Unintentional Injury and Death Under the Influence

Every year, many people in the U.S. unintentionally injure themselves or others while under the influence of alcohol, drugs, other substances, or a combination thereof. Some of these incidents result in early death. This article provides an overview of the rates of unintentional injury and death related to certain types of accidents that are the unfortunate consequence of substance abuse.

Car Accidents

Perhaps the type of substance-caused accident that is most talked about is car crashes (Read Drugged Driving). Of the more than 30,000 car-accident fatalities that occur in the United States annually, about a third involved a drunk driver.  This translates into roughly 30 people dying each day because of drunk or drugged drivers.  Perhaps a more distressing fact is that, of 180 children who were killed in such crashes, 50% of them had been in the car with the drunk driver, which means that a high percentage of children were also the victims of a type of abuse or neglect (Read The Addict Parent: What it Means for Child Development).

Boating Accidents

The Centers for Disease Control (CDC) reported that roughly 20% of boating-related deaths involve alcohol abuse.  California boating-related accident data from 2006 indicate that nearly half of those who died had been consuming alcohol.  Causes of the accidents included boats grounding or capsizing, inattention of the driver, passengers (or skiers) participating in unsafe behaviors, operating the boat at high speed, and passengers falling overboard.  Intoxicated boat passengers often do not realize that they are impaired and may attempt to jump from one craft to another, may lean over the side of the boat, or may swim in close proximity to boat propellers leading to injury or death.  The majority of fatalities (53%) occurred on trips for the purpose of fishing.

Hypothermia and Hyperthermia (Temperature-Related Injury and Death)

A person who has been drinking or using drugs may have difficulty responding quickly and appropriately to changes in body temperature; they may not process how long they have been exposed to extreme heat or cold, and this may result in corresponding injuries or even death.  A study of 51 cold-related deaths in Sweden found that two thirds had high blood alcohol levels.  Other drugs and even prescription medicines – especially sleeping pills and opiates – can cause similar problems. For example, in 2009, a Minnesota man was found dead outside in freezing temperatures; although it was not determined whether he had been drinking alcohol as well, the man was known to use the sleeping medicine Ambien to help with insomnia.  He had even crashed his car into a building while asleep. Individuals have also reported engaging in other activities while in an Ambien-induced sleep, including sleep-driving, which could be even more dangerous.  Heat is also a threat to inebriated people; the effects of alcohol in particular can be exacerbated by heat and prolonged exposure to the sun. Additionally, research suggests that hyperthermia (an increase in body temperature) can skew results of alcohol breath tests by as much as 23%.


According to the CDC, there are about 8 adolescent and adult drowning deaths (most not related to boating) each day. Of these, alcohol or other substance use has been implicated in approximately half.  In addition to causing impairments in coordination, balance, and other motor skills, the effects of alcohol may be made worse by the heat and sun, which are common during swimming.


Celebrity deaths often call attention to the problem of prescription drug abuse and the possibility of dying from an overdose (Read Michael Jackson & Dangers of Prescription Drug Abuse). But the CDC reports that nearly 20,000 people die in America each year from overdoses (Read Overdose: Why It Happens & What to Do When It Does). In fact, the rate of drug overdoses doubled from about 11,000 in 1999 to 22,000 in 2005. The types of drugs most often implicated in such overdoses are those in the opiate class (Read Oxycontin Withdrawal). Some states saw higher rates of unintentional (or unclear intention) overdoses in 2005:  Florida (2,003 deaths), North Carolina (848 deaths), and Kentucky (586 deaths), for example (Read Florida Fights Addiction: Submitting a Marchman Act).  Although the Drug Enforcement Administration is working hard to combat the increasing prescription-drug-abuse epidemic, there is still a long way to go (What the Doctor Ordered? Cracking Down on Prescription Drug Abuse).

Workplace Accidents

A perhaps surprising number of individuals consume substances while on the job or arrive at work inebriated (Read Working Under the Influence: Substance Abuse in the Workplace).  Research suggests that, of those who use illegal drugs, over 3% have done so on the clock; similarly, of those who abuse alcohol, greater than 7% have been guilty of drinking on the job.  Intoxicated employees become a serious liability for employers; they could injure themselves or others and their productivity is compromised.

Sports-Related Accidents

Competitive athletes are particularly at risk for abusing substances in an attempt to get ahead (Read Athletes with an Edge: How Far is Too Far? and Steroid Use in Female Body Builders).  But in addition to the potential side effects and the risk of disqualification from an event, athletes may increase their risk of death from abusing certain substances.  In particular, amphetamines can lead to ruptured blood vessels in the brain or adverse cardiovascular events, both of which can cause death (Read Then and Now: Past and Present Use of Amphetamines).  Abuse of steroids has also been implicated in the deaths of both famous and amateur athletes.


Consuming alcohol or other substances can impair balance and lead to falls, which is even more problematic among elderly patients who are at a higher risk for hip fractures (Read Substance Abuse and Seniors). A 2003 study examined 351 adults (age 16 to 60) who had fallen, 113 of whom had consumed alcohol prior to the fall.  The group who had been drinking were more likely to sustain craniofacial injury, and the severity of the injury often corresponded to the person’s blood alcohol level.

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