Alcohol-related accidents in Europe (2023)

Alcohol-related accidents in Europe (2)

Journal of Alcoholism, Substance Abuse and Drug AddictionCategory: MedicineType: research article

Eduardo Missoni1*,Sanja Mlinaric-Vrbica2,M Petty3eDear Pankrazi3
1University of Zagreb, Zagreb, Croatia
2Dubrovnik General Hospital, Dubrovnik, Croatia
3Sapienza Roma University, Rome, Italy
*Corresponding author(s):

Eduardo Missoni
University of Zagreb, Zagreb, Croatia
Telephone:+385 13361814,

receipt date: July 25, 2017

accepted date: January 17, 2018

release date of: January 31, 2018


The European Commission estimates that one in four incidents in the EU (25%) is alcohol-related. 96% of people involved in accidents of this type are male, of which 33% are young people aged between 15 and 34 years. The European Commission estimates that at least 10,000 people die every year in alcohol-related road accidents in the European Union.

Statistics at European level show that young people aged between 18 and 24 have a higher risk of causing or suffering these accidents, with 25% of them related to alcohol. The Higher Institute of Health estimates that alcohol-related road accidents represent 30-35% of the total number of accidents in Italy. One in 2012 as part of the XX. The analysis carried out in the ACI-CENSIS report on alcohol consumption and behavior shows that 13.8% of drivers do not abstain from alcohol before driving. 8.2% of them believe that alcohol is not a problem for their behavior behind the wheel.

Between 2012 and 2015, more than 8 in 100 drivers were intoxicated and driving after drinking two or more units of alcohol in the hour before driving. Another 6 out of 100 say they have been transported by a drunk driver. Systematic ethyl test checks are a proven tool to reduce road traffic fatalities, but they are still rare, covering only 10% of people stopped.

key words

blood alcohol concentration; Education; Prevention; Traffic accident


Although alcohol may initially cheer people up and even help them socialize at a party, it has a depressant effect on the central nervous system. Alcohol affects two groups of receptors in the brain. Its action on dopamine receptors produces pleasurable sensations, while its action on GABA and glutamate receptors acts as a sedative, causing slowing of movement and speech. Acute reactions to alcohol use include: walking difficulties, blurred vision, slurred speech, slow reaction times and impaired memory. Some of these deficiencies are noticeable after just one or two drinks. The degree of impairment depends mainly on the blood alcohol concentration (BAC).

The driving task can be divided into three subtasks. The first group includes tasks at the operational level. This includes steering, gear shifting, accelerating, braking, but also other manual and mostly fully automated interventions to maneuver and keep the vehicle in optimal operating condition. The second group of subtasks includes tasks at the tactical level. It consists of applying road traffic rules and making decisions about maneuvers with the participation of other road users. The third group includes tasks at the strategic level. These tasks deal with vehicle selection and route selection. In this particular case, one can think of the decision a driver must make whether or not to drive after consuming alcohol.

Alcohol affects task performance on all three levels. At the first level, most skills related to the task of driving begin to deteriorate at a BAK value as low as 0.18 g/l [1]. The initial impairment of directional stability (course keeping) when maintaining a distance from the vehicle in changing speed is impaired at BAC 0.3 g/l and poor when maintaining a distance from the vehicle at constant speed at BAC 0.54 g/l. Choice response time starts to decrease at a BAK of 0.6 g/l, while reactions to a visual recognition while driving start to decrease significantly at a BAK of 0.8 g/l. The decline in the ability to allocate attention between the task of driving and another task begins at BAC between 0.3 and 1 g/L.

At the second level, alcohol consumption leads to increased error rates and longer reaction times when faced with a complex parallel task, even when consuming small amounts of alcohol, which indicates impaired information processing by alcohol. When under the influence of alcohol, drivers tend to focus their eyes more on the central field of vision and make fewer eye movements for peripheral vision. Using fewer sources in the visual field to obtain information about the environment results in more time to recognize and act on important information about your environment [2].

