Unraveling the complexity of driving while intoxicated: a study into the prevalence of psychiatric and substance abuse comorbidity

Sex-specific analysis of traumatic brain injury events: applying computational and data visualization techniques to inform prevention and management

BACKGROUND

The interplay of host, agent, and environment implicated in traumatic brain injury (TBI) events is difficult to account for in hypothesis-driven research. Data-driven analysis of injury data can enable insight into injury events in novel ways. This research dissected complex and multidimensional data at the time of the TBI event by exploiting data mining and information visualization methods.

METHODS

We drew upon population-based decade-long health administrative data collected through the routine operation of the publicly funded health system in Ontario, Canada. We applied a computational approach to categorize health records of 235,003 patients with TBI versus the same number of reference patients without TBI, individually matched based on sex, age, place of residence, and neighbourhood income quantile. We adopted the basic concepts of the Haddon Matrix (host, agent, environment) to organize emerging factors significantly related to TBI versus non-TBI events. To explore sex differences, the data of male and female patients with TBI were plotted on heatmaps and clustered using hierarchical clustering algorithms.

RESULTS

Based on detected similarities, the computational technique yielded 34 factors on which individual TBI-event codes were loaded, allowing observation of a set of definable patterns within the host, the agent, and the environment. Differences in the patterns of host, agent and environment were found between male and female patients with TBI, which are currently not identified based on data from injury surveillance databases. The results were internally validated.

CONCLUSIONS

The study outlines novel areas for research relevant to TBI and offers insight into how computational and visual techniques can be applied to advance the understanding of TBI event. Results highlight unique aspects of sex differences of the host and agent at the injury event, as well as differences in exposure to adverse social and environmental circumstances, which can be a function of gender, aiding in future studies of injury prevention and gender-transformative care.

From phone use to speeding and driving under influence: Identifying clusters of driving risk behaviors as an opportunity for targeted interventions

Identifying the profile of risky behaviors among drivers is central to propose effective interventions. Due to the multidimensional and overlapping aspects of risky driving behaviors, cluster analysis can provide additional insights in order to identify specific subgroups of risk. This study aimed to identify clusters of driving risk behavior (DRB) among car drivers, and to verify intra-cluster differences concerning clinical and sociodemographic variables. We approached a total of 12,231 drivers and we included 6392 car drivers. A cluster algorithm was used to identify groups of car drivers in relation to the DRB: driving without a seat belt (SB), exceeding the speed limit (SPD), using a cell phone while driving (CELL), and driving after drinking alcohol (DUI). The algorithm classified drivers within five different DRB profiles. In cluster 1 (20.1%), subjects with a history of CELL. In cluster 2 (41.4%), drivers presented no DRB. In cluster 3 (9.3%), all drivers presented SPD. In cluster 4 (12.5%), drivers presented all DRB. In cluster 5 (16.6%), all drivers presented DUI. Clusters with DUI-related offenses (4 and 5) comprised more men (81.9 and 78.8%, respectively) than the overall sample (63.4%), with more binge drinking (50.9 and 45.7%) and drug use in the previous year (13.5 and 8.6%). Cluster 1 had a high years of education (14.4 ± 3.4) and the highest personal income (Md = 3000 IQR [2000-5000]). Cluster 2 had older drivers (46.6 ± 15), and fewer bingers (10.9%). Cluster 4 had the youngest drivers (34.4 ± 11.4) of all groups. Besides reinforcing previous literature data, our study identified five unprecedented clusters with different profiles of drivers regarding DRB. We identified an original and heterogeneous group of drivers with only CELL misuse, as well as other significant differences among clusters. Hence, our findings show that targeted interventions must be developed for each subgroup in order to effectively produce safe behavior in traffic.

Modeling Repeat DUI Offender Probation Outcomes Using the Wisconsin Risk Need Assessment

This multiyear study of felony driving while intoxicated (DWI) probationers explores the efficacy of the Wisconsin Risk Need Assessment tool along with sociodemographic factors as measures of probation outcomes. To date, few studies have explored the relationship between risk assessment data and technical violations as well as subsequent arrests of individuals on probation. The sample for this study consists of 596 chronic DWI offenders on community supervision in one county who either had been rearrested for a new offense, violated a technical condition of their probation, or committed no violations within the first 5 years of community supervision. The findings are that older defendants and those who had more dependents were more likely to have committed a technical violation compared with the other two groups. Those rearrested for a new offense were slightly younger compared with the other two groups, less likely to be employed and younger at the age of first adjudication of guilt. This study highlights the limited overall utility of the Wisconsin tool in determining probation outcomes and that static factors may be as important as dynamic factors when developing a supervision strategy for chronic DWI offenders.

