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Drug Recognition Expert Pre-School Instructor Manual

HS 172A R1/07, January 2007

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HS 172A R1/07

PRELIMINARY TRAINING

FOR DRUG EVALUATION AND CLASSIFICATION

ADMINISTRATOR'S GUIDE

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HS 172A R1/07

TABLE OF CONTENTS

A. PURPOSE OF THIS DOCUMENT

B. OVERVIEW OF THIS COURSE

1. For Whom Is The Training Intended? 2. What Is The Goal Of The Training? 3. What Will The Students Get Out Of The Training? 4. What Subject Matter Does The Course Cover? 5. What Activities Take Place During The Training? 6. How Long Does The Training Take?

C. OVERVIEW OF THE CURRICULUM PACKAGE

D. GENERAL ADMINISTRATIVE REQUIREMENTS

1. Facility Requirements 2. Instructor Qualifications 3. Class Size Considerations 4. Requirements For The Controlled Drinking Practice Session

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A. Purpose of This Document

This Administrator's Guide provides an introduction to and an overview of thetwo-day course entitled "Preliminary Training for Drug Evaluation andClassification Program". This course is the first in a series of three trainingprograms that, collectively, prepare police officers and other qualified personsto serve as Drug Recognition Experts (DREs). In some law enforcementagencies, these officers are known as Drug Recognition Technicians. TheInternational Association of Chiefs of Police (IACP) have adopted "DRE" as thegeneric title for the persons who carry out this program.

A person who satisfactorily completes this Preliminary Training program iseligible for advancement to the second stage of DRE training, i.e., the seven-dayclassroom program in Drug Evaluation and Classification. The seven-daycourse commonly is called the "DRE School", to distinguish it from this two-daypreliminary course (known as the "Pre-School"). Upon successful completion ofthe seven-day DRE School, the officer graduates to the final, or CertificationPhase, of his or her training. The Certification Phase is conducted on-the-job: under the supervision of duly-authorized instructors, the DRE trainee conductsevaluations of persons actually under arrest on suspicion of drug impairment. The instructors evaluate the trainee's skill in conducting drug recognitionexaminations, and also evaluate his or her judgment in forming opinions as tothe category or combination of categories of drugs causing the impairmentevident in the suspects. And, the trainee's opinions are compared with theresults of toxicological examinations, when they are available.

This Administrator's Guide is intended to facilitate planning andimplementation of the Preliminary Training Program. The Guide overviews thetwo-day course of instruction and also overviews the documents that make upthe curriculum package.

B. Overview of the Course

1. For Whom Is The Training Intended?

This course is designed for people who have been selected to serve as DREs. No one is permitted to enroll in the Pre-School unless he or she intend toproceed through the sub-sequent stages of training, and ultimately achievecertification as a DRE. The emphasis here should be kept on the concept ofactual service as DREs. The skills that a DRE applies can be kept sharponly if they are frequently used.

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There is no point in offering this training to someone who will not routinelyand regularly evaluate drug-impaired suspects, since that person wouldquickly lose whatever competence he or she gained through the training.The DRE's job is not like riding a bicycle: one can and will forget how to doit properly unless he or she does it frequently. Agencies interested in thistraining should take special note that it is not desirable to send full-timeinstructors to this course, with the intent of having those instructors comehome and teach others. Unless provisions are made to have thoseinstructors actually work as DREs, their ability to serve competently asteachers of other DREs will vanish rapidly. It is far preferable to selecttrainees who will subsequently serve primarily as DRE practitioners, andwho can be called upon part-time to serve as trainers.

Anyone selected as a DRE trainee must be fully competent with theStandardized Field Sobriety Tests (SFSTs), i.e., Horizontal GazeNystagmus, Walk and Turn, and One Leg Stand. No one can progress tothe seven-day DRE School until he or she demonstrates proficiency withthe three SFSTs.

2. What Is The Goal Of This Training?

The goal of this two-day Pre-School is succinct:

To prepare the student to participate successfully in his or her formalclassroom training in the drug recognition process, i.e., the seven-day DRESchool.

3. What Will The Students Get Out Of The Training?

As a result of successfully completing this Pre-School, the students will bebetter able to:

(1) Define the term "drug" and name the seven categories.

(2) Identify the twelve major components of the drug recognition process.

(3) Administer and interpret the psychophysical tests used in the process.

(4) Conduct the eye examinations used in the process.

(5) Check the vital signs that are relevant to the process.

(6) List the major signs and symptoms associated with each drug category.

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(7) Describe the history and physiology of alcohol as a drug.

These are a subset of the competencies expected of DRE trainees by thecompletion of the seven-day DRE School; the Pre-School gives them a "headstart" toward achieving those skills.

4. What Subject Matter Does The Course Cover?

The Pre-School covers concepts and skills that are fundamental to theDRE's job.

! A traffic safety-oriented definition of what constitutes a "drug" (i.e.,

Any substance which when taken into the human body can impair theability of the person to operate a vehicle safely.

! Enumeration of seven distinct categories of drugs; the drug recognitionprocess allows the DRE to identify which category or combination ofcategories is causing the impairment evident in a subject

! Demonstrations of and practice with four divided attention

psychophysical tests that are used to assess impairment during a drugevaluation.

! Demonstration of and practice with the three eye examinations thatprovide cues of the possible presence of various drug categories.

! Demonstrations of and practice with checks of certain vital signs thatpoint to the possible presence of various drug categories.

! A review of the major observable signs that distinguish the categoriesfrom each other.

5. What Activities Take Place During The Training?

Although a certain minimal amount of formal lectures are required, thecourse consists primarily of hands-on practice. Students repeatedly drill inthe divided attention tests, the eye examinations and in performing checksof the vital signs. A controlled drinking exercise (involving volunteers whoare not members of the class) provides an opportunity to practice assessingimpairment on the divided attention tests.

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6. How Long Does The Training Take?

The training encompasses approximately 13 and ½ hours of actualinstruction. With breaks, this occupies two full training days.

C. Overview of the Curriculum Package

1. Instructor's Lesson Plans

The Instructor's Lesson Plans are a complete and detailed outline of what isto be taught in the Pre-School (i.e. the subject matter) and also of how it isto be taught (i.e., the instructional methods). The lesson plans areorganized into modules. Each module corresponds to one of the course's tensessions.

Each module consists of a cover page; an outline page; the lesson plansthemselves; and copies of any visuals referenced in the lesson plans.

The cover page presents the session's title and the total time required toconduct the session.

The outline page presents the training objectives for the session, i.e. exactlywhat the student will be able to do as a result of successfully completingthe session. The outline page also lists the major content segments of thesession, as well as the principal instructional activities that take placeduring the session.

The lesson plans themselves are arrayed in a standard two-column format. The left-side column contains the outline of "content", or the subject matterto be taught. The right-side column outlines the "instructional notes", orhow the content is to be taught.

The Instructor's Lesson Plans serve, first, to prepare the instructor to teachthe course. He or she should review the entire set of plans, for all tensessions, to become familiar with the content and learning activities anddevelop a clear understanding of how the course fits together. Theinstructor is expected to become thoroughly familiar with each lesson plansegment that he or she is assigned to teach; to prepare acetate copies of thevisuals; to assemble all "props" and materials needed to deliver the lesson;and, to augment the instructional notes, as necessary and appropriate, toensure that his or her own style and experience are applied to teaching thelesson.

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Subsequently, the Instructor's Lesson Plans serve as an in-class referencedocument for the instructor, to help him or her maintain the sequence andpace of training.

It is worth emphasizing that the lesson plans are not speeches. Althoughthe outlines of content and instructional notes are fairly detailed, thoseoutlines are not to be read verbatim to the students. This training isintended to be a dynamic and highly interactive learning experience. Itmust not be permitted to degenerate into a series of mere lectures.

2. Visual Aids

Four kinds of audio-visual aids are employed in the Pre-School:

o wallcharts o Dry erase board/flip-chart presentations o visuals, i.e. PowerPoint slideso video/DVD

The wallcharts are permanently displayed items. They consist of sketcheswith brief captions, intended to depict major themes and segments of thecourse. The wallcharts should be positioned high on the far left and rightsides of the classroom's front wall where they will be visible withoutoccupying the center of attention.

The dry erase board/flip-chart presentations are outlined in the"instructional notes" column of the lesson plans, and are self-explanatory.

The visuals are simple graphic and/or narrative displays that emphasizekey points and support the instructor's presentations. In the "instructionalnotes", these are referred to as "visuals". Paper copies of all "visuals" arefound at the end of each module.

The video/DVD is a portrayal of major components of the drug influenceevaluation. This same video is used in the 7-day DRE School.

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D. General Administrative Requirements

1. Facility Requirements

The Pre-School requires a classroom with ample table/desk space for eachstudent; an audio visual projector and screen; a video/DVD player and oneor more monitors easily visible to all students; and, a dry-erase boardand/or flip-chart. The classroom must have sufficient open space to permitinstructors to give full and unimpeded demonstrations of the dividedattention tests; the eye examinations; and the checks of vital signs. And,the arrangement of the classroom must permit the students to have fullview of these demonstrations.

Adequate space must be available to permit the students to practice thevarious tests and checks that the instructors demonstrate. The practicespace may be a room separate from the classroom; a gymnasium oftenserves quite well for the practice segments.

The Alcohol Workshop also requires a separate room where the volunteerscan do their drinking. Breath testing instruments and operators must beavailable to monitor the volunteers' BACs.

2. Instructor Qualifications

All faculty for the Pre-School must be duly certified DREs. The principalinstructor, at least, must have completed DRE Instructor Training.

3. Class Size Considerations

This course is a highly participative learning experience. A significantamount of hands-on practice requiring close supervision and coaching takesplace. Because of the nature of this training, the recommended maximumclass size is 25 students. A more nearly ideal range would be 15 to 20.

4. Requirements For The Controlled Drinking Practice Sessions

Both the DRE Pre-School and DRE seven-day course require an alcoholworkshop and the use of volunteer drinkers. The participation of volunteerswho will consume carefully measured quantities of alcohol and submit toexaminations administered by the students. Without these volunteers,students have no opportunity to practice administering the tests underreasonably realistic circumstances, or to practice interpreting test results. Drinking volunteers, then, are an essential resource for this training. But

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they can be a difficult, even unpleasant, resource with which to work. Careful steps must be taken to insure that the volunteers contribute to aworthwhile learning experience, and suffer no harm themselves nor causeany harm to others.

The following criteria define who can be considered as drinking volunteers.

o They cannot be members of the class.

o They must be at least 21 years old.

o They cannot have any history of alcoholism.

o They cannot be known to suffer from any medical condition that may be

exacerbated by alcohol (such as hypertension or diabetes).

o They cannot be taking any medication (prescription or otherwise) thatmight interact with alcohol.

o They must be in good physical health, and have no impairments of

vision or limbs that might affect their performance of the StandardizedField Sobriety Tests.

o They must be under 60 years of age, and less than 50 pounds

overweight (conditions for which the standardized divided attentiontests have not been validated).

Every volunteer drinker participating in the alcohol workshop must readand sign the "Statement of Informed Consent" before receiving any alcohol. The Course Administrator or a designated DRE Instructor will obtain theindividual signatures from each of the volunteer drinkers prior tocommencing the alcohol workshop.

Transportation must be provided for the volunteers to and from thetraining session. Under no circumstances may a volunteer be permitted todrive from the training session, regardless of his or her blood alcoholconcentration at the time of departure. Volunteers should be released onlyinto the custody of responsible, sober persons.

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The practice sessions require a minimum of one drinking volunteer forevery five students. A more desirable ratio is one volunteer for every threestudents. Thus, for a class of 25 students, at least 5 volunteers, andpreferably 8 or 9 must participate in each session.

The effectiveness of the volunteers, as training resources, very muchdepends on their blood alcohol concentrations. If a volunteer's BAC is toolow (i.e., below 0.06), he or she generally will provide a poor simulation of atypical DWI subject If the BAC is too high (i.e., above 0.15), the volunteer'sstate of inebriation usually will be evident without standardized sobrietytesting, and the learning experience will not contribute as effectively aspossible to sharpening the students' detection skills.

Ideally, approximately half of the volunteers at any session should achievepeak BACs between 0.12 and 0.14 and the other half between 0.06 and0.08. But this is very difficult to control. It is always preferable to err, ifnecessary, on the low side: it is better to fail to get volunteers as "high" asdesired, rather than to get them too "high".

Volunteers should be instructed to refrain from eating two hours prior totheir arrival at the training facility. Food in their stomachs maydramatically affect the absorption of alcohol into their bloodstreams, andsignificantly impede your ability to control the peak BACs they achieve.

Volunteers should be brought to the training facility two hours before thepractice session is scheduled to begin. Each volunteer should be breathtested immediately upon arrival to verify that his or her BAC is zero.

The table on the next page indicates the ounces of 80-proof distilledalcoholic beverage that volunteers should consume, in relation to theirweight and the "target" peak BAC, during a three (3) hour interval to reacha target BAC of 0.12-0.14 percent.

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GUIDELINES FOR ACHIEVING TARGET BAC'SDURING A THREE (3) HOUR INTERVAL

Ounces of 80-Proof Alcoholic Beverage to Reach a B.A.C. of 0.12.

Weight (Pounds) MEN WOMEN110 5 4120 6 5130 6 5140 7 5150 7 6160 8 6170 8 7180 9 7190 9 7200 10 8210 10 8220 10 8

230 11 9 240 11 9 250 12 10

It is recommended that volunteers consume half of the total allocatedamount of alcoholic beverage during the first hour following their arrival atthe testing facility. They should refrain from drinking or smoking prior toany breath test.

NOTE: A volunteer may cease drinking at any time.

NOTE: No weapons should be present in the vicinity of any drinkingvolunteer.

Volunteers must be kept under constant supervision from the time of theirarrival at the training facility. At least one instructor's aide must bepresent for every four volunteers. The aids must monitor the volunteers,serve their drinks, make sure that they comply with the schedule, and ingeneral keep them under close observation.

NOTE: For a more complete description of Alcohol Workshop procedures,

refer to the latest edition of the Student-Instructor's Manual forthe DRE Instructor Training School, and specifically Unit Nine,"Planning and Managing an Alcohol Workshop".

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International Association of Chiefs of Police

Drug Evaluation and Classification Program

Drug Influence Evaluation Checklist

__________ 1. Breath alcohol test

__________ 2. Interview of arresting officer (Note: Gloves must be worn from this point on.)

__________ 3. Preliminary examination and first pulse

__________ 4. Eye examinations

__________ 5. Divided attention tests:

__________ Romberg balance __________ Walk and turn __________ One leg stand __________ Finger to nose

__________ 6. Vital signs and second pulse

__________ 7. Dark room examinations and ingestion examination

__________ 8. Check for muscle tone

__________ 9. Check for injection sites and third pulse

__________ 10. Interrogation, statements, and other observations

__________ 11. Opinion of evaluator

__________ 12. Toxicological examination

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Table of Contents

Session I Introduction and Overview

Session II Overview of Drug Evaluation and Classification Procedures

Session III The Psychophysical Tests

Session IV The Eye Examinations

Session V Alcohol Workshop

Session VI Examinations of Vital Signs

Session VII Overview of Signs and Symptoms

Session VIII Alcohol as a Drug

Session IX Preparing for the DRE School

Session X Conclusion of the Preliminary Training

HS 172A R1/07

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I-1

Thirty-Five Minutes

SESSION I

INTRODUCTION AND OVERVIEW

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SESSION I INTRODUCTION AND OVERVIEW Upon successfully completing this session the student will be able to:

o State the goal and objectives of the course.

o Define the term "drug" as it is used in the course.

o Name the seven categories of drugs and give at least one example of eachcategory.

CONTENT SEGMENTS LEARNING ACTIVITIES A. Welcoming Remarks and Objectives o Instructor-Led Presentations B. Definition and Categories of Drugs

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Aids Lesson Plan Instructor Notes

HS 172A R1/07 I-3

35 Minutes

INTRODUCTION AND OVERVIEW

10 Minutes

A. Welcoming Remarks andObjectives

I-I (Title)

1. Welcome to the PreliminaryTraining for the DrugEvaluation and ClassificationProgram.

Display Session Title

2. Instructor introductions.

a. Principal instructor(s).

b. Apprentice instructors.

Instructors' names andstudents' names on tent cards.

I-2 (Goal) 3. Preliminary training goal:

To prepare the students toparticipate successfully in the 7-day Drug Recognition Expert school.

Inform the students of whenand where their formal,seven-day DRE School will takeplace.

a. This two-day PreliminarySchool won't make youDREs.

b. But it will make it easier for

you to pass the 7-day DRESchool and successfullycomplete your certification

training.

I-3 (First 3Objectives)

4. Objectives of the PreliminaryTraining:

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a. Define "Drug" and name theseven categories.

b. Identify the twelvecomponents or steps in theDEC drug influenceexamination.

c. Administer and interpretthe Psychophysical Testsused by DRE’s during thedrug influence evaluation

I-3B (Last 4Objectives)

d. Check and measure asubject’s vital signs.

e. List the major signs and

symptoms of each drugcategory.

f. Conduct the eyeexaminations that are partof the drug influenceevaluation.

g. Describe the history andphysiology of alcohol as adrug.

Solicit students' questionsabout the goal and objectives.

5. Key point of emphasis:

This two-day school is only thefirst of three stages in yourtraining as DREs.

a. Next will come the seven-

day formal DRE school.

b. After that will come at leastseveral weeks of supervisedon-the-job training knownas the "Certification Phase".

Solicit students' questionsabout the three stages oftraining.

6. Preview of the remainder of thePre-School.

Briefly outline the upcomingsessions of the school. Refer to

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the wallcharts.

7. Certification Progress Logs.

Instruct students to open theirmanuals and remove theCertification Progress Log. Have students fill out the firstline of the log, then collect it.

25 Minutes

B. Definition and Categories ofDrugs

Pose this question. Solicitresponses from severalstudents

1. What do we mean by the word"drug"?

Source: Webster'sSeventh NewCollegiate Dictionary,1971 edition.

a. Alternative definitions, drawnfrom several sources.

o "A substance used as amedicine or in makingmedicines."

Ask students: "Would you agreethat all drugs are medicines oringredients of medicines?" Askstudents to name somesubstances they consider to be"drugs" that have no medicinalvalue.

o "A narcotic substance orpreparation."

Source: Webster's. Ask students if theyagree that all drugsare narcotics.

o "A chemical substanceadministered to a

Source: RandomHouse College

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person or animal toprevent or cure diseaseor otherwise to enhancephysical or mentalwelfare."

Dictionary, 1982 edition.

Point out that this definitionseems to exclude any drug thatis harmful or does not enhancewelfare.

o "A habit-formingmedicinal substance,especially a narcotic."

Source: RandomHouse

Ask students if they agree thatall drugs are habit-forming. Ask if, from an enforcementperspective, they can think ofany habit-forming substancesthey would not ordinarilyconsider to be a drug.

o A substance taken bymouth, injected orapplied locally to treat adisorder. (i.e., to easepain)

o A chemical substanceintroduced into the bodyto cause pleasure or asense of changed aware-ness, as in the non-medical use of LysergicAcid Diethylamide (LSD).

Source: MedicalDictionary For TheNon-professional,Barows EducationalSeries, Inc.,Woodbury, NY. 1984

o "Any substance, naturalor artificial that bychemical nature alters thestructure or function of aliving organism."

Source: Los AngelesPolice DepartmentDrug RecognitionTraining, May 1986.

o "Any substance that, insmall amounts, produceschanges in the body, mindor both."

Source: LAPD

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2. A simple, enforcement-oriented

definition of drugs.

I-4 (Working Definition ofDrug)

o "Any substance, which,when taken into thehuman body, can impairthe ability of the person tooperate a vehicle safely."

Working definition derivedfrom the 1985 CaliforniaVehicle Code.

Point out that this definitionexcludes many substances thatordinarily would be considered"drugs" by physicians,chemists, etc.

Emphasize that, as traffic lawenforcement officers, thestudents' concern has to remainfocused on substances thatimpair.

3. Within this simple, enforcement-oriented definition, there areseven categories of drugs.

a. Each category consists of

substances that impair aperson's ability to drive.

b. The categories differ from oneanother in terms of how theyimpair driving ability and interms of the kinds ofimpairment they cause.

Note: Emphasize that the DECProgram drug categories differfrom those of the AmericanMedical Association and theDrug EnforcementAdministration because theycategorize drugs on the basis oftheir chemical structures, whilewe categorize drugs on thebasis of the kinds ofimpairment they produce.

c. Because the categoriesproduce different types ofimpairment, they generatedifferent signs and symptoms.

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d. With training and practice,you will be able to recognizethe different signs of druginfluence and determinewhich category is causing theimpairment you observe in asuspect.

Ask students: "What are theseven categories of drugs?"

Write the names of thecategories on the dry eraseboard or flip-chart as they arementioned by the students.

Since the drug categories maybe new to the students you mayneed to assist them in correctlyidentifying each category.

I-5(Depressants)

4. Central Nervous SystemDepressants.

a. The category of CNSDepressants includes some ofthe most commonly abuseddrugs.

Point out that Chloral hydratesometimes is called "MickeyFinn" or "Knockout drops".

o Alcohol - - the mostfamiliar drug of all - - isabused by an estimated40-50 million Americans.

o It’s estimated that 119million Americans aged 12or older reported beingcurrent drinkers of alcoholin 2002 (51.0 percent ofthe population)

o In 2002, more than threemillion prescriptions werefilled for over 500,000different drugs in the

Source: National Survey onDrug Use and Health (NSDUH,2003)

Source: National Center onAddition and Substance Abuse,Columbia University, 2005

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U.S.; 234 million forcontrolled prescriptiondrugs.

o It is also estimated that in2003 there were 6.3million Americans age 12or older using prescriptiondrugs non-medically.

Source: National Survey onDrug Use and Health (NSDUH,2003)

b. Depressants slow down theoperation of the centralnervous system (i.e., thebrain, brain stem and spinalcord).

o cause the user to react

more slowly.

o cause the user to processinformation more slowly.

o relieve anxiety andtension.

o induce sedation,

drowsiness and sleep.

o in high enough doses,CNS depressants willproduce generalanesthesia.

i.e. depress the brain's abilityto sense pain.

o in very high doses, inducecoma and death.

I-6(Stimulants)

5. Central Nervous SystemStimulants

a. CNS Stimulants are a widelyabused category of drugs.

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o In 2000, there were anestimated 2.7 millionchronic cocaine users and3 million occasionalcocaine users in the U.S.

o The use and abuse ofMethamphetaminecontinues to rise and hasquickly become one of themajor drugs of abuse.

Source: Office of National Drug Control Policy (ONDCP)Cocaine Fact Sheet

Note: Instructors may wish toinclude statistics regarding theuse of methamphetamine intheir respective State.

o Several million appear touse amphetamines.

b. CNS Stimulants speed up theoperation of the centralnervous system, and of thevarious bodily functionscontrolled by the centralnervous system.

o cause the user to become

hyperactive, extremelytalkative.

o speech may become rapidand repetitive.

o heart rate increases.

o blood pressure increases.

o body temperature rises,user may becomeexcessively sweaty.

o induce emotional

excitement, restlessness,irritability.

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o can induce cardiacarrhythmia (unstable beating of the heart), cardiac seizures anddeath.

Remind students of well-knownathletes and others who have died because of cocaine abuse.

I-7 (Hallucin-ogens)

6. Hallucinogens

a. Hallucinogens are also widelyabused In recent years anincrease in the abuse of bothLSD and Ecstasy (MDMA)has been reported

Point out that LSD and Peyoteare only two examples ofhallucinogens.

b. It is estimated thatapproximately one millionAmericans abusehallucinogens.

c. Hallucinogens may create

hallucinations. That is, theymay create apparentperceptions of things not trulypresent.

d. Hallucinogens may also create

very distorted perceptions, sothat the user sees, hears andsmells things in a way quitedifferent from how they reallylook, sound and smell.

e. Instead, hallucinogens cause

the nervous system to sendstrange or false signals to thebrain.

o produce sights, soundsand odors that aren't real.

o induce a temporary

condition very much like psychosis or insanity.

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o can create a "mixing" ofsensory modes, for example the user "hearscolors", "sees music","tastes sounds", etc.,referred to as“Synesthesia.”

Point out that, with all of thesefalse and distorted perceptions,the person under the influenceof hallucinogens would be avery unsafe driver.

