Medical-Legal Aspects of Alcohol, fourth edition
Edited by James C. Garriott

Detailed Table of Contents

Preface

Chapter 1: The Chemistry of Alcoholic Beverages
Bill H. McAnalley, Ph.D.
1.1 A Description and History of Common Alcoholic Beverages
1.2 Fermentation
    A. Yeasts
    B. Bacterial contamination
1.3 Nutritional Value of Alcoholic Beverages
    A. Carbohydrates
    B. Proteins
    C. Fats
    D. Vitamins and minerals
1.4 Antimicrobial Properties of Alcoholic Beverages
1.5 Cancer and Alcohol
1.6 Ethyl Alcohol Content
1.7 Congeners
1.8 Classification of Congeners
    A. Volatile congeners
    B. Alcohols
    C. Aldehydes
    D. Esters
    E. Alcohols, aldehydes and esters
    F. Common Acids
    G. Ketones
    H. Phenols
1.9 Vasoactive Congeners
    A. Tyramine
    B. Histamines
    C. Toxic metals
1.10 Congeners from Spices and Herbs
1.11 Semivolatile Congeners
1.12 Xenobiotics in Alcoholic Beverages
References

Chapter 2: Pharmacology and Toxicology of Ethyl Alcohol
James C. Garriott, Ph.D.
2.1 Skin
2.2 Gastrointestinal Tract
2.3 Cardiovascular System
2.4 Liver
2.5 Kidney
2.6 Endocrine System
2.7 Central Nervous System
    A. General	
    B. Chronic CNS effects
2.8 Impairment of Specific Functions Related to Driving Ability
    A. Vision
    B. Auditory discrimination
    C. Other sensory effects
    D. Reaction time
    E. Review of research on alcohol impairment of driving and piloting skills
2.9 Effects of Alcohol in Combination with Other Drugs
    A. Acetaminophen
    B. Amphetamines
    C. Analgesics and narcotics
    D. Antidepressants
    E. Barbiturates
    F. Benzodiazepines
    G. Caffeine
    H. Cocaine
    I. Inhibition by histamine2-receptor antagonists
    J. Marihuana
2.10 Antagonists to Alcohol and Pharmacotherapeutic Agents for Alcoholism
    A. Disulfiram (Antabuse) and other acetaldehyde antagonists
    B. Other agents used in treatment of alcoholism
20.11 Tolerance
References

Chapter 3: Disposition and Fate of Ethanol in the Body
A.W. Jones, Ph.D., D.Sc.
3.1 Introduction
3.2 Analytical Considerations
3.3 Disposition and Fate of Alcohol in the Body
3.4. Absorption of Ethanol
    A. Inhalation of ethanol vapors
    B. Absorption through skin
3.5 Dosage Forms
3.6. Absorption from the Gut
3.7 Gastric Emptying	
3.8 Drinking on an Empty Stomach
3.9 Beverage Type and Alcohol Absorption
3.10 Gastric First-Pass Metabolism
    A. General	
    B. Effects of drugs on first-pass metabolism
3.11 Hepatic First-Pass Metabolism
3.12 Type of Beverage and Rate of Ethanol Absorption
3.13 Distribution of Ethanol
    A. Arterial-venous differences in ethanol concentration
    B. Concentrations of ethanol in plasma and whole blood
3.14 Widmark's Factor rho
    A. General
    B. Updating the Widmark r factor
3.15 Elimination of Alcohol
3.16. Metabolism of Ethanol
    A. Alcohol and aldehyde dehydrogenases
    B. Polymorphism of ADH and ALDH
    C. Microsomal enzymes cytochrom P450
    D. Phase-II conjugation of ethanol	
    E. Factors influencing the rate of ethanol disappearance from blood
    F. Inter- and intra-individual variations
    G. Sex differences
    H. Physiological range of ethanol elimination rates
    I. Elimination rates in alcoholics during detoxification
    J. Liver cirrhosis and ethanol elimination rate
    K. Inhibition and acceleration of ethanol metabolism
    L. Blood concentration-time profiles of ethanol
    M. Excretion of ethanol
    N. Ethanol in body fluids
    O. Breath
    P. Saliva
    Q. Urine
    R. Cerebrospinal fluid
    S. Other fluids and tissues
3.17 Concluding Remarks
References