Examining factors associated with postintervention recidivism in DUI repeat offenders after alcohol treatment: One-year follow-up study

Taiwan has deemed driving under the influence of alcohol (DUI) to be criminal, and offenders are subjected to fines and jail penalties without being offered alcohol-related treatment, although alcohol use problems are prevalent in this population. We followed the recidivism records of DUI repeat offenders for one year after they had received a newly established legal-medical joint intervention program for alcohol treatment and examined factors related to postintervention recidivism. In this study, 231 DUI repeat offenders with alcohol use problems screened out by the Alcohol Use Disorder Identification Test were referred from the prosecutors' office to one psychiatric hospital for SBIRT-based alcohol treatment. We divided the participants into two groups based on the official recidivism records within the year following the end of treatment. The study used a Cox proportional hazards model to examine the hazard ratio of the baseline clinical characteristics and intervention duration for post-treatment recidivism. The study used generalized estimation equation models to examine changes in psychological symptoms and drinking behaviors over time. We found that participants who recidivated in the next year after intervention did not differ from those without recidivism records in all measurements except for the length of duration they stayed in treatment. Survival analysis determined that participants who had received the intervention for >4 months showed significantly lower rates of one-year postintervention recidivism rates The study participants showed improved psychological symptoms and drinking behaviors during the follow-up period. In conclusion, adequate duration of alcohol treatment is a significant factor associated with a lower risk of postintervention recidivism. The results provide some insight into the design of a collaborative program between legal and medical systems to reduce DUI recidivism and improve mental health of DUI repeat offenders.

Evaluating the Computerized Assessment and Referral System (CARS) Screener: Sensitivity and Specificity as a Screening Tool for Mental Health Disorders among DUI Offenders

Background/Purpose: A growing body of evidence suggests that people who are arrested for driving under the influence (DUI) of alcohol are more likely to screen positive for psychiatric disorders than the general population. Additionally, psychiatric comorbidity has been shown to increase vulnerability to criminal re-offense. However, DUI programs face many barriers to screening for psychiatric disorders. This paper evaluates the sensitivity and specificity of a screening tool developed for these programs, the Computerized Assessment and Referral System (CARS) Screener. Methods: We used data from 381 DUI offenders in Massachusetts, as well as a secondary data source, the National Comorbidity Survey-Replication (NCS-R: N = 9,282) to examine the accuracy of the CARS Screener when compared to full assessment. Results: Based on both sets of analyses, we found that the CARS Screener offers a sensitive and specific method to screen for many psychiatric disorders. Specifically, the CARS Screener has a high sensitivity and specificity for bipolar disorder, intermittent explosive disorder, depressive disorders, generalized anxiety disorder, alcohol and drug use disorders, gambling disorder, post-traumatic stress disorder, panic attacks, and social phobia. Conclusion: The CARS Screener appears to be an effective tool that will help DUI programs better understand and address the mental health issues facing their clients.

Psychiatric comorbidity among first-time and repeat DUI offenders

Driving under the influence of alcohol or other substances is a serious public health concern. Previous research has shown that psychiatric comorbidity is more prevalent for repeat offenders than the general population, and that first-time offenders exhibit elevated rates of psychiatric comorbidity, but few studies have directly compared first-time and repeat DUI offenders. The current study compares psychiatric comorbidity among repeat and first-time DUI offenders. First-time and repeat DUI offenders completed the screener module of the Computerized Assessment and Referral System (CARS), adapted from the Composite International Diagnostic Interview (CIDI: Kessler & Ustun, 2004), to measure potential psychiatric comorbidity. For 16 of 19 psychiatric disorders, repeat DUI offenders were more likely to screen positive during their lifetime compared with first-time DUI offenders. Similarly, repeat DUI offenders were more likely to screen positive during the past year for 11 of 16 assessed psychiatric disorders. Overall, repeat DUI offenders screened positive for an average of 6.3 disorders during their lifetime, compared to first-time offenders who screened positive for an average of 3.7 disorders. Repeat DUI offenders also screened positive for more past-year disorders (M = 3.3) than first-time offenders (M = 1.9). Compared to first-time offenders, repeat DUI offenders evidence more severe and pervasive psychiatric comorbidity. Further research is necessary to determine whether psychiatric comorbidity among first-time offenders directly predicts re-offense. If so, screening for mental health issues among first-offenders could provide valuable information about how best to allocate resources for these offenders.