At the third level, the most important effect of alcohol consumption is related to the perception of ease or difficulty in performing a certain behavior that leads to loss of self-control. After a driver consumes alcohol, he is much more likely to believe that he can easily drive safely when he is slightly intoxicated.

Acute impairment resolves shortly after the blood alcohol concentration (BAC) returns to normal, and the most important thing is to avoid driving while alcohol is still in the system. Chronic alcohol users can develop brain deficits that persist long after they stop drinking, and some impairments may not return to normal even after a person stops drinking permanently. The risk of developing permanent brain damage from alcohol consumption depends on the age at which a person starts drinking, the frequency and amount of alcohol consumed per day, sex, comorbidities and use of some drugs, especially psychotropic ones. These individuals may have impaired driving ability even with a normal BAC.

According to the World Health Organization (WHO), the main causes of fatal road accidents are:

• Above speed limit
• Do not use security devices
• Use of alcoholic beverages by the driver

Human factors that affect motor vehicle deaths (Figure 1) include drunk driving (29%), speeding, which accounts for 27% of fatal crashes, drug-driving (21%), distracted driving (10 %) and drowsiness at the wheel (2 %). . The image below shows the distribution of factors involved in a fatal traffic accident in 2015 (data referring to America) [3].

Alcohol-related accidents in Europe (3)

Illustration 1:Factors involved in fatal traffic accidents-2015.

Source: Foundation to Promote Alcohol Responsibility.

The WHO also estimated the achievable outcomes that intervene in these causes:

• -25% fatalities for a 5 km/h reduction in average speed
• -15% fatalities due to the general use of safety devices
• -5/40% of deaths with a reduction in the alcohol content of drivers always below 0.5 g/l.

Driving under the influence of alcohol is one of the risk factors that lead to serious or fatal traffic accidents. Traffic accidents cause many deaths, but also temporary and permanent disabilities with serious physical and psychosocial consequences for quality of life.

Drinking alcohol before driving is an often underestimated social habit and therefore not considered at your risk. Scientific evidence shows that alcohol consumption, even in small doses, poses a risk to drivers and the people around them.

The problem of alcohol-related accidents is not unique to alcoholics: all drinkers/abusers, even occasional ones, pose a risk on the road, both to themselves and to others.

Leading is a complex task that requires attention and the ability to concentrate. These abilities are greatly influenced by the effects of ethyl alcohol, which, being a psychoactive substance, affects the nervous system and, consequently, its abilities.

The European Commission estimates that one in four incidents in the EU (25%) is alcohol-related. 96% of people involved in this type of accident are male, of which 33% are young people between 15 and 34 years old. The European Commission's estimates, which are very conservative regarding drunkenness, show that at least 10,000 people die every year in alcohol-related road accidents in the European Union.

Statistics at European level show that young people aged 18 and over 24 are at greater risk of causing or suffering an accident. Recent estimates show that 25% of accidents involving young people between the ages of 18 and 24 are alcohol-related.

The figure below (figure 2) shows the annual consumption value for each country [4].

Alcohol-related accidents in Europe (4)

Figure 2:Alcohol consumption adults (15+), liters per person (2013).

The highest values ​​are recorded in Luxembourg and the Czech Republic. The lowest values ​​are recorded in Turkey and Armenia, where the majority of Muslims live. In Italy, the value of annual alcohol consumption (6.94 liters) is the lowest among those recorded in Europe, where the average is 10.51 liters.