Chapter 4: The Biochemistry and Physiology of Alcohol: Applications to Forensic Science and Toxicology
A. W. Jones, Ph.D., D.Sc.
4.1 Introduction
4.2 The Fate of Alcohol in the Body
4.3 Enzymes Involved in the Metabolism of Alcohol
4.4 Isoenzymes of Alcohol Dehydrogenase
4.5 The Existence of ADH in the Stomach
4.6 Aldehyde Dehydrogenase
4.7 Microsomal Ethanol Oxidizing System
4.8 Biomedical Research on Acetaldehyde
4.9 Aspects of Ethanol Pharmacokinetics
4.10 Widmark or Michaelis-Menten Pharmacokinetics?
4.11 The Magnitude of Inter- and Intra-Individual Variations
4.12 The Zig-Zag or Steepling Effect
4.13 The Rate of Alcohol Elimination in Pathological Conditions
4.14 First-Pass Metabolism of Ethanol
4.15 Histamine2-Receptor Antagonists and the Pharmacokinetics of Ethanol
4.16 The Effects of Food on the Pharmacokinetics of Ethanol
4.17 Kinetics of Ethanol Metabolites--Acetaldehyde and Acetate
4.18 Biochemical Markers of Alcohol Abuse and Risk of Alcoholism
4.19 Concluding Remarks
References
Endnotes

Chapter 5: Blood, Urine and Other Fluid and Tissue Specimens for Alcohol Analyses
Yale H. Caplan, Ph.D. and Bruce A. Goldberger, Ph.D.
5.1 Blood
    A. General considerations	
    B. Sources of blood specimens	
5.2 Serum and Plasma
5.3 Urine
5.4 Bile
5.5 Saliva
5.6 Brain and Cerebrospinal Fluid
5.7 Vitreous Humor
5.8 Other Specimens
References

Chapter 6: Analysis for Alcohol in Postmortem Specimens
James C. Garriott, Ph.D.
6.1 Analytical Considerations
6.2 Distribution of Alcohol in the Body
    A. Blood
    B. Antemortem dilution
    C. Other body tissues
    D. Skeletal muscle
    E. Brain
    F. Intracerebral blood clots
    G. Urine
    H. Vitreous humor
6.3 Postmortem Effects on Blood Alcohol Concentrations
    A. Diffusion
    B. Sampling considerations
    C. Postmortem decomposition
    D. Effects of embalming
6.4 Acute Ethyl Alcohol Fatalities
References

Chapter 7: Breath as a Specimen for Analysis for Ethanol and Other Low-Molecular-Weight Alcohols
Morton F. Mason, Ph.D. and Kurt M. Dubowski, Ph.D.
7.1 Introduction
7.2 The History of Breath Alcohol Analysis
7.3 Sampling
References
Endnote

Chapter 8: Methods for Breath Analysis
Patrick Harding. B.S.
8.1 Introduction
8.2 Sampling Breath for Alcohol Analysis
    A. End-expiratory breath is the desired specimen
    B. Residual mouth alcohol
    C. Condensation losses, carryover
    D. Additional steps
8.3 Breath Alcohol Testing Instrumentation
    A. Testing instruments
    B. Calibrating units
8.4 Requirements for Evidential Breath Testing
    A. General
    B. Maintaining reliability
    C. Federal specifications
8.5 Challenges to the Validity of Breath Alcohol Results
    A. Rules, regulations and documentation
    B. Specificity
    C. Residual mouth alcohol
    D. Radio frequency interference
    E. Instrument variability
8.6 Breath Alcohol Testing Instruments
    A. Infrared spectroscopy
    B. Electrochemical oxidation or fuel cell
    C. Dual detector: Infrared/fuel cell
    D. Solid-state semiconductor (Taguchi) gas sensor
    E. Chemical oxidation and photometry
    F. Gas chromatography
References
Endnote

Chapter 9: Methods for Fluid Analysis
Richard F. Shaw, B.S.
9.1 Chemical Methods
9.2 Biochemical Methods
9.3 Gas-Chromatographic Methods
    A Extraction techniques
    B. Distillation techniques
    C. Direct-injection techniques
    D. Headspace techniques
9.4 Other Methods for Alcohol Analysis
    A. High-performance liquid chromatography
    B. Gas chromatography--Mass spectrometry
References