Predictive factors associated with driving under the influence among Brazilian drug-using drivers

The incidence of driving under the influence of psychoactive substances (DUI) and its recidivism can be curtailed by the proper identification of specific and predictive characteristics among drug users. In this sense, interpersonal violence (IV), psychiatric comorbidity and impulsivity seem to play an important role in DUI engagement according to previous studies. There are, however, limited data originated from low and middle income countries. In the present study, drug-using Brazilian drivers reporting DUI (n = 75) presented a higher prevalence of bipolar disorders (BD; DUI: 8% vs. non-DUI: 0%, p < 0.001), lower prevalence of obsessive-compulsive disorder (OCD; DUI: 0% vs. non-DUI: 12.6%, p < 0.001), and higher prevalence of childhood trauma (DUI: 65.3% vs. non-DUI: 46.8%, p = 0.022) than those not reporting DUI (n = 79). The evaluation of impulsivity though the Barratt Impulsivity Scale, which give impulsivity scores ranging from 30 to 120, showed higher impulsivity scores in the DUI group (80.4 ± 8) than in the non-DUI group (77.2 ± 10, p = 0.045). In general, subjects were young adults (mean age of 36 ± 9 years), Caucasians (58.4%), not married (61.0%), and with elementary schooling (40.3%) with no significant differences in demographic characteristics between drivers with and without DUI behavior. A multiple Poisson regression model showed that individuals reporting IV as perpetrators and history of childhood trauma were more likely to report DUI (PR: 1.66, 95%CI 1.22-2.7; PR: 1.57, 95%CI 1.02-2.42, respectively). The overlapping of violent situations (childhood trauma, IV and DUI) in some individuals presented here corroborates literature data suggesting that DUI can be an externalizing expression of a range of risky behavior, such as impulsiveness and aggressiveness. Moreover, while BD and higher impulsivity scores seem to act as risk factors for DUI, OCD was shown as a protective factor. These results corroborate the hypothesis that individuals with high risk for DUI could probably be identified by multidimensional assessment of cognitive, risky taking, and personality traits, which perhaps could facilitate the development of focused interventions.

Correlates of Breath Alcohol Concentration Among Driving Under the Influence Program Clients in Southern California

Understanding factors correlated with breath alcohol concentration (BrAC) at time of arrest for driving under the influence (DUI) may lead to informed rehabilitation programs. This study describes correlations between BrAC at time of arrest and sociodemographic, mental, and physical health, and alcohol-related characteristics among clients in a large California DUI Program. Client reported data ( n = 17,282) were collected at an intake from 2009 to 2014. BrACs ranged from 0.083% to 0.390%, with an average of 0.159% ( SD = 0.051), almost twice the legal limit in the state. Approximately 10.6% of the variance in BrAC was explained by 11 significant correlates. Two sociodemographic factors (age and race/ethnicity) as well as several alcohol-related characteristics were related to higher BrAC levels, whereas comorbid mental and physical health factors played less of a role. Factors associated with BrAC are complex and warrant further investigation to identify causality and inform future interventions.

Characteristics of Prescription-Opioid-Impaired and Other Substance-Impaired Drivers in Rural Appalachian Kentucky

Previous studies have highlighted the prescription opioid epidemic in rural Appalachia and its associated risk behaviors; however, no studies have examined prescription-opioid-impaired driving as a consequence of this epidemic. The purpose of the present study was to describe prescription-opioid-impaired drivers in rural Appalachian Kentucky and examine how they are similar to and different from other substance-impaired drivers from the region. A sample of convicted DUI offenders from rural Appalachian Kentucky completed a confidential research interview focused on their substance use, mental health, and criminal activity. Prescription-opioid-impaired drivers (n = 33) were compared to other drug-impaired drivers (n = 29) and to alcohol-only-impaired drivers (n = 44). Overall, prescription-opioid-impaired drivers had a similar prevalence of illicit substance use and criminal activity, including impaired driving frequency, to other drug-impaired drivers, but had a higher prevalence of illicit substance use and more frequent impaired driving when compared to alcohol-only-impaired drivers. Study implications include the importance of comprehensive substance abuse assessment and treatment for DUI offenders and the need for tailored interventions for prescription-opioid-impaired and other drug-impaired drivers.