The high proportion of alcohol-related accidents is due to normal alcohol consumption. Data from ISTAT (National Institute of Statistics of Italy) (Figure 3) show that 75% of Italians consume alcohol (87% of men and 63% of women) [5]. The first glass of alcohol is drunk at 11-12 years old and this is the lowest age in the entire European Union. There are over 3 million risky drinkers and 1 million alcoholics. About 400,000 young people under the age of 17 are alcoholics. Behaviors that go beyond the recommendations are reported among young people aged 18 to 24 years (22% and 8.7%, respectively) and young people aged 11 to 17 years (21.5% and 17.3%, respectively). Adolescence (18-24 years) presents a higher risk of excessive alcohol consumption: 14.5% of young people (21% of men and 7.6% of women) behave in this way, mainly when socializing. This is the most sensitive age group for alcohol-related accidents. Excessive drinking or drunkenness is very risky for you humans because you are not aware of the risks and consequences of your actions [6].

Alcohol-related accidents in Europe (5)

Figure 3:Alcohol consumption in Italy related to age.

Source: "Use and Abuse of Alcohol in Italy"-ISTAT.

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To determine the concentration of alcohol, it is not necessarily a laboratory blood test; As part of the alcohol absorbed by the body is excreted through urine and breathing, a very accurate and rapid test, commonly called the "balloon test", has been developed. To calculate the alcohol content, the test subject is asked to exhale into a balloon containing a substance that serves as a chemical indicator and therefore can change color if the concentration of alcohol in the exhaled air is greater than what is allowed. The name of this type of measurement is Breathalyzer [7].

It is a measuring instrument to determine the alcohol value, that is, the ethanol content in the blood. In Italy, devices are approved that can measure such concentrations by analyzing exhaled alveolar air. After ingestion, ethanol is rapidly absorbed from the stomach and small intestine and distributed into body water (which is about 0.55 L/kg for the human body). Most (about 90%) of ethanol is metabolized in the body, while a small portion is excreted in urine, sweat and exhaled air: the ethanolemia (blood ethanol concentration) to alveolar air ratio is relatively constant, 80 mg of ethanol per 100 ml of blood gives 35 micrograms/100 ml of ethanol in exhaled air.

The main factors on the road are three:

• The vehicle
• environmental conditions
• The human factor

The latter is very important and is the only thing people are directly responsible for. It is known that the altered psychophysical condition of the driver due to alcohol or drugs is the cause of serious accidents, even fatal ones.

The negative effects of alcohol on leadership are well known. It acts on various brain functions (perception, attention, processing, evaluation, etc.), with diverse effects closely related to the amount of alcohol present in the blood, that is, the alcohol level.

Alcohol content is measured in grams of alcohol per liter of blood; an alcohol content of 1 g/liter indicates that there is 1 gram of pure alcohol in each liter of the subject's blood; the same alcohol content can also be expressed as a percentage of 0.1%.

1. In general, the effects of alcohol are as follows [8]:

• Eye problems: After consuming alcohol, eye problems occur due to reduced side vision (tunnel vision) and reduced ability to adapt to night vision.
• Delaying reaction times: Reaction time is the time between exposure to the stimulus and the response. Reaction times vary from person to person and are influenced by several factors: alcohol makes it difficult to coordinate movements, increases reaction time, movements and obstacles are only perceived very late.
• Low concentration: Alcohol consumption impairs supervision and causes drowsiness and dizziness.
• Impaired Judgment: Alcohol creates a sense of well-being, security and euphoria that leads us to overestimate our abilities and take risks that we avoid in normal situations.

The first negative effects start at levels of 0.2 g/liter, affecting the ability to divide attention between two or more sources of information and interacting with fatigue; at a rate of 0.5 g/liter, lateral visual fields, reaction time, endurance endurance and psychomotor coordination begin to be impaired. At a rate of 0.8 g/liter, the previous symptoms worsen and the distances to be evaluated are also affected, the alertness decreases significantly, the sensitivity to red light decreases. At a rate of 1-1.2 g/liter, the above symptoms worsen and euphoria appears, side vision is severely impaired, as well as the perception of distances and the speed of movement of objects. With amounts between 1.5 and 2 g/litre, all the above mentioned symptoms are exaggerated, with the risks being completely underestimated, lack of coordination of movements (eg accelerating instead of braking), very delayed reactions. All this is reflected in the risks of a serious accident.

