10.

ll.

12.

13.

14,

Alcohol and Disease. Scientific Editor: S. Sherlock, Br. Med. Bull.,
38:1-106, No. 1, 1982.

Alling, C., J. Balldin; K. Kahiso, and R. Gilsson: Decreased Linoleic
Acid in Serum Lecithin After Ethanol Abuse, Subst. Alc. Actions Misuse,
1:557-563, 1980.

Azizi, F: G-Glutamyl Transpeptidase Levels in Thyroid Disease, Arch.
Intern. Med., 142:79-81, 1982.

Bergmen, H., L. Holm, and G. Agren: Neuropsychological Impairment and
a Test for the Predisposition Hypothesis With Regard to Field Dependence
in Alcoholics, J. Stud, Alc., 42:15-23, 1981.

Brohult, J., L. Levi, and H. Reichard: Urinary Excretion of Adrenal
Hormones in Man: Effects of Ethanol Ingestion, and Their Modification
by Chlormethiazole, Acta Med. Scand., 188:5-13, 1970.

Cahalan, Don: American Drinking Practices: A National Study of Drinking
Behavior and Attitudes. Monograph No. .6, Rutgers University Center of
Alcohol Studies. Rutgers University Press, New Brunswick, N. J., 1969.

Cobb, C. F., J. 8. Gavaler, and D. H. Van Thiel: Is Ethanol a Testicular
Toxin? Clin. Toxicol., 18:149-154, 1981,

Del Villano, B. C., S. I. Miller, L. P. Schacter, and J. A. Tischfield:
Elevated Superoxide Dismutase in Black Alcoholics, Science, 207:991-993, 1980.

Dreyer, A. S., C. A. Dreyer, and E. B. Nebelkopf: Portable Rod-and-Frame
Test as a Measure of Cognitive Style in Kindergarten Children, Percept. Mot.
Skills, 33:775-781, 1971.

Drum, D. E., P. A. Goldman, and C. B. Janowski: Elevation of Serum Uric
Acid as a Clue to Alcohol Abuse, Arch. Intern. Med., 141:477-479, 1981.

Eckardt, M. J., R. S. Ryback, 8. R. Rawlings, and B. I. Graubard: Bio-
chemical Diagnosis of Alcoholism. A Test of the Discriminating Capabilities
of G-Glutamyl Transpeptidase and Mean Corpuscular Volume, J. Am, Med. Assoc.,
246:2707-2710, 1981.

Edmondson, H. A.: Pathology of Alcoholism, Am. J. Clin, Pathol., 74:725-742,
1980.

Farnsworth, D: Manual for the Farnsworth-Munsell 100-Hue Test, Revised 1957.
The Munsell Color Co., Inc., Baltimore, MD, 1957.

Fridovich, I: The Biology of Oxygen Radicals, Science, 201:875-880, 1978.


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Technical Report Documentation Page.

T. Report No. 2. Government Accession No. . cm Recipient’? Cavalog Ne.
FAA-AM-83-2 iD A/ZE. (37

4. Tithe and Subtitle 5. Report Date
SENSITIVITY OF SOME TESTS FOR ALCOHOL ABUSE : January 1983
FINDINGS IN NONALCOHOLICS RECOVERING FROM $. Performing Organization Code
INTOXICATION .

ic Peclorming Srgenizotion Report No,

J: {"ikenzie, E. A. Higgins, P. R. Fowler,
G. E. Funkhouser, M. A. White, and E. Moser

9. Petforming Orgenszoron Noma ond Address 10. Work Unit No, (TRANS)
FAA Civil Aeromedical Institute TN Cane Bertie
P.O. Box 25082 enact ge Grant Ne

