Are drunk-driving offenders referred for screening accurately reporting their drug use?

Introducing Machine Learning to Detect Personality Faking-Good in a Male Sample: A New Model Based on Minnesota Multiphasic Personality Inventory-2 Restructured Form Scales and Reaction Times

Background and Purpose. The use of machine learning (ML) models in the detection of malingering has yielded encouraging results, showing promising accuracy levels. We investigated the possible application of this methodology when trained on behavioral features, such as response time (RT) and time pressure, to identify faking behavior in self-report personality questionnaires. To do so, we reintroduced the article of Roma et al. (2018), which highlighted that RTs and time pressure are useful variables in the detection of faking; we then extended the number of participants and applied an ML analysis. Materials and Methods. The sample was composed of 175 subjects, of whom all were graduates (having completed at least 17 years of instruction), male, and Caucasian. Subjects were randomly assigned to four groups: honest speeded, faking-good speeded, honest unspeeded, and faking-good unspeeded. A software version of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) was administered. Results. Results indicated that ML algorithms reached very high accuracies (around 95%) in detecting malingerers when subjects are instructed to respond under time pressure. The classifiers' performance was lower when the subjects responded with no time restriction to the MMPI-2-RF items, with accuracies ranging from 75% to 85%. Further analysis demonstrated that T-scores of validity scales are ineffective to detect fakers when participants were not under temporal pressure (accuracies 55-65%), whereas temporal features resulted to be more useful (accuracies 70-75%). By contrast, temporal features and T-scores of validity scales are equally effective in detecting fakers when subjects are under time pressure (accuracies higher than 90%). Discussion. To conclude, results demonstrated that ML techniques are extremely valuable and reach high performance in detecting fakers in self-report personality questionnaires over more the traditional psychometric techniques. Validity scales MMPI-2-RF manual criteria are very poor in identifying under-reported profiles. Moreover, temporal measures are useful tools in distinguishing honest from dishonest responders, especially in a no time pressure condition. Indeed, time pressure brings out malingerers in clearer way than does no time pressure condition.

Evaluating moderators of beneficial effects of severity-based assignment to substance use treatments in impaired drivers

Remedial programs for impaired driving offenders have proved valuable in reducing subsequent alcohol and other drug use and preventing recidivism in this population. Many of these programs are based on a severity-based assignment scheme, where individuals assessed to have greater problems or be at higher risk are assigned to longer, more intensive interventions. Recent research, using regression discontinuity analyses, provided support for severity-based assignment schemes in demonstrating that those with higher problem or risk levels assigned to longer and more intensive programming showed a significant reduction in drinking days over a follow-up interval, attributable to program assignment. Regression discontinuity analyses can also be used to assess moderators of this assignment benefit. We report an assessment of the impact of eight potential moderators of assignment benefit, derived from a factor analysis of the Research on Addictions Self-Inventory screening instrument. Five of the eight factors were found to moderate the assignment benefit: Negative Affect, Sensation Seeking, High Risk Lifestyle, Alcohol Problems, and Family History. The significance of these results for developing more effective program assignment procedures is discussed.

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.

Canadian drivers' attitudes regarding preventative responses to driving while impaired by alcohol

BACKGROUND

In many jurisdictions, a risk assessment following a first driving while impaired (DWI) offence is used to guide administrative decision making regarding driver relicensing. Decision error in this process has important consequences for public security on one hand, and the social and economic well being of drivers on the other. Decision theory posits that consideration of the costs and benefits of decision error is needed, and in the public health context, this should include community attitudes. The objective of the present study was to clarify whether Canadians prefer decision error that: i) better protects the public (i.e., false positives); or ii) better protects the offender (i.e., false negatives).

METHODS

A random sample of male and female adult drivers (N=1213) from the five most populated regions of Canada was surveyed on drivers' preference for a protection of the public approach versus a protection of DWI drivers approach in resolving assessment decision error, and the relative value (i.e., value ratio) they imparted to both approaches. The role of region, sex and age on drivers' value ratio were also appraised.