I-8 (Dissoc.Anesthetics)

7. Dissociative Anesthetics Point out that this categoryused to be Phencyclidine (PCP)but was changed in 2005.

a. This category includes drugssuch as PCP it’s analogs andDextromethorphan (DXM)These drugs generally inhibitpain by cutting off or“dissociating” the brain’sperception of the pain.

b. PCP is considered to be by themedical community anhallucinogen. However,because of thesymptomatology it presents; itis included in this category.

Point out that the definition ofDissociative Anesthetic iscontained in the Glossary ofTerms in the DRE Pre-SchoolStudent Manual.

Point out that people under theinfluence of a DissociativeAnesthetic may exhibit acombination of the signsassociated with hallucinogens,CNS stimulants anddepressants.

c. PCP is a synthetic drug, i.e., itdoes not occur naturally butmust be produced in alaboratory-like setting.

d. PCP is similar to CNSdepressants in that itdepresses brain wave activity.

o slows down thought o slows reaction time o slows verbal responses

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e. But PCP is similar to CNSstimulants in that it activatesthe parts of the brain thatcontrol emotions, the heartand the other autonomicsystems.

o heart rate increaseso blood pressure increases o adrenalin production

increases o body temperature rises o muscles become rigid

f. And PCP is similar tohallucinogens in that itdistorts or "scrambles" signalsreceived by the brain.

o sight, hearing, taste, smelland touch may all bedistorted

o user's perception of timeand space may bedistorted

o user may become

paranoid, feel isolated anddepressed

o user may develop a strong

fear of and pre-occupationwith death

o user may become

unpredictably violent

g. PCP analogs includeKetamine, Ketalar, Ketajet,and Ketaset.

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I-9(Narcotics)

h. Dextromethorphan (DXM), isan ingredient found innumerous over-the-countercough and cold remedies.

8. Narcotic Analgesics

a. There are two subcategoriesof Narcotic Analgesics

o Opiates are derivatives ofopium

o Synthetics are producedchemically in thelaboratory. They are notin any way derived fromOpium but producesimilar effects

Point out that heroin,morphine and codeine arenatural derivatives of opium.

b. The word "Analgesic" meanspain-killer. All of the drugs inthis category reduce theperson's reaction to pain.

c. Heroin is the most commonlyabused of the NarcoticAnalgesics. It is estimatedthat approximately 2.5million people have usedheroin (lifetime).

d. Heroin is highly addictive,

and very expensive.

Source: National Institute ofDrug Abuse (NIDA), 2003

o Many addicts supporttheir habit by stealingproperty and converting itto cash.

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e. In addition to reducing pain,they produce euphoria,drowsiness, apathy, lessenedphysical activity and sometimes impaired vision.

f. Persons under the influence of

Narcotic Analgesics often passinto a semi-conscious type of sleep or near-sleep.

Point out that this condition isoften called being "on the nod".

o persons "on the nod" maybe awakened easily.

o they often are sufficiently

alert to respond toquestions effectively.

g. Higher doses of NarcoticAnalgesics can induce coma,respiratory failure and death.

I-10(Inhalants)

9. Inhalants

a. Inhalants are fumes of certainsubstances that producemind-altering results.

b. There are three sub-categories of inhalants:

o Volatile Solvents (e.g.,gasoline, glue, oil-basedpaint, cleaning fluids,paint remover, etc.)

o Aerosols (i.e., the propellant gases in spraycans, e.g., hair sprays,insecticides, etc.)

o Anesthetic Gases (e.g., nitrous oxide, ether, amylnitrite, butyl nitrite, etc.)

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c. Different inhalantsproduce different effects.

o many produce effects

similar to those of CNSdepressants.

o a few produce stimulant

like effects.

o some produce hallu-cinogenic effects.

d. The inhalant abuser's attitudeand demeanor can vary frominattentive, stuporous andpassive to irritable, violentand dangerous.

e. The abuser's speech will oftenbe slow, thick and slurred.

I-11(Cannabis)

10. Cannabis

a. The category "Cannabis"includes the various formsand products of the CannabisSativa plant.

Write "Cannabis Sativa" on thedry erase board or flip-chart.

b. The active ingredient inCannabis is the substanceknown as "Delta-9Tetrahydrocannabinol", or "THC".

Write "Δ-9 THC" on the dryerase board or flip-chart.

c. Apart from alcohol, marijuanais one of the most commonlyabused drugs in this country.

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d. Marijuana continues to be themost used illegal drug in theU.S.; nearly 69 millionAmericans over the age of 12have used marijuana at leastonce. It is also estimated thatthere were 14.6 million users of marijuana in 2002.

Source: NIDA and MarijuanaAddiction Facts.

Source: The Drug AbuseWarning Network (DAWN)Report, August 2003.

e. Cannabis appears to interferewith the attention process. Drivers under the influence ofmarijuana often do not payattention to their driving.

Point out that divided attentionStandardized Field SobrietyTests usually disclose the bestevidence of cannabisimpairment.

f. Cannabis also produces adistortion of the user'sperception of time, anincreased heart rate (oftenover 100 beats per minute)and a reddening of the eyes.

I-12(Frequency ofDrug Use)

g. Marijuana is the mostfrequently reported drug inemergency departmentvisits related to drug abusein youth age 12 to 19.

11. Frequency of Drug Use

o In 2003, 51 percent of personsage 12 or older (119 million)were current alcohol drinkers.

o The exact number ofprescription drug users in theU.S. is unknown. However, in2003, the NationalAssociation of Chain Drug

Stores (NACDS) reported that3.14 billion scripts for prescription drugs were

Source: The Drug AbuseWarning Network (DAWN)Report, August 2003.

Source: National Survey onDrug Use and Health (NSDUH),2003


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written in the U.S.

o It is estimated that in 2003there were 6.3 millionAmericans age 12 and olderusing prescription drugs non-medically.

o 51% of students havetried an illicit drug by thetime they finish high school

o 16.6% of drivers age 21 andolder (30.7 million persons)admitted driving under theinfluence of alcohol or illicitdrugs during the past year.

o Approximately 2.4 millionAmericans began abusingprescription drugs within thepast year. The average age ofnew users was 23.3 years.

12. Polydrug Use

a. Though drug evaluationsubjects may be under theinfluence of any one of thementioned categories ofdrugs, it is not uncommon tofind individuals who havetaken several combinations ofdrugs.

Data being collected throughthe national DRE Databaseindicates that approximately25% of all toxicology resultsindicate two or more drugcategories.


Source: National Association ofChain Drug Stores (NACDS),2003

Source: “Driving Under theInfluence Among AdultDrivers”, SAMHSA, 2005.

Source: 2004 National Surveyon Drug Use and Health(NSDUH).

Point out that the PacificInstitute of Research andEvaluation (PIRE) maintainsthe national DRE data reportingsystem for the DEC Programand that DRE’s will beencouraged to enter evaluationdata into the website.

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b. The term "polydrug" userefers to instances where thesubject has ingested drugsfrom two or more drugcategories.

c. Most controlled prescriptiondrug abusers are poly-drugabusers. One study reportedthat approximately 75 percentof persons who abuse alcoholalso abuse illicit drugs.

Point out that the drugs do nothave to be actually ingested atexactly the same time.

Source: “Under the Counter:The Diversion and Abuse ofControlled Prescription Drugs inthe U.S.”, National Center onAddiction and Substance Abuse,July 2005

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REVIEW QUESTIONS Test your knowledge of the subject matter covered in this session by trying toanswer the following questions. 1. What is a "drug" as the term is used in this course?

For the purpose of this training, a “drug” is any substance which whentaken into the human body, can impair the ability of the person tooperate a vehicle safely”.

2. What are the seven major categories of drugs?

CNS Depressants, CNS Stimulants, Hallucinogens, DissociativeAnesthetics, Narcotic Analgesics, Inhalants and Cannabis.

3. What kind (category) of drug is alcohol? What about Cocaine? What about

Heroin?

Alcohol is a CNS Depressant. Cocaine is a CNS Stimulant. Heroin is aNarcotic Analgesic.

4. How would you respond to someone who suggests that the "drug problem"

basically occurs only in a few metropolitan areas, and doesn't apply to theircommunity?

There might be some rare communities in this country that are freefrom the “drug problem”, but they would be rare indeed. Aconservative estimate suggests that about 40-50 million Americansregularly use drugs other than alcohol. However, the exact number isnot known.

5. What category of drug is PCP classified? What about Marijuana? What about

Valium?

PCP belongs to the Dissociative Anesthetics category. Marijuana isCannabis and Valium is a CNS Depressant.

6. What category of drug is Methamphetamine? What about LSD? What aboutPeyote?

Methamphetamine is a CNS Stimulant. LSD and Peyote areHallucinogens.

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7. What does the term "polydrug use" mean?

“Polydrug use” is the practice of ingesting drugs from two or more drugcategories, i.e., combining drugs.

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ATTACHMENT

DRUG EVALUATION AND CLASSIFICATION PROGRAM

GLOSSARY OF TERMS

ACCOMODATION REFLEXThe adjustment of the eyes at various distances. Meaning the pupils willautomatically constrict as objects move closer.

ADDICTIONThe habitual, psychological, and physiological dependence on a substance beyondone’s voluntary control.

ADDITIVE EFFECTOne mechanism of polydrug interaction. For a particular indicator of impairment,two drugs produce an additive effect if they both affect the indicator in the sameway. For example, cocaine elevates pulse rate and PCP also elevates pulse rate. The combination of cocaine and PCP produces an additive effect on pulse rate.

AFFERENT NERVESSee "Sensory Nerves."

ALKALOIDA chemical that is found in, and can be physically extracted from, some substance. For example, morphine is a natural alkaloid of opium. It does not require achemical reaction to produce morphine from opium.

ANALGESICA drug that relieves or allays pain.

ANALOG (of a drug)An analog of a drug is a chemical that is very similar to the drug, both in terms ofmolecular structure and in terms of psychoactive effects. For example, the drugKetamine is an analog of PCP.

ANESTHETICA drug that produces a general or local insensibility to pain and other sensation.

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ANTAGONISTIC EFFECTOne mechanism of polydrug interaction. For a particular indicator of impairment,two drugs produce an antagonistic effect if they affect the indicator in oppositeways. For example, heroin constricts pupils while cocaine dilates pupils. Thecombination of heroin and cocaine produces an antagonistic effect on pupil size. Depending on how much of each drug was taken, and when they were taken, thesuspect's pupils could be constricted, dilated or within the normal range of size.

ARRHYTHMIAAn abnormal heart rhythm.

ARTERYThe strong, elastic blood vessel that carries blood away from the heart.

ATAXIAA blocked ability to coordinate movements. A staggering walk and poor balancemay be caused by damage to the brain or spinal cord. This can be the result oftrauma, birth defect, infection, tumor or drug use.

AUTONOMIC NERVEA motor nerve that carries messages to the muscles and organs that we do notconsciously control. There are two kinds of autonomic nerves, the sympatheticnerves and parasympathetic nerves.

AXONThe part of a neuron (nerve cell) that sends out a neurotransmitter.

BAC(Blood Alcohol Concentration) - The percentage of alcohol in a person’s blood.

BrAC(Breath Alcohol Concentration) - The percentage of alcohol in a person’s blood asmeasured by a breath testing device.

BLOOD PRESSUREThe force exerted by blood on the walls of the arteries. Blood pressure changescontinuously, as the heart cycles between contraction and expansion.

BRADYCARDIAAbnormally slow heart rate; pulse rate below the normal range.

BRADYPNEAAbnormally slow rate of breathing.

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BRUXISMGrinding the teeth. This behavior is often seen in persons who are under theinfluence of cocaine or other CNS stimulants.

CANNABIS1. One of the seven drug categories. Cannabis includes marijuana, hashish, hash

oil and marinol.

2. Several species of plants from which marijuana and related products are made(e.g. Cannabis Sativa and Cannabis Indicia).

CARBOXY THCA metabolite of THC (tetrahydrocannabinol).

CHEYNE-STOKES RESPIRATIONAbnormal pattern of breathing. Marked by breathlessness and deep, fastbreathing.

CNS (Central Nervous System)A system within the body consisting of the brain, the brain stem and the spinalcord.

CNS DEPRESSANTSOne of the seven drug categories. CNS depressants include alcohol, barbiturates,anti-anxiety tranquilizers and numerous other drugs.

CNS STIMULANTSOne of the seven drug categories. CNS stimulants include cocaine, theamphetamines, ritalin, preludin and numerous other drugs.

CONJUNCTIVITISAn inflammation of the mucous membrane that lines the inner surface of theeyelids caused by infection, allergy or outside factors and may be bacterial or viral. Persons suffering from conjunctivitis may show symptoms in one eye only. Thiscondition is commonly referred to as "pink eye", a condition that could be mistakenfor the bloodshot eyes produced by alcohol or Cannabis.

CONVERGENCEThe "crossing" of the eyes that occurs when a person is able to focus on a stimulusas it is pushed slowly toward the bridge of his or her nose. (See also "Lack ofConvergence".)

CRACK/ROCKCocaine base, appears as a hard solid form resembling pebbles or small rocks. Itproduces a very intense, but relatively short duration "high".

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CURRICULUM VITAEA written summary of a person’s education, training, experience, noteworthyachievements and other information about a particular topic.

CYCLIC BEHAVIORA manifestation of impairment due to certain drugs, in which the subjectalternates between periods (or cycles) of intense agitation and relative calm. Cyclic behavior, for example, sometimes will be observed in persons under theinfluence of PCP.

DELIRIUMA brief state characterized by incoherent excitement, confused speech, restlessnessand possible hallucinations.

DENDRITEThe part of a neuron (nerve cell) that receives a neurotransmitter.

DIACETYL MORPHINEThe chemical name for Heroin.

DIASTOLICThe lowest value of blood pressure. The blood pressure reaches its diastolic valuewhen the heart is fully expanded or relaxed (Diastole).

DIPLOPIADouble vision.

DISSOCIATIVE ANESTHETICOne of the seven drug categories. Includes drugs that inhibit pain by cutting off or"disassociating" the brain's perception of pain. PCP and it’s analogs are considereddissociative anesthetics.

DIVIDED ATTENTIONConcentrating on more than one task at a time. The four psychophysical testsused by DREs require the subject to divide attention.

DOWNSIDE EFFECTAn effect that may occur when the body reacts to the presence of a drug byproducing hormones or neurotransmitters to counteract the effects of the drugconsumed.

DRUGAny substance, which when taken into the human body, can impair the ability ofthe person to operate a vehicle safely.

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DYSPNEAShortness of breath.

DYSMETRIAAn abnormal condition that prevents the affected person from properly estimatingdistances linked to muscular movements.

DYSPHORIAA mood disorder. Feelings of depression and anguish.

EFFERENT NERVESSee "Motor Nerves".

ENDOCRINE SYSTEMThe network of glands that do not have ducts and other structures. They secretehormones into the blood stream to affect a number of functions in the body.

EXPERT WITNESSA person skilled in some art, trade, science or profession, having knowledge ofmatters not within the knowledge of persons of average education, learning andexperience, he/she may assist a jury in arriving at a verdict by expressing anopinion on a state of facts shown by the evidence and based upon his or her specialknowledge. (NOTE: Only the court can determine whether a witness is qualifiedto testify as an expert.)

FLASHBACKA vivid recollection of a portion of an hallucinogenic experience. Essentially, it is avery intense daydream. There are three types: (1) emotional -- feelings of panic,fear, etc.; (2) somatic -- altered body sensations, tremors, dizziness, etc.; and (3)perceptual -- distortions of vision, hearing, smell, etc.

GARRULITYChatter, rambling or pointless speech. Talkative.

HALLUCINATIONA sensory experience of something that does not exist outside the mind, e.g.,seeing, hearing, smelling or feeling something that isn't really there. Also, havinga distorted sensory perception, so that things appear differently than they are.

HALLUCINOGENSOne of the seven drug categories. Hallucinogens include LSD, MDMA, peyote,psilocybin and numerous other drugs.

HASHISH A form of Cannabis made from the dried and pressed resin of a marijuana plant.

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HASH OILSometimes referred to as “marijuana oil” it is a highly concentrated syrup-like oilextracted from marijuana. It is normally produced by soaking marijuana in acontainer of solvent, such as acetone or alcohol, for several hours and after thesolvent has evaporated, a thick syrup-like oil is produced with a THC contentusually 10% to 12%.

HEROINA powerful and widely-abused narcotic analgesic that is chemically derived frommorphine. The chemical, or generic name of heroin is "diacetyl morphine".

HIPPUSA rhythmic pulsating of the pupils of the eyes, as they dilate and constrict withinfixed limits.

HOMEOSTASISThe dynamic balance, or steady state, involving levels of salts, water, sugars, andother materials in the body's fluids.

HORIZONTAL GAZE NYSTAGMUS (HGN)Involuntary jerking of the eyes occurring as the eyes gaze to the side.

HORMONESChemicals produced by the body's endocrine system that are carried through theblood stream to the target organ. They exert great influence on the growth anddevelopment of the individual, and that aid in the regulation of numerous bodyprocesses.

HYDROXY THCA metabolite of THC (tetrahydrocannabinol).

HYPERFLEXIAExaggerated or over extended motions.

HYPERGLYCEMIAExcess sugar in the blood.

HYPERPNEAA deep, rapid or labored breathing.

HYPERPYREXIAExtremely high body temperature.

HYPERREFLEXIAA neurological condition marked by increased reflex reactions.

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HYPERTENSIONAbnormally high blood pressure. Do not confuse this with hypotension.

HYPOGLYCEMIAAn abnormal decrease of blood sugar levels.

HYPOTENSIONAbnormally low blood pressure. Do not confuse this with hypertension.

HYPOTHERMIADecreased body temperature.

ICEA crystalline form of methamphetamine that produces a very intense and fairlylong-lasting "high".

INHALANTSOne of the seven drug categories. The inhalants include volatile solvents (such asglue and gasoline), aerosols (such as hair spray and insecticides) and anestheticgases (such as nitrous oxide).

INSUFFLATIONSee "snorting".

INTEGUMENTARY SYSTEMThe skin and accessory structures, hair and nails. Functions include protection,maintenance of body temperature, excretion of waste and sensory perceptions.

INTRAOCULAR"Within the eyeball".

KOROTKOFF SOUNDSA series of distinct sounds produced by blood passing through an artery, as theexternal pressure on the artery drops from the systolic value to the diastolic value.

LACK OF CONVERGENCEThe inability of a person's eyes to converge, or "cross" as the person attempts tofocus on a stimulus as it is pushed slowly toward the bridge of his or her nose.

MARIJUANACommon term for the Cannabis Sativa plant. Usually refers to the dried leaves ofthe plant. This is the most common form of the cannabis category.

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MARINOLA drug containing a synthetic form of THC (tetrahydrocannabinol). Marinolbelongs to the cannabis category of drugs, but it is not produced from any speciesof cannabis plant.

METABOLISMThe sum of all chemical processes that take place in the body as they relate to themovements of nutrients in the blood after digestion, resulting in growth, energy,release of wastes and other body functions. The process by which the body, usingoxygen, enzymes and other internal chemicals, breaks down ingested substancessuch as food and drugs so they may be consumed and eliminated. Metabolismtakes place in two phases. The first step is the constructive phase (anabolism)where smaller molecules are converted to larger molecules. The second step is thedestructive phase (catabolism) where large molecules are broken down intosmaller molecules.

METABOLITEA chemical product formed by the reaction of a drug with oxygen and/or othersubstances in the body.

MIOSISAbnormally constricted pupils.

MOTOR NERVESNerves that carry messages away from the brain, to the body's muscles, tissues,and organs. Motor nerves are also known as efferent nerves.

MYDRIASISAbnormally dilated pupils.

NARCOTIC ANALGESICSOne of the seven drug categories. Narcotic analgesics include opium, the naturalalkaloids of opium (such as morphine, codeine, and thebaine), the derivatives ofopium (such as heroin, dilaudid, oxycodone, percodan and hycodan), and thesynthetic narcotics (such as demerol and numorphan).

NERVEA cord-like fiber that carries messages either to or from the brain. For drugevaluation and classification purposes, a nerve can be pictured as a series of "wire-like" segments, with small spaces or gaps between the segments.

NEURONA nerve cell. The basic functional unit of a nerve. It contains a nucleus within acell body with one or more axons and dendrites.

NEUROTRANSMITTERChemicals that pass from the axon of one nerve cell to the dendrite of the next cell,and that carry messages across the gap between the two nerve cells.

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NULL EFFECTOne mechanism of polydrug interaction. For a particular indicator of impairment,two drugs produce a null effect if neither of them affects that indicator. Forexample, PCP does not affect pupil size and alcohol does not affect pupil size. Thecombination of PCP and alcohol produces a null effect on pupil size.

NYSTAGMUSAn involuntary jerking of the eyes.

"ON THE NOD"A semiconscious state of deep relaxation. Typically induced by impairment due toheroin or other narcotic analgesic. The subject's eyelids droop and chin rests onthe chest. Subject may appear to be asleep, but can be easily aroused and willrespond to questions.

OVERLAPPING EFFECTOne mechanism of polydrug interaction. For a particular indicator of impairment,two drugs produce an overlapping effect if one of them affects the indicator but theother doesn't. For example, cocaine dilates pupils while alcohol doesn't affect pupilsize. The combination of cocaine and alcohol produces an overlapping effect onpupil size: the combination will cause the pupils to dilate.

PALLORAn abnormal paleness or lack of color in the skin.

PARANOIAMental disorder characterized by delusions and the projection of personal conflicts,that are ascribed to the supposed hostility of others.

PARAPHERNALIADrug paraphernalia are the various kinds of tools and other equipment used tostore, transport or ingest a drug. Hypodermic needles, small pipes, bent spoons,etc. are examples of drug paraphernalia. The singular form of the word is"paraphernalium". For example, one hypodermic needle would be called a "drugparaphernalium".

PARASYMPATHETIC NERVEAn autonomic nerve that commands the body to relax and to carry out tranquilactivities. The brain uses parasympathetic nerves to send "at ease" commands tothe muscles, tissues and organs.

PARASYMPATHOMIMETIC DRUGSDrugs that mimic neurotransmitters associated with the parasympathetic nerves. These drugs artificially cause the transmission of messages that produce lowerblood pressure, drowsiness, etc.

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PDR (Physician's Desk Reference)A basic reference source for drug recognition experts. The PDR provides detailedinformation on the physical appearance and psychoactive effects of licitly-manufactured drugs.

PHENCYCLIDINEA contraction of PHENYL CYCLOHEXYL PIPERIDINE, or PCP. Formerly usedas a surgical anesthetic, however, it has no current legitimate medical use forhumans.

PHENYL CYCLOHEXYL PIPERIDINE (PCP)Often called "phencyclidine" or “PCP”, it is a specific drug belonging to theDissociative Anesthetics category.

PHYSIOLOGYThe study of living organisms and the changes that occur during activity.

PILOERECTIONLiterally "hair standing up" or goose bumps. This condition of the skin is oftenobserved in persons who are under the influence of LSD.

POLYDRUG USEIngesting drugs from two or more drug categories.

PSYCHEDELICA mental state characterized by a profound sense of intensified or altered sensoryperception sometimes accompanied by hallucinations.

PSYCHOPHYSICAL TESTSMethods of investigating the mental (psycho-) and physical characteristics of aperson suspected of alcohol or drug impairment. Most psychophysical tests employthe concept of divided attention to assess a subject's impairment.

PSYCHOTOGENETICLiterally "creating psychosis" or "giving birth to insanity". A drug is considered tobe psychotogenetic if persons who are under the influence of the drug becomeinsane and remain so after the drug wears off.

PSYCHOTOMIMETICLiterally "mimicking psychosis" or "impersonating insanity". A drug is consideredto be psychotomimetic if persons who are under the influence of the drug look andact insane while they are under the influence.

PTOSISDroopy eyelids.

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PULSEThe expansion and relaxation of the walls of an artery, caused by the surging flowof blood.

PULSE RATEThe number of expansions of an artery per minute.

REBOUND DILATIONA period of constriction followed by dilation with a change equal to or greater than2 mm.

RESTING NYSTAGMUSJerking of the eyes as they look straight ahead.

SCLERAA dense white fibrous membrane that, with the cornea, forms the external coveringof the eyeball (i.e.the white part of the eye).

SENSORY NERVESNerves that carry messages to the brain from the various parts of the body,including notably the sense organs (eyes, ears, etc.). Sensory nerves are alsoknown as afferent nerves.

SINSEMILLAThe unpollenated female cannabis plant, having a relatively high concentration ofTHC.