Chapter 10: Quality Assurance
Barbara J. Basteyns and Graham R. Jones, Ph.D.
10.1 Pretesting Criteria
10.2 Laboratory Issues
10.3 Personnel Considerations
10.4 Testing Criteria
    A. Standard operating procedures manual
    B. Standards and controls
    C. Evaluation of quality control criteria
    D. instrument maintenance manuals
    E. Criteria for review and validation of results
10.5 External Proficiency Testing
10.6 Test Reporting Systems
10.7 Post-testing Issues
10.8 Computer Support
References
Reference Materials and Controls
Proficiency Test Programs

Chapter 11: Collection and Storage of Specimens for Alcohol Analysis
William H. Anderson, Ph.D.
11.1 Introduction
11.2 Loss of Ethanol	
    A. Evaporation
    B. Oxidation
    C. Microbial action
    D. Recommendations to prevent ethanol loss
11.3 Ethanol Gain
    A. Physical contamination
    B. Production of ethanol by microorganisms
    C. Recognition of postmortem generation of alcohol
11.4 Preservation of Biological Specimens
    A. Collection of specimens from living subjects
    B. Collection of postmortem specimens
11.5 Conclusions
References

Chapter 12: Reporting of Laboratory Results
James C. Garriott, Ph.D.
12.1 Analysis Specificity
12.2 Uniformity of Reporting Blood
12.3 Breath
12.4 Chain of Custody
12.5 Other Considerations for Reporting Results
References

Chapter 13: Alcohol Effects and Driver Impairment
Herbert Moskowitz, Ph.D.
13.1 Introduction
13.2 Alcohol Use while Driving
13.3 Alcohol and Accidents
13.4 Single-Vehicle Collisions
13.5 Subjective Measures of Impairment
13.6 Driving Abilities Impaired by Alcohol
13.7 Rate of Alcohol Consumption
13.8 Alcohol and Fatigue
13.9 Alcohol and Aggression
13.10 Alcohol and Degree of Injury
References

Chapter 14: Epidemiological Basis of Alcohol-Induced 
Psychomotor Performance Impairment (PMPI)
Barbara R. Manno, Ph.D. and Joseph E. Manno, Ph.D.
14.1 Introduction
14.2 Establishing the Relationship
14.3 Working through the Ambiguities
14.4 Chronological Development of Epidemiology Database
    A. North American studies
    B. International citations
14.5 The Twenty-First Century: What Has Been Learned from Epidemiological Research?
14.6 Summary
References
Endnote

Chapter 15. Experimental Basis of Psychomotor Performance Impairment
Joseph E. Manno, Ph.D. and Barbara R. Manno, Ph.D.
15.1 Introduction
15.2 Observation and Measurement of Alcohol Performance Impairment
15.3 Psychomotor Performance Testing
    A. National Advanced Driving Simulator (NADS)
    B. Roadside testing or field sobriety testing (FST)
    C. Impairment when BACs are between 0.00 and 0.079 g/dl
    D. Impairment at BAC „ 0.10 g/dl
15.4 Application of Performance Information to DWI
15.5 Conclusions
References

Chapter 16: Alcohol and the Law: The Legal Framework of Scientific Evidence and Expert Testimony
Boris Moczula
16.1 General Requirements for Admission of Expert Testimony
    A. Beyond the ken of the average layperson
    B. Meets legal threshold of reliability
    C. The Daubert standard: Reliability
    D. The Daubert test: Relevance
    E. The Daubert parties' contentions
    F. Daubert II: The case on remand
    G. The effect of Daubert
    H. Criticism of Daubert
    I. Methods of proving "general acceptance"
    J. Skill, knowledge or experience of the witness
    K. The independent role of the court
    L. Expert witness compared to lay witness expression of opinion
    M. Compelling an expert witness to testify at trial
    N. The range of expert witness testimony
16.2 Breath Alcohol Testing
    A. Admissibility of test readings
    B. Defense attacks on breath alcohol testing
Endnotes
Appendix. Federal Rules of Evidence and Criminal Procedure Relating to Expert Testimony