A descriptive analysis of drugged driving among rural DUI offenders

OBJECTIVE

Although driving under the influence (DUI) arrests occur at higher rates in rural areas and previous studies have shown more extensive drug use histories, little is known about how this relates to the prevalence and frequency of drugged driving. The present study examined drug use and drugged driving patterns among a sample of rural DUI offenders.

METHODS

Convicted rural DUI offenders (N = 118) completed a one-time, confidential research interview focused on drug use and drugged driving. A descriptive analysis was performed to examine the lifetime and past-year prevalence and frequency of drugged driving while under the influence of different drugs.

RESULTS

Approximately three fourths of the sample (77%) reported driving after illicit drug use in their lifetime and more than half of the sample (60%) reported doing so in the past year. Similar percentages of lifetime (86%) and past-year (81%) illicit drug users reported driving under the influence of at least one illicit drug. Illicit drug users reported a median of 240 lifetime and 16 past-year drugged driving episodes. Among those who reported ever driving after illicit drug use, marijuana (65%), prescription opioids (49%), and sedatives/tranquilizers/barbiturates (45%) were the most prevalent drugs involved in participants' drugged driving episodes.

CONCLUSIONS

Findings suggest that rural DUI offenders have extensive illicit drug use histories and frequently engage in drugged driving, posing a significant threat to public safety. Additional research on the characteristics of rural drugged drivers and their drug use and driving patterns is needed to inform the development of targeted interventions.

Comparison of Characteristics of Female Drivers with Single and Multiple DUI Convictions

BACKGROUND

Women are increasingly involved in drunk driving and fatal crashes, yet except for the screening performed in criminal justice settings, little is known about their life context, psychiatric histories, and family backgrounds. This study describes a sample of women with histories of arrest for driving under the influence of alcohol (DUI) who were interviewed outside a criminal justice setting and contrasts women with single versus multiple DUI convictions.

METHODS

Women with recent documented histories of DUI participated in a study of women's health behaviors. Thirty-six women with 1 DUI and 62 with 2 or more DUIs participated in a diagnostic telephone interview which assessed demographics, alcohol use and problems, psychiatric problems, treatment, and partner violence.

RESULTS

The sample overall had high rates of co-occurring psychiatric problems, parental alcohol problems, early sexual and physical abuse, and head injuries. Alcohol use severity and the prevalence of head injuries and partner alcohol problems were significantly higher among women with multiple DUIs than women with a single DUI. Measures reflecting life context, such as marital status, number of children, and childhood trauma, were not associated with number of DUIs.

CONCLUSIONS

Findings suggest that DUI recidivism in women is accounted for primarily by AUD severity and is not influenced by previous life events such as partner violence, psychiatric problems, and family context such as divorce/separation or number of children. Multiple DUIs in women may mark an alcohol severity threshold beyond which few factors account for additional risk.

Risks of road injuries in patients with bipolar disorder and associations with drug treatments: A population-based matched cohort study

OBJECTIVE

Using a nation-wide, population-based dataset, we aimed to investigate the risk of road injury among individuals with bipolar disorder (BD) compared to individuals without BD. In addition, we investigated the putative moderating effects of prescription for lithium, anticonvulsants, antidepressants, and/or first- or second-generation antipsychotic agents on the association between BD and risk of road injury.

METHOD

As part of an16-year longitudinal cohort study, we compared the risk of road injuries among study subjects aged 16 and above with a diagnosis of BD, with ten age- and sex-matched sample of individuals without BD. Individuals were compared on measures of incidence on road injuries using medical claims data based on the ICD-9-CM codes: E800~807, E810~817, E819~830, E840~848. Time dependent Cox regression models were used to adjust for time-varying covariates such as age, and medication uses. Hazard ratios before and after adjusting for age, sex, other comorbidities, and drug use were calculated.

RESULTS

3953 people with BD were matched with 39,530 controls from general population. Adjusted hazard ratios revealed a 1.66-fold (95% CI 1.40-1.97) increase in risk of road injuries among bipolar subjects when compared to controls. Female gender, older age (i.e. over 80), residence in areas of highest levels of urbanization, and use of antidepressants were associated with a lower risk of road injuries.

