Road Accidents, Alcohol, and Drugs: An Emergency Room Study in Florence, Italy

Road traffic injuries are a major cause of mortality and morbidity in the Western world, and the relative contribution of alcohol to road traffic accidents has been well documented in many international studies (World Health Organization, 2008). According to findings from several studies, alcohol-involved traffic accidents comprise at least one fifth of all traffic accidents (McLeod, Stockwell, Stevens & Phillip, 1999; Movig et al., 2004) and at least one third of all fatal traffic accidents (Athanasselis et al., 1999; NIAA, 2003; Drummer et al., 2004; Connor, Norton, Ameratunga, & Jackson, 2004). Alcoholinvolved road traffic accidents are typically associated with more severe injuries and fatalities (Fabbri et al., 2002; Connor et al., 2004; World Health Organization, 2008) and higher bloodalcohol concentrations (BACs) associated with fatal accidents (Holubowicz, Klaeden, & McLean, 1994; del Rio, Gomez, Sancho & Alvarez, 2002; NIAA, 2003). Road accidents in which one or more drivers had been drinking are also more likely to occur late at night and early morning as well as on weekends, times associated with periods of drinking (Peppiat, Evans, & Jordan, 1978; Schepens et al., 1998; Fabbri et al., 2002; Soffer et al., 2006; Puljula, Savola, Tuomivaara, Pribula, & Hillbom, 2007).Although other factors such as weather, speed, and traffic patterns also contribute to road accidents, alcohol and illicit drugs increase the risk of road accidents due to their potential to impair the skill and judgment of drivers. Much less is known about the contribution of licit and illicit drugs to the etiology of road accidents (Movig et al., 2004; Ronen et al., 2008); however, a positive correlation of cannabis (THC) use with road accidents was found when cannabis was consumed simultaneously with alcohol (Robbe & O'Hanlon, 1993; Brookoff, 1998; Ramaekers, Robbe & O'Hanlon, 2000; Lowenstein & Kaziol-McLain, 2001).The contribution of alcohol to road accidents is reported to vary across drinking cultures (Skog, 2001; Cherpitel et al., 2003) and the level of alcohol-related risk has been shown to be related to different drinking patterns (see Norstrom, Hemstrom, Ramstedt, Rossow & Skog, 2002). In Southern European countries, and particularly Italy, alcoholic beverages (especially wine) are often consumed daily during the week with meals. In this context, control of alcohol consumption and driving have often relied on the informal social control of drinking patterns, including control of heavy drinking (Simpura, 1998; Allamani & Prina, 2007).Road accidents and drinking and driving in ItalyThe Italian National Institute for Health Statistics (ISTAT) reported low rates for alcohol-related road accidents until 2008, after which these data were no longer collected. In 2008 alcohol-related road accidents accounted for 2.1% of all road accidents (ISTAT, 2009). Such rates were lower than those found in other countries (McLeod et al., 1999; Movig et al., 2004) and are potentially explained by the fact that alcohol involvement at the time of accident was subjectively attributed by police and not based on independent BAC testing. More in keeping with the aforementioned international literature, some forensic mortality studies report that alcohol is responsible for at least one third of all fatal road accidents in Italy (Sironi, Molendini, Bernabei, & Marozzi, 1999; Bernini, Conti, De Ferrari, Fornaciari, & Saligari, 2000). A study in Northern Italy reported 30.4% of 1,399 drivers stopped on the road during night-time on summer weekends between 1994 and 1997 on suspicion of excessive drinking had a BAC over 0.8 g/1 (Ferrara et al., 2000).Findings from a pilot study conducted in 2000-2001 in the Emergency Room (ER) of a metropolitan hospital in Florence showed that, among 70 people admitted for road accidents, 11.4% were BAC positive, and 19.1% were positive for alcohol and/or other drugs (Bardazzi et al. …