Chapter 17: Prosecution of Driving-under-the-Influence Cases
Jerry Landau
17.1 Introduction
17.2 Preparation
    A. Interviewing and preparing witnesses
    B. Driving
    C. Observing the driver and vehicle
    D. Field sobriety testing
    E. Expert witness
17.3 Sample Questions
    A. Introduction of breath-test results
    B. Qualification of the toxicologist
    C. Introducing blood (or urine) test results
    D. Opinion as to the effects of alcohol on the body and effects of alcohol on driving
    E. Time-of-test laws
17.4 Conclusion
References

Chapter 18: Defense of Driving-under-the-Influence Cases
William C. Head
18.1 Introduction
18.2 Statutory or Regulatory Controls
18.3 Qualifications to Draw or Analyze Blood
18.4 Procedure
18.5 Breath Tests and Blood Alcohol Concentration	
18.6 Limitations of Breath Testing Devices
18.7 Fifty Potential Challenges to Breath Tests
18.8 Intravenous Blood Samples
18.9 Blood Sample Kits
18.10 Contamination
18.11 Plasma or Serum Blood or Whole Blood
18.12 Variations in Blood Testing
18.13 Medication and Disease
18.14 Chain of Custody
18.15 Destruction of Blood Samples After Discovery Request
18.16 Documentation Errors
18.17 Consent
18.18 Refusal
18.19 Summary of Potential Blood Test Errors
Additional Reading
References

Chapter 19: The Role and Responsibilities of an Expert Witness
Theodore F. Shults, J.D. and Yale H. Caplan, Ph.D.
19.1 Introduction
    A. The need for expert witnesses
    B. What is an "expert witness"?
    C. Expert witness fees	
    D. Retainer and billing issues
19.2 The Law of Evidence
    A. Overview
    B. Burden of proof
    C. Degree of evidence required to sustain the burden of proof
    D. Reconciling statistical confidence levels and legal proof
19.3 Categories of Evidence
    A. Expert reports
    B. Diagrams and demonstrative evidence
19.4 The Threshold Question of Admissibility
19.5 Discovery and the Expert Witness
    A. The discovery process
    B. If you are contacted by the opposing attorney
    C. Informal interviews
    D. Written interrogatories
    E. Affidavits
    F. The subpoena
    G. The deposition
19.6 Elements of testimony
    A. Direct examination or examination-in-chief
    B. Cross-examination
    C. Re-direct
19.7 Credibility and Communication
    A. Credibility determinations and the jury
    B. Credentials and your testimony
19.8 Keys to Effective Testimony
    A. Before you get to the witness stand
    B. In the courtroom
    C. On the stand
    D. The "don'ts"
    E. Final pointers
19.9 The Nature of Litigation
    A. Hurry up and wait
    B. Variables in litigation
Selected Reading

Chapter 20: Alcohol Testing in the Workplace
Kurt M. Dubowski, Ph.D. and Yale H. Caplan, Ph.D.
20.1 Introduction
    A. Industries and workplaces affected by alcohol
    B. Regulated and nonregulated testing for alcohol
20.2 Some Legal Aspects of Alcohol Testing in the Workplace
    A. In general
    B. The regulatory environment
20.3 Features of Alcohol Testing in the Workplace
    A. Special features of workplace testing for alcohol
    B. Purpose of alcohol testing in the workplace
    C. Alcohol testing categories and indications for alcohol testing
    D. Reasonable suspicion testing
    E. Testing locations: On-site versus off-site
20.4 Alcohol Testing Regulated by the U.S. Department of Transportation
    A. Prohibited conduct
    B. Required alcohol testing
    C. Features of alcohol testing under DOT regulations
    D. Significance, interpretation and consequences of test results
    E. Quality assurance aspects
    F. Statutory and regulatory changes in transportation workplace alcohol testing
20.5 Testing Technology and Practices
    A. Analysis and specimens
    B. Testing in the DOT program
    C. Screening tests
    D. Evidentiary tests
    E. Calibrating devices
    F. Training requirements
20.6 Interpretation of Alcohol Test Results
    A. Acute effects of alcohol
    B. Combined effects of alcohol and other drugs
    C. Hangover effects of alcohol
    D. Abstention period
20.7 Acknowledgment
References
Endnotes

About the Authors
Index

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