CONCLUSIONS

In this large, national, population-based cohort, BD was associated with an elevated risk of road injuries. However, prescriptions of antidepressants might help mitigate the foregoing risk.

Is Major Depression Linked to Alcohol-Impaired Driving?

BACKGROUND

Alcohol-impaired driving causes a substantial proportion of motor vehicle accidents. Depression is a prevalent psychiatric disorder among drinker-drivers. Few previous studies have investigated the relationship between major depression and alcohol-impaired driving.

OBJECTIVES

We investigated whether depression has a positive relationship with the probability of alcohol-impaired driving after controlling for the co-occurrence of binge drinking and alcohol dependence.

METHODS

Our data consisted of drinkers aged 21-64 years from two waves of the National Epidemiologic Survey of Alcohol and Related Conditions. Cross-sectional analysis investigated whether depression is an independent risk factor for drinking-driving. Longitudinal analysis distinguished the relationship of depression onset, continuance, and recovery with changes in drinking-driving behaviors between the waves. These dual approaches allowed comparisons with previous studies.

RESULTS

Major depression was a small but statistically significant predictor of changes in alcohol-impaired driving behaviors among males but not females. Binge drinking and alcohol dependence were comparatively stronger predictors. Conclusions/Importance: There is limited empirical support that treating depression reduces drinking and driving in males who do not exhibit symptoms of alcohol use disorders. For persons with co-occurring depression and alcohol use disorders, depression treatment should be part of a strategy for treating alcohol use disorders which are highly related to drinking and driving.

Firearms, alcohol and crime: convictions for driving under the influence (DUI) and other alcohol-related crimes and risk for future criminal activity among authorised purchasers of handguns

Firearm violence frequently involves alcohol, but there are no studies of misuse of alcohol and risk for future violence among firearm owners. We examined the association between prior convictions for alcohol-related crimes, chiefly driving under the influence (DUI), and risk of subsequent arrest among 4066 individuals who purchased handguns in California in 1977. During follow-up through 1991, 32.8% of those with prior alcohol-related convictions and 5.7% of those with no prior criminal history were arrested for a violent or firearm-related crime; 15.9% and 2.7%, respectively, were arrested for murder, rape, robbery or aggravated assault. Prior alcohol-related convictions were associated with a fourfold to fivefold increase in risk of incident arrest for a violent or firearm-related crime, a relative increase greater than that seen for age, sex or prior violence. Prior convictions for alcohol-related crime may be an important predictor of risk for future criminal activity among purchasers of firearms.

Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers

BACKGROUND

Substance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC).

METHOD

A multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index - 6th version (ASI-6) and the Mini International Neuropsychiatric Interview.

RESULTS

Seventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUI's in the past month (n=82) had higher scores in the "psychiatric", "legal", and "family problems" subscales from the ASI-6, and lower scores in the "family social support" subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities.

CONCLUSION

The high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents.

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

AIMS

To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a psychoactive prescription drug, and to identify associated factors.

METHODS

Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was our outcome, defined as a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors.

RESULTS

In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with non-prescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with non-prescribed use.

CONCLUSIONS

Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

Feasibility of a computer-assisted alcohol screening, brief intervention and referral to treatment program for DWI offenders

BACKGROUND

Alcohol use patterns that are hazardous for one's health is prevalent among DWI (driving while intoxicated) offenders and is a key predictor of recidivism. The aim of this program evaluation was to determine the feasibility and usability of implementing a computer-assisted screening, brief intervention and referral to treatment (SBIRT) program for DWI offenders to enable the identification of those in need of treatment services soon after arrest. Our treatment program consisted of a web-based, self-guided screening tool for assessing alcohol use patterns and generating a personalized feedback report that is then used to deliver a brief motivational intervention and if needed, a referral to treatment.

METHODS

Between August and November 2014, all DWI offenders attending orientation for pre-trial supervision were assessed for eligibility. Of the 129 eligible offenders, 53.5 percent enrolled and the first 50 were asked to complete a usability and satisfaction questionnaire.

RESULTS

The results demonstrated that the majority of those screened reported at-risk alcohol use patterns requiring referral to treatment. Clients reported high ratings of usability and satisfaction with the screening tool and personalized feedback report, which did not significantly differ depending on alcohol use patterns. There were relatively few technical difficulties, and the majority of clients reported high levels of satisfaction with the overall SBIRT program.