Oklahoma City, Oklahoma 73125

‘ 13. Type of Repor jad Covered
12. Sponsoring Agency Nome ond Address

Office of Aviation Medicine OAM Report

Federal Aviation Administration

800 Independence Avenue, S.W. 14. Sponsoring Agency Code

Washington, D.C. 20591

15. Sipptementary Nores

Work was ‘done under approved tasks AN-A-81-PHY~126 and AM-A-82-PHY=126.
{

16 Abswoc A variety of measurements are sensitive to alcoholism; some may be applicable|
te screening programs, but more precise knowledge of sensitivity and specificity would!
help to select a minimal test battery. ‘This study assessed the sensitivity of some
tests for alcoholism to a single drinking episode. Fifteen nonalcoholic men, 26-59
years old, participated. On oné evening they drank. ethanol, raising their blood alco-
hol concentrations (BAC's) to 100-200 mg/dL for at least 2h. At 0700 on the next
morning, after 7 h of sleep, they ate breakfast, then completed a battery of perform
ance tests. Blood samples were drawn at 0730 and 1130. The effects of alcohol, esti-|
mated by comparison of data with those obtained on another morning of the same week
after an evening of abstinence, are summarized: Heart rate, during sleep and all the
next morning, was higher; blood pressure, at 0700 and 1100, was unaffected. There was
no effect on core body temperature, recorded hourly from 2400. The urinary excretion
rates of catecholamines and ketogenic adrenal steroids were augmented by alcohol. The}
drug did not affect blood levels of gamma-glutamyl transpeptidase, glutamate oxaloace-|
tate transaminase, high density lipid or total cholesterol, or uric acid. Performance’
tests affected by alcohol were number comparison, number addition, analysis of complex!
Statements, and adaptability (from an air traffic controller selection battery).
Tests not affected were abstract reasoning, digit code, digit symbol, short-term mem- |
ory, hand steadiness, pursuit tracking, ro¢~and-frame, and 100-hue color sorting. ~~—
Analysis of variance tests indicated that the order of presentation (alcohol first vs.|
control first) did not influence any of the results. The mechanisms of the alcohol
effects are unknown but the possible influence of low BAC's (ca. 40 mg/dL) present

during the test period cannot be ruled out.
17. Key Words. 18, Orstibution Statement

Aviation Personnel, Medical Certification] Document is available to the public through|

Diagnosis, Alcoholism, Alcohol Abuse, the National Technical Information Service,

*Psychometrics, *Blood Chemistry, *Body Springfield, Virginia 22161

Fluid Chemistry ' :

19.” Security Classil. (ol this report) 20. Security Clossil. (of this page) FW No. of Pages | 22. Pace
Unclassified Unclassified “17

Form DOT F 1700:7 (e-72) Reproduction of completed poge authorized

i



15.

16.

17.

18.

19,

20.

21,

22,

23.

24.

25.

26.

27.

28.

29.

Goldman, M..S., R..D. Whitmai
ability of Sensory and Motor

in, G. Rosenbaum, and D. Van Devusse: Recover-
Functioning. Following Chronic Alcohol Abuse.

In Currents in Alcoholism, F. A. Siexas, Ed., Vol. 3, Grune and Stratton,

New York, pp. 493-504, 1978.

Goldstein, D. B. and J. H. Chin: Interaction of Ethanol With Biological |

Membranes, Fed. Proc., 40:20

Hamilton, M. G. and M. Hirst

73-2076, 1981.

: Mini-Review: Alcohol-Related Tetrahydroiso- —

quinolines, Subst. Alc. Actions/Misuse, 1:121-"44, 1980.

Hochstein, P. and S. K. Jain
merization of Membrane Prote
183-188, 1981.

Kennedy, R. S. and A. C. Bit
Television-Computer Games fo.
Proc. 5lst MTG, Aerosp. Med.

Khan, A. R.:- Influence of E
Coupling of Skeletal Muscle

Levine, J. M., G. G. Kram rc,
Performance: An Integrat .on
sification, J. Appl. Psycrol

Litov, R. E., D. L. Gee, J.
Peroxidation During Chronic
Pentane Expiration in the Ra

Melton, C. E., J. M. McKenzi
of Opa Locka Tower With Othe

: Association of Lipid Peroxidation and Poly-
ins With Erythrocyte Aging, Fed. Proc., 40:

tner: The Utility of Commercially Available
r Assessing Performance and Other Applications,
Assoc., pp. 1-2, 1980.

thanol and Acetaldehyde on Electro-Mechanical
Fibres, Acta Physiol. Scand., 111:425-430, 1981.

and E. N. Levine: Effects of Alcohol on Human
of Research Findings Based on Abilities Clas~
+» 60:285-203, 1975,

E. Downy, and A. L. Tappel: The role of Lipid
and Acute Exposure to Ethanol as Determined by
t, Lipids, 16:52-57, 1981.

e, J. T. Saldivac, and S. M. Hoffman: Comparison
rv ATC Facilities by Means of a Biochemical Stress

Index, FAA Office of Aviation Medicine Report No. FAA-AM-74-11, 1974.

Mendelson, J. H. and N. K. M
N. Engl. J. Med., 301:912-92:

lello: Biologic Concomitants of Alcoholism,
1, 1979.

Merry, J. and V. Narks: Ethanol and Cortisol Release in Man. In Metabolic

Changes Induced by Alcohol, G. A. Martini and Ch. Bode, Eds., Springer-

Verlag, New York, pp. 199-201

Morse, R. M. and R. Hurt: §
242:2688-2690, 1979.

Nelson, T. M.: Hue Memory D.
tion and Alcoholism. Dept.
Alberta Dept. Public Health,

Nestoros, J. N.: Ethanol Spi
transmission in Feline Cereb:

Oltman, P. A.: A Portable R
26:503-506, 1968.

