Medical-Legal Aspects of Alcohol

by Garriott, James C.

• ISBN13: 9781930056695
• ISBN10: 1930056699
• Edition: 4th
• Format: Hardcover
• Copyright: 2003-10-01
• Publisher: Lawyers & Judges Pub Co

Summary

Alcohol-related litigation typically pertains to arrests of drinking drivers, but also includes industrial accidents, public transport accidents, and violent crimes. Even so, the medical and legal aspects of alcohol are complex topics due to many different components present in alcohol-related cases. This book covers many important topics including alcohol and the law, biochemistry of alcohol, physiology and alcohol, blood, urine, other fluid and tissue specimens for alcohol analyses, analysis for alcohol in postmortem specimens, computer tools for body alcohol evaluation, breath as a specimen for analysis for ethanol and other low molecular weigh alcohols. The wealth of information presented in this book makes it an invaluable resource when investigating and litigating cases involving alcohol.

Table of Contents

Preface	ix
The Chemistry of Alcoholic Beverages
Bill H. McAnalley
A Description and History of Common Alcoholic Beverages	2	(3)
Fermentation	5	(1)
Yeasts	6	(1)
Bacterial contamination	6	(1)
Nutritional Value of Alcoholic Beverages	6	(2)
Carbohydrates	7	(1)
Proteins	7	(1)
Fats	7	(1)
Vitamins and minerals	8	(1)
Antimicrobial Properties of Alcoholic Beverages	8	(1)
Cancer and Alcohol	9	(1)
Ethyl Alcohol Content	9	(1)
Congeners	9	(1)
Classification of Congeners	10	(5)
Volatile congeners	10	(1)
Alcohols	10	(2)
Aldehydes	12	(1)
Esters	12	(1)
Alcohols, aldehydes and esters	12	(2)
Common Acids	14	(1)
Ketones	14	(1)
Phenols	15	(1)
Vasoactive Congeners	15	(1)
Tyramine	15	(1)
Histamines	15	(1)
Toxic metals	15	(1)
Congeners from Spices and Herbs	16	(1)
Semivolatile Congeners	17	(3)
Xenobiotics in Alcoholic Beverages	20	(3)
References	20	(3)
Pharmacology and Toxicology of Ethyl Alcohol
James C. Garriott
Skin	23	(1)
Gastrointestinal Tract	24	(1)
Cardiovascular System	24	(1)
Liver	25	(1)
Kidney	25	(1)
Endocrine System	25	(1)
Central Nervous System	26	(3)
General	26	(2)
Chronic CNS effects	28	(1)
Impairment of Specific Functions Related to Driving Ability	29	(3)
Vision	29	(1)
Auditory discrimination	29	(1)
Other sensory effects	30	(1)
Reaction time	30	(1)
Review of research on alcohol impairment of driving and piloting skills	30	(2)
Effects of Alcohol in Combination with Other Drugs	32	(4)
Acetaminophen	33	(1)
Amphetamines	33	(1)
Analgesics and narcotics	33	(1)
Antidepressants	33	(1)
Barbiturates	33	(1)
Benzodiazepines	34	(1)
Caffeine	34	(1)
Cocaine	35	(1)
Inhibition by histamine2-receptor antagonists	35	(1)
Marihuana	36	(1)
Antagonists to Alcohol and Pharmacotherapeutic Agents for Alcoholism	36	(1)
Disulfiram (Antabuse) and other acetaldehyde antagonists	36	(1)
Other agents used in treatment of alcoholism	37	(1)
Tolerance	37	(10)
References	38	(9)
Disposition and Fate of Ethanol in the Body
A.W. Jones
Introduction	47	(2)
Analytical Considerations	49	(2)
Disposition and Fate of Ethanol in the Body	51	(1)
Absorption of Ethanol	51	(1)
Inhalation of ethanol vapors	51	(1)
Absorption through skin	51	(1)
Dosage Forms	52	(1)
Absorption from the Gut	52	(1)
Gastric Emptying	52	(2)
Drinking on an Empty Stomach	54	(1)
Beverage Type and Alcohol Absorption	55	(1)
Gastric First-Pass Metabolism	56	(3)
General	56	(2)
Effects of drugs on first-pass metabolism	58	(1)
