconsumptionofagiven
amountofalcohol.
Afemalemayhavemorefattissuethanamaleofthesameweightandthereforeasmallervolumeof
bodywater.Asaresult,afemalemayobtainaslightlyhigherBACuponconsumptionofthesame
quantityofalcoholasamale,allotherfactorsbeingequal.
AstheBACdecreases,alcoholdiffusesfromthetissuesbackintotheblood.

Eliminationofalcohol
Alcoholiseliminatedfromthebodybyexcretionandmetabolism.Mostalcoholismetabolized,or
burned,inamannersimilartofood,yieldingcarbondioxideandwater.Asmallportionofalcoholis
excreted,suchasthroughthebreath,leavingthebodyasalcohol,unchanged.Itisthislatterprocessthat
allowsforbreathalcoholtesting.

Averagerateofelimination
Eliminationoccursataconstantrateforagivenindividual.ThemedianrateofdecreaseinBACis
consideredtobe15milligramspercent(mg%)perhour.TherangeofdecreaseinBACis1020mg%
perhour.Thisrangerepresentstheextremeendsoftherateencounteredinanormalpopulation.Most
peopleeliminateatarateofbetween13and18mg%perhour.Ofthese,themajorityeliminatesatthe
higherend.Veryfewpeopleeliminateataslowarateas10mg%perhour.

Calculationsusingbloodalcoholcurve
Usingabloodalcoholcurveitispossibletoestimatethefollowing:1)Bloodalcohollevelatagiven
timebaseduponanindicatedconsumptionscenario2)Quantityofalcoholrequiredtoproducea
knownbloodalcohollevelatagiventime3)Bloodalcoholconcentrationforagivensubjectatatime
previoustosamplecollection(retrogradeextrapolation),oratatimesubsequenttosamplecollection
(anterogradeextrapolation).
Toaccuratelyestimateeachoftheabove,knowledgeofcertainfactorsisrequired.Thesefactorsmay
includesex,age,height,andweightofthesubjectconsumptionstarttimeandstoptime,aswellas
patternofdrinkingtypeofalcoholconsumedincludingnumberandsizeofdrinks,theiralcohol
contenttimeforwhichBACisbeingcalculatedorBACvalue(s)detectedifaretrogradeor
anterogradeextrapolationisrequired.Otherfactorsthatcouldaffecttheseestimatesincludetimeswhen
mealswereeatendiseasestatesandanymedicationsthatmaybetaken.Thisinformation,combined
withtheempiricalfactorsforalcoholabsorption,distributionandelimination,providesthebasisforthe
estimatesnotedabove.
SeetheBloodAlcoholCalculator.

BACReportingConventions
TheCriminalCodeofCanadareportsthelegallimitforalcoholas80milligramsofethylalcoholper
100millilitresofblood(80mg%).Thisisalsooftenexpressedas0.08gramsofethylalcoholper100
millilitresofblood.Intheclinicalworld,concentrationsofsubstancesarereportedusingtheS.I.
(InternationalSystemofUnits)systemofmeasurement,hencemillimolesperlitre.Onemillimoleof
ethylalcoholperlitreofbloodisequivalentto4.61milligramsofethylalcoholper100millilitresof
blood.Asaresultof80mg%isequivalentto17.3millimolesofethylalcoholperlitreofblood.

InformationRequiredforAlcoholRelatedReports
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Personaldata
Sexheightweightmedicalconditions(ifany)medication(ifany)includingthedosageregimen
beingfollowedandtheperiodoftimethismedicationwasusedpriortotheincidentinquestion(day,
monthsoryears).

Drinkingdata
Timeconsumptionbegantimeconsumptionceasedapproximatetimeatwhicheachdrinkwas
consumed(consumptionpatternevenlyspacedormoredrinksatthebeginningorattheendofthe
drinkingtimeinterval)mealseaten(timesanddescription).
Eachdrinkshouldbeidentifiedbybeveragesizeandalcoholcontent.Beershouldbedescribedby
brand,containertype(cans,bottles,draftglassesetc.),andwhetheritwaslight,regularorextrastrength.
Wineshouldbeidentifiedbybrandandalcoholcontent.Wineglassesshouldbedescribedbybeverage
volume.Liquor,liqueursandshootersshouldbeidentifiedby"shot"size,brandandalcoholcontent
wheneverpossible.Shooterswithmultipleingredientsshouldbeidentifiedaccordingtothe
componentsusedtoformulatethemixtureandtheproportionsused.