RESULTS

Seventy percent of Canadian drivers preferred a protection of the public from DWI approach, with the overall relative ratio given to this preference, compared to the alternative protection of the driver approach, being 3:1. Females expressed a significantly higher value ratio (M=3.4, SD=3.5) than males (M=3.0, SD=3.4), p<0.05. Regression analysis showed that both days of alcohol use in the past 30days (CI for B: -0.07, -0.02) and frequency of driving over legal BAC limits in the past year (CI for B=-0.19, -0.01) were significantly but modestly related to lower value ratios, R²(adj.)=0.014, p<0.001. Regional differences were also detected.

CONCLUSIONS

Canadian drivers strongly favour a protection of the public approach to dealing with uncertainty in assessment, even at the risk of false positives. Accounting for community attitudes concerning DWI prevention and the individual differences that influence them could contribute to more informed, coherent and effective regional policies and prevention program development.

Characteristics and predictors of recidivist drink-drivers

OBJECTIVE

The current study compared characteristics of nonrecidivist versus recidivist drink-drivers and of recidivists in their first versus second appearance at Back on Track (BOT), the remedial measures program for impaired drivers in Ontario, Canada.

METHODS

Information from 59,134 convicted drivers who participated in BOT between 2000 and 2010 was examined to identify drivers who completed the program a second time following reconviction.

RESULTS

A total of 586 recidivists were identified. Compared to nonrecidivist drivers, recidivists at first attendance were more likely to be male and had higher scores on measures of alcohol dependence and adverse legal consequences of substance use. Compared to nonrecidivist drivers, recidivists at second attendance were significantly older, had a higher income, were more likely to be retired, and were less likely to be employed part-time. They had fewer legal problems. Recidivists reported fewer drinking days and fewer drinks per occasion but greater use of benzodiazepines than nonrecidivists and had higher scores on a measure of future risk of alcohol- and drug-related problems. Comparison of recidivists' characteristics at first versus second attendance confirmed many of these findings, with second-time recidivists reporting fewer drinks per drinking day and greater use of benzodiazepines and having higher scores on a measure of future substance use problems than first-time recidivists.

CONCLUSIONS

Results suggest that identification of drivers at increased risk of recidivism may be possible at first program attendance by examining indicators of increased alcohol-related problems. In addition, recidivists appear to show a greater readiness to change at second attendance. Implications for remedial program development and recommendations for future research are discussed.

Cognitive and behavioral preoccupation with alcohol in recidivist DUI offenders

OBJECTIVE

A high proportion of individuals convicted of driving under the influence (DUI) are repeat offenders. Efforts have sought to identify specific factors underlying DUI recidivism. Of particular interest is the role that alcohol-related cognitions might play in the development and escalation of alcohol use. The present study investigated the degree to which preoccupation with, and attentional bias to, alcohol are heightened among repeat DUI offenders.

METHOD

Three groups of participants (recidivist DUI offenders, first-time offenders, and controls; n = 20 per group) performed a visual probe task to measure attentional bias and completed questionnaires regarding their cognitive and emotional preoccupation with alcohol and drinking habits.

RESULTS

Recidivist offenders displayed a significantly heightened alcohol attentional bias and reported greater preoccupation with alcohol compared with both first-time offenders and controls. By contrast, none of the groups differed with regard to the self-reported quantity and frequency of their consumption.

CONCLUSIONS

Factors reflecting preoccupation with alcohol have utility for differentiating recidivist offenders from both first-time offenders and nonoffenders. These findings highlight the value of moving beyond self-reported assessments of drinking patterns toward assessing specific cognitive and behavioral characteristics that can improve our understanding, assessment, and treatment of the problem of DUI recidivism.

Lower Cortisol Activity is Associated with First-Time Driving while Impaired

Driving while impaired (DWI) is a grave and persistent high-risk behavior. Previous work demonstrated that DWI recidivists had attenuated cortisol reactivity compared to non-DWI drivers. This suggests that cortisol is a neurobiological marker of high-risk driving. The present study tested the hypothesis that this initial finding would extend to first-time DWI (fDWI) offenders compared to non-DWI drivers. Male fDWI offenders (n = 139) and non-DWI drivers (n = 31) were exposed to a stress task, and their salivary cortisol activity (total output and reactivity) was measured. Participants also completed questionnaires on sensation seeking, impulsivity, substance use, and engagement in risky and criminal behaviors. As hypothesized, fDWI offenders, compared to non-DWI drivers, had lower cortisol reactivity; fDWI offenders also showed lower total output. In addition, cortisol activity was the most important predictor of group membership, after accounting for alcohol misuse patterns and consequences and other personality and problem behavior characteristics. The findings indicate that attenuated cortisol activity is an independent factor associated with DWI offending risk at an earlier stage in the DWI trajectory than previously detected.