6, 1972.

creening for Alcoholism, J. Am. Med. Assoc.,

eficit Among Alcoholics. Symposium on Percep-
Psychology, Univ. Alberta and Div. of Alcoholism,
pp. 27-35, 1968.

ecifically Potentiates GABA~Mediated Neuro~
tal Cortex, Science, 209:708-710, 1980,

od-and-Frame Apparatus, Percept. Mot. Skills,

15

x


44. Walker, D. W. D. EL. Barnes, S. F. Zornetzer, B. E. Kunter, and P. Kubanis:
Neuronal Loss in Hippocampus Induced by Prolonged Ethanol Consumption in

Rats, Science, 209:711-713, 1980.

» 45.

46.

47.

48.

Weston, J. T.: Alcohol’
Unnatural Death, Am. J.

Yew, M. L. §., S. Moore,

s Impact on Man's Activities: Its Role in
Clin. Pathol., 74:755-758, 1980. .

and M. M. Biesele: Effects of Chronic "Moderate"

Alcohol Consumption of Vitamins A and C Status of Male Sprague-Dawley Rats,
Nutr. Rep. Int., Los Altos, 23:227-236, 1981.

Unpublished data provided by Dr. Delbert Lacefield, AAC-114, Civil Aero-

medical Institute, Mike

Monroney Aeronautical Center, Oklahoma City, OK.

Unpublished data provided by the Federal Aviation Administration, National

Safety Data Branch, AFO~

500, Mike Monroney ‘Aeronautical Center, Oklahoma City

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SENSITIVITY OF SOME TESTS FOR ALCOHOL ABUSE:
FINDINGS IN NONALCOHOLICS RECOVERING FRO, INTOXICATION*

A variety of government~sponsored educational and enforcement Programs, as
well as personal experiences with the drug, should ensure that U.S. automobile
drivers are adequately aware of the threat of alcohol consumption to driving
safety. Yet statistics continue to show that significant numbers of drivers
killed in automotive accidents have been impaired by alcohol. In studies spon~
sored by the National Highway Traffic Safety Administration (41), 55 out of
every 100 dead drivers were found to have blood alcohol concentrations (BAC's)
above 59 mg/dL; of these 55, 47 had BAG's of over 190 mg/dL. In the laws of
most states the lower level (above 59 mg/dL) is recognized as relevant evidence
in trials for driving while impaired, and the higher level (190 mg/dL) is con-
sidered to be presumptive (prima facie) evidence of driving while under the
influence of alcohol (42),

The occurrence of frequent aleohol abuse (drinking too much or at inappru-
priate times) by automobile drivers raises questions about its prevalence in
other modes of transportation such as aviation. Data collected over the past
14 years by the Civil Aeromedical Institute's Aviation Toxicology Laboratory
(47) indicate that the incidence of alcohol abuse by general aviation pilots
is significantly less than that found in automobile drivers. Of 4,241 fatal
general aviation ace nvestigated, only 346 (8.2 percent) of the dead
‘pilots had RAC's’a gh as 40 mg/dL; and there is gone. indicarlan af downward
trend. Over 2,900 cases, representing 60 percent _of all fatal general aviation
aceident’s (ZB) occurring Gn'the latter vesrs-oF the study (1977-1981) - omietont

i ical

igation; only 6 percent oft 6ts "had signitivar:
n3_ only. " a “OES hag signitita

d alcohol.”
piged atcha!

; Although these findings are encouraging, especially when they are compared
/ to highway statistics, they are hardly ideal. Probably this incidence of abuse
could er reduced by nore aggressive enforcement of the federal regula-
if tions that discourage t. But the misuse—of atcohor by healthy individuals-is
not the oiily-thréat oF a?cohol to aviation safety. Alcoholism is another, pos-
bly more serious, threat, because pilots who suffer from this insidious disease
(we have no reason to believe that its incidence is any less in aircrewmembers
than in the general employed population) may have decrements in mental function |
that persist even during periods of "sobriety." Although the Federal Aviation Cond Uk
Administration (FAA) has made no definitiv pla al ~
cause of aviation ateidents, there can be IITttYs dowd
ical to sate Flytne: ———
— —
There are no perfect strategies for detecting alcoholism in aeromedical
: applicants. A carefully taken medical history could be useful, as could a thor~
/ ough examination for the signs of alcohol-induced pathology (1,12,24,26, 34,37).
But many alcoholics are cunning enough te recognize leading questions related to
their problem. And the physical signs cf abuse, when they appear, may not provide
sufficiently early warning of serious decrements in either health or in flying
proficiency. More reliable are biochemical tests that are sensitive to the path-
A ological changes prcduced by alcohol, and performance tests that might be useful
‘ in screening for the earliest and most to be feared consequence of alcohol abuse,
a decrement in mental function. A number of bicchemical and performance tests

* Some of this material was presented at the annual scientific meeting of the
Aerospace Medical Association, Bal Harbour, Florida, May 10-13, 1982.