Offencedata
Theoffencescommittedshouldbeprovidedalongwiththedateandlocationfortrial.TheCrown
disclosurematerialcompletewiththeAlcoholInfluenceReportshouldbeforwardedifavailable.Ifnot,
pleaseprovidethetimeoftheallegedoffenceandthetimesandvaluesofeachbreathtest.All
instrumentsusedshouldbeidentifiedaccordingtomanufacturermakeandmodelnumber.Allsignsof
impairmentshouldbedescribed.

Serum/Plasmaversuswholeblood
Ithasbeenobservedthatthehospitalanalysesofbloodsamplesforethylalcoholcontentareoften
baseduponserumorplasmaasthesamplematrix.
Plasmaistheliquidportionofthecirculatingblood.
Serumistheliquidremainingaftertheredbloodcellsareremovedbymechanicalmeans,suchas
centrifugation.
Serumcontainsslightlymorewaterthanwholebloodandhencewillhaveaslightlyhigheralcohol
levelthanwholeblood.Scientificstudieshaveshownthatserumwillcontainmorealcoholthanwhole
bloodbyafactorofbetween1.08:1and1.18:1,oronaverage,afactorof1.12:1.Asaresult,aserum
alcohollevelof108118mg%wouldbeequivalenttoanalcohollevelof100mg%inwholeblood.

Urinealcoholconcentration(UAC)considerations
Afteralcoholisabsorbedintothebloodstreamofagivenindividual,itisdistributedthroughoutall
bodyfluidsandtissuesaccordingtothewatercontentofthosefluidsortissues.Atanygivenpointin
timetheUACwillbeconsiderablydifferentfromtheBAC
AfterthecessationofdrinkingtheBACmayriseforaperiodoftime.Atthispoint,theUACwillbeless
thantheBACbecauseofabsorptionanddistributionconsiderations.Thereafter,theBACandUAC
curveswillcross.ForsomeperiodoftimetheUACwillcontinuetorise,whereastheBACwillremain
constant(plateau)orbegintodecrease.Inthefullypostabsorptivestate,theUACwillalwaysexceed
theBACbecauseofthehigherwatercontentforurinecomparedtothatforblood.ThepeakBACis
generallyreachedwithin30to90minutesafterthepeakBACisachieved.
Bloodanalysisisadirectmethodforthedeterminationofabloodalcohollevelandurineanalysisisan
indirectmethod.Inotherwords,abloodsampleanalysisisthemostaccuratemeanstopredictablood
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alcohollevel.TosomeextentaUACcancorroborateaBAC,butdifficultiescanarisewiththeuseofa
singleurinesamplebecauseofpooledurineinthebladder.Inlivingsubjects,morethanoneurine
sampleshouldbeobtainedoveraknowntimeinterval.Obviouslyincaseswheredeathhasoccurred,
theonlysamplethatisavailableforanalysisistheurinesamplefoundinthebladder,whichwasformed
priortodeath.
Urinealcohollevelsarefarmorereliablewhentwourinesamplesarecollectedabout0.51.0hoursapart
andthebladderiscompletelyemptiedatthefirstvoid.Thisensuresthattheurinesamplecollectedat
secondvoidwasformedwithintheperiodoftimebetweenthefirstandsecondvoidsamples.The
differenceinUACvaluesbetweenthefirstandsecondvoidprovidesinformationconcerningthestate
oftheUACcurve(risingorfalling).Inaddition,thealcoholcontentofthesecondvoidrepresentsthe
averagealcoholconcentrationoftheurineformedbetweenthefirstandsecondvoid.Whenaurine
sampleiscollectedinthismanneritisknownthattheUAC:BACrelationshipisapproximately1.33:1.
Thismeansthattheurinealcoholcontentwillbe1.33timesgreaterthanthebloodalcoholcontent.
UndertheseconditionsaUACof133mg%wouldequatetoaBACof100mg%.Becausetheurineis
formedoveraperiodoftime,thepredictedBACbaseduponaUACresultreferstoabloodalcohollevel
atsometimepriortothecollectionoftheurinesample.
Whensingleurinesamplesareanalyzed,afargreaterrangeofvaluesarereportedinthescientific
literaturefortheUAC:BACratio.OnescientificstudyreportedthatthemeanUAC:BACratiovaried
from1.41.7:1,whentheBACofthesubjectsstudiedexceeded50mg%.Whensecondspecimensof
urinewereobtainedapproximately60minutesafteraninitialvoid,themeanUAC:BACratiowas
foundtobe1.35:1.Thisstudyconfirmsthehighlydesirablefeatureofcollectingtwourinesamples,
whenurinealcohollevelsareusedtopredictaBAClevel,aswellastoassessthestateoftheblood
alcoholcurve(risingorfalling)atatimeintervalofinterest.