Addition of objective data to identify risk for medication misuse and abuse: the inconsistency score

OBJECTIVE

To identify and quantify the rate of aberrant drug-taking behaviors using objective data.

DESIGN

Institutional Review Board-approved anonymous, voluntary, quality improvement project.

SETTING

University-based, multidisciplinary pain management center.

SUBJECTS

Consecutive initial visit patients.

METHODS

Patients were interviewed, asked to provide a urine sample, and filled out a brief questionnaire about recent prescription, over-the-counter, and illicit drug use. Discrepancies between patient report (PQ), the Virginia State prescription monitoring program (PMP), referring physician records (MRs), and the point-of-care urine drug screen (POC UDS) results were scored from 0 (none) to a maximum of 2 points (2+ discrepancies) for each potential comparator between data sets. Maximum potential inconsistency score (IS) was 16 points.

RESULTS

Two hundred nine patients were interviewed to yield 118 specimens. Mean age of participants was 48.2 years (22-83 year); 65.3% were female. IS scores ranged from 1 to 11, and 52.5% of the patients had an IS ≥ 3. Higher IS scores correlated with higher numbers of pharmacies, prescribing physicians, prescriptions on the PMP, and presence of illicit substances in the urine. Addition of either POC UDS or PMP to PQ and MR increased identification of inconsistencies by >400%, and PMP plus UDS by >900%.

CONCLUSIONS

Patient report and the medical record are inadequate to screen for aberrant drug-related behaviors. Addition of PMP and POC UDS contribute significantly to identification of inconsistencies through higher IS scores and differentiate patients at higher risk of medication misuse, abuse, or diversion. Comparison of multiple sources of objective information provides better insight into inconsistencies of report and behavior, and may assist in more appropriate and safer prescribing decisions.

A randomized controlled trial of brief motivational interviewing in impaired driving recidivists: a 5-year follow-up of traffic offenses and crashes

Background

In a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292–301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information–advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI.

Methods

A sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions.

Results

For arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected.

Conclusions

BMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the real-world conditions of mandated relicensing programs.

Evidence from regression-discontinuity analyses for beneficial effects of a criterion-based increase in alcohol treatment

Brief interventions effectively reduce alcohol problems; however, it is controversial whether longer interventions result in greater improvement. This study aims to determine whether an increase in treatment for people with more severe problems resulted in better outcome. We employed regression-discontinuity analyses to determine if drinking driver clients (n = 22,277) in Ontario benefited when they were assigned to a longer treatment program (8-hour versus 16-hour) based on assessed addiction severity criteria. Assignment to the longer16-hour program was based on two addiction severity measures derived from the Research Institute on Addictions Self-inventory (RIASI) (meeting criteria for assignment based on either the total RIASI score or the score on the recidivism subscale). The main outcome measure was self-reported number of days of alcohol use during the 90 days preceding the six month follow-up interview. We found significant reductions of one or two self-reported drinking days at the point of assignment, depending on the severity criterion used. These data suggest that more intensive treatment for alcohol problems may improve results for individuals with more severe problems.

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.

Depression, Readiness for Change, and Treatment Among Court-Mandated DUI Offenders

OBJECTIVE

The current study is part of a larger study that was designed to evaluate the impact of brief interventions on subsequent alcohol and drug use of individuals convicted of driving under the influence (DUI). This element considers the interaction of depression levels with treatment on subsequent substance use and problems related to substance use.

METHODS

Subjects were referred to the Research Institute on Addictions from various courts in the Western New York area for clinical evaluation and treatment referral, if further treatment was indicated. A total of 765 individuals were referred to the program, with 549 agreeing to participate. Participants were assessed at baseline using a number of different measures, with depression and readiness to change among them. A follow-up assessment took place 18-24 months following the baseline, with subsequent treatment experiences being one of the primary measures of interest for this study. A total of 443 participants were successfully interviewed at follow-up.