SFSTStandardized Field Sobriety Testing. There are three SFSTs, namely HorizontalGaze Nystagmus (HGN), Walk and Turn and One Leg Stand. Based on a series ofcontrolled laboratory studies, scientifically validated clues of alcohol impairmenthave been identified for each of these three tests. They are the only StandardizedField Sobriety Tests for which validated clues have been identified.

SNORTINGOne method of ingesting certain drugs. Snorting requires that the drug be inpowder form. The user rapidly draws the drug up into the nostril, usually via apaper or glass tube. Snorting is also known as insufflation.

SPHYGMOMANOMETERA medical device used to measure blood pressure. It consists of an arm or leg cuffwith an air bag attached to a tube and a bulb for pumping air into the bag, and agauge for showing the amount of air pressure being pressed against the artery.

STETHOSCOPEA medical instrument used for drug evaluation and classification purposes in orderto listen to the sounds produced by blood passing through an artery.

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SYMPATHETIC NERVEAn autonomic nerve that commands the body to react in response to excitement,stress, fear, etc. The brain uses sympathetic nerves to send "wake up calls" and"fire alarms" to the muscles, tissues and organs.

SYMPATHOMIMETIC DRUGSDrugs that mimic the neurotransmitter associated with the sympathetic nerves. These drugs artificially cause the transmission of messages that produce elevatedblood pressure, dilated pupils, etc.

SYNAPSE (or Synaptic Gap)The gap or space between two neurons (nerve cells).

SYNESTHESIAA sensory perception disorder, in which an input via one sense is perceived by thebrain as an input via another sense. An example of this would be a person“hearing” a phone ring and “seeing” the sound as a flash of light. Synesthesiasometimes occurs with persons under the influence of hallucinogens.

SYSTOLICThe highest value of blood pressure. The blood pressure reaches its systolic valuewhen the heart is fully contracted (systole), and blood is sent surging into thearteries.

TACHYCARDIAAbnormally rapid heart rate; pulse rate above the normal range.

TACHYPNEAAbnormally rapid rate of breathing.

THC (Tetrahydrocannabinol)The principal psychoactive ingredient in drugs belonging to the cannabis category.

TOLERANCEAn adjustment of the drug user's body and brain to the repeated presence of thedrug. As tolerance develops, the user will experience diminishing psychoactiveeffects from the same dose of the drug. As a result, the user typically will steadilyincrease the dose he or she takes, in an effort to achieve the same psychoactiveeffect.

TRACKSScar tissue usually produced by repeated injection of drugs, via hypodermic needle,along a segment of a vein.

VERTICAL GAZE NYSTAGMUSAn involuntary jerking of the eyes (up and down) which occurs as the eyes are heldat maximum elevation.

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VOIR DIREA french expression literally meaning "to see, to say". Loosely, this would berendered in English as "to seek the truth", or "to call it as you see it". In a law orcourt context, one application of voir dire is to question a witness to assess his orher qualifications to be considered as an expert in a matter pending before thecourt.

VOLUNTARY NERVEA motor nerve that carries messages to a muscle that we consciously control.

WITHDRAWALThis occurs in someone who is physically addicted to a drug when he or she isdeprived of the drug. If the craving is sufficiently intense, the person may becomeextremely agitated and even physically ill.

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Sixty Minutes

SESSION II

OVERVIEW OF DRUG EVALUATION AND CLASSIFICATION PROCEDURES

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SESSION II OVERVIEW OF DRUG EVALUATION ANDCLASSIFICATION PROCEDURES

Upon successfully completing this session the student will be able to:

o Identify the twelve major components of the DRE drug influenceevaluation.

o Discuss the purposes of each component.

CONTENT SEGMENTS LEARNING ACTIVITIES A. Components of the Process o Instructor-Led

Presentations B. Video/DVD Demonstrations o Video/DVD Presentations

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60 Minutes

II-1 (Title)

II-2(Objectives)

OVERVIEW OF DRUGEVALUATION ANDCLASSIFICATION PROCEDURES


Briefly review the objectives,content and activities of thissession.

35 Minutes

A. Components of the Process

1. The Drug Evaluation andClassification process is a standardized and systematicmethod of examining a subjectto determine:

a. Whether the subject is

under the influence of adrug or combination ofdrugs.

b. If the impairment isresulting from an injury,illness, or drug related.

c. The category (or categories)of drugs that is (or are) thelikely cause of the subject'simpairment.

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2. The process is systematic inthat it is based on a carefulassessment of a variety ofobservable signs and symptomsthat are known to be reliableindicators of drug impairment.

Write on dry erase board orflip-chart: "A SYSTEMATICPROCESS"

a. Some of these observablesigns and symptoms relateto the subject's appearance.

Write "appearance" on dryerase board or flip-chart.

b. Some of the signs andsymptoms relate to thesubject's behavior.

Write "behavior" on dry eraseboard or flip-chart.

c. Some relate to the subject'sperformance of carefully -administeredpsychophysical tests.

o Drugs impair thesubject's ability tocontrol his or her mindand body.

o Psychophysical tests can

disclose that thesubject's ability tocontrol mind and body isimpaired.

Write "psychophysical testing"on dry erase board or flip-chart. Ask students: "What does'psychophysical' mean?"

Point out that "psycho-physical" relates to thesubject's mind (psyche) andbody (physique).

o The specific manner inwhich the subjectperforms the psycho-physical tests mayindicate the type ofimpairment from whichthe subject is suffering. In turn, this mayindicate the category orcategories of drugscausing the impairment.

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d. Some of the observablesigns and symptoms relateto automatic responses ofthe subject's body to thespecific drugs that arepresent.

Write "automatic responses ofthe body" on the dry eraseboard or flip-chart.

e. All of these reliableindicators are examined andcarefully considered before ajudgment is madeconcerning what categoriesof drugs are affecting thesubject.

II-3(Standard-ized andSystematic)

3. The process is standardized inthat it is administered the sameway, to every subject, by everydrug recognition expert.

a. Standardization helps toensure that no mistakes aremade.

o No examinations are left

out.

o No extraneous orunreliable "indicators"are included.

Ask students: "Why is it soimportant to perform the drugevaluation and classificationexamination in exactly thesame way, every time?" Probe to draw out all majorreasons for standardization.

b. Standardization helps topromote professionalismamong drug recognitionexperts.

c. Standardization helps to

secure acceptance in court.

II-4 (12-Steps)

4. The Drug Evaluation andClassification process hastwelve components or steps.

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II-5 (BreathAlcohol Test)

a. Breath Alcohol Test todetermine Blood AlcoholConcentration (BAC).

o The purpose of thebreath test is todetermine whether thespecific drug, alcohol,may be contributing tothe impairment observ-able in the subject.

o Obtaining an accuratemeasurement of BACenables the DRE toassess whether alcoholmay be the sole cause ofthe observable impair-ment, or whether it is likely that someother drug or drugs, orother complicatingfactors are contributingto the impairment.

Remind students that manysubjects who are under theinfluence of drugs other thanalcohol also have alcohol intheir bodies.

II-6(Interview of... Officer)

b. Interview of the Arresting Officer.

o In most cases, thesubjects you willexamine will not bepeople that youarrested.

o The arresting officermay have seen or heardthings that would bevaluable indicators ofthe kinds of drugs thesubject has ingested.

o The arresting officer, in

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searching the subject,may have uncovereddrug-related parapher-nalia, or even drugsthemselves.

o The arresting officeralso may be able to alertyou to importantinformation about thesubject's behavior thatcould be very valuablefor your own safety.

II-7 (Prelim. Exam)

c. Preliminary Examination.

o The preliminaryexamination is your firstopportunity to observethe subject closely anddirectly.

Point out that the preliminaryexamination begins the "handson" with the subject. Use ofprotective gloves is imperative.

o A major purpose of thepreliminaryexamination is todetermine if the subjectmay be suffering froman injury or some othermedical condition notnecessarily related todrugs.

Analogy: The preliminaryexamination is a "fork in theroad." It can help you decidewhether to continue with thedrug examination, or to pursuea possible medicalcomplication, or to proceed witha DWI (alcohol) case.

o Another major purposeof the preliminaryexamination is to beginsystematically assessingthe subject'sappearance, behaviorand automatic bodilyresponses for signs ofdrug-inducedimpairment.

Emphasize that the term"preliminary" does not imply"unimportant". Very valuableevidence often comes to lightduring the preliminaryexamination.

o The preliminaryexamination consists ofa series of questions

Emphasize that courtsgenerally accept thesequestions as not being in

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dealing with possibleinjuries or medicalproblems; observationsof the subject's face,speech and breath;initial checks of thesubject's eyes; and, aninitial examination ofthe subject's pulse.

conflict with the subject'sMiranda rights. However, thestudents must comply withtheir own departments' policiesas to whether they shouldadvise subjects of theirMiranda rights before askingthese questions.

o The initial examinationof the eyes may revealsigns of injury or illness. A difference in pupil sizeof greater that 0.5 mmmay indicate an injuryor existing medicalcondition.

II-8(Eye Exam-inations)

d. Examinations of the Eyes.

o Certain drugs producevery easily observableeffects on the eyes.

- One of the mostdramatic of theseeffects is nystagmus,which means aninvoluntary jerkingof the eyes.

Ask students: "What do welook for, in a subject's eyes, todetermine if he or she may beunder the influence of alcohol?"

Probe, as necessary, to drawout the response "nystagmus".

- Persons under theinfluence of alcoholusually will exhibitHorizontal GazeNystagmus, which isan involuntaryjerking of the eyesas the eyes turntoward the side.

- Alcohol is not theonly drug thatcauses nystagmus.

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- Horizontal GazeNystagmus is notthe only observableeffect on the eyesthat will beproduced by variousdrugs.

Point out that the examinationsof the eyes will be covered inmuch greater depthsubsequently.

II-9 (DividedAttentionTests)

e. Divided Attention Psycho-physical tests.

o All drugs that impairdriving ability will alsoimpair the subject'sability to performcertain carefully-designed dividedattention tests.

Ask students: "What does'divided attention' mean?"

Probe, as necessary, to draw outresponses indicating the conceptof "concentrating on more thanone thing or task at a time".

o These tests are familiarto you in the context ofexamining alcohol-impaired subjects.

o The same tests are veryvaluable for disclosingevidence of impairmentdue to drugs other thanalcohol.

Point out that students willhave opportunities to practiceadministering these testssubsequently in the course.

II-10 (Vital SignsExams)

f. Examination of Vital Signs.

o Many categories ofdrugs affect theoperation of the heart,lungs and other majororgans of the body.

o These effects show upduring examination ofthe subject's vital signs.

o The vital signs that arereliable indicators ofdrug influence include

Point out that examinations ofvital signs will be covered indepth subsequently, and that

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blood pressure, pulse,and temperature.

students will have ampleopportunity to practicemeasuring vital signs.

II-11(Dark RoomExams)

g. Dark Room Examinations

o Many categories ofdrugs affect how thepupils of the eyes willappear, and how theyrespond to light.

o Certain kinds of drugs

will cause the pupils towiden dramatically, ordilate.

o Some other drugs causethe pupils to narrow, orconstrict tightly.

o By systematically

changing the amount oflight entering thesubject's eyes, we canobserve the pupils'appearance and reactionunder controlledconditions.

o We carry out theseexaminations in a darkroom, using a penlightto control the amount ofillumination enteringthe subject's eyes.

Exhibit a penlight.

o We use a device called apupillometer to estimatethe size of the subject'spupils.

Exhibit a pupillometer. Point out that the pupillometerhas a series of circles or semi-circles of various sizes. Bylining up the circles or semi-circles alongside the subject'spupil, the pupil's size can be

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determined.

Select a student to step forwardand demonstrate themeasurement of the student'spupils.

Shine the penlight directly intothe student's eye, and againdemonstrate the measurementof the pupils.

Demonstrate that the two eyes"work together"; i.e., shine thepenlight into one eye, anddemonstrate that the pupil ofthe other eye also contracts.

o Other examinations arealso conducted in thedarkroom, using thepenlight: i.e.,examination of the nasalarea and mouth forsigns of drug use and forconcealed contraband.

Demonstrate the examination ofthe student's nasal area andoral cavity.

Excuse the student and thankhim or her for participating.

Point out that students willhave several opportunities topractice conducting dark roomexaminations subsequently inthe course.

II-12 (Muscle Tone)

h. Examination of Muscle Tone.

o Certain categories ofdrugs can cause theuser's muscles to becomemarkedly tense, andrigid.

o Evidence of muscle tonemay come to light whenthe subject attempts toperform the dividedattention test.

o Evidence of muscle tone Point out that examination for

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can also be observedwhen taking thesubject's pulse and bloodpressure.

muscle tone will be covered ingreater depth subsequently inthe course.

II-13 (Examfor InjectionSites)

i. Examination for InjectionSites.

o Certain drugs arecommonly injected bytheir users, viahypodermic needles.

Ask students: "What drug ismost often associated withinjection via hypodermicneedle?"

o Heroin is probably mostcommonly associatedwith injection, butseveral other types ofdrugs also are injectedby many users.

o Uncovering injectionsites on a subjectprovides powerfulevidence that he or shemay be under theinfluence of specifictypes of drugs.

II-14(Statements Observations)

j. Suspect's statements andother observations.

o At this point in theexamination, the trainedDRE should havereasonable grounds tobelieve that the subjectis under the influence ofa drug or drugs.

o The DRE should alsohave at least anarticulable suspicion asto the category orcategories of drugscausing the impairment.

Point out that though theinterview of the subject is theformal process of solicitinginformation about the subjectsdrug usage, any voluntarystatements previously madeduring the evaluation should be

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noted and recorded.

o The DRE should proceedto interview the subjectto confirm his or hersuspicion/opinionsconcerning the drug ordrugs involved.

Emphasize that any suchinterview can proceed only inconformance with formaladmonition and strictobservance of the subject'sConstitutional rights.

o The DRE must care-fully record the subject'sstatements, and anyother observations thatmay constitute relevantevidence of drug-inducedimpairment.

Point out that the appropriateprocedures for interviewingsubjects vary with the probablecategory or categories of drugsinvolved.

II-15(Opinion ofEvaluator)

k. Opinion of the Evaluator

o Based on all of theevidence and obser-vations gleaned from thepreceding ten steps, theDRE must reach aninformed conclusion asto:

- whether the subjectis under theinfluence of a drugor drugs

- if so, the probable

category orcategories of drugscausing theimpairment

o The DRE must record anarrative summary ofthe facts forming thebasis for his or her

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conclusions.

II-16 (Tox Exam)

l. Toxicological Examination

o The toxicologicalexamination is achemical test or testsdesigned to obtainscientific, admissibleevidence to substantiatethe DRE's conclusions.

o Departmental policy andprocedures must becarefully and completelyfollowed in requesting,obtaining and handlingthe chemical sample.

Solicit students' comments andquestions concerning thispreview of the Drug Evaluationand Classification procedures.

II-17(DrugInfluenceEvaluationChecklist)

m. Review of Drug InfluenceChecklist

Instruct students to turn to theDrug Influence EvaluationChecklist in Section II of theirStudent Manual.

25 Minutes

B. Video Demonstrations

Show the video of excerpts from theDrug Recognition Demonstration.

(NOTE: This is the 25-minute videosegment that is shown in Session V ofthe 7-day DRE School.) Solicit students' questions about thevideo demonstrations.

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International Association of Chiefs of Police

Drug Evaluation and Classification Program

Drug Influence Report Checklist

__________ 1. Breath Alcohol Test

__________ 2. Interview of Arresting Officer (Note: Gloves must be worn from this point on.)

__________ 3. Preliminary Examination and First Pulse

__________ 4. Eye Examinations

__________ 5. Divided Attention Tests:

__________ Romberg Balance __________ Walk and Turn __________ One Leg Stand __________ Finger to Nose

__________ 6. Vital Signs and Second Pulse

__________ 7. Dark Room Examinations and Ingestion Examination

__________ 8. Check for Muscle Tone

__________ 9. Check for Injection Sites and Third Pulse

__________ 10. Interrogation, Statements, and Other Observations

__________ 11. Opinion of Evaluator

__________ 12. Toxicological Examination

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REVIEW QUESTIONS

1. Study the drug influence evaluation checklist that appears on the precedingpage , then put it aside, and list the twelve components of the drug influenceevaluation in the sequence in which they are performed.

1. Breath Test 2. Interview with arresting officer 3. Preliminaryexamination 4. Eye examinations 5. Divided Attention tests 6. VitalSign examinations 7. Dark Room 8. Muscle Tone Examination 9.Injection Sites 10. Suspect interview 11. DRE Opinion 12.Toxicology Examination

2. Name the four divided attention psychophysical tests used to assess a subject'simpairment.

1. Romberg Test 2. Walk and Turn 3. One Leg Stand 4. Finger toNose

3. When is the first measurement of a subject's pulse rate taken?

Preliminary Examination

4. Name the two medical instruments that are needed to measure a subject'sblood pressure.

Sphygmomanometer and stethoscope

5. What is the name of the device used to estimate the size of the subject's pupils?

Pupillometer

6. Which categories of drugs usually cause nystagmus? Which usually cause Lackof Convergence?

CNS Depressants, Inhalants, Dissociative AnestheticsCNS Depressants, Inhalants, Dissociative Anesthetics, Cannabis

7. Which categories usually elevate the pulse rate? Which usually lower the pulserate?

CNS Stimulants, Hallucinogens, Dissociative Anesthetics, Inhalants,Cannabis, CNS Depressants, Narcotic Analgesics

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HS 172A R1/07 III-1

Ninety Minutes

SESSION III

THE PSYCHOPHYSICAL TESTS

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SESSION III THE PSYCHOPHYSICAL TESTS Upon successfully completing this session the student will be able to:

o Administer the four divided attention tests used in the drug influenceevaluation process.

o Document the subject's performance of those tests.

CONTENT SEGMENTS LEARNING ACTIVITIES

A. Romberg Balance o Instructor-Led Presentations B. Walk and Turn o Student-Led Demonstrations C. One Leg Stand o Hands-on Practice D. Finger to Nose

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HS 172A R1/07 III-3

90 Minutes

III-1 (Title)

III-2(Objectives)

THE PSYCHOPHYSICAL TESTS

Four divided attention psychologicaltests are administered in the DREevaluation - Romberg Balance, Walkand Turn, One Leg Stand and Fingerto Nose.

The Walk and Turn and One LegStand as well as HGN have beenscientifically validated by conductingcontrolled research to demonstratetheir reliability. The RombergBalance and Finger to Nose have notbeen subjected to that sort of scrutiny,however, if properly administered andrecorded they are very credibleevidence of impairment.


Point out that throughout theevaluation process theevaluator must be cognizant ofofficer safety issues. Officersurvival procedures should beobserved as appropriate duringthe administration of the DREdrug influence evaluation.

25 Minutes

A. Romberg Balance

1. The Romberg Balance is thefirst divided attention test thatis administered during the drugevaluation.

Write "Romberg Balance" ondry erase board or flip-chart.

III-3(RombergTest)

a. The test requires the subjectto stand with the feettogether and the head titledback slightly and with theeyes closed.

Demonstrate the stancerequired of the subject.

b. The test also requires thatthe subject attempt toestimate the passage ofthirty seconds; the subjectmust be instructed to openthe eyes and tilt the headforward and say “stop” whenthey think thirty secondshas elapsed.

Emphasize that the DRE mustnot instruct the subject as tohow they are supposed toestimate the passage of 30seconds.

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c. The DRE must record howmuch time actually elapsedfrom the start of the testuntil the subject opened theeyes.

d. If the subject continues tokeep the eyes closed for 90seconds, the DRE shouldstop the test and record thefact that it was terminatedat 90 seconds.

Point out that some drugs tendto "speed up" the subject'sinternal clock, so that thesubject may open the eyes afteronly 10 or 15 seconds have goneby. Other drugs may "slowdown" the internal clock, sothat the subject keeps the eyesclosed for 60 or more seconds. And, sometimes the drugsconfuse the subject to the pointwhere they won't remember toopen the eyes until instructedto do so by the DRE.

2. Administrative procedures andinstructions. Verbal instructionsshould be given as follows:

a. “Stand with your feettogether, arms at yoursides”.

b. “Watch me and listen while

I give you the instructionsfor this test; don't startdoing the test until I tell youto start”.”Do youunderstand?”

Two instructors shoulddemonstrate the administra-tive procedures for RombergBalance. One instructor willplay the role of the DRE, theother the "suspect".

Ask the subject if he/she understands the instructionsthus far. If the subject fails tomaintain the starting positionduring your instructions,discontinue the instructionsand direct the subject back tothe starting position beforecontinuing.

c. “When I tell you to start, Iwant you to tilt your headback slightly (demonstrate)and close your eyes.”

Point out that the DRE shouldnot close their eyes whiledemonstrating this test forsafety reasons. Emphasize thisto the students.

d. “Once you have closed youreyes I want you to remain inthat position until you thinkthat 30 seconds have goneby”.

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e. “As soon as you think 30seconds have passed by,open your eyes and tilt yourhead forward and say ‘stop’”.“Do you understand theinstructions?”

Ask the subject if he/she understands the instructions.

f. When the subject openstheir eyes ask them "Howmuch time was that?".

Emphasize that the DRE mustlook at a watch as soon as thesubject starts the test, andmust record the actual amountof time that passes by until thesubject opens his or her eyes.

3. Instructor-led demonstrations.

a. Instructor-to-instructordemonstrations.

One instructor shouldadminister a complete RombergBalance test to anotherinstructor.

Solicit students' questions.

b. Instructor-to-studentdemonstration.

Select a student to participatein the demonstration.

The instructor shouldadminister a complete RombergBalance test to the student.

Thank the student for his orher participation and solicitquestions.

4. Student-led demonstrations. Select two students to conductdemonstrations.

Have the first student admini-ster the test to the second.

Offer constructive criticism, asappropriate, about the student-administrator's demonstration.

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Have the second studentadminister the test to the first,and offer appropriateconstructive criticism.

Thank the students for theirparticipation and solicitquestions.

5. Recording results of theRomberg Balance test.

a. The major items that needto be recorded for theRomberg Balance test are:

o the amount that the

subject sways

Instruct students to turn to the"Romberg Test Diagram" intheir Student Manuals (thesame diagram that appears onVisual III-3).

o the actual amount oftime that the subjectkeeps the eyes closed.

b. To record swaying, the DREmust estimate how manyinches the subject sways,either front-to-back or left-to-right, or both.

c. To record the subject's timeestimate, simply write thenumber of seconds that thesubject kept his or her eyesclosed.

Example: if the subject swaysapproximately two inchestoward the left and approxi-mately two inches toward theright, the DRE should write thenumber "2" on each side of the"stick figure" that shows left-to-right movement.

Solicit students' questions.

6. Hands-on practice. Assign students to work inpairs.

Instruct teammates to practiceadministering the RombergBalance test to each other.

Monitor the practice and offercoaching and constructivecriticism, as appropriate.

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20 Minutes

B. Walk and Turn

1. Walk and Turn is the seconddivided attention testadministered during the druginfluence evaluation.

2. The test is administered thesame way that we have used itfor Standardized Field SobrietyTesting purposes.

Write "Walk and Turn" on thedry erase board or flip-chart.

It is suggested a visible line beplaced on the floor for useduring the demonstration.

3. Review of Walk and Turnadministrative procedures.

a. The test has two stages: theinstructions stage and thewalking stage.

b. During the instructionsstage the subject must standheel-to-toe, with the rightfoot ahead of the left foot,and keeping the arms at thesides.

Demonstrate the stance thatthe subject must maintainduring the instructions stage. Ifthe subject fails to maintainthe starting position duringyour instructions, discontinuethe instructions and direct thesubject back to the startingposition before continuing.

c. The subject must be told totake nine heel-to-toe stepsup the line, to turn, and toreturn nine heel-to-toe stepsdown the line.

d. You must demonstrate

several heel-to-toe steps,and you must demonstratethe turn.

Demonstrate how the steps aretaken and demonstrate theturn. Emphasis that the DREshould not turn his/her back tothe subject for safety reasons.

e. The subject must be told towatch his or her feet whilewalking, and to count thesteps out loud.

If the subject stops or fails tocount out loud or watch his/herfeet, remind him/her to performthese tasks. This interruptionwill not effect the validity of

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f. The subject must be told tokeep their arms at the sidesat all times.

g. The subject must be told not

to stop walking until thetest is completed.

the test and is essential forevaluating divided attention.