LIST OF TABLES

Nonalcoholics (This Study) With Findings in
Chronic Alcoholics (Other Studies).

Page
TABLE I. Experimental Subjects. Performance During the 4
Control (No Alcohol) Experiment.
TABLE II. Average Heart Rates During the Alcohol and Control 7
Experiments.
TABLE III. Performance Averages of 15 Subjects on a Morning 8
After an Evening of Drinking (Alcohol) Compared
to Performance on Another Morning After an Evening
of Abstinence (Control).
TABLE IV. Urinary Excretion of Catecholamines and Adrenal 9
. Steroids After Consuming Alcohol (ALC) and After
Consuming a Nonalcoholic Control Mixture (CON).
TABLE V. Comparison of Findings During Withdrawal in 12

Accession Por

NTIS GRARI iw

Distributions
_Avatlabihity Codes
iAvaLL and/or

Dist |! spectar
H

|

hi


Thus, some tests mteht be excluded from @ screening battery because they
do not clearly indicate the stage of alcoholism or because they respond only to
late effects from which the alcoholic is unlikely to recover (Acker, op. eit.).
Still other tests-~e.g., measurements of GCT (3)--may be flawed because they
respond to conditions unrelated to drinking or because, like some reported in
Table III, they give false positive indications of alcoholism in nonaleoholics
during a hangover period. Markers of greater specificity are possible; for
example, several chemical derivatives of acetaldehyde have been found in alco-
holics (17,18,39) and measurements of these compounds might be applied to esti-
mates of the long-term metabolic load of ethanol. But even these tests, although
they appear to be specific to alcohol abuse, may not be wholly unaffected by other
metabolic sources of acetaldehyde.

) In conclusion, the rationale for choosing a battery of tests rather than
depending on a single test for the detection of’ alcoholism is that, collectively,
the tests comprising the battery become more specific than their. individual char-
acteristics would indicate. Each test must possess a degree of specificity,
however. Our results indicate that some tests, although flawed by their response
to conditions unrelated to drinking, are not so sensitive to ethanol that they
are affected by a single episode of heavy drinking. Some performance tests that,
do respond to acute withdrawal Provide yet another illustration of the inadequacy
of t e "8-hour rule." Performance decrements reflected by these tests may be
-rels' d to aviation safety.

13


A second dose of 13 g per 12 was given at 2030 and BAC was measured at 2110
(20 min after finishing the drink). This regimen (a dose of 13 g. and a BAC
measurement after 20 min) was continued until a final dose was consumed at 2330,
except that. the dose of alcohol was reduced when it appeared that the BAC was |
rising at such rate that a concentration well over 200 mg/dL might result. The
goal of the investigators was to produce a BAC of at least 199 mg/dL but no
higher than 200 mg/dL during the 2330-2400 period. Each subject received eight
drinks (including three priming doses) during the 4-h drinking period; the total
dose consumed varied from 80~104 mL ethanol per M* body surface area.

Subjects slept in the laboratory from 2400 until 0790. They emptied their
bladders at 2400 and were awakened at 0300 to collect the urine that had formed
during the interim. Urine collection was continued. Collection periods were:
0000-0300, 0300-0700, and 0700-1130. Blood pressure (BP) was measured before
each subject arose at 0700 and again at 1100. Venous blood samples were taken
at 0730 and again at 1130. Rectal temperature was recorded hourly from a ther-
mistor probe during the evening and on the following morning. Heart rate (HR)
was recorded continuously via chest leads and Avionics Cardiocorders; recordings
were analyzed with the Avionics Cardioscanner.

Chemical Analyses. Urine samples were preserved by adjusting the pH to 2
with HCl, freezing immediately and storing at -20°C until analyses were made.
Blood samples were mixed immediately with heparin solution, centrifuged, and
the plasma fraction stored at -20°C. Measurements of urinary catecholamines
and of 17-ketogenic steroids (17-KGS) were carried out by methods used since
1971 (23). Blood constituents measured according to routine clinical tech-
niques (3,10,32) were uric acid, total* and high density* lipid cholesterol
(HDLC) gamma glutamyl transpeptidase (GGT) and serum glutamate oxaloacetate
transaminase (SGOT).