RESULTS

The high depression group had greater readiness to change and a greater likelihood of entering treatment than the low depression group (p's < .001). ANCOVAs showed depression by treatment interactions for drug problem severity, drug use, DUI risk, alcohol expectancies, abstinence self-efficacy, and psychiatric distress (all p's < .05). Furthermore, the treated high depression group made the largest positive gains across all outcomes (all p's < .01).

CONCLUSIONS

The readiness to change, treatment entry, and ANCOVA results, all support Wells-Parker and her colleagues' approach that depression may be a strong indicator of DUI offenders' readiness to change their substance use behavior.

Drugged driving: increased traffic risks involving licit and illicit substances

Driving under the influence of drugs poses risks for traffic safety. Most research attention has been focused on the most prevalent drugs of abuse, such as alcohol, illegal drugs, and prescription drugs with high abuse potential. The objectives of this study were to determine the types of drugs used by convicted DUI offenders on the day of their arrest, prevalence of poly-substance use, and offender characteristics associated with different drug use patterns. Data were collected from 6,339 individuals enrolled in the court-mandated Mississippi Alcohol Safety Education Program. After alcohol, cannabis was the most frequently used substance, followed by sedative medications and prescription analgesics. Among poly-substance users, 78.4% reported combining alcohol with other drugs. Findings could be used to inform public education campaigns, law enforcement training, and highway safety policies about the prevalence of combining alcohol with other drugs, as well as how poly-substance use further impairs traffic-related risks.

Convicted driving-while-impaired offenders' views on effectiveness of sanctions and treatment

In this article we analyze qualitative data from a multiple-method, longitudinal study drawn from 15-year follow-up interviews with a subsample of 82 individuals arrested for driving while intoxicated in a southwestern state (1989-1995). We explore reactions to the arrest and court-mandated sanctions, including legal punishments, mandated interventions, and/or participation in programs aimed at reducing recidivism. Key findings include experiencing certain negative emotional reactions to the arrest, reactions to being jailed, experiencing other court-related sanctions as deterring driving-while-intoxicated behavior, and generally negative opinions regarding court-mandated interventions. We discuss interviewees' complex perspectives on treatment and program participation and their effects on lessening recidivism, and we offer suggestions for reducing recidivism based on our findings.

The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers

OBJECTIVES

This study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics.

METHODS

A nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information-advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change.

RESULTS

Recidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type.

CONCLUSIONS

The results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.

Persistence of addictive disorders in a first-offender driving while impaired population

CONTEXT

We compared the prevalence of alcohol use and other psychiatric disorders in offenders 15 years after a first conviction for driving while impaired with a general population sample.

OBJECTIVE

To determine whether high rates of addictive and other psychiatric disorders previously demonstrated in this sample remain disproportionately higher compared with a matched general population sample.

DESIGN

Point-in-time cohort study.

SETTING

Pacific Institute for Research and Evaluation, Albuquerque, New Mexico.

PARTICIPANTS

We interviewed convicted first offenders using the Composite International Diagnostic Interview 15 years after referral to a screening program in Bernalillo County, New Mexico. We calculated rates of diagnoses for non-Hispanic white and Hispanic women (n = 362) and men (n = 220) adjusting for missing data using multiple imputation and compared psychiatric diagnoses with findings from the National Comorbidity Survey Replication by sex and Hispanic ethnicity.

RESULTS

Eleven percent of non-Hispanic white women and 12.8% of Hispanic women in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with 1.0% and 1.8%, respectively, in the National Comorbidity Survey Replication (comparison) sample. Almost 12% of non-Hispanic white men and 17.5% of Hispanic men in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with to 2.0% and 1.8%, respectively, in the comparison sample. These differences were statistically significant. Rates of drug use disorders and nicotine dependence were also elevated compared with the general population sample, while rates of major depressive disorder and posttraumatic stress disorder were similar.

CONCLUSION

In this sample, high rates of addictive disorders persisted over 10 years among first offenders and greatly exceeded those found in a general population sample.

Does screening classification predict long-term outcomes of DWI offenders?