AlcoholPharmacology
Centralnervoussystemdepressant
Drinkersoftenperceivealcoholtobestimulating.Thisperception,whichusuallyoccursatlowerlevels
ofalcoholintake,resultsfromadepressionofinhibitorycontrolmechanismsinthebrain.
Alcoholisclassifiedasageneralanesthetic,whichproducesarangeofcentralnervoussystem(CNS)
effectssimilartothoseofothersedative/hypnoticdrugs.Firstitdestroystheintegratingcontrolofthe
brainwhichmaycausethoughtprocessestobecomedisorganizedandchaotic.Thedrinkermaybecome
confusedanddisoriented.Inadditionmotorfunctionsmaybecomelessfluid.

Uncontrolledmoodswings
Thefirstmentalprocessestobealteredarethosethatdependontrainingandexperience.Thefiner
componentsofdisrimination,memory,judgement,decisionmaking,concentrationandinsightare
erodedandeventuallylostasdrinkingcontinues.
Thedrinkermaybecomeveryconfidentandexhibitpersonalitychangeswithuncontrolledmood
swings.Emotionaloutburstsmaybecomefrequentandthesubjectmaysuffersensoryandmotor
disturbances.Asintoxicationprogresses,generalimpairmentofnervousfunctionandgeneralanesthesia
couldresultinrespiratorydepression,andultimatelydeath.

Factorsgoverningeffectofalcohol
Theeffectofagivenamountofalcoholonaspecificpersonisafunction,amongotherthings,oftherate
atwhichthealcoholisconsumed,thesubject'stolerancetoalcohol,andthecircumstancesrelatedto
drinking(partyatmosphereversusamoresombresetting).
Thedegreeofimpairmentisdoserelated.However,itisnotidenticalorlinearforallbehaviors.Itis
clearthatbehavioralskillsrequiringcognitivefunctioningsufferthegreatestimpairment.Putanother
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way,impairmentofthecognitivefunctionsbeginsatlowerlevelsofalcoholconsumptionthanfor
simpletasks.

Alcoholtolerance
Tolerancewilldevelopinregulardrinkers,butnotnecessarilyuniformlyforallbehavioralskills.Motor
coordinationshowsthemosttolerance.Whethertolerancedevelopswithrespecttocomplexskillsand
cognitivefunctioningisunclear.Impairmentofdividedattentionskills(performanceoftwoormore
tasks)showslittleevidenceoftolerance,whereassomeshorttermmemorystudiessuggestthatitmay
developforcomplextasks,aswellassimpleones.

Morealcoholneededtoachievesameeffect
Tolerancetomanyeffectsofalcoholiseasilydeveloped.Alcoholismetabolizedbytheliver.Aperson
whousesalcoholwantsthedesiredeffecttolastaslongaspossible.Alcoholmetabolismor
transformationlimitsitsdurationofaction.Repeatedexposureofthemetabolizingsystem(mainlythe
liver)toalcoholincreasesthesystem'scapabilityandefficiency.Asaresult,thealcoholismetabolized
morequicklyandthedurationandintensityofthedesiredeffectareconsiderablyreduced.Thisiscalled
metabolictolerance.Toregainthedesiredeffectofthealcohol,theindividualmustincreasethedosage
and/orfrequencyofconsumption.

Centralnervoussystemtolerance
Centralnervoussystem(CNS)toleranceoccurswhencellsadapttothepresenceofalcoholinsucha
wayastodiminishtheeffectofagivenlevelofalcoholonthem.Thiskindoftoleranceischaracterized
bydifferentialdevelopmentfordifferenteffects.Inotherwords,itdoesnotdevelopatthesameratefor
alleffectsofadrugoritmaynotdevelopatallforsomeeffects.Thisiscalledfunctionaltolerance.As
withmetabolictolerance,theuserincreasesthedoseorfrequencyofadministrationtoovercomethis
tolerance,reinstatingorenhancingthedesiredeffect.

Lossoftolerance
Tolerancetoadrug,suchasalcohol,oncedeveloped,willbeminimizedwithtime,ifthedrugisno
longertakenregularly.Generally,cessationofdrugusewillcausethebodytoreverttoitsoriginal
tolerancelevels,whenitfirstexperiencedthepresenceofthedrug.If,afteralongperiodofabstinence,
thedrugisusedagainregularly,thereisconsiderableevidencetosuggesttheformertoleranceis
acquiredmoreeasilyandquickly.