4. Demonstrations of Walk andTurn.

a. Instructor-to-student

demonstration.

Select a student to serve as the"suspect".

Instructor should administer acomplete Walk and Turn test.

Thank the student for his orher participation and solicitquestions about testadministrative procedures.

b. Student-to-studentdemonstration.

Select two students to conducta demonstration.

Have one student administer acomplete Walk and Turn test tothe other.

Offer appropriate commentsand constructive criticismabout the test administration.

Thank the students for theirparticipation and solicitquestions.

III-4(Walk andTurn TestDiagram)

5. Recording results of the Walkand Turn test.

Instruct students to turn to the"Walk and Turn Test Diagram"in their Student Manuals (thesame diagram that appears onVisual III-4).

a. We record the very sameclues on this test that weuse for Standardized FieldSobriety Testing purposes.

Ask students: "What are thetwo clues that we mightobserve during the instruc-tions stage of the Walk andTurn test?"

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b. Instructions stage clues:

o Failure to maintainbalance (feet break awayfrom the heel-to-toestance)

o Starting to walk too

soon.

c. Walking stage clues:

o Stops walkingo Misses Heel-To-Toeo Steps off lineo Raises armso Wrong number of stepso Turns improperly

Ask students: "What are thesix clues that we might observeduring the walking stage?"

d. During the walking stageclues will be marked in thefollowing manner:

o On the lines indicate thenumber of times the clueoccurred. Draw a slashmark at an angle in thedirection the step wastaken.

e. During the walking stageclues will be marked in thefollowing manner:

o Indicate by a check thenumber of times thesubject stops, missesheel to toe, steps off line,or raises arms.

o Record the actualnumber of steps taken.

o If the subject stopswalking a slash mark

The “S” indicates “stopped”

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should cross betweenthe feet and labeled withan “S”.

o If the subject steps offthe line, indicate with ahalf of a slash mark atan angle in the directionthe step was taken.

o If the subject missesheel to toe, indicate witha slash mark betweenthe feet and label withan “M”.

The “M” indicates “missed”

6. Hands-on practice. Assign students to work inpairs. Instruct teammates totake turns administering theWalk and Turn test to eachother.

Note: It is not necessary thatthe teammate playing the roleof the “suspect” actually carryout the walking stage of thetest.

The idea is to take turnspracticing the proper way togive instructions for the test.

Monitor the practice and offercoaching and constructivecriticism, as appropriate.

20 Minutes

C. One Leg Stand

1. One Leg Stand is the thirddivided attention testadministered during the druginfluence evaluation.

Write "One Leg Stand" on the dry erase board or flip-chart.

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2. For drug evaluation purposes,One Leg Stand is given twice tothe subject.

Write "given twice" on dryerase board or flip-chart.

a. First, the subject is requiredto perform the One LegStand while standing on theleft foot.

b. Next, they are required to

perform the test whilestanding on the right foot.

Note: The One Leg Stand isadministered twice to test boththe left and right legs to assistthe DRE in makingcomparisons and identifypotential medical conditionsthat may be present..

3. Otherwise, One Leg Stand isused in the same fashion as inStandardized Field SobrietyTesting.

4. Review of One Leg Standadministrative procedures.

a. The test has two stages, theinstructions stage and thebalance and counting stage.

Two instructors should be usedfor this demonstration, one asthe "suspect" and the other asthe examiner.

b. During the instructionsstage the subject must standwith the feet together, armsat the side, facing theexaminer.

Demonstrate the stance thatthe “suspect” is required tomaintain.

c. The subject must be toldthat they will have to standon the left foot, and raisethe right foot approximately6 inches off the ground, withthe right leg held straightand the raised foot parallelto the ground.

The examiner must demon-strate the one-leg stance.

Emphasize that the subjectmust maintain the footelevation throughout the test.

If the subject lowers his/herfoot, he/she should beinstructed to raise it.

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d. The subject must be toldthat they must look at theelevated foot during thetest.

Emphasize that the examinershould not look at his or herown foot while giving theinstructions; for safety reasons,the examiner must keep theeyes on the subject at all times.

e. The subject must be toldthat they will have to countout loud in the followingmanner: "one thousand-andone, one thousand-and two,one thousand-and-three"and so on until told to stop”.

After giving the instructions,the examiner should ask the"suspect" if they understand.

Solicit students' questionsabout the administrativeprocedures for One Leg Stand.

Point out that the validation ofthe One Leg Stand was basedon a thirty-second time period. Therefore, the DRE must keeptrack of the actual time thesubject stands on each foot. When thirty seconds havepassed, stop the test.

f. After the subject hascompleted the test on theleft foot, they must be toldto repeat the test on theright foot.

Point out that the DRE shouldexplain the instructions againprior to having the “suspect”perform the test on the rightfoot.

III-5(One LegStand TestDiagram)

5. Recording results of the OneLeg Stand.

Instruct students to turn to the"One Leg Stand Test Diagram"in their Student Manuals (thesame diagram that appears onVisual III-5).

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a. For drug evaluationpurposes, we use the sameclues on the One Leg Standthat we use forStandardized Field SobrietyTesting.

Ask students: "What are thefour clues of the One Leg Standtest?"

b. The One Leg Stand clues:

o Sways while balancingo Uses arms to balanceo Hopping o Puts foot down

Solicit questions aboutdocumenting the results of the One Leg Stand.

c. Indicate above the feet thenumber they were countingwhen they put their footdown.

d. Check marks should bemade to indicate thenumber of times the subjectswayed, used arms forbalance, hopped or put theirfoot down.

e. The subjects actual countduring the 30 secondsshould be documented in thetop area of the box above thefoot on which the subjectwas standing.


Instruct teammates to taketurns administering the OneLeg Stand to each other.

Note: It is not necessary thatthe student serving as the“suspect” actually stand on onefoot for thirty seconds. The ideais to practice giving theinstructions for the test.

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Monitor the practice and offerappropriate coaching andconstructive criticism.

25 Minutes

D. Finger to Nose.

1. The Finger to Nose is the finaldivided attention test used inthe drug influence evaluation.

2. Finger to Nose differs from the

other three tests in that theexaminer must continue to giveinstructions to the subjectthroughout the test.

Write "Finger to Nose" on dryerase board or flip-chart.

3. Administrative procedures forFinger to Nose.

Two instructors should serve inthis demonstration, one as theexaminer and the other as"suspect".

a. The subject must be told tostand with feet together,arms down at the sides,facing the examiner.

The examiner shoulddemonstrate the stance.

b. The subject must be told toclose his/her hands, rotatethe palms forward and thento extend the index fingersfrom the closed hands. Demonstrate the proper exten-

sion of the index fingers.

c. The examiner must tellsubject that they will beasked to touch the tip of theindex finger to the tip of thenose.

d. The examiner must demon-strate to the subject howthey are expected to touchthe fingertip to the nose.

Demonstrate the movement ofthe fingertip to the nose bystanding at an angle to the“suspect” so that he/she can seethe proper method for touchingthe nose.

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e. The “suspect” must be toldthat he/she will be given aseries of commands, i.e.,"left, right, etc." to indicatewhich fingertip is to bebrought to the tip of thenose.

Demonstrate: "When I say'right', touch the tip of yourright index finger to the tip ofyour nose."

f. The examiner must tell the subject that they areexpected to return the armto the side immediatelyafter touching the fingertipto the nose.

g. The “suspect” must be toldto tilt the head back slightlyand to close the eyes, andkeep them closed until theexaminer says to open them.

Note: the subject's head shouldbe tilted back in the samefashion as in the RombergBalance test.

The examiner shoulddemonstrate the stance withhead tilted back, arms at thesides with index fingersextended. Remind the studentsthat they should not close theireyes during the instructions forsafety reasons.

h. The test is always given inthe following sequence ofcommands:

Write the sequence on dry eraseboard or flip-chart.

o left o right o left o right o right o left

Solicit students' questionsconcerning administrativeprocedures for Finger to Nose.

4. Instructor-led demonstrations.

a. Instructor-to-instructordemonstration.

One instructor should give acomplete demonstration ofFinger to Nose, using anotherinstructor as the "suspect".

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b. Instructor-to-studentdemonstration.

Select a student to serve as the"suspect" and administer acomplete Finger to Nose test tothat student.

Thank the student for his/herparticipation and solicitquestions about thedemonstrations.

5. Student-led demonstrations. Select two students and havethem take turns administeringFinger to Nose to each other.

Offer appropriate comments andconstructive criticisms about thestudents' administration of thetest.

Thank the students for theirparticipation and solicitquestions from the class.

III-6 (Finger toNose TestDiagram)

6. Recording results of the Fingerto Nose test.

a. The results of Finger toNose test are recorded bydrawing a "map" showingwhere the fingertips landedon each attempt.

Instruct students to turn to the"Finger to Nose Test Diagram"in their Student Manuals (thesame diagram that appears onVisual III-4).

b. A line should be drawn tothe appropriate triangle toindicate where the subjecttouched their nose.

Suggestion: If the DRE drawsthe line from the place wherethe subject touches to theappropriate triangle it enablesthem to draw a straighter line.

Solicit questions aboutrecording the results of Fingerto Nose.


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Instruct teammates to taketurns administering Finger toNose to each other.

Note: It is not necessary for theteammate who is the “suspect”to carry out the test completely.

Monitor the practice and offerappropriate coaching andconstructive criticism.

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REVIEW QUESTIONS

1. List the four divided attention test in the sequence in which they areadministered in the drug influence evaluation.

1. Romberg 2. Walk and Turn 3. One Leg Stand 4. Finger to Nose

2. On which foot must the subject stand the first time he or she performs the OneLeg Stand?

Left

3. How much time must the subject estimate during the Romberg Balance?

30 seconds

4. List all of the scientifically validated clues of impairment for Walk and Turn.

1. Loses Balance During Instructions 2. Starts too soon 3. Stopswhile walking 4. Steps off line 5. Wrong number of steps 6. Does nottouch heel to toe 7. Raises arms for balance 8. Incorrect turn

5. List all of the scientifically validated clues of impairment for Finger to Nose.

None

6. What sequence of finger commands must you give for the Finger to Nose?

Left, Right, Left, Right, Right, Left

7. List all of the scientifically validated clues of impairment for Romberg Balance.

None

8. List all of the scientifically validated clues of impairment for One Leg Stand.

1. Raises arms for balance 2. Puts foot down 3. Hops 4. Sways whilebalancing

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Ninety Minutes

SESSION IV

THE EYE EXAMINATIONS

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SESSION IV THE EYE EXAMINATIONS


o Administer tests of Horizontal Gaze Nystagmus, Vertical Gaze Nystagmusand Lack of Convergence.

o Estimate pupil size.

o Relate the expected results of the eye examinations to the seven categoriesof drugs.


A. Purposes of the Eye Examinations o Instructor-Led Presentations

B. Procedures and Clues o Instructor-Led Demonstrations

C. Demonstrations o Hands-on Practice

D. Relationship of Drug Categories tothe Eye Examinations

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90 Minutes

IV-1 (Title)

IV-2 (Objectives)

THE EYE EXAMINATIONS Display Session Title

Briefly review the content,objectives and activities of thissession.

15 Minutes

A. Purposes of the EyeExaminations

IV-3 (Eye Exams)

1. The principal purpose of all ofthe eye examinations is toobtain articulable factsindicating the presence orabsence of specific categories ofdrugs.

a. Certain drug categoriesusually cause the eyes toreact in specific ways.

b. Other drug categories

usually do not cause thosereactions.

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2. The tests of Horizontal GazeNystagmus (HGN) and VerticalGaze Nystagmus (VGN) provideimportant indicators of the drugcategories that may or may notbe present.

a. If HGN is observed, it is

likely that the subject mayhave taken a CNSDepressant, DissociativeAnesthetics, an Inhalant, ora combination of those.

b. If VGN is observed, theimplication may be that thesubject took DissociativeAnesthetics, or fairly largedoses of depressants orinhalants (for thatindividual).

Point out that it is veryunlikely that a subject wouldexhibit Vertical GazeNystagmus without alsoexhibiting HGN.

c. By comparing the subject'sblood alcohol concentrationwith the angle of onset ofHGN, it may be possible todetermine that alcohol is oris not the sole cause of theobserved nystagmus.

Clarification: If the angle ofonset is significantlyinconsistent with the BAC, theimplication may be that thesubject has also taken aDissociative Anesthetics or anInhalant, or some CNSDepressant other than alcohol,or that the subject may have amedical condition.

d. The consistency of onsetangle and BAC can becompared using thefollowing formula:

BAC = 50 - A

Write the formula on the dryerase board or flip-chart.

Explanation: BAC = 100 x blood alcohol (e.g., if blood alcohol is 0.10,BAC = 10)

A = onset angle (in degrees)

Example: If onset angle is 35

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degrees, thenBAC = 50 - 35 = 15.

The corresponding bloodalcohol concentration would beapproximately 0.15.

e. Keep in mind that thisformula is only a statisticalapproximation. It is not anexact relationship for allsubjects at all times.

Emphasize this point: Theformula can easily be "off" by0.05 or more, even though thesubject has consumed no drugother than alcohol.

f. The only purpose of com-paring BAC and the angle ofonset is to obtain a grossindication of the possiblepresence of anotherDepressant, Inhalants, orDissociative Anesthetics.

Emphasize that many otherfacts will also be consideredthat will help to determinewhether Depressants,Inhalants or DissociativeAnesthetics may be present.

g. A DRE is expected to be ableto estimate the angle ofonset of nystagmus to thenearest 5 degree increment,over the range from 30 to 45degrees.

o If the subject's eyesbegin to jerk before theyhave moved to the 30degree mark, you willnot attempt to estimatethe angle precisely, butwill record they exhibit"immediate onset".

o From 30 degrees on out,you will record a numer-ic estimate of onset.

3. The check for Lack of Conver-gence can provide another clueas to the possible presence of

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Depressants, Inhalants, orDissociative Anesthetics.

4. Lack of Convergence is also anindicator of the possiblepresence of Cannabis.

Point out that a DRE mightbegin to suspect the presence ofcannabis if Lack ofConvergence was observed butno HGN was observed.

5. The checks of pupil size andreaction to light provide usefulindicators of the possible pre-sence of many drug categories.

Point out that in addition tosigns of drug use, checks of thepupil size and reaction to lightmay reveal signs of injury orexisting medical conditions.

a. Depressants, CNSStimulants, Inhalants andNarcotic Analgesics willusually cause the pupils toreact very slowly or not atall to light.

b. CNS Stimulants and

Hallucinogens usually willcause the pupils to dilate.

c. Narcotic Analgesics willusually cause the pupils toconstrict.

Solicit students' comments andquestions concerning the pur-poses of the eye examinations.

50 Minutes

B. Procedures and Clues

1. Prior to the administration ofthe HGN test, the eyes arechecked for equal pupil size,equal tracking and resting nystagmus.

NOTE: If the eyes do not tracktogether, or if the pupils arenoticeably unequal in size, thechance of a medical disorder orinjuries causing the nystagmusmay be present. RestingNystagmus may also beobserved at this time.

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IV-4(HGN Clues)

2. Horizontal Gaze Nystagmustest consists of three separatechecks, administeredindependently to each eye.

Remind the students that theHGN test is done exactly the

same as in the SFST trainingand that the DRE start withthe “suspects” left eye first.

IV-4A(Lack ofSmoothPursuit)

a. The first check is for "lack ofsmooth pursuit".

o Position the stimulusapproximately 12 to 15inches in front ofsubject's nose.

Select a student, anddemonstrate the first check ofHGN on that student.

o Hold the tip of thestimulus slightly above the subject's eye level.

Point out that this procedureinsures that the eyes will beopen wide and easy to observe.

o Instruct the subject tohold the head still andfollow the stimulus withthe eyes only.

o Move the stimulussmoothly, all the way tothe subject's left, thenall the way to the right,then back again all theway to the left, thenonce again all the wayback to the right.

Point out that we begin bychecking the subject's left eye,then we immediately check theright eye. And, we make atleast two complete passes infront of both eyes.

Demonstrate two completepasses in front of the eyes,using the student-volunteer asyour test subject.

Emphasize: For standardiza-tion, we always begin bychecking the left eye.

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Point out that the stimulusshould moved at a speed thatrequires approximately twoseconds to bring it from thecenter to side.

b. While the eye is moving,examine it for evidence of alack of smooth pursuit.

Use these or similar analogies: (1) A smoothly pursuing eye

will move withoutfriction, much the waythat a windshield wiperglides across the wind-shield when it is rainingsteadily. An eye showing lack of smoothpursuit will move in afashion similar to a wipermoving across a drywindshield.

(2) A smoothly pursuing eyewill roll in the socket theway that a marble or ballbearing would glidesmoothly across apolished pane of glass. An eye exhibiting lack ofsmooth pursuit wouldmove more like thatmarble rolling over asheet of heavy gaugesandpaper.

Excuse the student-volunteerand thank him/her forparticipating.

c. Students' initial practice ofthe check for lack of smoothpursuit.

Instruct students to work inpairs, taking turns checkingeach other's eyes for lack ofsmooth pursuit.

Monitor, coach and critique thestudents' practice.

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Allow this practice to continuefor only about 2 minutes.

IV-4B(Distinct...AtMaximum)

d. The second check is for"distinct and sustainednystagmus at maximumdeviation".

o Again position thestimulus as before.

Select a student anddemonstrate the second checkof HGN on that student.

Note: Remind students that thenystagmus must be bothdistinct and sustained.

o Move the stimulus allthe way to the subject'sleft side and hold itthere so that thesubject's eye is turned asfar to the side aspossible.

Remind students that wealways start by checking thesubject's left eye.

o Hold the eye at thatposition for a minimumof 4 seconds, to checkcarefully for any jerkingthat may be present.

o Then, move the stim-ulus all the way to thesubject's right side, andhold it there for aminimum of 4 seconds.

o Repeat the procedure.

Remind students that, as soonas we have finished checkingthe left eye, we immediatelyrepeat the check on the right.

e. With this cue, the examinerlooks for distinct andsustained jerking.

o A slight or barely visibletremor is not sufficientto consider this cuepresent.

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o A definite, strongjerking must be seen.

Point out that for HGN to beconsidered present, a distinctand sustained jerking must bepresent for a minimum of fourseconds.


f. Students' initial practice ofthe check for distinct andsustained nystagmus atmaximum deviation.

Instruct students to work inpairs, taking turns checkingeach other's eyes for distinctand sustained nystagmus atmaximum deviation.

Monitor, coach and critique thestudents' practice. Allow thispractice to continue for onlyabout 2 minutes.

IV-4C(Angle ofOnset)

g. The final check is for the"angle of onset". Theformula is BAC = 50 - A.

o Position the stimulus asbefore.

o Slowly move the stimu-lus to the subject's leftside, carefully watchingthe eye for the first signof jerking.

Select a student anddemonstrate the third check ofHGN on that student.

o When you think thatyou see the eye jerk,stop moving thestimulus and hold itperfectly still.

o Verify that the eye is, infact, jerking.

Point out: if the eye is notjerking, resume moving thestimulus slowly to the side,again observing for the first

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sign of jerking.

o Once you have estab-lished that you havelocated the point of on-set, estimate the angle.

Exhibit a template if available.

o Then, repeat this proce-dure on the subject'sright eye.

Point out that angle estimationsimply requires practice.

Point out that the template willbe used during practice. Excuse the student-volunteerand thank him or her forparticipating.

h. Students' initial practice ofangle of onset estimation.

Instruct students to work inpairs, taking turns estimatingangles of each other's eyes.

Instruct students that they areto try to draw their partners'eyes to 3 different angles: 30,35, 40 degrees.

Students will check theiraccuracy using the template.


Allow this practice to continuefor only about 3 minutes. INSTRUCTOR PLEASENOTE: In their previoustraining in HGN, somestudents may have been taughtto look for all 3 clues in oneeye, and then to check theother eye for all 3 clues. Thereis nothing wrong with thatprocedure, from either ascientific or legal perspective. As DREs however, we expect

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them to switch from eye to eyeas they "work through" thethree clues. There are tworeasons for this:

(1) Standardization: we wantall DREs to work in thesame way; the "lefteye/right eye" switchingprocedure is simply thestandard approach thatwe have adopted.

(2) Medical Complications:DREs must always bealert to the possibility ofa medical complication,such as a stroke, braintumor or other injury tothe brain. These kinds ofinjuries often will causethe two eyes to behavequite differently from oneanother. For example,the left eye might jerknoticeably while the righteye tracks smoothly. Byalways immediatelycomparing the perform-ances of the two eyes, theDRE might more quicklyspot the possibility of amedical complication.

NOTE: NHTSA modified itsSFST training courses toconform to this "left/right"procedure in 1989.

IV-5 (VGN)

2. The Vertical Gaze Nystagmustest is a very simple test.

Select a student anddemonstrate the Vertical GazeNystagmus test on the student.

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a. Position the stimulushorizontally, approximately12 to 15 inches in front ofthe subject's nose.

b. Instruct the subject to holdthe head still and follow aspecific point on thestimulus with the eyes only.

c. Raise the stimulus until the

subject's eyes are elevatedas far as possible.

d. Watch closely for evidence ofjerking.

Point out that the examinershould keep the subject's eyeselevated for approx. 4 secondsto verify that the jerking ispresent and continues duringthe full four seconds.

Point out that we do notattempt to estimate an angle ofonset for Vertical Gaze Nystag-mus: We simply recordwhether a visible up-and-downjerking is present or notpresent. Excuse the student-volunteerand thank him or her forparticipating.

e. Students' initial practice ofthe Vertical GazeNystagmus test.

Instruct students to work inpairs, taking turns admini-stering the Vertical GazeNystagmus test to each other.



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IV-6 (LOC)

3. The test for Lack ofConvergence determineswhether the subject is able tocross his or her eyes.

a. Position the stimulusapproximately 12 to 15inches in front of thesubject’s nose in the sameposition we use for the HGNtest.

Select a student and demon-strate the test for Lack ofConvergence on that student.

Point out in simplest terms,Lack of Convergence means aninability to cross the eyes.

IV-7(LOCProcedures)

b. Inform the subject that youare going to move thestimulus around in a circlein front of his/her face andto follow the stimulus withhis/her eyes only.

Point out that the stimulus canbe moved either clockwise orcounterclockwise.

c. Inform the subject that youwill move the tip of thestimulus in toward thebridge of his or her nose.

d. Point out to the subject thathe or she will have to keeptheir head steady and try tocross the eyes in order tokeep the eyes focused on thestimulus as it moves intoward the nose.

Emphasize that it is import-antthat the subject be aware ofwhat will happen so that he orshe will not flinch or becomefrightened when you move thestimulus toward his or her face.

Point out that you will notactually touch the subject’snose.

e. Start to move the objectslowly in a circle.

Point out that this initialcircular motion helps to verifythat the subject has focused onthe stimulus and is able totrack it.

f. Verify the subject istracking the stimulus.

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g. Move the stimulus to withinapproximately two inches of

the bridge of the nose. Carefully observe thesubject's eyes to determinewhether both eyes convergeon the stimulus.

Point out not to actually touch

the nose and not go any closerthan approximately two inchesfrom the bridge of the nose.

IV-8(NormalConvergenceResponse)

h. In a normal non-impairedsubject, the eyes shouldcome together (converge)and remain converged forone second.

i. If the eyes do not convergeor remain converged on thestimulus for one second,then Lack of Convergence ispresent.

Point out that convergenceresponse in most people is adistance of approximately 2inches from the bridge of thenose.

Point out that many normalnon-impaired people cannotconverge to the bridge of thenose. Moving the stimuluswithin two inches of the noseprovides a better indicator oflack of convergence attributedto drug impairment.

j. Students' initial practice ofthe test for Lack ofConvergence.

Point out to keep the stimulushigh enough so that eyemovement can be observed.

Excuse the student-volunteerand thank him or her forparticipating.

Instruct students to work inpairs, taking turns testing eachother's eyes for Lack ofConvergence.



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IV-9 (DrugsCausingLOC)

IV-10(EstimatingPupil Size)

k. Drug categories which usuallycause lack of convergenceinclude:

• CNS Depressants• Inhalants• Dissociative Anesthetics• Cannabis

4. Estimation of pupil size.

a. We use a device called apupillometer to estimate thesize of the subject’s pupil.

b. The DRE pupillometer has aseries of circles or semi-circles, with diametersranging from 1.0 mm to 10.5mm, in half-millimeterincrements.

Point out that our eyescontinually adjust toaccommodate different lightingconditions.

