Garriott’s Medicolegal Aspects of Alcohol, Fifth Edition
Edited by James C. Garriott

Detailed Table of Contents

Preface

Chapter 1. Chemistry of Alcoholic Beverages
Bill H. McAnalley, Ph.D. and Erik H. Aguayo, B.S.
1.1 Description and History of Common Alcoholic Beverages
A. Fermented Alcoholic Beverages
B. Distilled Alcoholic Beverages
C. The Effects of Aging (Maturation)
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. Ethanol and Grain Components
D. Toxic Metals
1.10 Congeners from Spices and Herbs
1.11 Semivolatile Congeners

Chapter 2. Pharmacology and Toxicology of Ethyl Alcohol
James C. Garriott, Ph.D. and Joseph E. Manno, Ph.D.
2.1 Skin
2.2 Gastrointestinal Tract
2.3 Cardiovascular System
2.4 Liver
2.5 Kidneys
2.6 Endocrine System
2.7 Central Nervous System
A. 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/Piloting Skills
2.9 Effects of Alcohol in Combination with Other Drugs
A. Acetaminophen
B. Amphetamines
C. Analgesics/Narcotics
D. Antidepressants
E. Barbiturates
F. Benzodiazepines
G. Caffeine
H. Cocaine
I. Inhibition by Histamine2-Receptor Antagonists
J. Marijuana
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
2.11 Tolerance

Chapter 3. Biochemical and Physiological Research on the Disposition and Fate of Ethanol in the Body
A.W. Jones, Ph.D., D.Sc.
3.1 Introduction
3.2 Fate of Drugs in the Body
3.3 Forensic Science Aspects of Alcohol
3.4 Ethyl Alcohol
A. Chemistry
B. Amounts of Alcohol Consumed
C. Alcoholic Beverages
D. Analysis of Ethanol in Body Fluids
E. Reporting Blood Alcohol Concentration
F. Water Content of Biofluids
3.5 Alcohol in the Body
A. Endogenous Ethanol
B. Absorption
C. Distribution
D. Metabolism
3.6 Pharmacokinetics of Ethanol
A. First-Order Kinetics
B. Zero-Order Kinetics
C. Non-Linear Saturation Kinetics
D. The Widmark Equation
E. Updating the Widmark Equation
F. Pharmacokinetics of Ethanol Metabolites
G. Physiological Range of Ethanol Elimination Rates
3.7 Characteristics of Blood-Alcohol Curves
A. Ingestion of Alcohol on an Empty Stomach
B. Inter- and Intra-Individual Variations
C. Factors Influencing Cmax and tmax
D. Effects of Food in the Stomach
E. Gender Differences
F. Repetitive Drinking
G. Effect of Age on Widmark Parameters
H. Blood-Alcohol Profiles after Drinking Beer
I. Retrograde Extrapolation
J. Massive Ingestion of Alcohol under Real-World Conditions
K. Effects of Drugs on Metabolism of Ethanol
L. Elimination Rates of Ethanol in Alcoholics During Detoxification
M. Ethanol Metabolism in Pathological States
N. Short-Term Fluctuations in Blood-Alcohol Profiles
O. Intravenous vs. Oral Route of Ethanol Administration
3.8 Ethanol in Body Fluids and Tissues
A. Water Content of Specimens
B. Urine
C. Breath
D. Saliva
E. Cerebrospinal Fluid (CSF)
F. Tears
G. Sweat
H. Mother's Milk
I. Brain and Body Organs
J. Vitreous Humor
K. Hair
3.9 Concluding Remarks

Chapter 4. Biomarkers of Acute and Chronic Alcohol Ingestion
A.W. Jones, Ph.D., D.Sc.
4.1 Introduction
4.2 Human Biomonitoring
4.2 Untoward Effects of Alcohol
A. Acute Toxicity
B. Alcohol-Related Impairment
C. Blood Alcohol Concentration
D. Alcohol Hangover
E. Alcohol-Related Liver Disease
4.3 Quantity of Alcohol Consumed
A. Definition of a Standard Drink
4.4 Alcohol in the Body
A. Absorption from the Gut
B. Distribution in All Body Fluids and Tissues
C. Elimination via Excretion and Metabolism
D. Oxidative Metabolism of Ethanol
E. Metabolic Consequences
4.5 Evaluating Drinking Habits
A. Questionnaires and Self-Reports
B. Biochemical Markers of Alcohol Problems
C. Markers of Acute Alcohol Ingestion
D. Analysis of Methanol in Body Fluids
E. Urinary Metabolites of Serotonin
F. Non-Oxidative Metabolites of Ethanol
4.6 Biochemical Markers of Excessive Alcohol Consumption
A. Carbohydrate Deficient Transferrin (CDT)
B. Gamma-glutamyltransferase (GGT)
C. Mean Corpuscular Volume (MCV)
D. Other Biomarkers of Excessive Drinking
4.7 Forensic Applications of Biomarkers
A. Postmortem Toxicology
B. Control of Abstinence
C. Alcohol Biomarkers in Hair
D. Traffic Medicine
4.8 Efficacy of Diagnostic Screening Tests
A. Sensitivity and Specificity
B. Positive and Negative Predictive Values
4.9 Concluding Remarks