OBJECTIVES

To determine the usefulness of a screening classification system in predicting treatment use, current substance abuse disorders (SUD), and driving over the alcohol limit (DOL) at 15-year follow-up.

METHODS

Interviewed 583 driving while imparied (DWI) first offenders with SUDs. Univariate and multivariate statistics were used to determine predictors of long-term outcomes.

RESULTS

Screening classification defined groups with different treatment histories and 15-year outcomes. Current SUDs were reported by 21% and DOL by 10%, of subjects.

CONCLUSIONS

Group differences suggest that screening data could be used more effectively to triage and treat DWI offenders.

Are biomarkers of chronic alcohol misuse useful in the assessment of DWI recidivism status?

A first driving while impaired by alcohol (DWI) conviction is a key opportunity to identify offenders who are at high risk for recidivism. Detection of alcohol use disorder (AUD) is a major target of current DWI assessments. However, offenders frequently underreport their alcohol consumption, and use of biomarkers has been proposed as a more objective indicator. Among the best established are aspartate aminotranferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), mean corpuscular red blood cell volume (MCV), carbohydrate-deficient transferrin (CDT), and thiamine. To our knowledge, no research has directly verified whether AUD biomarkers predict DWI recidivism status. Using a cross-sectional design, this study tested three hypotheses related to the utility of biomarkers in DWI assessment.

HYPOTHESES

(1) DWI recidivists possess biomarkers indicative of greater prevalence of AUD compared to first-time offenders; (2) multiple biomarkers better differentiate first-time offenders from recidivists compared to individual biomarkers; and (3) biomarkers add significantly to the prediction of recidivism over and above psychosocial questionnaires.

METHODS

First-time offenders (n = 49) and recidivists (n = 95) participated in the study. In addition to self-reported information on sociodemographic and driving characteristics, data from several AUD questionnaires were gathered: Michigan Alcoholism Screening Test, Alcohol Use Disorders Identification Test, Composite International Diagnostic Interview, and Timeline Follow-Back. Blood samples were collected to measure AST, ALT, GGT, MCV, CDT, and thiamine.

RESULTS

AUD biomarkers, taken individually or in combination, did not indicate that recidivists had more frequent AUD compared to first-time offenders. Also, they failed to significantly differentiate first-time offenders from recidivists or predict recidivism status. Finally, the superiority of biomarkers over psychosocial AUD questionnaires was not supported in the laboratory setting.

CONCLUSION

The present findings suggest that biomarkers of chronic patterns of heavy drinking may not be adequate to capture the multiple processes that appear to promote recidivism (e.g., binge drinking, other risky behavioural and personality features). Despite their objectivity, caution is warranted in the interpretation of a positive score on these biomarkers in DWI assessment. Longitudinal research is needed to more comprehensively explore the relationship between positive biomarkers in first-time offenders and their risk of becoming recidivists.

Drug use and criminal activity among rural probationers with DUI histories

The present study examined whether ever being arrested for driving under the influence (DUI) was associated with higher levels of substance use and criminal activity in a sample of 800 probationers. Lifetime and 30-day histories of substance use and criminal activity were compared across three groups of probationers from rural Kentucky: those with a single DUI arrest, those with two or more DUI arrests, and those with no DUI arrests. A larger percentage of probationers with a DUI arrest reported lifetime and 30-day substance use than non-DUI offenders in almost all drug and alcohol categories. Higher prevalence of criminal activity was limited primarily to the multiple DUI arrest group. Findings add to the literature on rural substance abusers and indicate that DUI may be used as a marker to help identify opportunities for targeted substance abuse interventions.

Brief motivational interviewing for DWI recidivists who abuse alcohol and are not participating in DWI intervention: a randomized controlled trial

BACKGROUND

Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6- and 12-month follow-up compared to an information-advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition.

METHODS

Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30-minute BMI session or information-advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., > or =3 standard drinks/d for males; > or =2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse-related behaviors using the MMPI-Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected.

RESULTS

Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12-month follow-up, which compared to the control intervention (n = 92) represented a significant decline from 6-month levels. Exposure to BMI also produced significantly greater improvement at 6-month follow-up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems.

CONCLUSIONS

Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings.