Hepatic First-Pass Metabolism	59	(1)
Type of Beverage and Rate of Ethanol Absorption	60	(1)
Distribution of Ethanol	61	(2)
Arterial-venous differences in ethanol concentration	61	(1)
Concentrations of ethanol in plasma and whole blood	61	(2)
Widmark's Factor rho	63	(3)
General	63	(2)
Updating the Widmark r factor	65	(1)
Elimination of Ethanol	66	(1)
Metabolism of Ethanol	67	(14)
Alcohol and aldehyde dehydrogenases	67	(1)
Polymorphism of ADH and ALDH	68	(1)
Microsomal enzymes cytochrome P450	69	(1)
Phase-II conjugation of ethanol	70	(1)
Factors influencing the rate of ethanol disappearance from blood	70	(1)
Inter- and intra-individual variations	71	(1)
Sex differences	71	(1)
Physiological range of ethanol elimination rates	71	(1)
Elimination rates in alcoholics during detoxification	72	(1)
Liver cirrhosis and ethanol elimination rate	73	(1)
Inhibition and acceleration of ethanol metabolism	73	(1)
Blood concentration-time profiles of ethanol	74	(7)
Excretion of Ethanol	81	(13)
Ethanol in body fluids	81	(1)
Breath	82	(3)
Saliva	85	(2)
Urine	87	(4)
Cerebrospinal fluid	91	(1)
Other fluids and tissues	91	(3)
Concluding Remarks	94	(19)
References	96	(17)
The Biochemistry and Physiology of Alcohol: Applications to Forensic Science and Toxicology
A.W. Jones
Introduction	113	(2)
The Fate of Alcohol in the Body	115	(1)
Enzymes Involved in the Metabolism of Alcohol	116	(1)
Isoenzymes of Alcohol Dehydrogenase	117	(1)
The Existence of ADH in the Stomach	118	(1)
Aldehyde Dehydrogenase	119	(1)
Microsomal Ethanol Oxidizing System	120	(1)
Biomedical Research on Acetaldehyde	120	(3)
Aspects of Ethanol Pharmacokinetics	123	(3)
Widmark or Michaelis-Menten Pharmacokinetics?	126	(2)
The Magnitude of Inter- and Intra-Individual Variations	128	(1)
The Zig-Zag or Steepling Effect	129	(3)
The Rate of Alcohol Elimination in Pathological Conditions	132	(1)
First-Pass Metabolism of Ethanol	133	(1)
Histamine2-Receptor Antagonists and the Pharmacokinetics of Ethanol	133	(3)
The Effects of Food on the Pharmacokinetics of Ethanol	136	(2)
Kinetics of Ethanol Metabolites---Acetaldehyde and Acetate	138	(1)
Biochemical Markers of Alcohol Abuse and Risk of Alcoholism	138	(1)
Concluding Remarks	139	(10)
References	140	(8)
Endnotes	148	(1)
Blood, Urine and Other Fluid and Tissue Specimens for Alcohol Analyses
Yale H. Caplan
Bruce A. Goldberger
Blood	149	(2)
General considerations	149	(1)
Sources of blood specimens	150	(1)
Serum and Plasma	151	(1)
Urine	152	(1)
Bile	153	(1)
Saliva	153	(1)
Brain and Cerebrospinal Fluid	154	(1)
Vitreous Humor	154	(1)
Other Specimens	155	(8)
References	156	(7)
Analysis for Alcohol in Postmortem Specimens
James C. Garriott
Analytical Considerations	163	(1)
Distribution of Alcohol in the Body	163	(6)
Blood	164	(1)
Antemortem dilution	164	(1)
Other body tissues	164	(1)
Skeletal muscle	165	(1)
Brain	166	(1)
Intracerebral blood clots	166	(1)
Urine	167	(1)
Vitreous humor	167	(2)
Postmortem Effects on Blood Alcohol Concentrations	169	(2)
Diffusion	169	(1)
Sampling considerations	169	(1)
Postmortem decomposition	170	(1)
Effects of embalming	171	(1)
Acute Ethyl Alcohol Fatalities	171	(6)
References	174	(3)
Breath as a Specimen for Analysis for Ethanol and Other Low-Molecular-Weight Alcohols
Morton F. Mason
Kurt M. Dubowski
Introduction	177	(1)
The History of Breath Alcohol Analysis	178	(2)
Sampling	180	(5)
References	181	(2)
Endnote	183	(2)
Methods for Breath Analysis
Patrick Harding, B.S.