Performance Tests. Each written test was available in two versions.
One version was presented to the.subject under each of the two experimental
conditions. The Abstract Reasoning and Adaptability tests were the two elements
of U.S. Civil Service Commission Test Number 157, Series 1 and 2, 1958. The
other tests. listed in Table I were obtained. from Dr. Robert Carter of the U.S.
Naval Aerospace Medical Research Laboratory, New Orleans, Louisiana. Other per~
formance tests used were the Farnsworth-Munsell 100-Hue Color Discrimination
Test (13), a Hand Steadiness (Motor Steadiness Kit, Marietta Apparatus Co.,
Marietta, Ohio), and the Oltman Rod~and-Frame field dependency test (9,29) using
a portable apparatus (Cat. No. 12011) purchased from the Stoelting Company,
Chicago, Illinois. The written tests were presented from 0800-0840 on each
occasion and the color sort, hand steadiness and rod-and-frame tests were com-
pleted by 1030. Between 1000 and 1100 each subject completed 10 trials of the
Air Combat Test. This test, based on game number 24 of the Atari video game
Combat cartridge, bas been described by Kennedy and Bittner (19). Subjects
practiced this test for a total of 2 h on 2 days prior to the first experiment.
Two video game modules and accessory equipment including joysticks and game
cartridges were loaned by Atari, Inc., Sunnyvale, California.

Transportation to and from the laboratory was provided to each subject for
the experiment in which he drank alcohol.

* Guilford Diagnostics; Trinder method; precipitant: Mgt+/dextran sulfate.



| FAR
UNCLASSIFIED

be oe

Technical
Report

distributed by
é<2% Defense Technical Information Center
Cy, DEFENSE LOGISTICS AGENCY

Cameron Station + Alexandria, Virginia 22314

UNCLASSIFIED


0.12

0.10

0.08

BAC (gm/dl)

0.06

0.04

0.02

0.00

0000 0200 0400 0600 0800 1000 1200
TIME

Figure 2. Blooc alcohol concentrations on the morning after the experiment
illustrated in Fig. 1. Data points at 0000 and 0030 are identical to those

for 2400 and 2430 on Fig. 1. Note BAC's from 0730 to 1100. Ordinate and
abscissa units are identical to those used in Fig. l.

Signs of Ethanol Intoxication were apparent in all subjcets by 2200 and
all reported symptoms by 2100. Waking the subjects for urine collection at
0300 was far more difficult after they drank ethanol than during the control
experiment. Four of nineteen subjects experienced nausea and voniting between
0100 and 0300 and these symptoms continued intermittently until about 1100.
No performance data were collected from these four subjects. None of the

other subjects was asked about his symptoms on the following morning and no
complaints were made.

Physiological Measurements. HR's were significantly higher when the sub-
jects drank ethanol (see Table Il). Average systolic/diastolic BP's were
115/73 at 0700 and 125/78 at 1100; there were no differences in BP's related
to control and experimental conditions. Body (rectal) temperatures were all
within the normal range and did not appear to be affected by alcohol.



RESULTS

Blood Alcohol Measurements. -Fig. 1 summarizes BAC's measured during. the
evenings when the subjects drank ethanol.. The amounts of ethanol given to each
subject varied according to the rate at which his BAC rose during the experi-
ment; subjects who tended to exhibit a fast rise in BAC received lower doses
according to that rate as the experiment progressed. As Fig. 1 shows, this .
titration of BAC levels produced BAC's above 100 mg/dL in all but three stbjects
by 2200 and in all subjects by 2230. Levels. remained between 100 and 200 ng/dL
until. about 2400 when the last measurements of the evening were made. Fig. 2
contains the BAC's measured at about 2400 and at 0730 and 1100: the following morniug.
As expected, most of the subjects exhibited significant levels of blood ethanol

at 0730, 8h after their last drink of the evening before; all but two of them
had BAC's above 40 mg/dL.

0.20

0.18

0.16

O14

0.12

T

O10 F

0.08

BAC (gm/di)

0.06 -

0.04

T

0.02

0.00 f t L r L { L 7
1909, 4 20 00 2100 2200 2300 4 24 00

TIME

Figure 1. Blood alcohol concentration (BAC) in 15 male subjects given 10%
ethanol in multiple doses over a 4-h period (see text). Time units are hours
CDT;"BAC units are in gm ethanol per 100 mL blood, measured by a CMI Co.
Intoxilyzer. Arrows on the time axis denote first and last doses of ethanol.



have. been recommended for the purpose, but to select all of them and others that
may be devised later for inclusion in an alcohol test battery would be both
impractical and uneconomical.

Certainly, some of the measurements that are sensitive to alcohol abuse (e.g.,
several for hepatic function; several for perceptual and motor performance) are so
alike in scope and sensitivity that to use more than one of each group could be
unnecessarily redundant. It is also possible that some measurements might be 50
setsitive to alcohol that they would be useless. in a battery intended for the detec-
tion of. prelonged abuse. As one group of investigators (11) has stated, "...alcohol
is distributed uniformly throughout body water and consequently produces a variable
pattern of toxic effects on multiple organ systems." Thus, alcohol concentration,
dwell time, frequency of abuse, sensitivity of the tissue, and a host of other fac-
tors may affect the results of a biochemical or performance test. Some of the recom-
mendations for certain tests have been based on studies comparing alcoholics with
Jnondrinkers or control subjects who had abstained from aleohol before the evalua-
tion period. Such experiments do net rule out the possibility that recent drinking
might produce false positive signs of alcoholism in persons who drink infrequently.
The study reported here evaluated this likelihood for some recommended tests and .
other tests that might be applicable to the screening of aeromedical applicants.