Examining factors in the Research Institute on Addictions Self-Inventory (RIASI): Associations with alcohol use and problems at assessment and follow-up

Impaired driving is a leading cause of alcohol-related deaths and injuries. Rehabilitation or remedial programs, involving assessment and screening of convicted impaired drivers to determine problem severity and appropriate programs, are an important component of society's response to this problem. Ontario's remedial program, Back on Track (BOT), involves an assessment process that includes administration of the Research Institute on Addictions Self-Inventory (RIASI) to determine assignment to an education or treatment program. The purpose of this study is to identify factors within the RIASI and examine how factor scores are associated with alcohol use and problem indicators at assessment and six-month follow-up. The sample included 22,298 individuals who completed BOT from 2000 to 2005. Principal component factor analysis with varimax rotation was conducted on RIASI data and an eight factor solution was retained: (1) Negative Affect, (2) Sensation Seeking, (3) Alcohol-Quantity, (4) Social Conformity, (5) High Risk Lifestyle, (6) Alcohol Problems, (7) Interpersonal Competence, and (8) Family History. Regression analyses were conducted to examine associations between factors and alcohol and problem measures obtained at assessment and at follow-up. Most factors, except for Interpersonal Competence, were associated with more alcohol use and problems at assessment. A similar pattern was observed at 6-month follow-up, but interestingly some factors (Negative Affect, Sensation Seeking, Alcohol-Quantity and Family History) predicted fewer days of alcohol use. The Interpersonal Competence factor was associated with significantly lower levels of alcohol use and problems at both assessment and follow-up. This work suggests that the RIASI provides information on several domains that have important relationships with alcohol problem severity and outcomes.

Depressive symptoms, drinking consequences, and motivation to change in first time DWI offenders

BACKGROUND

Psychological disorders are common among driving-while-intoxicated (DWI) offenders; thus, a DWI arrest may serve as an important opportunity for further screening and subsequent treatment.

OBJECTIVES

The current study examined the extent to which mild to moderate pretreatment depressive symptoms, as measured by the Beck Depression Inventory (BDI), could predict intervention outcomes in 284 first-time DWI offenders.

METHODS

Participants were given drinking-related and psychosocial assessments at the beginning and end of a 10-week intervention and at 6- and 12-month follow-ups.

RESULTS

After the intervention and at both follow-ups, all participants reported declines in depressive symptoms, alcohol consumption, and negative drinking consequences and higher self-efficacy to avoid high-risk drinking. It was notable, however, that offenders with depressive symptoms reported more drinking-related consequences and lower self-efficacy at all time points, but greater motivation to change their drinking behavior.

CONCLUSIONS

The findings suggest that offenders with depressive symptoms have more severe symptomatology than nondepressed offenders but may be more amenable to changing their drinking.

SCIENTIFIC SIGNIFICANCE

The BDI may be a useful screening tool for determining which offenders are in need of an intervention following a DWI arrest.

Concurrent and predictive validity of drug use and psychiatric diagnosis among first-time DWI offenders

BACKGROUND

Previous studies have found that driving while intoxicated (DWI) offenders report high rates of substance dependence and other psychiatric disorders.

METHOD

The current study evaluated the prevalence, clinical correlates at program admission, and prognostic significance over a 1-year follow-up of 2 diagnostic subgroup variables (drug abuse or dependence; mood or anxiety disorder) among 290 first-time DWI offenders receiving group counseling interventions.

RESULTS

A lifetime diagnosis of drug abuse or dependence (42% of sample) was associated with higher levels of alcohol consumption, lower coping confidence, greater readiness to change, increased alcohol, drug, and legal problems, and more alcohol-related negative consequences at the initiation of DWI intervention. Significant decreases in drinking were noted at intervention termination for the drug diagnoses subgroup, but were not sustained at 1-year follow-up. The presence of a lifetime diagnosis of anxiety or mood disorder (30% of sample) was associated with lower coping confidence, greater readiness to change, and with greater and more enduring negative consequences of drinking during the DWI intervention and 1-year follow-up period.

CONCLUSIONS

Results suggest that a psychiatric diagnosis might guide the intervention and aftercare planning for DWI offenders to reduce recidivism and drinking.