Emphasize the measurement isan “estimate”.

Select a student anddemonstrate pupil sizeestimation using the student.

Exhibit a pupillometer.

c. The pupillometer is heldalongside the subject’s eye,and moved up and downuntil the circle or semi-circleclosest in size to the pupil islocated.

Point out to begin by testingthe subject’s left eye first.

d. The pupil size estimationsare recorded as the numericvalue that corresponds tothe diameter of the circle orsemi-circle closest in size tothe subject’s pupil in each

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lighting condition.

e. Students' initial practice ofpupil size estimation.

Select a student from the classand demonstrate how the pupilsize is estimated.

Upon completion, excuse thestudent-volunteer and thankhim/her for participating.

Instruct students to work inpairs, taking turns estimatingeach other's pupils.

Monitor, coach and critique thestudents' practice. Allow thispractice to continue for onlyabout 2 minutes.

Tell the students to record onpaper the pupil sizes of theirpartners.

Ask the students how manyfound partners with different-sized pupils (i.e., one pupillarger or smaller than theright). Point out that it is nottoo uncommon to find peoplewhose pupils differ by as muchas one-half millimeter, but thelarger differences are moreunusual.

Tabulate the pupil size esti-mates made by the students, onthe flip-chart using thefollowing sizes:

8.5 or larger _________8.0 _________7.5 _________7.0 6.5

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6.0 5.5 5.0 4.5 4.0 3.5 3.0

2.5 or smaller

Point out that the "normal"range of pupil size in room lightis 2.5 to 5.0 mm.

IV-11 (ThreeLightingConditions)

IV-12(TestingConditions)

f. We estimate pupil size underthree (3) different lightingconditions:

• Room Light• Near Total Darkness• Direct Light

Different testing conditionscreate different demands on theautonomic nervous system,including the pupil.

g. Examining the pupils in threedifferent lighting conditions issimilar to examining otherclinical indicators, i.e., pulse orblood pressure in differentconditions.

1. Estimation of pupil sizeunder Room Light

a. Pupils are examined inRoom Light prior todarkening the room.

2. Estimation of pupil sizeunder Near Total Darknessand Direct Light.

Instructor Note: The In-DirectLight estimation was removedfrom the DRE protocol in 2003after research determined ithad no direct correlation toimpairment.

Point out that the human pulseand blood pressure can vary depending on whether theperson is standing, resting, orrunning.

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a. The final two pupil sizeestimations are madewith the use of apenlight in a neartotally darkened room.

b. Prior to estimating thepupil sizes, we darkenthe room and wait 90seconds to allow thesubject’s eyes and ourown to adapt to thedark.

c. For the estimationunder near totaldarkness, completelycover the tip of thepenlight with yourfinger or thumb, so thatonly a reddish glow andno white emerges.

Demonstrate this.

d. Bring the glowing redtip up toward thesubject’s left eye untilyou can distinguish thepupil from the coloredportion of the eye (iris).

e. Position thepupillometer alongsidethe pupil (left eye first)and locate the circle orsemi-circle that isclosest in size to thepupil.

Select a student to participatein demonstrations of darkroompupil measurements.

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f. Repeat the procedure forthe subject’s right eye.

g. For the estimationunder direct light bringthe light from the side ofthe subject's face, thencompletely uncover thetip of the penlightshinning the beam intothe subject’s eye. Hold itthere for 15 seconds.

h. Bring the pupillometerup alongside the lefteye, and find the circleor semi-circle that isclosest in size to thepupil.

Demonstrate this.

Emphasize that the penlightshould be positioned so that thebeam just "fits" orapproximately fills the eyesocket.

i. Repeat the procedure forthe right eye.

5. Normal sizes for the pupil.

a. Since we estimate pupilsize under threedifferent lightingconditions; Room Light,Near Total Darkness,and Direct Light, therange of pupil sizes willvary.

IV-13(ResearchValues)

6. Basic Concepts Relative toInterpreting Pupil Sizes.

a. It is important tounderstand a few basicconcepts relative tointerpreting pupil sizes.

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Understanding theseconcepts will allowDRE’s to betterunderstand therelationship of pupil sizeto impairment

b. Mean Values andAverage Ranges:Scientifically validatedstudies were conductedto determine normativevalues for pupil size innon-impaired persons.These studies showwhat one would expect aperson to exhibit whentheir pupil sizes arechecked under differentlighting conditions.Sometimes averagemeans “in the middle”,or sum of all numbersdivided by the numberin a particular group.What we use forinterpretation purposesare “average ranges” ofpupil sizes.

c. As a DRE, you will bemaking your decision ofimpairment based onclinical, psychophysical,and behavioralindicators. This includesusing pupil sizes as oneof the factors indetermining thatimpairment.

d. With many people, evenunder very bright light,the pupils won’tconstrict much below a

Point out that when all of thestudy subjects were tested, themajority (approximately 88%)of the “normal” non-impairedpeople fell within the “averageranges.”

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diameter of 2.5 mm, andeven under near totaldark conditions, thepupils usually onlydilate to a diameter ofnot more than 8.5 mm.

IV-14(Research)

e. Studies have indicatedthere are significantdifferences between theaverage pupil size inthese three conditions.

Consequently, the use ofthree distinct pupil sizeranges for each of thedifferent testingconditions may be moreuseful to determineimpairment vs. non-impairment.

Point out: That although thereare several studies thatindicate these pupil sizes are“for the majority of normal,non-impaired people”, there isone study in particular thatspecifies the average size andranges:

“An Evaluation of Pupil SizeStandards Used By PoliceOfficers for Detecting DrugImpairment” JAOA, March2004, Richman, McAndrew,Decker & Mullaney.

IV-15 (RoomLight)

1. Room Light isapproximately 4.0 mm withan average range of normalsizes ranging from 2.5 to 5.0mm.

IV-16 (NearTotalDarkness)

2. Near Total Darkness isapproximately 6.5 mm withan average range of normalpupil sizes ranging from 5.0to 8.5 mm.

IV-17(Direct Light)

3. Direct Light isapproximately 3.0 mm withan average range of normalpupil sizes ranging from 2.0to 4.5 mm.

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d. Many drugs, however,will affect the dilation orconstriction of the pupilsand many cause thepupil size to go outsidethese normal ranges.

Point out that specific drugcategories and theirrelationship to pupil sizes willbe covered later.

6. The check of the pupil's reactionto light takes place at the sametime as the test of pupil sizeunder direct light.

a. Observe the subject's pupilsize as the penlight is aimedat the side of the subject'sface.

Demonstrate this using aparticipant-volunteer.

b. As you bring the beam oflight directly into thesubject's eye, note how thepupil reacts. Demonstrate this.

c. Under ordinary conditions,the pupil should react veryquickly, and constrictnoticeably when the lightbeam strikes the eye.

Point out that pupillaryreaction to light should occurwithin one second.

d. Under the influence ofcertain categories of drugs,the pupil's reaction may bevery sluggish, or there maybe no constriction at all.


e. Students' initial practice inmeasuring the pupil'sreaction to light.

Instruct the students to workin pairs, taking turns shiningthe light into each other's eyeand observing the pupil'sreaction.

Remind students to positionthe penlight so that the beamexactly "fits" the eye socketwhen the beam is broughtdirectly into the eye.

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Allow the practice to continuefor only about 2 minutes.

Solicit students' comments andquestions concerning the eyeexaminations.

15 Minutes

C. Demonstrations

1. Demonstrate equal tracking andequal pupil size.

2. Demonstration of HorizontalGaze Nystagmus.

Select two students to comebefore the class.

a. Check for lack of smoothpursuit.

Instruct one student to demon-strate the administration ofHGN to the other student.

b. Check for distinct andsustained nystagmus atmaximum deviation.

Coach and critique the student-administrator's performance.

Make sure that the student-administrator checks both eyes.

c. Estimation of the angle ofonset.

When the participant-administrator has completedthe HGN test, instruct thestudent-administrator to drawthe student-subject's eye to anangle of 35 degrees. Check theaccuracy of this estimate, usingthe template.

Excuse the two students andthank them for participating.

3. Demonstration of Vertical GazeNystagmus and Lack ofConvergence.

Select two other students tocome before the class.

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Instruct one student to checkthe other for Vertical GazeNystagmus.


Instruct the second student tocheck the eyes of the firststudent for Lack ofConvergence.



4. Demonstration of pupil sizeestimation and test for reactionto light.


a. Pupil size estimation underroom light.

Instruct one student toestimate the other's pupilsunder room light.


b. Darkroom estimations ofpupil size.

o near total darkness o direct light

Instruct the second student todemonstrate how to performthe dark room estimations ofpupil size.


Point out that assessment ofthe pupil's reaction to lighttakes place in conjunction withthe direct-light estimation.


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IV-18(NormalRangesRecap)

c. To review, the normalranges for non-impairedpeople are:

Room Light: 4.0 mm with anaverage range of 2.5 - 5.0mm.

Near Total Darkness: 6.5mm with an average rangeof 5.0 - 8.5 mm.

Direct Light: 3.0 mm withan average range of 2.0 - 4.5mm.

Solicit students' comments andquestions concerning thedemonstrations of the eyeexaminations and the pupilsize ranges.

10 Minutes

D. Relationship of Drug Categoriesto the Eye Examinations

Note: Draw the Matrix at theend of this session on the dryerase board or flip-chart at theoutset of this segment.

1. Three of the seven drugcategories normally will causeHorizontal Gaze Nystagmus.

Ask the students which drugcategories normally induceHGN.

a. CNS Depressants, Inhalantsand Dissociative Anesthetics normally will cause HGN.

Along the "HGN" line on thematrix, write "PRESENT"under the columns forDepressants, DissociativeAnesthetics and "YES" forInhalants.

b. The other four categoriesnormally will not cause HGN.

Write "NONE" on the "HGN"line under the other columns.

2. Any drug that will cause HGNalso will cause Vertical GazeNystagmus, if a high enoughdose of the drug is taken.

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a. So, Depressants, Inhalantsand DissociativeAnesthetics, can all causeVertical Gaze Nystagmus athigher doses for thatindividual.

Along the "VERT NYST" line,write "PRESENT" under thecolumns for those threecategories.

b. But if a drug will not causeHGN, then it also will notcause Vertical GazeNystagmus.

Write "NONE" for "VERTNYST" under the other fourcolumns.

3. All drugs that cause nystagmusalso will cause the eyes to beunable to converge.

a. Therefore, Depressants,Inhalants and DissociativeAnesthetics, including PCPand its analogs, usually willcause Lack of Convergence.

Write "PRESENT" along the"LACK CONV" line under thecolumns for those threecategories.

b. Interestingly, there is onecategory of drug that doesnot cause nystagmus butthat does usually causeLack of Convergence.

Ask students which categorythat is.

c. Cannabis usually does causelack of convergence, eventhough it does not causenystagmus.

Write "PRESENT" along the"LACK CONV" line under"CANNABIS".

d. The other three categoriesdo not cause a Lack ofConvergence.

Write "NONE" along the lineunder the remaining threecolumns.

4. An interesting and importantfact is that the drugs that causenystagmus usually don't affectpupil size, and the drugs thatdon't cause nystagmus usuallydo affect pupil size.

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a. CNS Stimulants andHallucinogens usually causethe pupils to become larger or "dilated".

Write "DILATED" along the"PUPIL SIZE" line under thecolumns for CNS Stimulantsand Hallucinogens.

b. Cannabis may cause thepupils to dilate.

Write "DILATED" under the"CANNABIS" column; how-ever, explain they may also beNORMAL. (Exception #6)

c. Narcotic Analgesics usuallycause the pupils to becomesmaller or "constricted".

Write "CONSTRICTED" underthe "NARCOTICS" column.

d. Dissociative Anesthetics andmost Inhalants tend to leavepupil size in the normalranges.

Write "NORMAL" under thecolumns for DissociativeAnesthetics and Inhalants. BUT POINT OUT THATSOME INHALANTS WILLCAUSE PUPIL DILATION.(Exception #4)

e. CNS Depressants alsousually leave the pupilsnear normal.

Write "NORMAL" under the"DEPRESSANT" column.

f. However, there are someexceptions, i.e., depressantdrugs that usually dilate thepupils.

Ask students whichdepressants causes pupildilation.

g. Methaqualone, or"Quaaludes" and Somausually cause pupil dilation.

Put a (1) next to the"NORMAL" in the"DEPRESSANT" column, andexplain that this exception #1;Soma and Quaaludes usuallydilate pupils.

Solicit students' questions andcomments.

5. Generally, the pupillaryreaction to light is either slowedby the effect of the drug or thepupil reacts normally. The most

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HS 172A R1/07 IV-29

significant exception is theeffect caused by NarcoticAnalgesics. Though there isalways some reaction to light, inlive subjects, the constrictedpupil caused by narcotics makesit difficult to perceive a changein the pupil size.

a. CNS Depressants and CNSStimulants usually cause aslowed reaction to light.

Write "SLOW" under thecolumns for CNS Stimulantsand Depressants.

b. With Hallucinogens,Dissociative Anesthetics andCannabis the pupillaryreaction to light is usuallynormal.

Write "NORMAL" under thecolumns for Hallucinogens,Dissociative Anesthetics andCannabis.

Point out that certainpsychedelic amphetaminescause slowing of the pupils;Exception #3.

c. Due to the constrictednature of the pupils whenunder the influence ofNarcotic Analgesics, it isdifficult to perceive areaction to light. As a resultwe list reaction to light forNarcotic Analgesics as“little or none visible”.

Write "LITTLE OR NONEVISIBLE” under NarcoticAnalgesics.

d. Inhalants may cause aslowed reaction or thepupils may react normallydepending on the substanceused.

Write "SLOW" in the columnfor inhalants and explain thatthis is only a general rule.

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HS 172A R1/07 IV-30

DEPRESS STIMULS HALLUCS D/A NARCOTS INHALS CANNABIS HGN ____ __ __

VGN ____ __ __

LACK CONV. ____ __ __

PUPIL SIZE ____ __ __

RCTN-LIGHT ____ __

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HS 172A R1/07 IV-31

REVIEW QUESTIONS

1. Name the three clues of impairment associated with Horizontal GazeNystagmus.

1. Lack of smooth pursuit 2. Distinct and sustained nystagmus atmaximum deviation 3. Onset of nystagmus prior to 45 degrees

2. Complete this formula:

BAC = 50 - ????Angle of onset

3. Which categories of drugs will not cause Vertical Gaze Nystagmus?

CNS Stimulants, Hallucinogens, Narcotic Analgesics, Cannabis

4. Which categories of drugs usually will cause Lack of Convergence?

CNS Depressants, Inhalants, Dissociative Anesthetics, Cannabis

5. Name the three lighting conditions under which a DRE makes pupil sizeestimations.

Room light, Near total darkness, Direct light

6. What is the normal range of pupil size for room light?

2.5-5.0 mm

7. Which categories of drugs will usually slow down the reaction of the pupils tolight?

CNS Depressants, CNS Stimulants, Inhalants

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HS 172A R1/07 IV-31

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HS 172A R1/07 V-1

Two Hours

SESSION V

ALCOHOL WORKSHOP

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HS 172A R1/07 V-2

SESSION V ALCOHOL WORKSHOP


o Administer the psychophysical tests and the eye examinations to personswho have consumed varying amounts of alcohol.

o Document the results of these tests and examinations.

o Accurately assess the extent of a person's alcohol impairment based on thetests and examinations.


A. Assignments and Procedures o Hands-on Practice

B. Testing o Student-led Presentations

C. Feedback and Discussion

D. Alcohol Workshop Checklist

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HS 172A R1/07 V-3

120 Minutes

V-1(Title)

V-2 (Objectives)

ALCOHOL WORKSHOP Display Session Title

Discuss the objectives of theAlcohol Workshop.

INSTRUCTOR NOTE: Themain emphasis of the alcoholworkshop is to evaluate thestudent’s proficiency in theadministration of SFSTs.

15 Minutes

A. Assignments and Procedures

1. Team assignments.

a. One member will be anexaminer and willcomplete all portions ofthe exam.

b. One member will be therecorder and documentthe findings of theexamination on theevaluation form.

Group the participants intoteams. The number of stu-dents in each team isdetermined by dividing thetotal number of students by thetotal number of volunteerdrinkers. Example: if thereare 23 students and 7 volun-teer drinkers, form five teamsof three members and twoteams of four members.

c. All others in the groupwill observe/coach.

d. Each team member willconduct at least onecomplete examination.

(NOTE: All volunteer drinkersmust read and sign the"Statement of InformedConsent" form prior toreceiving any alcohol.)

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HS 172A R1/07 V-4

2. Explanation of testingprocedures.

a. Each team will conductthe following sequence oftests and examinationson each volunteer:

Write the sequence of tests andexaminations on dry eraseboard or flip-chart.

V-3(TestingProcedures)

o HGN (record angleof onset in each eye)

o Vertical Gaze

Nystagmus

o Lack of Convergence

o Romberg Balance

o Walk and Turn

o One Leg Stand(standing on left leg)

Emphasize that the team willadminister each test only onceto each volunteer, e.g., only onemember of a team willadminister the HGN test to aparticular volunteer.

Emphasize that the tests andexaminations are to be given inthe order listed for allvolunteers.

o One Leg Stand(standing on rightleg)

o Finger to Nose

b. Teams will record theresults of each test andexamination.

c. Upon completing the testand examinations, theteam members willrecord their bestestimate as to thevolunteer's BAC.

Solicit questions about thetesting procedures.

Hand out test recording formsto the teams if available.

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HS 172A R1/07 V-5

75 Minutes

B. Testing Monitor the testing to ensurecompliance with theprocedures.

Always allow a team tocomplete the full sequence oftests and examinations beforesending the volunteer toanother team.

Offer coaching and construc-tive criticism as appropriate.

30 Minutes

C. Feedback and Discussion Transcribe on the board thematrix found at the end of thissession to be completed duringthe discussion phase of theworkshop.

For each volunteer, select oneteam to report in detail on eachtest and examinationadministered to that volunteer.

Call upon students to reporttheir best estimates as to thatvolunteer's BAC.

Inform the students of theresults of that volunteer'sbreath tests.

Continue this process until allvolunteers have been reportedupon.

Solicit students' questions andcomments.

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HS 172A R1/07 V-6

Drinker’sName

Below .05 .05 - .09 .10 - .14 .15 or Greater

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HS 172A R1/07 VI-1

Three Hours

SESSION VI

EXAMINATIONS OF VITAL SIGNS

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HS 172A R1/07 VI-2

SESSION VI EXAMINATIONS OF VITAL SIGNS


o Define basic terms relevant to pulse rate and blood pressuremeasurements.

o Measure pulse rate.

o Measure blood pressure.

o Relate the expected results of vital signs examinations to the various categories of drugs.


A. Purposes of the Examinations o Instructor-Led Presentations

B. Procedures and Cues o Instructor-Led Demonstrations

C. Demonstrations o Hands-on Practice

D. Normal Ranges of Vital Signs

E. Relationship of Drug Categories tothe Vital Signs Examinations

F. Practice

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180 Minutes

VI-1 (Title)

VI-2(Objectives)

EXAMINATIONS OF VITAL SIGNS



5 Minutes

A. Purposes of theExaminations

1. The vital signs that are relevantto the drug evaluation andclassification process include:

a. Pulse rate b. Blood pressure c. Temperature

Point out these vital signs onthe wallchart.

2. Different types of drugs affectthese vital signs in differentways.

a. Certain drugs tend to "speedup" the body and elevatethese vital signs.

Clarification o pulse may quicken o blood pressure may rise o temperature may rise

b. Other drugs tend to "slowdown" the body and lowerthese vital signs.

Clarification o pulse may slow o blood pressure may drop

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o temperature may fall

3. Systematic examination of thevital signs gives us much usefulinformation concerning thepossible presence or absence ofvarious categories of drugs.

Point out that for purposes ofstandardization, the pulse andblood pressure readings will beobtained using the left arm if atall possible.

75 Minutes

B. Procedures and Cues

VI-3 (PulseDefinitions)

1. Measurement of pulse rate.

a. Pulse is the expansion andrelaxation of an arterygenerated by the pumpingaction of the heart.

b. Pulse rate is the number ofpulsations in an artery perminute.

Point out that pulse rate isequal to the number of contrac-tions of the heart per minute.

c. An artery is a strong, elasticblood vessel that carriesblood away from the heart .

d. A vein is a blood vessel thatcarries blood back to theheart.

e. When the heart contracts, itsqueezes blood out of itschambers into the arteries.

f. The surging blood causesthe arteries to expand.

g. By placing your fingers onthe skin next to an arteryand pressing down, you can

Emphasize: The "surge" can befelt as the blood is squeezedfrom the heart through an

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HS 172A R1/07 VI-5

feel the artery expand as theblood surges through.

artery. The pulse cannot befelt in a vein.

h. By keeping your fingers onthe artery and counting thenumber of pulses that occurin one minute, you willmeasure the pulse rate.

Demonstrate this, by holdingyour fingers on your own radialartery.

i. Pulse is easy to measure,once you locate an arteryclose to the surface of theskin.

VI-4 (RadialArtery)

j. One convenient pulse pointinvolves the radial artery.

o The radial artery can belocated in or near thenatural crease of thewrist, on the side of thewrist next to the thumb.

Point to the radial artery pulsepoint on your own wrist.

o Hold your left hand out,with the palm down.

Demonstrate this.

o Place the tips of yourright hand's index fingerand middle finger intothe crease of your leftwrist, and exert a slightpressure.

Demonstrate this.

o Allow your left hand tocurl downward.

Demonstrate this.

o You should be able tofeel the pulse in yourradial artery.

Ask students whether they canfeel their pulses. Coach anystudents who have difficulty inlocating the pulse.

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VI-5(BrachialArtery)

k. Another pulse point involvesthe brachial artery.

o The brachial artery canbe located in the crook ofthe arm, halfwaybetween the center ofthe arm and the side ofthe arm closest to thebody.

Point to the brachial arterypulse point in your own arm.

Instruct students to roll uptheir sleeves, if necessary, toexpose their brachial arterypulse points.

o Hold your left hand out,with the palm up.

Demonstrate this.

o Place the tips of yourright hand's index andmiddle fingers into thecrook of your left arm,close to the body, andexert a slight pressure.

Demonstrate this.

o You should be able tofeel the pulse in yourbrachial artery.

Ask students whether they canfeel their pulses. Coach anystudents who have difficultylocating the pulse.

l. Another pulse point involvesthe carotid artery.

VI-6 (CarotidArtery)

o The carotid artery canbe located in the neck,on either side of theAdam's apple.

Point out the carotid arterypulse point on your own neck.

o Place the tips of yourright hand's index andmiddle fingers alongsidethe right side of your“Adam's Apple”.

Demonstrate this.

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HS 172A R1/07 VI-7

o You should be able tofeel the pulse in yourcarotid artery.

Ask students whether they canfeel their pulses. Coach anystudents who have difficultylocating the pulse.

m. Basic Do's and Don'ts ofmeasuring pulse.

o Don't use your thumb toapply pressure whilemeasuring a subject'spulse.

Point out that there is anartery located in the thumb. Ifyou apply pressure with thethumb, you may be actuallymeasuring your own pulseinstead of the subject’s.

o If you use the carotidartery pulse point, don'tapply pressure to bothsides of the Adam'sApple: this can cut offthe supply of blood tothe brain.

o When measuring thepulse rate, use 30seconds as the standardtime interval.

Point out that pulse rate isalways expressed as "beats perminute". If you count the beatsduring an interval of 30seconds, you must double theresult to obtain the pulse rate. The pulse reading should notbe an odd number.

n. Students' initial practice atmeasuring pulse rate.

Instruct students to work inpairs, taking turns measuringeach other's pulse.

Tell students to record onpaper their partner's pulserates.


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HS 172A R1/07 VI-8

Allow the practice to continuefor only about 5 minutes.

Print the following lists on thedry erase board or flip-chart:

50 or less 76-78 52-54 80-82 56-58 84-86 60-62 88-90 64-66 92-94 68-70 96-98 72-74 100 or more

Tabulate the numbers ofstudents whose pulse rateswere in each of the listedintervals.

Point out that the "normalrange" of pulse rate is 60-90beats per minute.

VI-7 (BloodPressureDefinitions)

2. Measurement of blood pressure.

a. Blood pressure is the forcethat the circulating bloodexerts on the walls of thearteries.

b. Blood pressure changesconstantly as the heartcontracts and relaxes.

c. Blood pressure reaches itsmaximum as the heartcontracts and sends theblood surging through thearteries. This is called thesystolic pressure.