The above data is included in Table 1 below.

Alcohol g/l

driving effect


Response times are starting to increase


Slow down mental performance


legal limit
Decreased field of view and reaction times


Europe and the unpredictable perception of risk


increase in response times


Less adaptability to darkness


Intoxication and unstable balance


Mental confusion and inability to judge distances

Table 1:driving effect.

Source: ACI: (Italian Automobile Club).

In Italy, the legal limit is 0.5 g/l. In America, the blood alcohol limit, which determines the state of drunkenness, is 0.8 g/l, 60% more than in Italy, and before the intelligence campaign of the 1980s (where arrests were more twice as much) varied between 1 and 1.5.

The figure below (Figure 4) shows the legal limit of alcohol consumption for different countries.

Alcohol-related accidents in Europe (6)

Figure 4:Legal limit for alcohol consumption in different.

The alcohol content depends on several individual factors: depending on the alcohol diffusion mechanism (from the stomach to the blood and then to the cellular brain fluids), the alcohol content of the drinks, the way the alcohol is ingested, gender and age of the subject, his alcoholic habit of drinking alcohol.

The following figure (Figure 5) shows the evolution of alcohol content over time.

Alcohol-related accidents in Europe (7)

Figure 5:Negotiating with the alcoholic ate ​​in time.

Source: ACI (Italian Automobile Club).

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It is noticed that the time that alcohol takes to take effect is short in relation to the duration of the effects, which can last several hours.

When you consume consecutive amounts of alcohol over a period of time (for example, during and after a meal), each absorption and elimination curve adds up and overlaps the previous one, resulting in cumulative effects.


From 2013 to 2014, deaths in crashes involving drunk driving dropped by 1.4% (10,110 to 9,967 deaths). The number of drunk driving deaths fell 27% over the last 10 years, from 13,582 in 2005 to 9,967 in 2014), a decrease of 0.34 in 2013. percent, from 0.45 in 2005 to 0.33 in 2014 [9].

The image below (Figure 6) shows the numbers and rates of deaths in the last decade.

Alcohol-related accidents in Europe (8)

Figure 6:Fatalities and death rate per 100 million VMT in drunk driving crashes, 2005-2014.

Quelle: Fatalities-FARS 2005-2013 Arquivo Final.

Table 2 shows that the alcoholism rate among drivers involved in fatal accidents in 2014 was almost four times higher at night than during the day (34% vs. 9%). In 2014, 16% of all drivers involved in fatal crashes on weekdays were drunk, compared to 29% on weekends. The table below provides information on drivers involved in fatal crashes in 2005 and 2014 by time of day and day of week, as well as data on single and multiple vehicle crashes.

Drivers involved in fatal accidents



Percent change with BACs0,08+2005-2014

total number

BAK = 0,08+

total number of drivers

BAK 0,08+


total percentage


total percentage

No total







Drivers by accident type and time of day

single vehicle accident

No total*








time of day








At night








Several vehicles collide

No total*








time of day








At night







Driver due to time delay

time of day







At night








Drivers by day of the week and delay time

Day of the week*








time of day








At night
















time of day








At night








Mesa 2:Drivers involved in fatal accidents with CAS22 equal to or greater than 0.008 g/dL, by type of accident, day of the week (2005-2014).

Source: Final Archive FARS 2005 and ARF 2014.

There has been a very significant decrease in accidental deaths of under-21s. The data in Figure 7 show that, in 1982, 5,215 under-21s were involved in traffic deaths, while in 2015 the number was 1,021. Drunk driving deaths among those under 21 dropped by 80% from 1982 to 2015. The data provided is shown in the following figure.

Alcohol-related accidents in Europe (9)

Figure 7:Children under 21 involved in accidents

Source: “2015 Status of Drunk Driving Deaths in America”; Alcohol Responsibility Foundation.