Relapse to driving under the influence (DUI): A review

Driving under the influence (DUI) is a major public health problem. In 2003, there were 17,401 alcohol-related crash fatalities. Although there has been a large decrease in the fatality rates over the past two decades, further progress has stalled in recent years. This plateau in the injury and death rates resulting from impaired driving has been attributed, in part, to the persistent or repeat DUI offender. Broadly defined, repeat offenders are those individuals who, following an initial DUI arrest, relapse to driving under the influence of alcohol and other drugs. In this paper, we first provide a brief overview of several models of DUI relapse. We then review the empirical literature on DUI relapse, the data describing characteristics of first-time and repeat DUI offenders, and, especially, studies that have evaluated the impact of legal sanctions and rehabilitation programs on subsequent DUI behavior. The data reveal that DUI offenders are a heterogeneous group, and that simple models relying on only one or two behavioral domains (e.g., driving characteristics, demographics) to explain DUI relapse are insufficient to account for the DUI behavior of offenders. To advance our understanding of DUI relapse, we argue for development and testing of multifactorial models focusing on the interplay of legal, social and psychological factors that describe and explain relapse among DUI offenders. By recognizing the heterogeneity within the offender population it will be easier for researchers and clinicians to identify subgroups that are at high-risk for relapse and which should be targeted by prevention and intervention programs.

Concentration of drugs in blood of suspected impaired drivers

Analytical records concerning 440 living drivers suspected of driving under the influence of drug (DUID) were collected and examined during a 2 years period ranging from 2002 to 2003 in canton de Vaud, Valais, Jura and Fribourg (Switzerland). This study included 400 men (91%) and 40 women (9%). The average age of the drivers was 28+/-10 years (minimum 16 and maximum 81). One or more psychoactive drugs were found in 89% of blood samples. Half of cases (223 of 440, 50.7%) involved consumption of mixtures (from 2 to 6) of psychoactive drugs. The most commonly detected drugs in whole blood were cannabinoids (59%), ethanol (46%), benzodiazepines (13%), cocaine (13%), amphetamines (9%), opiates (9%) and methadone (7%). Among these 440 cases, 11-carboxy-THC (THCCOOH) was found in 59% (median 25 ng/ml (1-215 ng/ml)), Delta(9)-tetrahydrocannabinol (THC) in 53% (median 3 ng/ml (1-35 ng/ml)), ethanol in 46% (median 1.19 g/kg (0.14-2.95 g/kg)), benzoylecgonine in 13% (median 250 ng/ml (29-2430 ng/ml)), free morphine in 7% (median 10 ng/ml (1-111 ng/ml)), methadone in 7% (median 110 ng/ml (27-850 ng/ml)), 3,4-methylenedioxymethamphetamine (MDMA) in 6% (median 218 ng/ml (10-2480 ng/ml)), nordiazepam in 5% (median 305 ng/ml (30-1560 ng/ml)), free codeine in 5% (median 5 ng/ml (1-13 ng/ml)), midazolam in 5% (median 44 ng/ml (20-250 ng/ml)), cocaine in 5% (median 50 ng/ml (15-560 ng/ml)), amphetamine in 4% (median 54 ng/ml (10-183 ng/ml)), diazepam in 2% (median 200 ng/ml (80-630 ng/ml)) and oxazepam in 2% (median 230 ng/ml (165-3830 ng/ml)). Other drugs, such as lorazepam, zolpidem, mirtazapine, methaqualone, were found in less than 1% of the cases.

SALIVARY CORTISOL: A PREDICTOR OF CONVICTIONS FOR DRIVING UNDER THE INFLUENCE OF ALCOHOL?

AIMS

To examine the relationship between salivary cortisol and frequency of past driving under the influence of alcohol (DUI) convictions.

METHODS

A total of 104 males with previous DUI convictions (from one to eight) and mean age of 44.7 years were assessed on measures characterizing repeat DUI offenders, including sociodemographic information, alcohol use behaviours, biological indices of the organic consequences of chronic abuse, negative consequences of excessive drinking, past DUI conviction history, impulse control, and antisocial behaviour tendencies. Saliva samples were taken approximately every 30 min over a 6 h period during an exhaustive multidimensional assessment protocol, and were then assayed to obtain cortisol responses.