METHODS

Subjects. Nineteen paid male volunteers were recruited... Four of them becane
so nauseated on the morning after they drank alcohol that they were unable to com-
plete the study; their data are not included in this report. Of the 15 other sub-~
jects, only 1 could be classified by questionnaire as a light drinker, 4 were medium
drinkers, and 10 were heavy social drinkers. The questionnaire was based on one
used by Cahaian (6). Average age of the subjects was 33.2; the oldest was 59 and
the youngest was 26. Each had been evaluated by a medical officer, who based his
examination on the FAA Class III medical examination form. Oniy one subject, number
10, showed any signs of medicai deficiency; the examining physician's remark that
this subject appeared to have an incipient emphysema was consistent with his dif-
ficulties in providing end-tidal breath samples for alcohol measurements. This
subject also exhibited high rates of catecholamine excretion. He stated that he
had taken no medication (tetracyclines were suspected) for several weeks prior to
the study. Table I contains some of the data obtained from the subjects during
the control (no alcohol) portion of the experiment.

Protocol. Each subject was studied during a l-week period on two occasions:
on a morning after he had drunk alcoho] and on another morning after an evening of
abstinence. All subjects were cautioned not to drink any alcohol over the weekend
prior to the study and to drink only the alcohol provided by the investigators dur-
ing the week of the study. (One prospective subject declined to participate after
hearing these instructions). On both occasions the subjects reported to the labo~
ratcry at 1600 and remained in the laboratory until released at 1200 on the follow-
ing day. Seven drank alcohol on the first evening and eight were given alcohol on
the second evening so that the order of presenting the control and experimental
treatments was approximately equal. The drinking and control periods began at 1930
and ended at 2330. Ten percent ethanol flavored with unsweetened lemon juice and a
control mixture of juice and water were used. From 1930 to 2010 the subject consumed
a priming dose of 39 g ethanol per ue body surface area. At 2030 his BAC was meas-
ured with a calibrated "breathalyzer" (Intoxilyzer, CMI, Inc., Mintum, Colorado).


30,

31.

32.

33.

36.

Sy

38.

4l.

Be

43.

Parker, E. S. and E. P. Noble: Alcohol Consumption and Cognitive Functioning
in Social Drinkers, J. Stud. Alc., 38:1224-1232, 1977.

Parker, E. S. and E. P. Noble: Alcohol and the Aging Process in Social
Drinkers, J. Stud. Alc., 41:170-178, 1980. .

Reyes, E. and W. R. Miller: Serum Gamma-Glutamyl Transpeptidase as a Diagnos~
tic Aid in Problem Drinkers, Addict. Behav., 5:59-65, 1980.

Ryan, C., N. Butters, and K. Montgomery: Memory Deficits in Chronic Alco-
holics: Continuities Between the "Intact" Alcoholic and the Alcoholic Korsa~
koff Patient. In Biologic Effects of Alcohol, H. Berglieter, Ed., Plenum
Press,- New York, 1980.

Saunders, J. B., D. G. Beevers, and A. Palon: Alcohol-Induced Hypertension,
Lancet, 2:643-656, 1981.

Sellers, E. M. and H. Kalant: Alcohol Intoxication and Withdrawal, N. Engl. ©
J. Med., 294:757-762, 1976.

Sellers, E. M., N. Degani, L. B. Cohen, D. H. Zilm, and E. A. Sellers:
Central and. Peripheral Adrenergic Components in Alcohol! Withdrawal. In
Currents in Alcoholism, F. A. Seixas, Ed., Grune and Stratton, New York,
pe. 191-202, 1978.

Smith, R.: Alcohol and Alcoholism: The Relation Retseen Consumption and
Damage, Br. Med. J., 283:894-898, 1981.

Steinberg, S.-E., C. L. Campbell, and R. S. Hillman: The Toxic Effects of
Alcohol on Folate Metabolism, Clin. Toxicol., 17:407-411, 1980.

Stevens, V. J., W. J. Fantl, C. B. Newman, R. V. Sims, A. Cerami, and
C. M. Peterson: Acetaldehyde Adducts With Hemoglobin, J. Clin. Invest.,
67: 361-369, 1981.

Thuraan, R. G and D. E. Pathman: Withdrawal Symptoms From Ethanol:
Evidence Against the Involvement of Acetaldehyde. In Role of Acetalde-
hyde_in‘the Actions of Ethanol, Satellite Symp. 6th Inz. Cong. Pharmac.,
K. 0. Lindros and C. J. PL Eriksson, Eds, The Finnish Foundation for Alco-
hol Studies, Vol. 23, pp. 217-231, 1975.