Introduction	185	(1)
Sampling Breath for Alcohol Analysis	185	(1)
End-expiratory breath is the desired specimen	186	(1)
Residual mouth alcohol	186	(1)
Condensation losses, carryover	186	(1)
Additional steps	186	(1)
Breath Alcohol Testing Instrumentation	186	(2)
Testing instruments	186	(1)
Calibrating units	187	(1)
Requirements for Evidential Breath Testing	188	(1)
General	188	(1)
Maintaining reliability	189	(1)
Federal specifications	189	(1)
Challenges to the Validity of Breath Alcohol Results	189	(2)
Rules, regulations and documentation	190	(1)
Specificity	190	(1)
Residual mouth alcohol	190	(1)
Radio frequency interference	191	(1)
Instrument variability	191	(1)
Breath Alcohol Testing Instruments	191	(22)
Infrared spectroscopy	191	(5)
Electrochemical oxidation or fuel cell	196	(5)
Dual detector: Infrared/fuel cell	201	(1)
Solid-state semiconductor (Taguchi) gas sensor	202	(1)
Chemical oxidation and photometry	203	(3)
Gas chromatography	206	(2)
References	208	(3)
Endnote	211	(2)
Methods for Fluid Analysis
Richard F. Shaw
Chemical Methods	213	(1)
Biochemical Methods	214	(3)
Gas-Chromatographic Methods	217	(5)
Extraction techniques	217	(1)
Distillation techniques	218	(1)
Direct-injection techniques	218	(2)
Headspace techniques	220	(2)
Other Methods for Alcohol Analysis	222	(7)
High-performance liquid chromatography	222	(1)
Gas chromatography---Mass spectrometry	223	(1)
References	223	(6)
Quality Assurance
Barbara J. Basteyns
Graham R. Jones
Pretesting Criteria	229	(1)
Laboratory Issues	230	(1)
Personnel Considerations	230	(1)
Testing Criteria	231	(2)
Standard operating procedures manual	231	(1)
Standards and controls	232	(1)
Evaluation of quality control criteria	233	(1)
Instrument maintenance manuals	233	(1)
Criteria for review and validation of results	233	(1)
External Proficiency Testing	233	(1)
Test Reporting Systems	233	(1)
Post-testing Issues	233	(1)
Computer Support	234	(3)
References	234	(1)
Reference Materials and Controls	234	(1)
Proficiency Test Programs	235	(2)
Collection and Storage of Specimens for Alcohol Analysis
William H. Anderson
Introduction	237	(1)
Loss of Ethanol	237	(2)
Evaporation	237	(1)
Oxidation	238	(1)
Microbial action	239	(1)
Recommendations to prevent ethanol loss	239	(1)
Ethanol Gain	239	(5)
Physical contamination	239	(1)
Production of ethanol by microorganisms	240	(2)
Recognition of postmortem generation of alcohol	242	(2)
Preservation of Biological Specimens	244	(1)
Collection of specimens from living subjects	244	(1)
Collection of postmortem specimens	245	(1)
Conclusions	245	(4)
References	245	(4)
Reporting of Laboratory Results
James C. Garriott
Analysis Specificity	249	(1)
Uniformity of Reporting Blood	249	(2)
Blood	249	(1)
Breath	250	(1)
Chain of Custody	251	(1)
Other Considerations for Reporting Results	251	(2)
References	251	(2)
Alcohol Effects and Driver Impairment
Herbert Moskowitz
Introduction	253	(1)
Alcohol Use while Driving	253	(1)
Alcohol and Accidents	254	(2)
Single-Vehicle Collisions	256	(1)
Subjective Measures of Impairment	257	(1)
Driving Abilities Impaired by Alcohol	258	(6)
Rate of Alcohol Consumption	264	(1)
Alcohol and Fatigue	264	(1)
Alcohol and Aggression	265	(1)
Alcohol and Degree of Injury	265	(4)