Impairmentversusintoxication
Itshouldbenotedthatindividualscanbeimpairedbyalcoholwithoutmanifestinganyvisiblesigns.
Impairmentisnotsimplytheappearanceofgrossphysicalsymptomsbutadeteriorationofjudgment,
attention,lossoffinecoordinationandcontrolwithapossibleincreaseinreactiontimeanda
diminishingofsensoryperceptions.Intoxicationisanadvancedstateofimpairmentinwhichthegross
physicalsymptomsoftheeffectsofalcoholareapparent.Thepointatwhich"impairment"becomes
"intoxication"isuniquetothesubjectanddependsontolerance.

ImpairmentandrisingorfallingBAC
StudieshaveshownthatimpairmentisgreateratagivenbloodalcohollevelwhentheBACis
increasingthanforthesameBACwhenthebloodalcohollevelisfalling.ThisiscalledtheMellanby
effect.
Themannerofconsumptionalsocanaffectimpairment.Ifalcoholisconsumedataslowandsteady
pace,itislikelythattherewillbeaslowandsteadyincreaseinimpairment.Ifthealcoholisconsumed
morequickly,therateofincreaseinimpairmentmayalsobemorerapidandappearatlowerBACs.
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Bolusdrinking
Ifalcoholisconsumedquickly(bolusdrinking),therateofperformancedeficitmaybefurther
acceleratedbecausethealcoholisabsorbedintothebloodstreammorerapidly.Theincreasing
impairmentisgenerallyobvioustotheobserverduetothegreaterthanexpectedrateofdeteriorationin
abilitiesandperformance.TolerancedevelopedtoagivenBAC,whichisachievedonthebasisofa
socialdrinkingpattern,maynothelptomoderatetheeffectsofalcoholwhenthesameBACisachieved
bybolusconsumption.

AlcoholandDriving
Therelationshipbetweendrivingabilityandalcoholimpairmentisparticularlysignificantasitis
probablythemostintenselystudiedareaoftheeffectofalcoholoncognitivefunctions.Drivingisa
complextaskinvolvingtheintegrationandcoordinationofmanyskillsandabilities.Itinvolves
dynamicandcontinuousinteractionamongthedriver,thevehicleandtheenvironment.Itrequiresswift
andaccuratetransferofinformationfromtheenvironmenttothedriver,theprocessingofthat
information,decisionmakingonhowtorespond,andthetranslationofdecisionsintophysicalactions.

ImpairmentatlowBAClevels
Thescientificcommunityisunabletoreplicatetherealworlddrivingtask.Toassesstheeffectsof
alcoholontheabilitytodrive,researchershavedisassembledthedrivingfunctionintotheoreticalparts
forstudy.AlthoughthereissomeevidencethatimpairmentinsomeindividualsmaybeginatlowBAC
levels,thisdatamustbetreatedwithsomecaution.Itisclear,however,thatmostpersonswithaBACof
100mg%wouldsuffersomeimpairment.

Experimentalstudies
Therearetwoseparateanddistinctsourcesofdataconcerningtheissueofalcoholimpairmentand
drivingability.Experimentalstudiesrelatetheeffectsofalcoholtosomeaspectofphysiological
functionthatmayormaynotrelatetodrivingability.Thisusuallyinvolveslaboratorytesting,driving
simulatorsoractualinvehicle,closedcoursedrivingsituations.Theseexperimentsusuallyattemptto
replicatesomeaspectoftherealdrivingexercise.

Epidemiologicalstudies
EpidemiologicalstudiesattempttorelateBACtothelikelihoodorriskofaccidentinvolvement.These
studiesattempttoobserveasmanyfactorsaspossibleinordertodevelopathesisabouttheir
relationshiptoanactivity(suchasdriving)andabouttheirinteractionwitheachother.Thiskindof
researchattemptstodefinehowalcoholandroadaccidentsareassociated.
Thefollowingfeatureshavebeenshowntobenegativelyinfluencedbyalcohol.
Vision:(visualacuity,depthperceptionperipheralvisionandglarerecovery)
Reactiontime:simple,choiceandcomplexreactiontimes
Trackingtasks:compensatoryandpursuittracking
Cognitivefunctions:concentratedattentiondividedattentionratesofinformationprocessing
judgementanddecisionmaking.
Psychomotorskills:coordinationbodyswaymanualdexterityandgeneralwalking
Drivingsimulatorsandclosedcoursedrivingexperiments:brakingandstoppingefficiency
steeringlanepositionevasivemanoeuvresparkingandemergencyresponse
Otheraspects:memoryrisktakingovercompensation
Epidemiologicalstudies:increasedriskofaccidentwithincreasingBACs

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