U.S. Department of Transportation. National Highway Traffic Safety Admin-
istration: Alcohol and Highway Safety: A Review of the State of Knowledge,
Summary Volume. DOT HS~805-172, 1979.

U.S. Deparceent of Transportation. National Highway
istration: Alcohol and Highway Safety Laws: A Natic=
DOT HS-805-173, 1980.

ffic Safety Admin-
2 Overview.

Verriest, S., P. Franeq, and P. Pierart: Results of Color Vision Tests in
Alcoholic and Mentally Disordered Subjects, Ophthalmol. (Basel) 180:247-256,
1980.

16


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of heavy drinking. Those tests found responsive to the acute effects of ethanol
or to the withdrawal period following acute intoxication could be eliminated trom
a battery intended for the detection of alcoholism.

We simulated as’ nearly as practicable a test Protocol that might be applied
during the morning hourr to a nonalcoholic applicant who may have imbibed heavily
on the previous evening. All of the data were collected during the period follow-
ing the last drink; most were collected during the eighth hour of this period.
Although our subjects were regular users of alcohol (see Table I) none had high
levels of serum GGT, SGOT, or uric acid consistent with alcoholism (10,34) and
none gave a history of compulsive drinking. Performance in the rod-and-frame -
test by two subjects was consistent with the performance of a'coholics but the
diagnostic value of this test is in question (4).

A summary of our results and a comparison with results obtained from alco-
holics by other investigators are presented in Table V. Note that timing may be
an important factor in the interpretation of our results. For example, we found
no effect of drinking on the chemistry of blood samples withdrawn 12 h after the
drinking period and conclude that within that time frame there is little risk
of confusing alcoholics and nonalcoholics by these measurements. We do not know,
however, if the similarities between the control and withdrawal periods were due
to nonresponsive systems or were obtained mereiy because more than 12 h are
required for a response to become manifest. Other studies employing higher
doses of ethanol and longer observation periods would help to answer the question,

Sympathoadrenal responses to ethanol were noted (see also Table IV). These
findings consonant with those reported by others (5,25,36) support our conclusion
chat the subjects of these experiments were not alcoholics whose levels.of plasma
cortisol do not rise after a challenge dose of ethanol (25).

In contrast to the biochemical findings the results of performance tests
indicate a greater range of sensitivity to ethanol (see also Table III). Whether
the effects that were seen can be attributed zo recidual effects of the high BAC's
found on the previous evening, to the Presence of acetaldehyde during the testing
period, or to low BAC's present during that period cannot be concluded from this
study. We found no reports in the literature of experiments dealing with the
effects of low BAC's on these particular tests. Assuming that our experiments
represent a typical evening of drinking and the withdrawal Period that follows
we offer these findings as examples of changes in performance during acute
withdrawal. Possibly, these deficits in performance are important to aviation
safety. Changes in one subtest (adaptability) of the ATC selection battery are
consistent with that possibiiity.

Tests for alcoho! abuse often derive from complex biochemical and parhological
responses to ethanol. For example, blood levels of folate may be low in the alco-
holic because of nutritional deficiency but blood folate is also responsive to
acute doses of alcohol, falling to low levels when the BAC is high (38) and return—
ing to higher levels as the BAC declines. This is probably due to an effect of
ethanol on pteroylglutamate transport. The results of psychometric tests may, of
course, be affected by a sufficiently high BAC but in the absence of blood alco~
hol the results of some tests, notably those for memory loss, problem-solving
ability, and abstract Processing, may be abnormal only in those with the Wernicke-
Korsakoff Syndrome (see Thomson and Ron, Ref. 1, p- 87) associated with changes in
brain morphology. .


MA126138

O FILE COPY

SENSITIVITY OF SOME TESTS FOR ALCOHOL ABUSE:
FINDINGS IN NONALCOHOLICS RECOVERING FROM INTOXICATION

J. M. McKenzie
E. A. Higgins
P. R. Fowler
G. E, Funkhouser
M.A. White
E. Moser

Civil Aeromedical Institute
Federal Aviation Administration
Oklahoma City, Oklahoma

MAR 29 1983 ,-

ors |

January 1983

Document is available to the public through the
National Technical Information Service,
Springfield, Virginia 22161

Prepared for
U.S. DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
Office of Aviation Medicine
Washington, D.C. 20591

og 994

ae



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TABLE. II. Average Heart Rates During the Alcohol and Control
Experiments. Beats Per Minute.

TIME: 16 - 24h O-7h 7-(lh

CONTROL ALCOHOL CONTROL SLCQHOL CONTROL ALCOHOL.
74.5 87.1% 61.5 78.8% 76.5 87.8%

*® Significant, by t-test, at the 0.001 level.