RESULTS

Blunted cortisol response, typically observed in alcoholics and in high-risk non-alcoholics, was associated with increased number of past DUI convictions. This association was particularly pronounced in multiple DUI offenders, and was stronger than, and independent of, other measures of alcohol use severity and chronicity commonly used for DUI assessment.

CONCLUSIONS

Cortisol response may be useful in understanding the mediators underlying repeat DUI offending and the frequent failure of intervention efforts in curbing DUI behaviour.

Accuracy of alcohol diagnosis among DWI offenders referred for screening

BACKGROUND

Most US courts use screening programs to evaluate substance-abuse problems of convicted driving while impaired (DWI) offenders. Typically self-report information determines need for treatment. However, little is known about the accuracy of self-reports of alcohol-use problems in this population.

METHODS

DSM-III-R alcohol abuse and dependence diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted DWI offenders were compared with diagnoses and other self-reported information from a voluntary, noncoerced interview 5 years after the screening referral.

RESULTS

At initial screening, 16.8% of offenders were diagnosed with alcohol abuse and 20.1% with alcohol dependence. At the 5-year interview, 19.9 and 60.1% received a retrospective diagnosis of alcohol abuse or dependence at the age at which they were screened. Significantly fewer of those with a retrospective alcohol diagnosis reported that their alcohol use self-reports at screening were "very accurate" compared to those with no retrospective diagnosis.

CONCLUSIONS

Although many DWI offenders undergoing screening have diagnosable alcohol-related problems, underreporting is common, leading to inaccurate diagnosis and, therefore, a missed treatment opportunity. The research community and policymakers should review and reform the current screening system for alcohol-impaired drivers to better address this serious public health problem.

Questions raised by a reasoned action approach: comment on Ogden (2003)

In her critique of social cognition or reasoned action models, J. Ogden (see record 2003-05896-016) claimed that such models are not falsifiable and thus cannot be tested, that the postulated relations among model components are true by definition, and that questionnaires used to test the models may create rather than assess cognitions and thus influence later behavior. The authors of this comment challenge all 3 arguments and contend that the findings Ogden regarded as requiring rejection of the models are, in fact, consistent with them, that there is good evidence for the validity of measures used to assess the models' major constructs, and that the effect of completing a questionnaire on cognitions and subsequent behavior is an empirical question.

The emergency care setting for screening and intervention for alcohol use problems among injured and high-risk drivers: a review

Each year thousands of people are treated in emergency departments and trauma centers for alcohol-related injuries, including those sustained in drinking driving crashes. Emergency departments and trauma centers provide an opportunity to screen for alcohol use problems and intervene with injured or high-risk drivers to reduce future alcohol-related traffic and injury risk. Recently physicians have expressed interest in exploring screening and intervention for alcohol use problems in these venues as a means of improving clinical care. This article reviews the literature that has examined screening and brief interventions in acute care settings to reduce future alcohol consumption and alcohol-related injury. The methodological and practical issues inherent in conducting these studies as well as in actual practice are discussed. The chaotic environment of acute care, the large numbers of patients required to be screened to obtain an adequate study sample, and high attrition rates make study in these settings difficult at best and are methodological problems that should be addressed in future research. A basic question that has not been adequately answered by research to date is whether reduction in alcohol consumption will translate to reduced alcohol-related harm, such as driving while impaired, or injurious or fatal crashes. Long-term studies that assess records-based outcomes in addition to alcohol-consumption levels are needed.

Urine drug testing in pain medicine

The use of urine drug testing (UDT) has increased over recent years. UDT results have traditionally been used in legal proceedings under supervision of a medical review officer (MRO). In this context, testing has been required by statute or regulation and so is typically not in the "donor's" interest. Physicians, however, can use UDT to assist in monitoring their patient's treatment plan. By using UDT in a patient-centered fashion, both patient and physician interests are maintained. The MRO-based model of testing in the clinical setting can lead to mistrust and a deterioration of the doctor-patient relationship. Clinical testing can enhance the doctor-patient relationship when the results are used to improve communication. A patient-centered model of UDT should be used to improve quality of care. This article discusses why urine is the biological specimen of choice for drug testing; who, when and why to test; testing methods; and, most importantly, interpretation of results.