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HS 172A R1/07 VI-9

d. Blood pressure reaches itsminimum when the heart isfully expanded. This iscalled the diastolic pressure.

e. It is always necessary tomeasure and record both thesystolic and diastolic bloodpressure.

Remind students that "systolic"is the higher number,"diastolic" the lower number.

Memory aid: Systolic: "S" for "Superior"Diastolic: "D" for "Down"

f. The device used formeasuring blood pressure iscalled asphygmomanometer.

Write"SPHYGMOMANOMETER" onthe dry erase board or flip-chart.

Exhibit a sphygmomanometer.

g. The sphygmomanometerhas a special cuff that canbe wrapped around thesubject's arm and inflatedwith air pressure.

Select a student to come beforethe class. Have the student sitin a chair facing the class, androll up a sleeve (if necessary) toexpose the left bicep.

Wrap the cuff around thestudent-volunteer's arm andinflate it.

h. As the pressure in the cuffincreases, the cuff squeezestightly on the arm.

Ask the student-volunteerwhether they can feel thepressure of the cuff.

i. When the pressure gets highenough, it will squeeze theartery completely shut.

Ask students: "What artery islocated in the crook of thearm?" (Point to that locationon the student-volunteer'sarm).

j. Blood will cease flowingthrough the brachial artery. And, since the brachialartery "feeds" the radial

Release the pressure in the cuffon the student-volunteer's arm.

000139


HS 172A R1/07 VI-10

artery, blood will also ceaseflowing through the radialartery.

k. If we slowly release the airin the cuff, the pressure onthe arm and on the arterywill start to drop.

l. Eventually, the pressurewill drop enough so thatblood will once again startto flow through the artery.

Ask students: "How far mustthe pressure in the cuff dropbefore the blood can start tosqueeze through the artery?"

o Blood will start flowingin the artery once thepressure inside theartery equals the pres-sure outside the artery.

o The two pressures willbecome equal when theair pressure in the cuffdrops down to thesystolic pressure.

o When that happens,blood will spurt throughthe artery each time theheart contracts.

Ask students: "What wouldhappen if we allowed thepressure in the cuff to dropdown to the systolic level, andheld the air pressure at thatlevel?"

Point out that the blood wouldspurt through the artery eachtime the heart contracted, butwould cease flowing when theheart expanded.

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Ask students: "How far downmust the air pressure in thecuff drop before the blood willflow through the arterycontinuously?"

o Once the air pressure inthe cuff drops down tothe diastolic level, theblood will flowcontinuously throughthe artery.

VI-8 (BP Basics)

m. Overview of procedures formeasuring blood pressure.

o Apply enough airpressure to the cuff tocut off the flow of bloodthrough the artery.(Approximately 180mmHg)

Demonstrate, using thestudent-volunteer (applypressure to the cuff). As DREswe usually inflate the cuff untilthe manometer shows areading of approximately 180mmHg.

o Slowly release the airpressure until the bloodjust begins to spurtthrough the artery: thatlevel will be the systolicpressure.

o Continue to release theair pressure until theblood flows continuouslythrough the artery: thatlevel will be the diastolicpressure.

Slowly release the pressure inthe cuff.

Emphasize that the pressureshould drop at approximately 2mmHg per second. (5 sec foreach 10 mm drop)

Ask students: (1) "How can we tell when

the blood starts to spurtthrough the artery?"

000141


HS 172A R1/07 VI-12

(2) "How can we tell whenthe blood is flowingcontinuously through theartery?"

n. We can listen to thespurting blood, using astethoscope. Exhibit a stethoscope.

o Apply the stethoscope tothe skin directly abovethe artery.

Demonstrate, using thestudent-volunteer.

o Apply pressure to thecuff, enough to cut offthe flow of blood.

Inflate the cuff on thestudent-volunteer's arm.

o When no blood isflowing through theartery, we hear nothingthrough the stethoscope.

o Slowly release the airfrom the cuff, letting thepressure start to drop.

Release the air in the cuff.

o When we drop to thesystolic pressure, westart to hear a spurtingsound.

NOTE: This begins as a clear,tapping sound.

o As we continue to allowthe air pressure to drop,the surges of bloodbecome steadily longer.

NOTE: The sounds take on aswishing quality, and becomefainter.

o When we drop to thediastolic pressure, theblood flows steadily andall sounds cease.

Excuse the student-volunteerand thank him or her forparticipating.

VI-9(Korotkoff)

o. The sounds that we listen toare called Korotkoff Sounds.

Named after Dr. NikolaiKorotkoff, a Russian physicianwho introduced the method of

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HS 172A R1/07 VI-13

They are divided into five(5) phases.

determining blood pressure in1905.

o Phase 1 - the firstappearance of clear,tapping sounds thatgradually increase inintensity.

Point out that the beginning ofPhase 1 corresponds to thesystolic pressure.

o Phase 2 - the soundschange to a murmur andtake on a swishingquality.

o Phase 3 - the soundsdevelop a loud, knockingquality (not quite asclear as the Phase 1sounds).

o Phase 4 - the soundssuddenly becomemuffled and again havea faint swishing quality.

o Phase 5 - the soundscease.

Point out that the beginning ofPhase 5 corresponds to thediastolic pressure.

VI-10(Sphygmo-manometer)

p. Familiarization with thesphygmomanometer.

Hand out stethoscopes andsphygmomanometers (one pereach student is desirable. At aminimum, there should be onefor every four students).

o The compression cuffcontains an inflatablerubber bladder.

Point out the components of thesphygmomanometer on VisualVI-10.

o A tube connects thebladder to themanometer, or pressuregauge.

Clarification: The manometerdisplays the air pressure insidethe bladder.

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HS 172A R1/07 VI-14

o Another tube connectsthe bladder to thepressure bulb, which canbe squeezed to inflatethe bladder.

o The pressure controlvalve permits inflationof the bladder andregulates the rate atwhich the bladder isdeflated.

- To inflate thebladder, thepressure controlvalve must betwisted all the wayto the right.

Demonstrate this.

- When the valve istwisted all the wayto the right, air canbe pumped into thebladder, but no aircan escape from thebladder.

- To deflate thebladder, twist thevalve to the left.

- The more the valveis twisted to the left,the faster thebladder will deflate.

VI-11(Details ofBP)

q. Details of blood pressuremeasurement.

o Position the cuff on thebicep so that the tubesextend down the middleof the arm.

Select a student to serve as ablood pressure subject. Demonstrate the proceduresusing the student.

000144


HS 172A R1/07 VI-15

o Wrap the cuff snuglyaround the bicep.

o Clip the manometer(pressure gauge) on thesubject's sleeve, so thatit is readily viewable.

o Twist the pressurecontrol valve all the wayto the right.

o Put the stethoscopeearpieces in your ears.

o Place the diaphragm orbell of the stethoscopeover the brachial artery.

Make sure the earpieces areturned forward, i.e., toward thenose.

o Rapidly inflate the blad-der to approximately180 mmHg.

o Twist the pressurecontrol valve slightly tothe left to release thepressure slowly.

Emphasize the need to releasethe pressure slowly. If thepressure drops too fast, theneedle will sweep down thegauge too quickly to be readaccurately. The pressureshould be released at a speedthat takes one second for theneedle to move a singlegradation (i.e., 2 millimeters ofmercury) on the gauge.

o Keep your eyes on thegauge and listen for theKorotkoff sounds.

Point out that the needle on thepressure gauge generally will"bounce" slightly when bloodstarts to spurt through theartery.

Excuse the student and thankhim or her for participating. Solicit students' questions

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HS 172A R1/07 VI-16

concerning these procedures.

Point out that "normal" valuesof blood pressure are:

Systolic 120 - 140 Diastolic 70 - 90

Note, however, that "normal"people can have significantlydifferent blood pressures: there is wide variation inhuman blood pressure.

r. Do's and Don'ts of bloodpressure measurement:

o If you inflate thebladder and then needto repeat the measure-ment, wait at least threeminutes to allow thesubject's artery to returnto normal.

Point out that if difficulty isencountered in hearing theKorotkoff sounds, try havingthe subject raise his/her armand clench the fist to allowblood flow back to the heart.

o Hold the bell of thestethoscope with yourfingers; don't slide itunder the cuff: that willdistort themeasurement.

s. Students initial practice atmeasuring blood pressure.

If at least one sphygmo-manometer and stethoscope areavailable for every twostudents, instruct students topractice in pairs. Otherwise,assign students to practice inteams of 3 or 4 members.

3. Measurement of temperature.

VI-12(MeasuringTemp)

a. Temperature is measuredorally using a thermometer.

Exhibit this.

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HS 172A R1/07 VI-17

Point out that the "normal"range for body temperaturetaken orally is 98.6 degrees +/-1 degree.

b. Make sure that a freshdisposable mouthpiece isused each time.

Solicit students' comments andquestions concerning thisoverview of procedures andcues.

c. Ensure that the subject doesnot take any hot or coldliquids by mouth prior totaking the temperature.

Point out that hot and coldliquids immediately prior to thetemperature examination mayeffect the result.

15 Minutes

C. Demonstrations

1. Pulse rate measurementdemonstrations.

Select two students to comebefore the class.

a. Radial artery pulse point. Instruct the first student tomeasure the second's pulseusing the radial artery pulsepoint. (Simultaneously, theinstructor should measure thesubject's pulse using a carotidartery pulse point).

b. Carotid artery pulse point. Instruct the second student tomeasure the first's pulse usingthe carotid artery pulse point. (Simultaneously, the instructorshould measure the subject'spulse using a radial arterypulse point.)


2. Blood pressure measurementdemonstrations.


000147


HS 172A R1/07 VI-18

Instruct the first student tomeasure the second's bloodpressure.

Have the students reverseroles.


IV-13(NormalRanges ofVital Signs)

D. Normal Ranges of Vital Signs

1. Normal human vital signs varybetween individuals. However,the DEC program has identifieda set of “normal” ranges for eachof the three vital signexaminations used in the druginfluence evaluation process.The ranges used in the DECprogram are normally a bitwider than those used by themedical profession. DEC normalranges:

a. Pulse rate: 60 to 90 beats per minute

b. Blood Pressure: Systolic: 120 - 140 mmHgDiastolic: 70 - 90 mmHg

c. Body Temperature: 98.6degrees, plus or minus 1degree.

Remind students that the“normal” ranges identified forthe DEC program have beenestablished through years ofresearch and with medicalinput. However, normal rangesmay vary from individual toindividual and are normally alittle wider than those used bythe medical profession.

15 Minutes

E. Relationship of DrugCategories to the Vital SignsExaminations.

Note: Draw the Matrix (at theend of this session) on the dryerase board or flip-chart at theoutset of this session.

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HS 172A R1/07 VI-19

1. All seven categories of drugsordinarily will affect pulse rateand blood pressure.

2. Some categories usually willlower pulse and blood pressure.

Ask the students whichcategories will lower pulse rateand blood pressure.

a. CNS Depressants andNarcotic Analgesics usuallylower pulse and BP.

Write "DOWN" on the pulseand blood pressure lines underthe columns for Depressantsand Narcotics.

Point out that ETOH andQuaaludes may cause the pulseto increase.

3. The other five categories alltend to elevate pulse rate.

4. Most of the drug categories thatelevate pulse rate also elevateblood pressure.

Write "UP" on the pulse lineunder the five remainingcolumns.

a. CNS Stimulants, Hallucino-gens, DissociativeAnesthetics and Cannabisall usually cause bloodpressure to rise.

Write "UP" on the bloodpressure line for those fourcategories.

b. The vast majority ofInhalants -- namely, thevolatile solvents and theaerosols -- also elevate bloodpressure.

c. But the remaining smallgroup of Inhalants -- theanesthetic gases -- actuallylower the blood pressure.

Remind students that theanesthetic gases include suchthings as nitrous oxide, amylnitrite and ether.

d. So for Inhalants, the effecton blood pressure will be upor down.

Write up/down with thefootnote - down with anestheticgases, up with volatile solventsand aerosols on the blood

000149


HS 172A R1/07 VI-20

pressure line under theInhalants column.

5. Three of the categories usuallywill cause the body temperatureto rise.

Ask students which categoriesusually cause an elevation inbody temperature.

a. The drug PCP and itsanalogs from theDissociative Anestheticscategory usually increasesbody temperature; PCPusers have been known toremove their clothing to cooldown.

Write "UP" on the "TEMP" lineunder the DissociativeAnesthetics column.

b. CNS Stimulants andHallucinogens also willusually increase bodytemperature.

Write "UP" on the "TEMP" linefor CNS Stimulants andHallucinogens.

6. The effect of Inhalants on bodytemperature depends on thespecific substance that isinhaled.

Write "up/down/or normal" onthe "TEMP" line for Inhalants.

a. Some inhalants may causetemperature to increase orbe down.

b. But other inhalants may

leave the temperature nearnormal.

7. One category usually causesbody temperature to be lowered.

Ask students which categoryusually lowers temperature.

a. Narcotic Analgesics usuallylower body temperature.

Write "DOWN" on the "TEMP"line for Narcotics.

8. The remaining two categoriesusually do not affecttemperature.

Write "NORMAL" on the"TEMP" line for Depressantsand Cannabis. Solicit students' questions andcomments.

000150


HS 172A R1/07 VI-21

70 Minutes

F. Practice

1. Assignments and procedures.

a. Team assignments.

b. Explanation of practiceprocedures:

Group the students into teamsof three (3) members each. Each team must have at leastone blood pressure kit.

o Teammates will taketurns measuring eachother's pulse rate andblood pressure.

o Each student will writedown every measure-ment he or she makesand the time at whichthe measurement wasmade.

o Whichever member ofthe team is not engagedin taking the measure-ment or in serving asthe "suspect" will act asa coach and offer appro-priate constructivecriticism to his or herteammate.

o Practice will continueuntil each student hastaken at least threecomplete pulse andblood pressure measure-ments on bothteammates.

Solicit questions about thepractice procedures.

2. Testing (students testingstudents).

Monitor the practice to ensurecompliance with theprocedures. Offer coaching and constructivecriticism as appropriate.

000151

HS 172A R1/07 VI-22

DEPRESS STIMULS HALLUCS D/A NARCOTS INHALS CANNABIS

PULSE BLOOD PRESS

TEMP

000152

HS 172A R1/07 VI-23

REVIEW QUESTIONS 1. Where is the radial artery pulse point?

Crease of the wrist

2. Why should you never attempt to feel a subject's pulse with your thumb?

You can mistakenly measure your own pulse 3. Does an artery carry blood to the heart or from the heart?

Away from the heart

4. What does the symbol "Hg" represent?

Mercury (Hydrargyrum)

5. What is diastolic pressure?

The pressure when the heart relaxes

6. When do the Korotkoff Sounds begin?

At the systolic level when the blood begins to spurt through thebrachial artery

7. Name and describe the major components of a sphygmomanometer.

Compression Cuff, Pressure bulb, Manometer, Pressure control valve,Tubes

8. Which of the seven categories of drugs generally will cause pulse rate to beelevated?

CNS Stimulants, Hallucinogens, Dissociative Anesthetics, Inhalants,Cannabis

9. What is the normal range of body temperature?

98.6 +/- 1 degree

000153

HS 172A R1/07 VI-24

10. For how long must a DRE count the beats to obtain a measurement of pulserate?

30 seconds

11. What is the normal range of pulse rate?

60-90 bpm

12. Which categories of drugs usually lower body temperature?

Narcotic Analgesics

13. What is the normal range for the higher value of blood pressure? What is thenormal range for the lower value?

120-140/70-90

000154

HS 172A R1/07 VI-25

000155

HS 172A R1/07 VI-26

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HS 172A R1/07 VI-27

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HS 172A R1/07 VII-1

Seventy-Five Minutes

SESSION VII

OVERVIEW OF SIGNS AND SYMPTOMS

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HS 172A R1/07 VII-2

SESSION VII OVERVIEW OF SIGNS AND SYMPTOMS


o Give examples of specific drugs belonging to the seven drug categories.

o Describe the major signs and symptoms of impairment associated with eachcategory.


A. CNS Depressants o Interactive Discussions

B. CNS Stimulants

C. Hallucinogens

D. Dissociative Anesthetics

E. Narcotic Analgesics

F. Inhalants

G. Cannabis

H. Wrap-Up

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HS 172A R1/07 VII-3

75 Minutes

VII-1 (Title)

VII-2(Objectives)

OVERVIEW OF SIGNS ANDSYMPTOMS



Note: Prior to the start of thissession, draw the matrix foundat the end of this session on thedry erase board or flip-chart.

1. Sign: An observable ordetectable indicator of druginfluence. (i.e., dilated pupils,vital signs)

Frequently the term "objectivesymptoms" is used in lawenforcement to refer to "signs".

2. Symptom: A subjective indica-tor of drug influence that isreported by the drug-impairedsubject. (i.e., "I feel nauseous.")

10 Minutes

A. CNS Depressants

1. Central Nervous SystemDepressants is a category thatincludes many different drugs.

Ask students to name someexamples of CNS Depressants. Make sure that the examplesgiven include alcohol, somebarbiturates and sometranquilizers.

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HS 172A R1/07 VII-4

2. Indicators of CNS Depressantinfluence found in eye exams.

Ask students: "Do depress-antscause Horizontal GazeNystagmus?"

a. HGN usually will bepresent.

Write "Present" on the "HGN"line for Depressants.

Ask: "Do Depressants causeVertical Gaze Nystagmus?"

b. Vertical Gaze Nystagmusmay be present, especiallywith high doses (for thatindividual) of Depressants.

Write "Present" on the "VERTNYST" line for Depressants.Denote in parentheses above"(High Doses)".

Ask: "Do Depressants causethe eyes to be unable toconverge?"

c. Under the influence ofDepressants, Lack ofConvergence usually will bepresent.

Write "Present" on the "LACKCONV" line for Depressants.

Ask: "How do Depressantsaffect pupil size?"

d. Depressants usually do notaffect pupil size; therefore,Depressants usually leavethe pupils near normal insize.

Write "Normal" on the "PUPILSIZE" line for Depressants.

o But some specificDepressant drugs doaffect pupil size.

Ask: "What are theDepressants that affect pupilsize?"

o Methaqualone(Quaaludes) and Soma usually cause the pupilsto dilate.

Put a (1) next to "Normal" andwrite "Common exceptions:Soma and Quaaludes " belowthe matrix.

e. Depressants generally willcause pupillary reaction tolight to be sluggish.

Write "Slow" on the "RCTN-LIGHT" line for Depressants.

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HS 172A R1/07 VII-5

3. Indicators of CNS Depressantinfluence found in checks of thevital signs.

Ask: "How do Depressantsaffect pulse rate?"

a. Depressants usually lowerpulse rate.

Write "Down" on the "PULSE"line for Depressants.

o But some specificDepressant drugs mayelevate the pulse.

Ask: "What are theDepressants that may elevatepulse rate?"

o Methaqualone(Quaaludes) and alcoholmay cause an elevationin pulse rate.

Put a (2) next to "Down" andwrite "Quaaludes and ETOHmay elevate" below the matrix.

Ask: "How do Depressantsaffect blood pressure?"

b. Depressants usually lowerblood pressure.

Write "DOWN" on the "BLOODPRESS" line for Depressants.

Ask: "How do Depressantsaffect body temperature?"

c. Depressants usually leavetemperature near normal.

Write "Normal" on the "TEMP"line for Depressants.

Solicit students' questionsabout CNS Depressants.

10 Minutes

B. CNS Stimulants

1. The category called CentralNervous System Stimulantsincludes many drugs.

Ask students to name someexamples of CNS Stimulants. Make sure the examplesinclude cocaine and someamphetamines.

2. Indicators of CNS Stimulantinfluence found in eye exams.

Ask students: "Do CNSStimulants cause HorizontalGaze Nystagmus?"

a. HGN will not be present. Write "None" on the "HGN"line for CNS Stimulants.

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HS 172A R1/07 VII-6

Ask: "Do CNS Stimulantscause Vertical GazeNystagmus?"

b. Vertical Gaze Nystagmuswill not be present.

Write "None" on the "VERTNYST" line for CNSStimulants.

Ask: "Do CNS Stimulantscause the eyes to be unable toconverge?"

c. Under the influence of CNSStimulants, the eyes shouldstill be able to converge;therefore, lack of conver-gence will not be present.

Write "None" on the "LACKCONV" line for CNSStimulants.

Ask: "How do CNS Stimulantsaffect pupil size?"

d. CNS Stimulants usuallycause the pupils to dilate.

Write "Dilated" on the "PUPILSIZE" line for CNS Stimulants.

e. We have seen that CNSDepressants effect pupillaryreaction; similarly, CNSStimulants may cause aslowing in the pupillaryreaction to light.

Write "Slow" on the "RCTN-LIGHT" line for CNSStimulants.

3. Indicators of CNS Stimulantinfluence found in checks ofvital signs.

Ask: "How do CNS Stimulantsaffect pulse rate?"

a. CNS Stimulants usuallyincrease pulse rate.

Write "Up" on the "PULSE"line for CNS Stimulants.

Ask: "How do CNS Stimulantsaffect blood pressure?"

b. CNS Stimulants usuallyincrease blood pressure.

Write "Up" on the "BLOODPRESS" line for CNSStimulants.

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HS 172A R1/07 VII-7

Ask: "How do CNS Stimulantsaffect body temperature?"

c. CNS Stimulants usuallyelevate body temperature.

Write "Up" on the "TEMP" linefor CNS Stimulants.

d. Though not directly relatedto the vital signs, the evalu-ator may find the subjectsmuscle tone to be rigid withpossible body tremors. Agrinding of the teeth ,referred to as "bruxism",may also be noticed.

Point out that, as shown on thematrix, the signs of Stimulantinfluence are almost exactlyopposite to the signs ofDepressant influence.

Solicit students' questionsabout CNS Stimulants.

10 Minutes

C. Hallucinogens

1. Hallucinogens include somenaturally occurring substancesas well as some synthetic drugs.

Ask students to name somehallucinogenic drugs. Makesure the examples include somenatural Hallucinogens as wellas some synthetics.

2. Indicators of Hallucinogeninfluence found in eye exams.

Ask students: "Do Halluci-nogens cause Horizontal GazeNystagmus?"

a. HGN will not be present. Write "None" on the "HGN"line for Hallucinogens. Ask: "Do Hallucinogens causeVertical Gaze Nystagmus?"


Write "None" on the "VERTNYST" line for Hallucinogens.

Ask: "Do Hallucinogens causethe eyes to be unable toconverge?"

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HS 172A R1/07 VII-8

c. Under the influence of Hall-ucinogens, the eyes shouldstill be able to converge;therefore, lack of conver-gence will not be present.

Write "None" on the "LACKCONV" line for Hallucinogens.

Ask: "How do Hallucinogensaffect pupil size?"

d. Hallucinogens usually causethe pupils to dilate.

Write "Dilated" on the "PUPILSIZE" line for Hallucinogens.

e. Normally Hallucinogens donot effect pupillary reactionto light.

o However, psychedelicamphetamines willcause a slowing in thepupillary reaction.

Write "Normal" on the "RCTN-LIGHT" line for Hallucinogens.

Put a (3) next to "Normal", andwrite psychedelicamphetamines cause slowing.

3. Indicators of Hallucinogeninfluence found in checks ofvital signs.

Ask: "How do Hallucinogensaffect pulse rate?"

a. Hallucinogens usuallyincrease pulse rate.

Write "Up" on the "PULSE"line for Hallucinogens.

Ask: "How do Hallucinogensaffect blood pressure?"

b. Hallucinogens usuallyincrease blood pressure.

Write "Up" on the "BLOODPRESS" line for Hallucinogens.

Ask: "How do Hallucinogensaffect body temperature?"

c. Hallucinogens usuallyelevate body temperature.

Write "Up" on the "TEMP" linefor Hallucinogens.

Point out that, as shown on thematrix, the major signs ofHallucinogen influence areidentical to the major signs ofStimulant influence.

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HS 172A R1/07 VII-9

If we only had these majorsigns to go by, it would be im-possible to distinguish betweensomeone under the influence ofCNS Stimulants from someoneunder the influence ofHallucinogens.

Point out that, in their seven-day DRE School, the studentswill learn of more subtle indi-cators that help to distinguishHallucinogen influence fromStimulant influence. Butemphasize that it is oftendifficult to distinguish betweenthese two categories.

Solicit students' questionsabout Hallucinogens.