CONCLUSION

Results of this program evaluation suggest that computer-assisted SBIRT may be successfully implemented within the criminal justice system to DWI offenders soon after arrest; however, further research is required to examine its effects on treatment utilization and recidivism.

Alcohol, drug and other prior crimes and risk of arrest in handgun purchasers: protocol for a controlled observational study

BACKGROUND AND OBJECTIVE

Alcohol abuse is common in the USA and is a well-established risk factor for violence. Other drug use and criminal activity are risk factors as well and frequently occur together with alcohol abuse. Firearm ownership is also common; there are >50 million firearm owners in the USA. This study assesses the relationships between alcohol and drug abuse and future violence among firearm owners, which no prior research has done.

DESIGN AND STUDY POPULATION

This records-based retrospective cohort study will involve all persons who legally purchased handguns in California in 2001-approximately 116 000 individuals-with follow-up through the end of 2013.

METHODS

The principal exposures include prior convictions for alcohol-related and drug-related offenses. The primary outcome measure is an arrest following handgun purchase for a violent Crime Index offense: homicide, rape, robbery or aggravated assault. Subjects will be considered at risk for outcome events for only as long as their residence in California can be established independently of outcome events. Covariates include individual characteristics (eg, age, sex, criminal history, firearm purchase history) and community characteristics (eg, demographics, socioeconomic measures, firearm ownership and alcohol outlet density). We will employ survival analytic methods, expressing effects as HRs.

DISCUSSION

The results of this large-scale study are likely to be generalisable and to have important implications for violence prevention policies and programmes.

The use of psychoactive prescription drugs among DUI suspects

BACKGROUND

The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once.

METHODS

In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression.

RESULTS

The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once.

CONCLUSIONS

In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated.

The Effect of Cognitive-Behavioral Therapy on Driving While Intoxicated Recidivism

This longitudinal study examined differences in driving while intoxicated (DWI) recidivism among defendants with multiple DWI offenses after receiving a 16-week cognitive-behavioral therapy (CBT) program compared with those who received standard services. Defendants on probation supervision with histories of repeated DWI offenses ( N = 286; male = 240, female = 46) were referred to CBT. There was a significant difference in DWI recidivism 3 years after CBT among participants (11%) and the New York State (25%) and national (30%) rates; the comparison group reoffended at the rate of 25%. Level of Service Inventory–Revised (LSI-R) scores of the CBT group also decreased significantly compared with the comparison group, and CBT participants showed significant improvement in overall functioning measured by Global Assessment of Functioning (GAF). CBT offered in this innovative manner was more effective with recalcitrant, hard to treat, DWI offenders. It may also benefit precontemplative offenders by helping them recognize that their drinking is negatively impacting their lives and may warrant more traditional alcohol treatment.

Do preferences of drinker-drivers differ?

Why people engage in illegal activities is not well understood. Using data collected for this research from eight cities in four states, this study investigates alternative explanations as to why people drive while intoxicated (DWI). We find that preferences and subjective beliefs about arrest/incarceration of persons who drink and drive do differ systematically from others in terms of benefits and costs of drink and driving, and in their risk tolerance. While most findings imply that DWI is a deliberate choice, we do find that drinker drivers tend to be more impulsive and lack self-control in their drinking.

A Prospective Study of Psychiatric Comorbidity and Recidivism Among Repeat DUI Offenders

Psychiatric comorbidity has emerged as a key element distinguishing DUI offenders from others, and, in some cases, distinguishing repeat offenders from first-time offenders. This paper utilizes a prospective design to determine whether the comorbid disorders identified among repeat DUI offenders can predict recidivism. Seven hundred forty-three repeat DUI offenders were recruited from a two-week inpatient treatment program at which they received a standardized mental health assessment and followed across five years post-treatment to track DUI offense, motor vehicle-related offenses, and general criminal offenses. Psychiatric comorbidity, though it did not predict DUI recidivism specifically, predicted criminal re-offense more generally. In addition, there was a specific relationship between lifetime attention deficit disorder and repeated motor vehicle-related offenses. These findings suggest that for many repeat offenders, DUI is one outlet in a constellation of criminal behavior, and that psychiatric comorbidity increases vulnerability for criminal re-offense.