Performance Tests. Results from the Farnsworth-Munsell 100-Hue tests
indicated no color deficiencies in any of the subjects. Differences between
the results obtained during the alcohol and control experiments were insignif~
icant. There were no apparent residual effects of ethanol on hand steadiness.
Two of the subjects (see Table I) exhibited a field dependency, as measured by
the rod-and~frame test but no effects of alcohol on this measurement were
observed in these or any other subjects. The average Atari pursuit tracking
Score during the control experiment (see Table I) was 135.3; on the mornings
after subjects drank ethanol the average was 134.3. For this test and for
all other tests used in the study there was no order effect detectable by
analysis of variance.

Table III contains the average values of the results of the written teets.
Scores in the number comparison and. addition tests are reduced by about 16 per-
cent after aleohol; scores in the complex statements and adaptability tests
were reduced by 19 and 22 percent.. These changes were statistically signifi-
cant by the t-test. Levels of performance in the abstract reasoning, digit
code, digit symbol, and pattern comparison tests were not significantly dif-
ferent under the two experimental conditions nor were there any consistent
trends indicating subtle changes due to ethznol.

Biochemical Findings. Table IV presents the mean urinary excretion rates
of catecholamines and 17-KGS under both experimental conditions. Significant
findings were an enhanced norepinephrine excretion during the 0000-0300 collec-
tion period, an increased excretion of steroids during the 0300-0700 period,
ead a decrease in the excretion of epinephrine during the 0700-1130 period.
These chan3es were apparently superimposed on more-or-less normal patterns of
circadian rhythms for these compounus.

In blood samples taken at 0730 and 1130 (8 and 12 h after the last dose
of alcohol), values fer uric acid, SGOT, serum GGT, total cholesterol, and HDLC
were within normal range and there were no apparent effects of drinking on
these variables.



DISCUSSION

Aviation activities are highly susceptible to alcohol abuse. Many of the
workforce--aircrew8, air traffic controllers (ATCS's), and others--must maintain
the highest levels of proficiency to meet standards of safety and economy; alco-
hol threatens that proficiency (45). Those who abuse alcohol may suffer sensory
defects (15,27,43), mental impairment (4,21,30,31,33), and loss of health (1,34,
37,45,46), all of which can adversely affect the skills and judgment. necessary
for safe flying.

Crewmembers are discouraged by the "8-hour rule" of Federal Aviation Reg-
ulations, Part 91.11, from flying within 8 h after consuming the drug-~dis-
couraged but not prevented because: (i) the rule is difficult to enforce, and
(ii) although it provides a guideline for the prudent drinker the rule does
not allow time for complete metabolism of large quantities of alcohol (see
Fig. 2). Crewmembers can become educated to this latter deficiency but without
objective tests for compliance we must rely on the flyer's sense of professicnal-
ism; we may do so with some confidence in the case of the air carrier pilot who
depetids on aviation for her/his livelihood. The general aviation population,
however, which contains all of the nonprofessional flyers may not be so depend~
able (47). —~ .

Possibly then, any further reduction in the rate of alcohol misuse by air
crewmembers can be obtained only through more explicit guidelines and more vig-
orous enforcement. Clearly, the intent of the present rale is that people should
not fly when their BAC's are above a safe level but no means of assessing the BAC
is provided for in the existing regulations. A precise and accurate method for
that is now available. It is noninvasive, requiring only a sampling of the
breath, and evidence obtained by the method is admissible in the courts of al}
states. Thus, there is legal precedent for applying the method in che field of
transportation; today the 50 states, the District of Columbia, Puerto Rico, and
the Virgin Islands all have an implied consent law as a deterrent to operating
motor vehicles while intoxicated, aad there seems no barrier. to applying the
implied consent principle to federal regulation (42).

Strengthening the Federal Aviation Regulations and providing for objective” ~
means of enforcing them may reduce accidents caused by the episodic form of
alcohol abuse but this strategy offers less protection against air crashes
caused by victims of the chronic form of abuse. Alcoholics suffer more or less
permanent decrements in flying proficiency, decrements that do not depend on
the presence of alcohol in the blood. Although"a high BAC--especially one
covered in a person who is about to act as an air crewmember--should raise sus-~
picions of alcoholism, the disease could go undetected if the presence of alco-
hol were the sole diagnostic criterion. There are, however, other tests for .
alcoholism that are sensitive to biochemical changes (7,10,11,26,32,36) or to
decrements in performance (1,4,15,21,27,30,31,33,43). Apparently these tests
reflect pathologic changes for which a variety of mechanisms have been proposed
(1,2,8,14,16,20,22,28,37,38,39,40).

The ideal alcoholism screening battery would be comprised of only a few
tests Selected from the large number available for maximum sensitivity and
specificity. One approach to this selection process is to evaluate tests
known to respond to chronic abuse for their sensitivity to a single episode