According to ISTAT statistics, in 2012 in Italy there were 186,726 road accidents with personal injuries, 264,716 injuries and 3,653 deaths. However, data from the ANIA (American Nursing Informatics Association) show a much worse situation, showing about 3 million accidents and about 900,000 injuries. Occurrences related to improper driver behavior represent more than 80% of the total, according to ISTAT: 16.6% of them are due to distracted driving, 16.2% to disrespect for passing preference or traffic lights and 11.2 % to speeding. The Istituto Superiore di Sanità (ISS) estimates that traffic accidents account for 30-35% of fatal accidents in Italy: therefore, in our country, in 2012, the number of victims at the wheel due to alcohol abuse would be 1100-1300 .


A few simple interventions could lead almost immediately to a drastic reduction in the number of traffic accidents and, therefore, in their most serious consequences [9]. Alcohol ignition lockouts, reinforced alcohol screening lanes and stricter legislation are the measures that all European countries must implement to reach the target of reducing alcohol-related road accidents.

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Italy still lags behind in preventing alcohol-related injuries: there aren't as many engine blocks and alcohol-free driving only applies to professional drivers and newcomers. In addition, roadside alcohol testing is increasing, but still insufficient. As shown in Figure 8, the European average in 2010 was 176 checks per 1,000 inhabitants, while the Italian standard is a scant 27 checks per 1,000 inhabitants.

Alcohol-induced risky driving is often exacerbated by impaired driving skills and poor inhibitory control [10,11].

Alcohol-related accidents in Europe (10)

Figure 8:European average values ​​of police checks on road traffic.

Source: ARS Toscana (Regional Health Company).


With regard to the tightening of legislation in Italy, the law on "street homicides" is a starting point to introduce an important and radical cultural change, especially with regard to behavior patterns in youth. This law condemns anyone who causes the death of a person by violating the Highway Code. Those who, while intoxicated with an alcohol content of more than 1.5 g/l or in a state of psychophysical alteration resulting from the ingestion of narcotic drugs or psychotropic substances, cause the death of another person to be sentenced to the death penalty. twelve years.

Finally, it is possible to analyze the economic costs of all traffic accidents involving motor vehicles. For example, in the United States in 2010, these costs totaled $242 billion, of which $44 billion was attributable to DUI accidents. In Italy, according to the study carried out by the Ministry of Infrastructure and Transport, the cost of social accidents with injuries in 2013 was estimated at 17.95 billion euros. With the additional costs of accidents without injuries, this estimate increases to more than 24 billion euros.

These costs represent tangible losses caused by traffic accidents involving automobiles. However, in cases of serious injury or death, these costs do not capture the relatively intangible value of the lost quality of life that directly results from these injuries. Looking at quality-of-life rankings, it was estimated in the United States in 2010 that the total social harm from road crashes was $836 billion, of which $201.1 billion was due to crashes involving drunk drivers.


  1. Moskowitz H, Robinson C (1987) Impaired ability to drive with low blood alcohol levels. In: Noordzij PC, Rosbach R (eds.). Alcohol, Drugs and Road Safety, T86. Excerpta Medica, Amsterdam, Netherlands.
  8. worrying-data-from-european-commission.html
  9. Road Safety Facts 2014. US Department of Transportation, NHTSA, Washington DC, USA.
  10. Missoni E, Boži? B, Missoni I (2012) Alcohol-related traffic accidents before and after the adoption of the Traffic Safety Act in Croatia. Coll Antropol 4: 1483-1489.
  11. Laude JR, Fillmore MT (2015) Simulated driving performance under the influence of alcohol: effects on driver risk versus driver skill. Drug Alcohol Depend 154: 271-277.

Quote:Missoni E, Mlinariš-Vrbica S, Meschino M, Pancrazi E (2018) Alcohol-related crashes in Europe. JJ Alcohol Drug Addict Subst Abuse 4:008.

Copyright ©:© 2018 Eduard Missoni, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided attribution is given.

Alcohol-related accidents in Europe (11)


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