The usefulness of biomarkers of alcohol abuse in hair and serum carbohydrate-deficient transferrin: a case report

The detection of carbohydrate-deficient transferrin (CDT) in serum is widely accepted to identify chronic alcohol consumption over the previous two weeks, but minor ethanol metabolites detected in hair often complete the information obtained. In particular, ethylglucuronide and cocaethylene (a marker of simultaneous intake of cocaine and alcohol) allow correct interpretation of data obtained in forensic cases. We refer to a negative CDT value obtained from a serum sample collected during hospitalization of a man admitted for cardiac arrest who died about 14 h later. Clinical analysis performed on admission showed a high ethanol level and a positive urinary screening for cocaine. The toxicological analyses of post-mortem samples found cocaine metabolites in his urine and blood. The negative CDT level suggested the ethanol concentration at admission to be an acute episode. Cocaine and cocaethylene well above the cut-off suggested by the literature were found in hair analyzed for the entire length (about 1 cm). Ethylglucuronide detected on the same hair sample confirmed chronic abuse of ethanol in the previous month, at least. The present report suggests caution in the interpretation of biomarkers of alcohol abuse, encouraging the detection of more than one marker to avoid misinterpretation.

Treatment Needs of Driving While Intoxicated Offenders: The Need for a Multimodal Approach to Treatment

OBJECTIVE

This study aimed to characterize and compare the treatment needs of adults with driving while intoxicated (DWI) offenders recruited from a correctional residential treatment facility and the community to provide recommendations for treatment development.

METHOD

A total of 119 adults (59 residential, 60 community) with at least one DWI offense were administered clinical diagnostic interviews to assess substance use disorders and completed a battery of questionnaires assessing demographic characteristics, legal history, psychiatric diagnoses, medical diagnoses, and health care utilization.

RESULTS

Almost all (96.6%) DWI offenders met clinical diagnostic criteria for an alcohol use disorder, approximately half of the sample also met diagnostic criteria for comorbid substance use disorders, and a substantial proportion also reported psychiatric and medical comorbidities. However, a high percentage were not receiving treatment for these issues, most likely as a result of having limited access to care, because the majority of participants had no current health insurance (64.45%) or primary care physician (74.0%). The residential sample had more extensive criminal histories compared to the community sample but was generally representative of the community in terms of their clinical characteristics. For instance, the groups did not differ in rates of substance use, psychiatric and medical health diagnoses, or the treatment of such issues, with the exception of alcohol abuse treatment.

CONCLUSIONS

DWI offenders represent a clinical population with high levels of complex and competing treatment needs that are not currently being met. Our findings demonstrate the need for standardized screening of DWI offenders and call for the development of a multimodal treatment approach in efforts to reduce recidivism.

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil

OBJECTIVE

To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil.

METHOD

This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level.

RESULTS

A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08).

CONCLUSIONS

In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.

A Comparison of First Time and Repeat Rural DUI Offenders

The purpose of the current study was to examine whether the differences found between first time and repeat rural DUI offenders were the same as those found previously in urban samples. A total of 118 rural DUI offenders were interviewed, approximately half (51.7%) of which were repeat offenders. Although demographic and mental health characteristics were similar across the two groups, repeat offenders reported more extensive substance use and criminal histories. Results suggest that the pattern of differences between rural first time and repeat DUI offenders may be different from the pattern found in prior urban-based studies. Treatment implications are discussed.

Mental disorders associated with driving under the influence of alcohol and/or drugs: a register-based study

BACKGROUND/AIMS

Mental disorders are associated with driving under the influence (DUI), but the evidence is scarce and mostly focused on a limited group of repeat drunken drivers. Thus, the aim of this study was to examine which mental disorders were risk factors for DUI of alcohol only (DUIA), of illicit drugs (DUID) or of alcohol and psychoactive prescription drugs (DUIAP), and whether and how the risk differs over time.

METHODS

A register-based case-control study was conducted. Cases (n=44,188) suspected by the police of DUI during 1997-2007 and controls (n=45,148) were drawn from the general Finnish population. The official national register of hospital treatments was the data source for mental disorders. The effects of mental disorders on DUI were estimated using logistic regression analysis.

RESULTS

Substance use disorders increased the risk of DUI overall. Childhood- and adolescence-onset disorders were a strong predictor of DUID, and bipolar and depressive disorders predicted DUIAP. The risk was highest soon after hospital admission with a psychiatric diagnosis, but it decreased over time.

CONCLUSIONS

Actions to prevent DUI should be developed and implemented during the treatment of mental disorders.