One for My Baby, but 0.08 for the Road
Why the liquor lobby's arguments against cutting blood-alcohol limits are all wet.
It isn't quite as much fun as it used to be now that tobacco lobbyists are admitting that nicotine is addictive and smoking is harmful. But the flacks at the American Beverage Institute are doing their best to take up the slack. They're fighting to stop federal legislation that would crack down harder on people who drive after drinking. The measure--backed by Mothers Against Drunk Driving and up for a vote as an amendment to the highway bill next month--would make all states change their definition of who is drunk from a person with a minimum blood-alcohol level of 0.10 to someone with a level of 0.08 percent. The ABI's case against the proposal is surprisingly persuasive. Well, almost.
Currently, everywhere in the country it is illegal to drive with a blood-alcohol concentration of 0.10 percent or higher. But with alcohol-related crashes claiming over 17,000 lives a year--accounting for 41 percent of all traffic fatalities--16 states have dropped that level to 0.08 percent. Now, Sen. Frank Lautenberg, D-N.J., is leading a push to make the 0.08 level a national standard.
The ABI says the whole effort is nuts. A trade association for restaurants that serve alcohol, it offers two arguments. First, its lobbyists say, hardly any drinking at all can put you over the limit. As ABI spokesman John Doyle says, "All it takes for a 120-pound woman are two glasses of wine at a restaurant, and she's going to jail ... just the same as if she downed a fifth of gin." The lower standard will capture perfectly responsible social drinkers and dramatically increase the number of drivers who would be subject to arrest. Second, they say it's the roaring drunks who are out there killing people. "Suppose we had people dying at 110 miles an hour," Doyle observes, "and I said let's lower the speed limit to 45. Wouldn't somebody say that's ludicrous?"
The argument is not unreasonable. When I'm on duty in the emergency room, I see all the victims of serious car crashes that come through. The paramedics wheel them in and start rattling off information while I check their breathing and injuries: "This is an unidentified, white-male unrestrained driver in a high-speed rollover, unresponsive at the scene." You don't even have to wait for the results. You know he's wasted on alcohol and possibly drugs, too. I've never seen a positive alcohol level less than about 0.20 percent in these cases. It seems like drivers in crashes are either completely blotto or stone-cold sober.
The damnedest thing is, after we save them, they hardly ever get arrested for driving while intoxicated. An injured drunken driver is far less likely to be charged than an uninjured one. Studies show that 50 percent to 80 percent of drunken drivers escape prosecution. There are many reasons. Police have to put the driver's safety first and ship them off to a hospital; following after the driver is a major hassle, and things happen so fast, the police sometimes don't even realize alcohol is involved. But we know.
N ational Highway Traffic Safety Administration data suggest my experience is a bit one-sided, however. About 60 percent of alcohol-related fatal crashes do involve drivers with an alcohol level of 0.15 percent or higher. But 7 percent involve drivers with a level of 0.08 percent or 0.09 percent--killing an estimated 1,000 people per year.
The ABI claims that there's no evidence that a 0.08 level is any more dangerous than a 0.02 level. However, a 1991 study in the Journal of Studies on Alcohol from the Insurance Institute for Highway Safety showed otherwise. It found that the risk of a single-vehicle crash for a driver with a blood-alcohol level of 0.05 percent to 0.09 percent is 11 times that of someone at 0.02 percent to 0.04 percent. Higher is certainly worse. Drivers with a level of 0.10 percent to 0.14 percent are 48 times more likely to crash, and those at 0.15 percent or more are 385 times more likely to crash. But getting behind the wheel with a 0.08 alcohol level is risky--more risky than any other known factor, including young age and driving at night.
Nonetheless, ABI's specter of people ending up in jail for driving after as little as two drinks is giving some policy-makers pause. But the ABI is using loaded dice to play on our ignorance of alcohol levels. By choosing a skinnier than average woman and defining each "drink" as 6 ounces of high-alcohol wine, they make it sound easy to hit 0.08. But two of these "drinks" are equal to about half a bottle of wine.
How many drinks does it really take for your blood to reach 0.08 percent alcohol? To make it simple, let's talk in terms of 12-ounce cans of Budweiser (about 5 percent alcohol). It would take 3.5 cans in an hour on an empty stomach to put the average 137-pound woman over that limit, 4.5 cans for a 170-pound man. Or about a six-pack in the course of an evening. (Estimate your own capacity by clicking here.) These are peak levels. After you stop drinking, your alcohol level drops about 0.02 percent an hour. Also, keep in mind, light beer has 20 percent less alcohol than regular beer. Wine has anywhere from two to four times as much alcohol, but 6 ounces of a typical table wine would be about the same as a can of Bud. A single martini would have about twice as much alcohol as that.
It's silly that this is all such a guessing game. In countries such as Australia, breathalyzer machines for checking your own alcohol level apparently are ubiquitous at bars and stadiums. Still, most people know by now that after a few beers at dinner, they've had too much to get up and drive. A 0.08 alcohol limit is not going to catch as many people unawares as the ABI claims. And drinking even less than what it takes to put you over the 0.08 standard is still not entirely safe.
Atul Gawande, a surgical resident in Boston, is a staff writer on medicine for The New Yorker and author of the new book Complications: A Surgeon's Notes on an Imperfect Science.