10 Minutes

D. Dissociative Anesthetics

1. The category called DissociativeAnesthetics consists of the drugPCP, its various analogs andDextromethorphan.

Ask students: "What does'analog' mean in this context?"

a. An 'analog' of PCP is a drugthat is a 'chemical firstcousin' of PCP; that is, it isa drug that has a slightlydifferent molecularstructure from that of PCP,but produces the sameeffects as PCP.

b. One of the most popularanalogs of PCP is the drugcalled Ketamine.

Write "Ketamine: An analog ofPCP" on the dry erase board orflip-chart.

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HS 172A R1/07 VII-10

c. Ketamine is a legally-manufactured (butcontrolled) drug that is usedas an anesthetic in somesurgical applications.

d. Some other analogs of PCPinclude Ketalar, Ketasetand Ketajet.

e. Dextromethorphan is a drugfound in numerous over-the-counter substances.

Point out thatDextromethorphan, also knownas DXM is a widely abusedsubstance and is easy to obtain.

2. Indicators of the DissociativeAnesthetic drug PCP and itsanalogs influence found in eyeexams.

Ask students: "Do DissociativeAnesthetics cause HorizontalGaze Nystagmus?"

a. HGN usually will bepresent, and often with avery early onset with thedrug PCP.

Write "Present" on the "HGN"line for DissociativeAnesthetics.

INSTRUCTOR NOTE: BothHGN and VGN were noted invarious DRE evaluationsconducted on persons impairedby DXM. Research has alsoconfirmed HGN in personsimpaired by DXM.

Ask: "Do DissociativeAnesthetics cause VerticalGaze Nystagmus?"

b. Vertical Gaze Nystagmususually will be present.

Write "Present" on the "VGN"line for DissociativeAnesthetics.

Ask: "Do DissociativeAnesthetics cause the eyes tobe unable to converge?"

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HS 172A R1/07 VII-11

c. Lack of Convergence usuallywill be present.

Write "Present" on the "LACKCONV" line for DissociativeAnesthetics.

Ask: "How does DissociativeAnesthetics affect pupil size?"

d. Dissociative Anesthetics donot normally affect pupilsize; therefore, a personunder the influence of aDissociative Anesthetic,such as PCP usually willhave pupils that are nearnormal in size.

Write "Normal" on the "PUPILSIZE" line for DissociativeAnesthetics.

INSTRUCTOR NOTE: ActualDRE evaluations conducted onpersons impaired by DXMresulted in pupils in the normalranges.

e. Dissociative Anestheticsnormally will not effectpupillary reaction to light.

Write "Normal" on the "RCTN-LIGHT" line for this category.

3. Indicators of DissociativeAnesthetic influence found inchecks of vital signs.

Ask: How do DissociativeAnesthetics affect pulse rate?"

a. Dissociative Anestheticsusually increases pulse rate.

Write "Up" on the "PULSE"line for this category.

Ask: "How do DissociativeAnesthetics affect bloodpressure?"

b. Dissociative Anestheticsusually elevates bloodpressure.

Write "Up" on the "BLOODPRESS" line for this category.

Ask: "How do DissociativeAnesthetics affect bodytemperature?"

c. PCP and its analogs usuallyelevate body temperature.Dextromethorphan may or

Write "Up" on the "TEMP linefor this category.

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HS 172A R1/07 VII-12

may not rise temperature. Point out that PCP tends toproduce the eye indicatorsassociated with Depressants,and the vital sign indicatorsassociated with CNSStimulants or Hallucinogens.

Solicit students' questionsabout Dissociative Anesthetics.

10 Minutes

E. Narcotic Analgesics

1. Narcotic Analgesics includesome natural derivatives ofopium as well as some syntheticdrugs.

Ask students to name someexamples of NarcoticAnalgesics. Make sure theexamples include some naturalopiates as well as somesynthetics.

2. Indicators of Narcotic Analgesicinfluence found in eye exams.

Ask students: "Do Narcoticscause Horizontal GazeNystagmus?"

a. HGN will not be present. Write "None" on the "HGN"line for Narcotics.

Ask: "Do Narcotics causeVertical Gaze Nystagmus?"


Write "None" on the "VGN" linefor Narcotics.

c. Under the influence ofNarcotics, the eyes shouldstill be able to converge;therefore, Lack ofConvergence usually is notpresent.

Ask: "Do Narcotics cause theeyes to be unable to converge?"

Write "None" on the "LACKCONV" line for Narcotics.

Ask: "How do Narcotics affectpupil size?"

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HS 172A R1/07 VII-13

d. Narcotic Analgesics usuallycause a very noticeableconstriction of the pupils.

Write "Constricted" on the"PUPIL SIZE" line forNarcotics.

e. Though there is alwayssome reaction to light, theconstricted pupils caused byNarcotic Analgesics make itnearly impossible toperceive a change in pupilsize. However, whenobserved it will generally belittle or none visible.

Write "Little or None Visible"on the "RCTN-LIGHT" line forNarcotics.

3. Indicators of Narcotic Analgesicinfluence found in checks ofvital signs.

Ask: "How do Narcotics affectpulse rate?"

a. Narcotics usually lowerpulse rate.

Write "Down" on the "PULSE"line for Narcotics.

Ask: "How do Narcotics affectblood pressure?"

b. Narcotics usually lowerblood pressure.

Write "Down" on the "BLOODPRESS" line for Narcotics.

Ask: "How do Narcotics affectbody temperature?"

c. Narcotics usually lowerbody temperature.

Write "Down" on the "TEMP"line for Narcotics.

Point out that Narcotics and Depressants tend to producesimilar indicators in the vitalsigns, but very differentindicators in the eyes.

Solicit students' questionsabout Narcotic Analgesics.

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HS 172A R1/07 VII-14

10 Minutes

F. Inhalants

1. The category of Inhalantsincludes a wide variety of gasesand fumes that have the powerto intoxicate.

Ask students to name somecommonly abused Inhalants.

2. Not all Inhalants affect theirusers in exactly the same way.

a. There is probably lessconsistency in the signs andsymptoms of Inhalants thanthere is with any othercategory.

b. When we talk of the signsand symptoms of Inhalants,we often must qualify ourstatements.

c. For example, we may saythat a particular effect willbe observed "for mostInhalants".

3. Indicators of Inhalant influencefound in eye exams.

Ask students: "Do Inhalantscause HGN"

a. With most Inhalants, HGNusually will be present.

Write "Present" on the "HGN"line for Inhalants.

Ask: "Do Inhalants causeVertical Gaze Nystagmus?"

b. With most Inhalants,Vertical Gaze Nystagmusmay be present, especiallywith large doses.

Write "Present" on the "VGN"line for Inhalants. Denote inparentheses above "(HighDoses)".

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HS 172A R1/07 VII-15

Ask: "Do Inhalants cause theeyes to be unable to converge?"

c. Under the influence ofInhalants, Lack ofConvergence usually will bepresent.

Write "Present" on the "LACKCONV" line for Inhalants.

Ask: "How do Inhalants affectpupil size?"

d. The effect of Inhalants onpupil size depends on theparticular substanceinhaled.

o Most Inhalants usuallyleave the pupils nearnormal in size.

o Some Inhalants may

cause pupil dilation.

Write "Normal" on the "PUPILSIZE" line for Inhalants.

Put a (4) next to "Normal", andwrite "Normal, may be dilated."below the matrix.

e. Depending on the substanceused, Inhalants may cause aslowed reaction to light orthe pupils may reactnormally. However, themost frequently observedeffect will be a sluggishreaction to light.

Write "Slow" on the "RCTN-LIGHT" line for Inhalants.

4. Indicators of Inhalant influencefound in checks of vital signs.

Ask: "How do Inhalants affectpulse rate?"

a. Inhalants usually elevatepulse rate.

Write "Up" on the "PULSE"line for Inhalants.

Ask: "How do Inhalants affectblood pressure?"

b. Most Inhalants usuallyelevate blood pressure, butsome lower blood pressure.

Write "Up/Down" on the"BLOOD PRESS" line forInhalants. Put a (5) Next to

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HS 172A R1/07 VII-16

"Up/Down" and write downwith "Anesthetic Gases and“UP” with "Volatile Solventsand Aerosols".

Ask: "How do Inhalants affectbody temperature?"

c. The effects of Inhalants ontemperature depend on theparticular substanceinhaled.

Write "Up/Down/or Normal" onthe "TEMP" line for Inhalants.

Solicit students' questionsabout Inhalants.

10 Minutes

G. Cannabis

1. Indicators of Cannabis influencefound in eye exams.

Ask students: "Does Cannabiscause Horizontal GazeNystagmus?"

a. HGN will not be present. Write "None" on the "HGN"line for Cannabis.

Ask: "Does Cannabis causeVertical Gaze Nystagmus?"


Write "None" on the "VERTNYST" line for Cannabis.

Ask: "Does Cannabis cause theeyes to be unable to converge?"

c. Under the influence ofCannabis, Lack of Conver-gence will be present.

Write "Present" on the "LACKCONV" line for Cannabis. Point out that Cannabis is theonly category that causes Lackof Convergence but does notcause nystagmus.

Ask: "How does Cannabisaffect pupil size?"

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HS 172A R1/07 VII-17

d. Under the influence ofCannabis, the pupils may bedilated or possibly normal insize.

Write "Dilated" on the "PUPILSIZE" line for Cannabis.

Put a (6) next to "Dilated", andwrite "Possibly normal".

e. The pupillary reaction tolight will appear normalwhen under the influence ofCannabis.

Write "Normal" on the "RCTN-LIGHT" line for Cannabis.

2. Indicators of Cannabis influencefound in checks of vital signs.

Ask: "How does Cannabisaffect pulse rate?"

a. Cannabis usually elevatespulse rate.

Write "Up" on the "PULSE"line for Cannabis.

Ask: "How does Cannabisaffect blood pressure?"

b. Cannabis usually elevatesblood pressure.

Write "Up" on the "BLOODPRESS" line for Cannabis.

Ask: "How does Cannabisaffect body temperature?

c. Cannabis usually leavestemperature near normal.

Write "Normal" on the "TEMP"line for Cannabis.

Solicit students questionsabout Cannabis.

5 Minutes

H. Wrap-Up Point out that the matrixsummarizes the major signs ofdrug influence that areexamined by DREs. Butemphasize there are othersigns that a DRE considers inreaching a determination as tothe category or combination ofdrugs affecting a particularsubject.

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HS 172A R1/07 VII-18

These additional signs will becovered in depth during theseven-day DRE School.Solicit students' questions.

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HS 172A R1/07 VII-19

DEPRESS STIMULS HALLUCS D/A NARCOTS INHALS CANNABIS HGN

VGN

LACK CONV

PUPIL SIZE

RCTN- LIGHT

PULSE RATE

BLOOD PRESS

TEMP

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HS 172A R1/07 VII-20

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HS 172A R1/07 VIII-1

One Hour and Thirty Minutes

SESSION VIII

ALCOHOL AS A DRUG

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SESSION VIII ALCOHOL AS A DRUG

Upon successfully completing, this session the student will be able to:

o Describe a brief history of alcohol.

o Identify common types of alcohols.

o Describe the physiologic processes of absorption, distribution andelimination of alcohol in the human body.

o Describe dose response relationships that impact on alcohol's impairingeffects


A. A Brief Overview of Alcohol o Instructor-led Presentations

B. Physiological Processes o Oral Quiz

C. Dose-Response Relationships

D. Questions for Review

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90 Minutes

VIII-1(Title)

VIII-2(Objectives)

ALCOHOL AS A DRUG Display Session Title

Briefly review the objectives,content and learning activitiesof this session.

POSE this question to theclass: "This is a course on drugimpairment recognition; whydo we have a session onalcohol?"

GUIDE the students'responses to bring out theseand other appropriate points:

(1) Alcohol is a drug, and infact is the mostcommonly abused drug.

(2) As DREs, the studentswill often encounterpersons who are underthe combined influence ofalcohol and some otherdrug.

(3) Point out: Byunderstanding the basicfundamental concepts ofhow alcohol effects thebody, students will gain abetter understanding ofthe concept of how drugseffect the body.

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25 Minutes

A. A Brief Overview of Alcohol

VIII-3(Alcohol)

1. The word "alcohol" refers to anumber of distinct but similarchemicals.

a. Each of the chemicals thatis called an "alcohol" iscomposed of the threeelements: hydrogen, carbon,and oxygen.

b. Each of the "alcohols" is adrug within the scope of ourdefinition.

Clarification: All of the"alcohols" are chemicals thatimpair driving ability.

c. But only one can betolerated by the humanbody in substantialquantities.

Clarification: Most "alcohols"are highly toxic, and will causeblindness or death if consumedin significant quantities. Onlyone is intended for humanconsumption.

ASK STUDENTS: What arethe names of some of thechemicals that are "alcohols"?

VIII-4 (Some Types)

2. Three of the more commonly-known "alcohols" are Methyl,Ethyl and Isopropyl.

a. Methyl Alcohol, also knownas Methanol, or "woodalcohol".

b. Ethyl Alcohol, also knownas Ethanol, or "beveragealcohol".

EMPHASIZE: Ethanol is theonly kind of alcohol thathumans can tolerate insignificant quantities.

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c. Isopropyl Alcohol, alsoknown as Isopropanol, or"rubbing alcohol".

3. Ethanol is the kind of alcohol onwhich we will focus, because itis the only type intended forhuman consumption.

VIII-5(Ethanol)

a. Ethanol is the activeingredient in beer, winewhiskey and other alcoholicbeverages intended fordrinking.

b. Like all "alcohols", ethanolis composed of hydrogen,carbon and oxygen.

VIII-5(ETOH)

c. Chemists use a number ofdifferent symbols torepresent ethanol.

d. We will stick with thesymbol "ETOH".

4. Ethanol has been around for along time. People drank it longbefore they learned to write.

Instructor, for your informa-tion: The "ET" represents"ethyl", and the "OH"represents an oxygen atom andhydrogen atom, bondedtogether in what the chemistsrefer to as the "hydroxyradical". All alcohols have anhydroxy radical in theirmolecules.

VIII-6 (Production)

5. Ethanol is a naturally occurringdrug. That is, it is producedthrough a process calledfermentation.

Selectively reveal the first partonly.

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a. In fermentation, spores of yeast,carried by the wind, come incontact with fruit or grain thathas fallen to the ground.

b. Sugars in the fruit or grainchemically react with the yeast,and produce ethanol.

POINT OUT that humansalmost certainly firstencountered ethanol that hadbeen produced accidentally inthis fashion.

6. Of course, today we don't sitaround waiting for the wind tobring yeast to fallen fruit: Mostfermentation takes place onpurpose, under controlledconditions.

7. Through the process offermentation, we can produce abeverage that has, at most,about 14% ethanol.

ASK STUDENTS: "Why can'tfermentation produce a higherethanol concentration than14%?"

a. When the ethanolconcentration reaches 14%,the yeast die, sofermentation stops.

VIII-6(Distillation)

b. If we want to have a higherconcentration ethanol bever-age, we have to use anotherstep in the production.

Reveal the lower part of visual.

8. Distillation is the process usedto produce a higherconcentration of ethanol.

a. In distillation, a fermentedbeverage is heated to thepoint where the ethanolbegins to boil.

POINT OUT that ethanolstarts to boil at a lowertemperature than does water.

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b. The ethanol vapor is collec-ted and allowed to cool untilit turns back into a liquid.

c. By repeating the process ofheating the liquid andcollecting and cooling thevapors, higher and higherconcentrations of ethanolcan be produced.

d. Ethanol beverages that areproduced by distillation arecalled distilled spirits.

ASK STUDENTS to namesome "distilled spirits" (e.g.,whiskey; vodka; gin; rum; etc.)

9. Over the centuries in whichpeople have produced ethanol,some standard sized servings ofdifferent beverages haveevolved.

VIII-7A(Standard -Beer)

a. Beer is usually served in 12-ounce cans or bottles. Sincebeer averages an ethanolconcentration of fourpercent, a can or bottlecontains a bit less than one-half ounce of pure ethanol.

Reveal only the "beer" part.

VIII-7B(Standard -Wine)

b. Wine typically is served in afour-ounce glass. At anethanol concentration of 12percent, the glass of winealso has just a bit less thanone-half ounce of pureethanol.

Reveal the "wine" part ofvisual.

c. Whiskey and other distilledspirits are dispensed in a"shot" glass, which usuallycontains one and one-quarter ounces of liquid.

Reveal the "whiskey" part ofvisual.

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VIII-7C(Standard -Whiskey)

d. Since whiskey usually hasan ethanol concentration of40%, a "shot" of whiskey hasexactly one-half ounce ofpure ethanol.

POINT OUT that the "proof" ofa distilled spirit is equal totwice the ethanolconcentration.

10. For all practical purposes,standard sized servings of beer,wine and whiskey all pack thesame "punch".

SOLICIT students commentsand questions on this overviewof alcohol.

35 Minutes

B. Physiologic Processes

VIII-8(Alcohol/DrugAbuse)

1. Alcohol is the most abused drugin the United States.

2. Ethanol is a Central NervousSystem Depressant:

a. It doesn't impair until itgets into the brain.

b. It can't get into the brainuntil it first gets into theblood.

c. It can't get into the blooduntil it first gets into thebody.

Point out: This concept is truewith all drugs that impair.

3. There are a number of ways inwhich alcohol can get into thebody.

a. It can be injected into avein, via hypodermic needle.

b. It can be inhaled, i.e.,alcohol fumes can be

Point out that a person wouldhave to inhale concentrated

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brought into the lungs, andsome molecules will passinto the blood.

c. It could also be inserted asan enema and ingested byquickly passing from thelarge intestine into theblood.

alcohol fumes for a prolongedperiod of time in order todevelop a significant bloodalcohol concentration.

VIII-9(Absorption)

d. But the vast majority oftimes that alcohol gets intothe body, it gets their viadrinking.

4. Once the alcohol is in thestomach, it will take two routesto get into the blood.

VIII-9A

a. One interesting thing aboutalcohol is that it is able topass directly through thestomach walls.

POINT to that "route ofpassage" on visual.

b. Under normal conditions,about 20% of the alcohol aperson drinks gets into theblood by diffusing throughthe walls of the stomach.

VIII-9B

c. But most of the alcoholusually passes through thebase of the stomach into thesmall intestine, fromwhich it passes quickly intothe blood.

POINT to that "route ofpassage" on visual.

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HS 172A R1/07 VIII-10

5. Another interesting thing aboutalcohol is that it does not haveto be digested before it can movefrom the stomach to the smallintestine.

a. When a person eats food,the food must remain for atime in the stomach.

b. Acids and enzymes in thestomach must begin tobreak down the food toprepare it to pass to thelower portion of thegastrointestinal track.

VIII-9C c. While the initial digestiveprocess is underway, amuscle at the base of thestomach will constrict, andshut off the passage to thesmall intestine.

POINT to the pylorus on thevisual.

d. That muscle is called thepylorus, or pyloric valve.

6. Since alcohol doesn't have to bedigested, the pylorus does notconstrict when alcohol entersthe stomach.

a. If we drink on an emptystomach, the pylorus stayswide open.

b. The alcohol will passimmediately through thebase of the stomach, into thesmall intestine, and quicklymove into the bloodstream.

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HS 172A R1/07 VIII-11

7. But what will happen if there isfood in the stomach when theperson drinks alcohol?

POSE this question to theclass.

VIII-9D

a. Food will cause the pylorusto constrict.

b. While the pylorus is closed,nothing will move from thestomach to the smallintestine.

c. Any alcohol that is in thestomach will be "trapped"there, along with the food.

d. The alcohol will not get intothe blood as quickly, and theblood alcohol concentra-tionwill not get as high, as if thedrinking had been done onan empty stomach.

e. While the alcohol is trappedin the stomach, the acidsand enzymes will start toreact with it and break itdown.

f. By the time the pylorusopens, some of the alcoholwill have been chemicallychanged, so there will beless available to get into theblood.

SOLICIT students' commentsand questions about theabsorption of alcohol into theblood.

VIII-10A(Distribution)

9. Once the alcohol gets into theblood, the blood will carry it tothe various tissues and organsof the body.

Reveal top part only.

000188


HS 172A R1/07 VIII-12

VIII-10B (BasicPrinciple)

a. Alcohol is attracted to water. The blood will deposit thealcohol in all the parts of thebody where water is found.

Now reveal lower part ofvisual.

b. Parts of the body that havea lot of water will receive alot of alcohol.

c. Parts of the body that haveonly a little water willreceive little alcohol.

VIII-11(Which Parts ..)

10. Which parts of the body have alot of water?

a. The brainb. The liverc. Muscle tissued. The kidney

POSE this question, and solicitresponses from students. Then, display the first part ofvisual.

VIII-11A

11. Which parts contain very littlewater?

a. Bonesb. Fatty tissue

POSE this question and solicitresponses from students. Then, display the second partof visual.

VIII-11B

12. The muscle tissue will receive arelatively high proportion of thealcohol that a person drinks.

POINT to "muscle tissue" onvisual.

VIII-11C

13. The fatty tissue will receivevery little of the alcohol.

POINT to "fatty tissue" onvisual.

000189


HS 172A R1/07 VIII-13

VIII-11D(Theaverage..)

14. Here is an interesting andsignificant difference betweenmen and women: pound-for-pound, the average male hasmuch more water in his bodythan the average female.

NOW REVEAL the last part ofvisual.

ASK students to suggest whythis significant differenceexists.

a. The female body has morefatty tissue than does themale body.

b. Pound-for-pound, theaverage female has more fatand less muscle than doesthe average male.

Clarification: the female'sextra fatty tissue serves as a"shock absorber" and thermalinsulator to protect a baby inthe womb.

c. Since fatty tissue has verylittle water, the averagefemale, pound-for-pound,has less water than theaverage male.

d. This means that the averagewoman has fewer places inher body in which to depositthe alcohol she drinks.

15. The woman's blood alcoholconcentration will be higherthan the man's, because she hasless water in which to distributethe alcohol.

ASK STUDENTS: Suppose awoman and a man who weighexactly the same drink exactlythe same amount of alcoholunder exactly the sameconditions. Who will reach thehigher BAC?

Solicit students' comments andquestions about thedistribution of alcohol in thebody.

VIII-12(Elimination)

16. As soon as alcohol gets into thebody, the body begins workingto get rid of it.

Reveal only the top part ofvisual.

000190


HS 172A R1/07 VIII-14

VIII-12A(Direct ...)

a. Some alcohol is simplyexpelled directly from thebody, i.e., on the breath, inthe sweat, in urine, etc.

Reveal the middle part ofvisual.

b. Relatively little of thealcohol we drink is directlyexpelled from the body.

Clarification: Only about 2-10% of the alcohol we consumeis directly excreted in thebreath, urine, etc.

VIII-12B

c. The body eliminates most ofthe alcohol by chemicallybreaking it down.

ASK STUDENTS: What organin the body is primarilyresponsible for chemicallybreaking the alcohol down?

Reveal the bottom part ofvisual.

d. The liver is primarilyresponsible for breakingdown, or metabolizing, thealcohol.

Clarification: Some metabolismof alcohol also takes place inother parts of the body,including the brain. But theliver does the vast majority ofthe job.

VIII-13A(Metabolism)

17. Metabolism of alcohol actuallyconsists of a slow, controlledburning of the alcohol.

Reveal the first "bullet" ofvisual.

a. In the burning process, thealcohol combines withoxygen.

Reveal the second "bullet".

VIII-13B

b. The liver has an enzymecalled alcohol dehydro-genase, which helps to speedup the reaction of oxygenwith the alcohol.

Clarification: The enzyme doesnot react with the alcohol itself,but simply makes it easier forthe oxygen to react with thealcohol. The technical term forsomething that helps achemical reaction while not

000191


HS 172A R1/07 VIII-15

itself taking part in thereaction is a catalyst.

Alcohol dehydrogenase is acatalyst for the metabolism ofalcohol.

VIII-13C

c. The reaction of alcohol withoxygen ultimately producescarbon dioxide and water,which can be directlyexpelled from the body.

Reveal the third "bullet".

VIII-13D

d. The speed with which theliver burns alcohol variesfrom person to person, andwill change from time totime for any particularperson.

Reveal the final "bullet".

e. BUT ON THE AVERAGE: Due to metabolism, aperson's BAC will drop byabout 0.015 per hour.

POSE this problem to the class:

Suppose a person reaches apeak BAC of 0.15. How longwill it take for his or her bodyto eliminate all of the alcohol?

