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Perception of Alcohol Use and Alcohol Use Disorder among Perso= ns Involved in Road Accidents at an Emergency Department:

A Cross-Sectional Study

*Eugene Kobla Dordoye¹, Kwame Affr= am², Emmanuel Dziwornu¹, Abigail <= /span>

Frempomaa Danso¹, Francis Djankpa³, Saviour Kweku Adjenti⁴

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¹Department of Psychological Medicine and Mental Health, School= of Medicine, University of Health and Allied Sciences, Ghana.� ²St. Joseph Health Regional Hospital, Bryan, Texas, USA� ³⁼School of Medical Sciences, University of Cape Coast, Ghana ⁴School of Medicine & Heal= th Sciences, Central University, Ghana

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Background

Alcohol plays a significant role in road traffic accidents in Ghana. However, little is known about the perspectives= of victims who suffer road traffic accidents, RTAs, and the extent to which alcohol use disorder is involved.

Methodology

We conducted a three-month cross-sectional study in a teaching hospital involving 102 patients involved in a road acci= dent and presented to the hospital�s emergency. The Alcohol Use Disorder Identification Test, AUDIT, was used to assess for Alcohol Use Disorder, AU= D, at a score of 8. In addition, we used open-ended questionnaires to assess t= heir perception of alcohol use and road accidents.

Results

Of the 102 respondents, 75% were males, a= nd 60% were between 15 and 35 years old. About 69% of respondents admitted to using alcohol, while 31%, including a single female, screened positive for alcohol use disorder. A significant majority of about 90% of respondents believed in some myths of alcohol use in Ghana, and a similar percentage we= re aware of the risks alcohol use posed to road use. Over 30% of respondents, mainly drivers or riders, had used alcohol within 12 hours of the accident.= All but three respondents knew alcohol-induced aggression and poor coordination= of movements. A similar number of respondents knew alcohol made people cross r= oads carelessly and were hyperactive or disinhibited.

Conclusion

Alcohol use and alcohol use disorder are significantly high among persons presenting with RTA to the emergency. Knowledge of the deleterious effects of alcohol is high, yet their behavior= did not reflect the knowledge. Therefore, a significant reduction in RTA can be achieved by enforcing blood alcohol concentration limits for road users and intensive education to the populace.

Keywords: Alcohol= Use Disorder, Identification Test, Emergency Department, Ghana, Myths of= Alcohol = Use, Road Accidents.

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��= *Correspondence Dr Eugene K Dordoye Department of Psychological Medicine and Ment= al Health, School of Medicine, University of Health and Allied Sciences, Ghana= .� Email: edordoye@uhas.edu.gh=

This is an open access journal, and articles are distributed und= er the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-c= ommercially, as long as appropriate credit is given and the new creations are licensed u= nder the identical terms.

How to cite this article: Dordoye EK, Affram K, Dziwornu E, Danso AF, Djankpa F, Adjenti SK. Perception of Alcohol Use and Alcohol Use Disorder among Persons Involved in Road Accidents at an Emergency Departmen= t: A Cross-Sectional Study. Niger Med J 2023;64(40); 503-507. Accepted: July 31, 2023. Published: September 21, 2023.

5-7.

Education would be a key component in an attempt to intervene in the impact of alcohol on RTA on the Ghanaian population. A previous study suggests that only 4% of drivers knew= the legal limits of blood alcohol concentration¹⁰. Thus far, it is unknown whether drivers and road users understand the extent to which alcoh= ol can alter their abilities and increase the risk of accidents. Understanding= the perceptions of alcohol users on the effect of alcohol on RTAs would be necessary for tailoring and administering interventions that can reduce the rate of RTAs. In addition, it will be essential to identify persons with al= cohol use disorder (AUD) who, despite knowing the effects of alcohol on road usag= e, will still go ahead and risk it. Such persons should be the focus of tailor-made interventions where possible.

In this study, we assessed the perceptions of persons involved in RTA and presenting to the emergency of Ho Teaching Hospital, a new teaching hospital in Ho municipality. The municipa= lity has about 220,000 people on 164,000 sq km of land¹¹. The primary means of transport are taxis, mini-buses, and, in the past few years, motor= ized cycle rickshaws, which have become most people�<= /span>s primary means of transport. Motorized cycle rickshaws have become the primary means of trans= port outside Ghana�s first two cities (Acc= ra and Kumasi). They are popularly referred to as Kɛkɛ in Ho an= d Pragia or Aboboya in other municipalities in the country. =

We also assessed them for AUD using the Alcohol Use Disorder Identification Test (AUDIT) in the responden= ts to determine the extent to which extra intervention may be warranted in red= ucing alcohol-related RTAs.<= /o:p>

Methodology <= b>

A cross-sectional survey was conducted over three months, from May to July 2021. Information was obtained from road users involved in RTAs presenting to the Emergency Department (ED= ) of the regional hospital in the Volta region of Ghana.