References	266	(3)
Epidemiological Basis of Alcohol-Induced Psychomotor Performance Impairment (PMPI
Barbara R. Manno
Joseph E. Manno
Introduction	269	(1)
Establishing the Relationship	270	(6)
Working through the Ambiguities	276	(5)
Chronological Development of Epidemiology Database	281	(8)
North American studies	281	(6)
International citations	287	(2)
The Twenty-First Century: What Has Been Learned from Epidemiological Research?	289	(1)
Summary	290	(7)
References	291	(5)
Endnote	296	(1)
Experimental Basis of Psychomotor Performance Impairment
Joseph E. Manno
Barbara R. Manno
Introduction	297	(4)
Observation and Measurement of Alcohol Performance Impairment	301	(2)
Psychomotor Performance Testing	303	(18)
National Advanced Driving Simulator (NADS)	308	(1)
Roadside testing or field sobriety testing (FST)	308	(4)
Impairment when BACs are between 0.00 and 0.079 g/dL	312	(7)
Impairment at BAC 0.10 g/dL	319	(2)
Application of Performance Information to DWI	321	(5)
Conclusions	326	(10)
References	327	(9)
Alcohol and the Law: The Legal Framework of Scientific Evidence and Expert Testimony
Boris Moczula
General Requirements for Admission of Expert Testimony	336	(12)
Beyond the ken of the average layperson	336	(1)
Meets legal threshold of reliability	337	(1)
The Daubert standard: Reliability	338	(1)
The Daubert test: Relevance	339	(1)
The Daubert parties' contentions	340	(1)
Daubert II: The case on remand	341	(1)
The effect of Daubert	342	(1)
Criticism of Daubert	343	(1)
Methods of proving ``general acceptance''	343	(1)
Skill, knowledge or experience of the witness	344	(2)
The independent role of the court	346	(1)
Expert witness compared to lay witness expression of opinion	346	(1)
Compelling an expert witness to testify at trial	347	(1)
The range of expert witness testimony	348	(1)
Breath Alcohol Testing	348	(15)
Admissibility of test readings	348	(1)
Defense attacks on breath alcohol testing	349	(5)
Endnotes	354	(7)
Appendix. Federal Rules of Evidence and Criminal Procedure Relating to Expert Testimony	361	(2)
Prosecuting Driving-under-the-Influence Cases
Jerry Landau
Introduction	363	(1)
Preparation	363	(5)
Interviewing and preparing witnesses	363	(1)
Driving	364	(1)
Observing the driver and vehicle	365	(1)
Field sobriety testing	366	(1)
Expert witness	366	(2)
Sample Questions	368	(4)
Introduction of breath-test results	368	(1)
Qualification of the toxicologist (or other expert) who analyzed the blood sample (can also be used in a DUI-drugs case with a few modifications)	369	(1)
Introducing blood (or urine) test results	369	(1)
Opinion as to the effects of alcohol on the body and effects of alcohol on driving	370	(1)
Time-of-test laws	371	(1)
Conclusion	372	(1)
References	372	(1)
Endnotes	372	(1)
Defending Driving-under-the-Influence Cases
William C. Head
Introduction	373	(1)
Statutory or Regulatory Controls	374	(1)
Qualifications to Draw or Analyze Blood	375	(1)
Procedure	376	(1)
Breath Tests and Blood Alcohol Concentration	377	(1)
Limitations of Breath Testing Devices	378	(2)
Fifty Potential Challenges to Breath Tests	380	(3)
Intravenous Blood Samples	383	(2)
Blood Sample Kits	385	(1)
Contamination	385	(2)
Plasma or Serum Blood or Whole Blood	387	(1)
Variations in Blood Testing	387	(1)