Answer: ten hours[0.15-(X hours)(0.015/hour) X =10]

18. For the average male, a BAC of0.015 is equal to the alcoholcontent of about two-thirds of a"standard drink".

a. i.e., about two-thirds of acan of beer.

000192


HS 172A R1/07 VIII-16

b. Or about two-thirds of aglass of wine, or two-thirdsof a shot of whiskey.

19. For the average woman, a BACof 0.015 is equal to the alcoholcontent of only one-half of a"standard drink".

a. So the average male can"burn up" about two-thirdsof a drink in an hour.

b. But the average female canonly burn up about one-halfof a drink in an hour.

c. In other words: Suppose aperson gulps down a can ofbeer, or a glass of wine, or ashot of whiskey; if theperson is an average man, itwill take him about an hourand one-half to burn up thatalcohol; if the person is awoman, it will take herabout two hours.

20. How can we speed up the metabolism of alcohol?


a. We can't speed it up.

b. Drinking coffee won't help.

c. A cold shower won't help.

d. Exercise won't help.

21. Our livers take their own sweettime burning the alcohol.

Solicit students' comments andquestions about the elimina-tion of alcohol from the body.

000193


HS 172A R1/07 VIII-17

10 Minutes

C. Symptomatology of Alcohol Note: Prior to the start of thissession, draw the followingchart on the dry erase board orflip-chart.

ALCOHOL HGN > present VGN > (high dose) present LACK CONV > present PUPIL SIZE > normal

RCTN- LIGHT > slow PULSE RATE > down BLOOD PRESS > down TEMP > normal

Point out that ETOH mayelevate the pulse rate in lowerBAC levels.

1. Indicators of Alcohol influencefound in Eye Exams.

Ask students: "What categoryof drugs is alcohol most closelyassociated?"

a. HGN will be present. Write "Present" on the "HGN"line.

Ask: "Does Alcohol causeVertical Gaze Nystagmus?"

b. Vertical Gaze Nystagmusmay be present, especiallywith high doses (for thatindividual) of alcohol.

Write "Present" on the "VGN"line. Denote in parentheses"(High Doses)".

000194


HS 172A R1/07 VIII-18

Ask: "Does alcohol cause theeyes to be unable to converge?"

c. Under the influence ofalcohol, Lack ofConvergence frequently willbe present.

Write "Present" on the "LACKCONV" line.

Ask: "How do Depressantsaffect pupil size?"

d. Alcohol does not affect pupilsize; therefore, alcoholusually leaves the pupilsnormal in size.

Write "Normal" on the "PUPILSIZE" line.

e. Alcohol will cause pupillaryreaction to light to besluggish.

Write "Slow" on the "RCTN-LIGHT" line.

2. Indicators of alcohol influencefound in checks of vital signs.

Ask: "How does alcohol affectpulse rate?"

a. Pulse rate will normally bedown. However, somesubjects have been found tohave elevated pulse rates atlower BACs..

Write "Down”on the "PULSE"line. Refer to matrix exceptionfor pulse.

Ask: "How does Alcohol affectblood pressure?"

b. Blood pressure response toalcohol will normally bedown.

Write "Down" on the "BLOODPRESS" line.

Ask: "How does alcohol affectbody temperature?"

c. Alcohol usually leavestemperature near normal.

Write "Normal" on the "TEMP"line.

Solicit students' questionsabout the signs and symptomsof alcohol.

000195


HS 172A R1/07 VIII-19

20 Minutes

D. Dose-ResponseRelationships

VIII-14A(BAC)

1. What does "Blood AlcoholConcentration" mean?

(Reveal only the question at thetop)

Solicit students' responses.

VIII-14B

a. Blood alcohol concentrationmeans the number of gramsof pure ethanol that arefound in every 100milliliters of a person'sblood.

Reveal the middle part ofvisual.

b. A gram is a measure ofweight; it takes almost 500grams to make a pound.

Instructor, for yourinformation: It actually takes454 grams to make a pound.

c. A milliliter is a measure ofvolume. It takes about 500milliliters to make a pint.

Example: A 12-ounce can ofbeer has about 350 milliliters.

VIII-14C

d. The so-called "illegal limit"of BAC is 0.08 in all states.

e. If a person has a BAC of0.08, it means there is 0.08grams (g) of ethanol in every100 milliliters (ml) ofhis/her blood.

Reveal the bottom part ofvisual.

Point out that in 2005, all 50states have adopted 0.08 BAC.

Point out that BAC results arereported in a variety of units. Two common variations aremilligrams/milliliters andpercent. There are 1000milligrams (mg) in one gram;therefore, 0.08 grams equals 80milligrams (mg) and a BAC of0.08 would be reported as 80mg of ethanol/100 ml of blood.

000196


HS 172A R1/07 VIII-20

Percent means parts of 100.

2. How much alcohol does a personhave to drink to reach a BAC of0.08?


a. Take an average maleweighing 175 pounds and inreasonably good physicalshape.

b. Assume he does his drink-ing on an empty stomach.

c. He would have to gulp downabout 4 or 5 cans of beer, or4 or 5 glasses of wine, or fiveshots of whiskey in a fairlyshort period of time to reach0.08 BAC.

d. In terms of pure ethanol,that would amount to justabout two and one-half fluidounces, or about two shotglasses.

DISPLAY two standard-sizedshot glasses, filled with water.

e. If these two shot glasseswere filled with pureethanol, we would have justenough of the drug to bringan average man to a BAC ofapproximately 0.10.

HOLD up the two shot glasseswhile posing the next question.

f. So answer this: Does it takea lot of ethanol to impair aperson, or only a little? Solicit students' responses to

the question.

3. In one respect, it certainlydoesn't take much ethanol toimpair: Just two full shotglasses will more than do thetrick for a full-sized man. HOLD up the glasses again.

000197


HS 172A R1/07 VIII-21

4. BUT COMPARED TO OTHERDRUGS, it takes an enormousquantity of ethanol to causeimpairment.

VIII-15A(Grams...)

5. In order to compare ethanol toother drugs, we have to reviewsome more units of weight.

Reveal only the first "bullet".

VIII-15B

a. We're already familiar withthe gram. It weighs onlyabout one five-hundredth ofa pound.

Now reveal the second "bullet".

b. The milligram is much lighter still;it takes one thousand milligrams tomake a gram.

Instructor, for your infor-mation: The prefix "milli"derives from the latin wordmille, meaning one thousand.

c. That means it takes nearlyfive hundred thousandmilligrams to make a pound.

VIII-15C

d. If one gram is equal to onethousand milligrams, thenone-tenth of a gram is equalto one hundred milligrams.

Now reveal the third "bullet".

Clarification: 100 is one-tenthof 1,000.

VIII-15D

e. So a person with a BAC of0.10 has 100 milligrams ofethanol in every 100milliliters of his or herblood.

Now reveal the remainder ofvisual.

000198


HS 172A R1/07 VIII-22

VIII-16A (More on ...)

f. That is exactly the same assaying there is onemilligram of ethanol inevery one milliliter of blood.

Reveal only the first "bullet".

6. Here is a new term: thenanogram.

a. It takes a million nano-grams to make a milligram.

VIII-16B

b. That means it takes onebillion nanograms to make agram.

Now reveal the parentheticsentence on visual.

VIII-16C

c. And that means that ittakes almost five hundredbillion nanograms to make asingle pound.

Now reveal the second "bullet"on visual.

VIII-16D

d. So if a person's BAC is 0.10,he or she has one millionnanograms of pure ethanolin every milliliter of blood.

Now reveal the question at thebottom of visual.

7. What kinds of concentrations ofother drugs does it take toproduce impairment?

Don't solicit responses to thisquestion; it is purely rhetorical.

VIII-17A(Drug ...)

8. IT IS MOST IMPORTANT tounderstand that we cannotstate exact correspondencesbetween alcohol concentrationsand other drug concentrations.

Reveal only the "alcohol"segment of the visual.

000199


HS 172A R1/07 VIII-23

a. For example, we can saythat someone with a bloodalcohol concentrationbetween 0.05 and 0.10 willexhibit significantimpairment, because thereis a large body of scientificresearch that backs up thatstatement.

VIII-17B

b. So we can say that researchshows that significant im-pairment will be found, withalcohol, at concentrations of500,000 to one millionnanograms per milliliter.

POINT to the alcohol line onvisual.

c. But we can't say exactlyhow much cocaine, or THC,or morphine or any otherdrug it would take toproduce exactly the sameimpairment that we wouldfind at 0.10 BAC.

d. In part, this is because wedo not have extensivescientific research for mostother drugs.

e. But also it is because manyother drugs do not impair inthe same way that alcoholimpairs.

EXAMPLE: Unlike alcohol,some other drugs (such as THCand PCP) readily deposit infatty tissue, and may continueto cause impairment even afterthey have cleared from theblood.

9. Nevertheless, based on theavailable research, it is possibleto make some generalstatements about drugconcentrations that can safelybe said to induce significant

000200


HS 172A R1/07 VIII-24

driving impairment.

VIII-17C

a. First example: Amphetamines

b. Researchers agree that if wehad two shot glasses full ofpure amphetamine, we'dhave enough to impair asmany as ten thousandpeople.

Reveal the Amphetamine lineon visual.

HOLD UP the two shot glassesagain.

ASK STUDENTS: What ifthese shot glasses were full ofpure THC, the activeingredient in Cannabis?

VIII-17D

c. Second example: Cannabis

d. Available evidence suggeststhat if these two littleglasses were full of pureTHC, we'd have enoughdrug to impair as many astwenty thousand people.

Reveal the Cannabis (THC)line on visual.

ONCE AGAIN, hold up the twoshot glasses.

ASK STUDENTS: But what ifthese glasses were full of pureLSD?

VIII-17E

e. Many researchers believethat significant impairmentresults from very low LSDconcentrations.

Reveal the LSD line on visual.

f. If these two glassescontained pure LSD, wecould impair up to onemillion people.

10. What does all this mean? NOTE: This is a rhetoricalquestion.

a. First, it means that, com-pared to alcohol, most otherdrugs are very powerful: Alittle goes a very long way.

b. Second, it means that labor-atories may be stretched to

Example: A person who is"only" carrying one fluid ounceof LSD (hold up one shot glass)would be capable of impairing"only" the entire population of,say, Wyoming.

000201


HS 172A R1/07 VIII-25

the limits of their techno-logic capabilities when wesend them samples and re-quest certain drug analyses.

c. All analytic techniques havedetection thresholds, i.e.,minimum concentrations ofdrugs that must be presentif a scientific confirmation ofthe presence of the drug isto be obtained.

d. If the concentration of thedrug is less than thedetection threshold, thelaboratory simply will not beable to confirm that thedrug is present.

e. The problem is that somepeople will be significantlyimpaired at drug concentra-tions that are below thelab's detection threshold.

f. What this means is that aDRE sometimes examines asubject, concludes correctlythat he or she is under theinfluence of a certain drugcategory, perhaps evenobtains an admission fromthe subject that he hastaken a drug, gets atoxicological sample andsends it off to the lab, onlyto have the lab report backthat “No drugs were found”.

11. When this happens to you -- andit will -- it is important that youdon't let yourself becomediscouraged.

000202


HS 172A R1/07 VIII-26

a. As a DRE, all you areexpected to do is the bestthat you can do, given thetools available.

b. You will never becomeperfect in your diagnosis ofdrug impairment.

c. There will be times whenyou will "miss" the fact thata subject is impaired.

d. And there may times whenyou will conclude that asubject is under theinfluence of a drug when, infact, he or she isn't.

e. We rely on the laboratory tocorroborate our opinions, tohelp make sure that aninnocent person is notpunished because of anhonest mistake in judgmenton our part.

f. The problem is that thelaboratory isn't perfecteither: The toxicologistswon't always be able tocorroborate your opinion,even though your opinion isaccurate.

SOLICIT students' commentsand questions about dose-response relationshipsinvolving alcohol and otherdrugs.

000203


HS 172A R1/07 VIII-27

10 Minutes

E. Questions for Review

Refer to the Question and Answer Keyon the following pages.

Direct students to turn to thereview questions, at the end ofSection VIII of their StudentManual.

POSE each question to theclass, and solicit responses. Make sure all students under-stand the correct answers.

SOLICIT students' commentsand questions about "Alcohol asa Drug".

000204

HS 172A R1/07 VIII-28

REVIEW QUESTIONS

1. Name three different chemicals that are alcohols. Which of these is beveragealcohol, intended for human consumption? What is the chemical symbol forbeverage alcohol?

Answers: Methyl, Ethyl and Isopropyl (or Methanol, Ethanol andIsopropanol or Wood Alcohol, Beverage Alcohol and Rubbing Alcohol).Ethanol is the beverage intended for human consumption. The fourletter chemical symbol for alcohol is ETOH.

2. What is the name of the chemical process by which beverage alcohol isproduced naturally? What is the name of the process used to produce high-concentration beverage alcohol?

Answers: Fermentation. Distillation.

3. Multiple Choice: "Blood alcohol concentration is the number of of alcohol in every 100 milliliters of blood."

A. gramsB. milligramsC. nanograms

Answer: Correct answer is A, “grams”

4. True or False: Pound-for-pound, the average woman contains more water thandoes the average man.

Answer: False. The average woman actually has a good deal less water,pound for pound, than the average man. She has about 55% water, heis about 68% water.

5. What do we mean by the "proof" of an alcoholic beverage?

Answer: “Proof” means twice the ethanol percentage of the beverage.For example, 80 proof vodka is 40% ethanol.

6. Every chemical that is an "alcohol" contains what three elements?

Answer: The three elements common to all alcohols are carbon,hydrogen and oxygen.

000205

HS 172A R1/07 VIII-29

7. True or False: Most of the alcohol that a person drinks is absorbed into theblood via the small intestine.

Answer: The statement is true. Under normal conditions, about 80% ofthe ethanol in the stomach will pass through the pyloric value into thesmall intestine, from which it will quickly move into the bloodstream.

8. What is the name of the muscle that controls the passage from the stomach tothe lower gastrointestinal tract?

Answer: The muscle is called the pylorus, or pyloric valve.

9. True or False: Alcohol can pass directly through the stomach walls and enterthe bloodstream.

Answer: The statement is true. Usually, about 20% of the ethanol aperson drinks diffuses through the stomach walls to enter the blood.

10. Multiple Choice: Suppose a man and a woman who both weigh 160 poundsarrived at a party and started to drink at the same time. And suppose that,two hours later, they both have a BAC of 0.10. Chances are ....

A. he had more to drink than she did.B. they drank just about the same amount of alcohol.C. he had less to drink than she did.

Answer: “A”, more to drink.

11. In which organ of the body does most of the metabolism of the alcohol takeplace?

Answer: The liver is where most metabolism takes place.

12. What is the name of the enzyme that aids the metabolism of alcohol?

Answer: Alcohol dehydrogenase is the enzyme that serves as a catalystfor alcohol’s metabolism in the liver.

13. Multiple Choice: Once a person reaches his or her peak BAC, it will drop at arate of about per hour.

A. 0.025 B. 0.015 C. 0.010

000206

HS 172A R1/07 VIII-30

Answer: “B”, 0.015 percent. (But remember, this is an average value,with wide variations among individuals).

14. Multiple Choice: If a person has a blood alcohol concentration of 0.10, thenthere are nanograms of alcohol in every milliliter of his or her blood.

A. one millionB. one hundred thousandC. ten thousandD. one thousandE. one hundred

Answer: “A”, one million

15. True or False: It takes about thirty minutes for the average 175-pound man to"burn off" the alcohol in one 12-ounce can of beer.

Answer: The statement is false. The average 175 pound man will needmore like ninety minutes to metabolize the alcohol.

000207

HS 172A R1/07 VIII-31

000208

HS 172A R1/07 VIII-32

000209

HS 172A R1/07 VIII-33

000210

HS 172A R1/07 IX-1

Thirty Minutes

SESSION IX

PREPARING FOR THE DRE SCHOOL

000211

HS 172A R1/07 IX-2

SESSION IX PREPARING FOR THE DRE SCHOOL

Upon successfully completing this session the student will be informed of thelogistical and other arrangements necessary for their participation in the seven dayDRE School.

000212

HS 172A R1/07 IX-3

SESSION IX GUIDE

Review the following points with the students:

a. Dates of the seven-day school

b. Location of the school

c. Dress code

d. Materials that the students should bring to the school

e. Transportation arrangement (if applicable)

f. Lodging arrangements (if applicable)

g. Recreational facilities and opportunities (if appropriate)

Tell the students to open their manuals to Session IX. Point out that a detaileddescription of "Things you will need at the DRE School" is presented there. Also point out that some very important suggestions of "things to do prior to theDRE School" are given there. Emphasize that the students will be expected tobe fully prepared when they come to the school. This is also a good time for thestudents to begin preparation of their professional Curriculum Vitae (C.V.). Aworksheet for the C.V. is provided on the following page and is located inSession IX of the DRE student manual.

000213

HS 172A R1/07 IX-4

DRE CURRICULUM VITAE (C.V.) WORKSHEET

Formal Education

High School

College

Specialized College / Vocational Courses

Formal Professional Training

Academy

Specialized Police Training

Other Specialized / Professional Training

Relevant Experience

Job Experience (Law Enforcement)

Other Job-related Experiences

Drug Enforcement / Evaluation Experience

Court Qualifications

Outside Readings - (relative to the DEC program)

000214

HS 172A R1/07 IX-5

000215

HS 172A R1/07 X-1

Forty-Five Minutes

SESSION X

CONCLUSION OF THE PRELIMINARY TRAINING

000216

HS 172A R1/07 X-2

SESSION X CONCLUSION OF THE PRELIMINARY TRAINING

Upon successfully completing this session the student will have:

o Demonstrated his or her knowledge of the concepts covered during the DREPre-School.

o Offered anonymous comments and criticisms concerning the school.

CONTENT SEGMENTS LEARNING ACTIVITIES A. Post-Test and Critique o Written Examinations

B. Certificates and Dismissal

000217


HS 172A R1/07 X-3

45 Minutes

X-1(Title)

X-2(Objectives)

CONCLUSION OF THEPRELIMINARY TRAINING



35 Minutes

A. Post-Test and Critique

1. Post-test Hand out copies of the post-test. Allow about 15 minutesfor students to complete thetest.

2. Critique Hand out copies of theStudent's Critique Form.

Allow about 15 minutes forstudents to complete thecritique.

3. Review of Post-test Go over the post-test questions. Limit this review to 10minutes. Instruct the studentsto retain the Pre-School post-test as a study guide for theupcoming DRE School. Collect the completed critiques.

000218


HS 172A R1/07 X-4

10 Minutes

B. Certificates and Dismissal Hand out certificates of coursecompletion.

Hand back the students'Certification Progress Logs,after making sure than aninstructor has signed the Pre-School line on each log. Remind the students that theymust bring the progress logswith them to the DRE School.

Tell the students to open theirmanuals to Session X. Pointout the "Post Test" that is giventhere. Emphasize that the"Post Test"is a very usefulstudy device that will helpthem get ready for the DRESchool. Urge them to take the"Test" as a self-study exerciseat least once between now andthe start of the school. Thank the students for theirparticipation.

000219

HS 172A R1/07 X-5

000220

Adm

inistrator’s Guide

Session IIntroduction and O

verviewSession II

Overview

of Drug Evaluation

& C

lassification Procedures

Session IIIThe Psychophysical Tests

Session IVThe Eye Exam

inations000261

Session VA

lcohol Workshop

Session VIExam

inations of Vital SignsSession VII

Overview

of Signs andSym

ptoms

Session VIIIA

lcohol As A

Drug

Session IXPreparing for the D

RE

School

000262

Session XC

onclusion of thePrelim

inary Training

Appendix

000263

_________________________________________________ ________________________Course Location Date

Preliminary Training For Drug Evaluation and ClassificationStudent’s Critique Form

A. Course Objectives

Please indicate whether you feel that you personally achieved the following courseobjectives.

Yes NoNotSure

Can you define the term “drug” and name the seven drugcategories?

Can you identify the twelve major components of the drugrecognition process?

Can you administer and interpret the psychophysical tests usedin a drug evaluation?

Can you conduct the eye examinations used in the evaluations?

Can you check the vital signs used in the evaluation?

Can you list the major signs and symptoms associated with eachdrug category?

Can you describe the history and physiology of alcohol as a drug?

B. Course Activities

Please rate how helpful each workshop session was for you personally. Also, pleaserate the quality of instruction (subject knowledge, instructional techniques andlearning activities). Use a scale from 1 to 5 where: 5=Excellent, 4=Very Good,3=Good, 2=Fair, 1=Poor.

Session/Activity Quality

Overview of Drug Evaluation and Classification Procedures

The Psychophysical Tests

The Eye Examinations

Alcohol Workshop

Examination of Vital Signs

Overview of Signs and Symptoms

Alcohol as a Drug

Preparing for the DRE School

000264

C. Course Design

Please indicate your own personal feeling about the accuracy of each statement.Agree Disagree Not Sure

1. I wish we had more practice with drinkingvolunteers.

2. There was too much “bull throwing” in thiscourse.

3. I now have a much better idea as to what thedrug recognition process is all about.

4. The course was at least one-half day too long.

5. I got a great deal of practical, usefulinformation from this course.

6. I’m still pretty confused as to what the drugrecognition process is all about.

7. I think I could do a pretty good job conducting adrug evaluation right now, without additionaltraining.

8. This course should have been at least one-halfday longer.

9. We spent too much time with the volunteerdrinkers session.

10. Some of the practice sessions in this coursewere dragged out a bit too much.

11. I don’t think that our instructors were as wellprepared as they should have been.

12. This course was a good review, but it reallydidn’t teach me anything new.

13. I am very glad that I attended this course.

14. The instructors seemed to be more interested inpracticing their teaching skills than in seeing toit that we learned what we were supposed tolearn.

15. I would have to say that this course was notquite as good as I expected it to be.

000265

D. Suggestions for Deletion and Additions

If you absolutely had to cut four hours out of this course, what would you delete orshorten?

If you could add four hours to this course, how would you spend the extra time?

E. Ratings of the Course and the Instructors

On a scale from 1 (=very poor) to 5 (=excellent), please give your opinion of thecourse as a whole.

The course as a whole: _______________________________

On a scale from 1 (=very poor) to 5 (=excellent), please give your opinion of eachinstructor.

Instructor Rating

F. Final Comments and Suggestions

Please offer any final comments that you wish to make.

R1/07

000266

PRINTING AND COLLATING GUIDETitle DRE Pre-School Instructor Manual - 01/07 Edition

Cover

Prints Stock Ink Size1 2 3 4

DescriptionNumber

of Pages

FirstPrintedPage

LastPrintedPage

BlankPage

Sizeof

Page

Special Instructions or Stock

Spine 1 Face Back 1 x 11 White Index - Color Print

Cover 1 Face Back 8 ½ x 11 White Index - Color Print

Table of Contents 1 1 1 8 ½ x 11

Tab - Administrator’s Guide 1 Face Back 8 ½ x 11 White Index - Black Print

Cover Page 1 1 1 8 ½ x 11

Table of Contents 1 1 1 8 ½ x 11

Contents 9 1 9 1 8 ½ x 11

Checklist 1 1 1 8 ½ x 11

Tab - Session I 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 17 I-1 I-17 1 8 ½ x 11

IACP Progress Log 2 1 2 8 ½ x 11

PPT Slides 2 1 2 8 ½ x 11

Tab - Session II 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 15 II-1 II-15 1 8 ½ x 11

PPT Slides 3 1 3 1 8 ½ x 11

Tab - Session III 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 17 III-1 III-17 1 8 ½ x 11


Tab - Session IV 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 24 IV-1 IV-24 8 ½ x 11


Tab - Session V 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 6 V-1 V-6 8 ½ x 11


Tab - Session VI 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 23 VI-1 VI-23 1 8 ½ x 11


Tab - Session VII 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 18 VII-1 VII-18 8 ½ x 11

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Tab - Session VIII 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 30 VIII-1 VIII-30 8 ½ x 11

PPT Slides 3 1 3 1 8 ½ x 11

Tab - Session IX 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 4 IX-1 IX-4 8 ½ x 11

Tab - Session X 1 Face Back 8 ½ x 11 White Index - Black Print

Contents 4 X-1 X-4 8 ½ x 11


Post Test 5 1 5 1 8 ½ x 11

Critique 3 1 3 1 8 ½ x 11

Total Blank Pages 19

Total Index Pages 196

Total Pages 215

Total Tabs 11

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