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 (Oral Fluid)
5.6 Brain and Cerebrospinal Fluid
5.7 Vitreous Humor
5.8 Other Specimens

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

Chapter 7. Methods for Breath Analysis
Patrick Harding, B.S. and J. Robert Zettl, B.S., MPA
7.1 Introduction
7.2 Sampling Breath for Alcohol Analysis
A. End-expiratory Breath is the Desired Specimen
B. Residual Mouth Alcohol
C. Condensation Losses, Carryover
D. Additional Steps
7.3 Breath Alcohol Testing Instrumentation
A. Testing Instruments
B. Calibrating Units
7.4 Requirements for Evidential Breath Testing
A. General
B. Data Collection
C. Maintaining Reliability
D. Federal Specifications
7.5 Challenges to the Validity of Breath Alcohol Results
A. Rules, Regulations and Documentation
B. Specificity
C. Residual Mouth Alcohol
D. Blood:Breath Alcohol Ratio
E. Radio Frequency Interference
F. Instrument Variability
7.6 Breath Alcohol Testing Instruments
A. Infrared Spectroscopy
B. Electrochemical Oxidation/Fuel Cell
C. Dual Detector: Infrared/Fuel Cell
D. Chemical Oxidation/Photometry
7.7 Challenges to Breathalyzer Results

Chapter 8. Methods for Fluid Analysis
Bruce A. Goldberger, Ph.D., Yale H. Caplan, Ph.D. and Richard F. Shaw, B.S.
8.1 Chemical Methods (Colorimetric) 2
8.2 Biochemical Methods (Enzymatic)
8.3 Gas Chromatographic Methods
A. Extraction Techniques
B. Distillation Techniques
C. Direct Injection Techniques
D. Headspace Sampling
8.4 Gas Chromatography-Mass Spectrometry
8.5 Analysis of Volatiles-Practical Considerations

Chapter 9. Quality Assurance
Graham R. Jones, Ph.D. and Laura Liddicoat, B.S.
9.1 Pre-testing Issues
A. Collection Tubes and Directions
9.2 The Laboratory
A. Personnel
9.3 Testing
A. Specimen Suitability for Testing
B. Analytical Methods-Calibration
C. Validation and Approaches to Calibration
D. Quality Control and Matrix Validation
E. Batch Analysis
F. Quality Control
G. Acceptance Criteria
H. Monitoring Quality Control Performance
I. Instrument Maintenance
J. Proficiency Tests
9.4 Post Testing
A. Reporting
B. Uncertainty
C. Records and Specimen Retention

Chapter 10. Collection and Storage of Specimens for Alcohol Analysis
William H. Anderson, Ph.D.
10.1 Introduction
10.2 Loss of Ethanol
A. Evaporation
B. Oxidation
C. Microbial Action
D. Recommendations to Prevent Ethanol Loss
10.3 Ethanol Gain
A. Physical Contamination
B. Production of Ethanol by Microorganisms
C. Recognition of Postmortem Generation of Alcohol
10.4 Preservation of Biological Specimens
A. Collection of Specimens from Living Subjects
B. Collection of Postmortem Specimens
10.5 Conclusions

Chapter 11. Alcohol Effects and Driving Impairment
Herbert Moskowitz, Ph.D.
11.1 Introduction
11.2 The Presence of Alcohol in Drivers
11.3 Alcohol and Accidents
11.4 Single-Vehicle Collisions
11.5 Measures of Intoxication
11.6 Driving Abilities Impaired by Alcohol
11.7 Rate of Alcohol Consumption
11.8 Alcohol and Fatigue
11.9 Alcohol and Memory
11.10 Alcohol and Aggression
11.11 Alcohol and Degree of Injury

Chapter 12. Epidemiologic Basis of Alcohol-Induced Psychomotor Performance
Barbara R. Manno, Ph.D., Joseph E. Manno, Ph.D., and Kenneth E. Ferslew, Ph.D.
12.1 Introduction
12.2 Establishing the Relationship
12.3 Working Through The Ambiguities
12.4 Chronological Development of Epidemiology Database
12.5 North American Studies
12.6 International Studies
12.7 Have Our Actions From Studying Epidemiological Studies Produced Effects?
12.8 Summary