We included all 102 persons between the ages of 15 and 60 who presented with RTA for the duration of the study. The Alcohol Use Disorder Identification Test (AUDIT) was used to ass= ess alcohol use disorder (AUD) among respondents. A score of 8 or more out of a maximum score of 40 was associated with AUD. A score of 8 gives the maximum AUROC [area under the ROC (Receiver Operational and Characteristic - graph = of sensitivity against 1 - specificity curve)] and was used to screen persons = with AUD¹². Also, open-ended questionna= ires were used to generate responses on their perceptions of alcohol use and knowledge of AUD. We used thematic analysis to group the responses for the following results.<= /o:p>

Results

The ratio of males to females= who presented with RTA was 3:1, and over 70% of the respondents were aged betwe= en 15 and 35. This age group was also more likely to have AUD, with 56.3% being positive. Of the 32 respondents who screened positive for AUD, only one was female. About 19% of respondents admitted taking alcohol within 12 hours of= the RTA, and 67% of respondents who had taken alcohol in the preceding 12 hours were either a driver or K= ɛkɛ rider. Thus, those who had m= ore control to prevent an RTA were more likely to be impaired by alcohol use th= an their passengers who had little control.

Perception of Alcohol Consumption: <= /o:p>

Almost all respondents (98%) agreed they consume alcohol to enhance sociability, increase work performan= ce, and boost confidence. In addition, 55.9% of the respondents noted that they consume alcohol to escape personal issues, while 15.7% simply consumed it to get drunk. However, almost all (94.1%) had some myths or misperceptions of alcohol use, such as use for medicinal purposes or to improve appetite, sim= ilar to misperceptions found among engineering workers in Ghana13. Most responde= nts, 91.1%, agreed that they consume alcohol for enjoyment, while 87.3% agreed t= hat they consume alcohol to deal with fear.

Perception of Alcohol-Induced Behavior: <= /o:p>

About 97% of the respondents = were aware that alcohol causes people to be aggressive and induces poor coordina= tion of movements. Furthermore, over 83% agreed that alcohol causes loss of consciousness, while 95.1% noted that it causes drowsiness and inattention. Also, more than 95% said alcohol causes people to cross busy roads careless= ly, while 94.1% stated it causes hyperactivity or disinhibition. Finally, 89.2% noted that alcohol causes poor vision.

Discussion

It has been previously noted = that alcohol use contributes significantly to traffic accidents in Ghana. Besides the poor nature of roads and inadequate maintenance of some vehicles, alcoh= ol use can contribute to almost all factors that increase the risk of RTA, including distracted driving, nonadherence to traffic rules and regulations, and overspeeding¹⁰.

An essential step in mitigati= ng the role of alcohol in RTAs is the education of the masses. A good understanding of the perceptions of victims of road traffic accidents who h= ave used alcohol will help develop practical educational tools to prevent RTAs. Also, identifying people with alcohol use disorder can help prevent recurre= nt offending.<= /o:p>

Alcohol consumption resulting= in RTAs was more rampant among drivers under 35 than those older, with a male preponderance. This is consistent with the study in Accra by Mock et al. ^{8, 9}. The preponderance of young adult males in alcohol-related RTAs was further reflected in the high prevalence of alcohol use disorder among them. AUDIT assessment revealed th= at 56% of young drivers under 35 had alcohol use disorder, of which 96% were m= ale. The estimated rate of AUD in the Ghanaian population is 7.3%; thus, a 56% r= ate among drivers involved in RTAs in the municipality suggests a disproportion= ally high rate.<= /o:p>

To develop practical educatio= nal tools, we thought it essential to know why respondents drank before using t= he roads. Most respondents claimed they consumed alcohol to improve their sociability and confidence levels. Some said they drank to deal with fear a= nd improve their appetite. These responses are consistent with the general the= ory for reasons for alcohol use, mainly social and coping with stress14. The Ghanaian culture is rife with many social opportunities for drinking, including out-dooring, funerals, and weddings, which are available for attending nearly every week= end. Educating drivers to limit alcohol consumption and strategies like alternat= ive transportation or having designated substitute drivers on these occasions w= ould be beneficial in curbing alcohol-related RTAs¹⁵.<= /o:p>

Prevention or significant reduction of avoidable deaths, injuries, and disabilities can be prevented = by enforcing the regulation on blood alcohol concentration, BAC, limits (of 80= mg alcohol per 100ml of blood or 0.08% BAC in Ghana)¹⁶. This can be achieved at a lower cost if the police do random checks on the road with Breathalyzers just as they check the roadworthiness= of vehicles.<= /o:p>

When assessed on the implicat= ions of alcohol use, it was apparent that many of the respondents did know the deleterious effects of alcohol on driving, including increased aggressivene= ss, hyperactivity, loss of consciousness, and poor vision. Thus, they drink alc= ohol and drive despite their knowledge of its deleterious effects. This construes high levels of AUD among the respondents, as noted in the AUDIT evaluations. Policies for implementing screening and brief interventions may be necessar= y to reduce alcohol use among this population and hopefully reduce RTA recurrence rates.<= /o:p>

Because AUD would require intervention beyond education, more extensive studies, including multicenter studies, will be needed to assess the extent of AUD among drivers involved = in RTAs and the appropriate interventions proposed. Also, efforts should be ma= de for future studies to utilize breathalyzers and actual blood alcohol levels= to have more objective measurements of alcohol use.

Conclusions

Persons involved in RTAs who = have consumed alcohol were predominantly young males, with a significant proport= ion of them most likely having AUD. Over 90% of respondents know the harmful ef= fects of alcohol and the risks it poses to them when using the road, yet they took it. Knowledge of the deleterious effects of alcohol is high, yet their behaviour did not reflect the knowledge. Reduction in= road accidents can be achieved by enforcing blood alcohol concentration limits f= or road users and intensive education of road users.

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