Medication and Disease	388	(1)
Chain of Custody	388	(2)
Destruction of Blood Samples after Discovery Request	390	(1)
Documentation Errors	391	(1)
Consent	391	(1)
Refusal	392	(1)
Summary of Potential Blood Test Errors	392	(3)
Additional Reading	393	(1)
Books	393	(1)
Newsletters	393	(1)
References	393	(2)
The Role and Responsibilities of an Expert Witness
Theodore F. Shults
Yale H. Caplan
Introduction	395	(2)
The need for expert witnesses	395	(1)
What is an ``expert witness''?	396	(1)
Expert witness fees	396	(1)
Retainer and billing issues	397	(1)
The Law of Evidence	397	(2)
Overview	397	(1)
Burden of proof	397	(1)
Degree of evidence required to sustain the burden of proof	398	(1)
Reconciling statistical confidence levels and legal proof	399	(1)
Categories of Evidence	399	(1)
Expert reports	400	(1)
Diagrams and demonstrative evidence	400	(1)
The Threshold Question of Admissibility	400	(1)
Discovery and the Expert Witness	401	(3)
The discovery process	401	(1)
If you are contacted by the opposing attorney	401	(1)
Informal interviews	402	(1)
Written interrogatories	402	(1)
Affidavits	402	(1)
The subpoena	403	(1)
The deposition	403	(1)
Elements of testimony	404	(1)
Direct examination or examination-in-chief	404	(1)
Cross-examination	405	(1)
Re-direct	405	(1)
Credibility and Communication	405	(1)
Credibility determinations and the jury	405	(1)
Credentials and your testimony	405	(1)
Keys to Effective Testimony	406	(4)
Before you get to the witness stand	406	(1)
In the courtroom	406	(1)
On the stand	407	(1)
The ``don'ts''	408	(1)
Final pointers	409	(1)
The Nature of Litigation	410	(1)
Hurry up and wait	410	(1)
Variables in litigation	410	(1)
Selected Reading	410	(1)
Alcohol Testing in the Workplace
Kurt M. Dubowski
Yale H. Caplan
Introduction	411	(2)
Industries and workplaces affected by alcohol	412	(1)
Regulated and nonregulated testing for alcohol	413	(1)
Some Legal Aspects of Alcohol Testing in the Workplace	413	(4)
In general	413	(2)
The regulatory environment	415	(2)
Features of Alcohol Testing in the Workplace	417	(4)
Special features of workplace testing for alcohol	417	(1)
Purpose of alcohol testing in the workplace	418	(1)
Alcohol testing categories and indications for alcohol testing	418	(1)
Reasonable suspicion testing	419	(2)
Testing locations: On-site versus off-site	421	(1)
Alcohol Testing Regulated by the U.S. Department of Transportation	421	(4)
Prohibited conduct	421	(1)
Required alcohol testing	422	(1)
Features of alcohol testing under DOT regulations	422	(1)
Significance, interpretation and consequences of test results	423	(1)
Quality assurance aspects	423	(2)
Statutory and regulatory changes in transportation workplace alcohol testing	425	(1)
Testing Technology and Practices	425	(4)
Analysis and specimens	425	(1)
Testing in the DOT program	425	(1)
Screening tests	426	(1)
Evidentiary tests	426	(2)
Calibrating devices	428	(1)
Training requirements	428	(1)
Interpretation of Alcohol Test Results	429	(3)
Acute effects of alcohol	430	(1)
Combined effects of alcohol and other drugs	431	(1)
Hangover effects of alcohol	431	(1)
Abstention period	432	(1)
Acknowledgment	432	(5)
References	433	(2)
Endnotes	435	(2)
About the Authors	437	(2)
Index	439