Chapter 13. Experimental Basis of Alcohol-Induced Psychomotor Performance
Joseph E. Manno, Ph.D., Barbara R. Manno, Ph.D. and Kenneth E. Ferslew, Ph.D.
13.1 Introduction
13.2 Observation and Measurement of Alcohol Performance Impairment
13.3 Psychomotor Performance Testing
A. National Advanced Driving Simulator
B. Roadside Testing or Field Sobriety Testing
C. Impairment When BACs Are Between 0.00–0.079 g/dL
D. Impairment at BAC = 0.10 g/dL
13.4 Application of Performance Information To DWI
13.5 Conclusions

Chapter 14. Prosecution of the Alcohol-Impaired Driving Case
Mary F. Anderson, J.D.
14.1 Introduction
14.2 The Big Picture
14.3 Complexity of Prosecuting the Impaired Driving Case
14.4 The Alcohol-Impaired Driving Case
14.5 Factual Witnesses
14.6 Expert Witnesses
14.7 Preparing for Court Prior to Being Called to Trial

Chapter 15. Defense of Driving Under the Influence Cases
James Nesci, Esq.
15.1 Introduction
15.2 Driving and Field Sobriety Testing
A. Overview: National Highway Traffic Safety Administration (NHTSA)
B. Driving Behavior
C. Standardized Field Sobriety Testing (SFST) Validation Studies
D. Legal Analysis and Summary of the SFST Validation Studies
E. Final Thoughts on the Standardized Field Sobriety Test Battery
15.3 Chemical Testing
A. Preliminary Breath Testing/Preliminary Alcohol Screening
B. Safeguards
C. Commonly Used PBT Devices
D. Evidential Breath Testing
E. Breath Testing: Methods of Attack
F. Calibration
G. Blood Testing: Methods of Attack From the Vein to the Lab
H. Headspace Gas Chromatography
I. Secondary Blood Testing
15.4 Trial
A. Overview
B. Cross-Examination

Chapter 16. Legal Proceedings and the Expert Witness
Yale H. Caplan, Ph.D. and Bruce A. Goldberger, Ph.D.
16.1 Introduction
16.2 The Need for Expert Witnesses
16.3 What is an Expert Witness?
16.4 Financial Issues
16.5 The Law of Evidence
A. Overview
B. Burden of Proof
16.6 Degree of Evidence Required to Sustain the Burden of Proof
A. Beyond a Reasonable Doubt
B. Preponderance of the Evidence
C. Clear and Convincing Evidence
16.7 Reconciling Statistical Confidence Levels and Legal Proof
16.8 Categories of Evidence
16.9 Expert Reports
16.10 Diagrams and Demonstrative Evidence
16.11 The Threshold Question of Admissibility
16.12 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. If You Are Subpoenaed
H. The Deposition
I. Depositions Are Used For:
16.13 Elements of Testimony
A. Voir Dire
B. Direct Examination or Examination in Chief
C. Cross-Examination
D. Re-Direct
E. Credibility and Communication
F. Credibility Determinations and the Jury
G. Credentials and Your Testimony
16.14 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
16.15 The Nature of Litigation
A. Hurry Up and Wait
B. Variables in Litigation

Chapter 17. Alcohol Testing in the Workplace
Kurt M. Dubowski, Ph.D., LL.D., Yale H. Caplan, Ph.D. and Dennis V. Canfield, Ph.D.
17.1 Introduction
A. Industries and Workplaces Affected by Alcohol
B. Regulated and Non-Regulated Testing for Alcohol
17.2 Some Legal Aspects of Alcohol Testing in the Workplace
A. In General
B. The Regulatory Environment
17.3 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
17.4 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
17.5 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
G. Testing in the Nuclear Regulatory Commission Programs
17.6 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
17.7 Acknowledgment

Chapter 18. Statistical Applications in Forensic Toxicology
Rod G. Gullberg, M.S.
18.1 Basic Introductory Statistics
18.2 Samples, Populations and Distributions
A. Descriptive Statistics
B. Inferential Statistics
C. Regression Analysis
D. Non-Parametric Statistical Analyses
18.3 Transformations
18.4 Bayesian Statistics
18.5 Basic Principles of Measurement
18.6 Basic Properties of Measurement
18.7 A Traceability and Uncertainty Example
18.8 Sample Size
18.9 Duplicate Test Agreement Criteria
A. Proficiency Testing
18.10 Widmark’s Equation
18.11 Blood/Breath Alcohol Ratios
18.12 Experimental Design
18.13 Communicating Statistical/Numerical Information
18.14 Conclusions

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