High Risk of Alcohol-Impaired Driving in Adults With Comorbid Alcohol and Substance Use Disorders in the US Population

Objective: Alcohol-impaired driving is a significant source of injury and morbidity in the United States. People with alcohol use disorder (AUD) are more likely to drive while impaired by alcohol than their nonclinical counterparts. Less is known about rates of impaired driving in people with AUD and a comorbid substance use disorder (SUD). The current study examined the association among AUD, other SUDs, and alcohol-impaired driving in a nationally representative sample of adults in the United States. Method: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 36,309). AUD and SUD diagnoses according to DSM-5 criteria were determined using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. We compared rates of past-year alcohol-impaired driving in people with AUD, another SUD (i.e., cannabis use disorder, stimulant use disorder, opioid use disorder), or AUD comorbid with another SUD against those with no past-year AUD or SUD diagnoses. Results: People with AUD had increased odds (adjusted odds ratios [AORs] = 15.85-28.27) of past-year alcohol-impaired driving behavior compared with past-year drinkers with no AUD or SUD. Although other SUDs per se were not consistently associated with increased odds of these behaviors (AORs = 0.28-4.07), people with AUD comorbid with SUD showed comparatively higher odds of these behaviors (AORs = 30.46-93.97). These effects held even when alcohol use quantity/frequency and AUD severity were controlled for. Conclusions: People with AUD and a comorbid SUD are at high risk for alcohol-impaired driving. More research is needed to understand the factors mediating increased odds of driving while impaired in people with substance use comorbidities, especially considering societal movement toward cannabis legalization.