DUI offenders who delay relicensing: a quantitative and qualitative investigation

Recidivism prevention for impaired driving: Longitudinal 5-year outcomes from Quebec's severity-based intervention assignment program

INTRODUCTION

Driving while impaired by alcohol (DWI) is a persistent problem. Tailoring intervention modality to client risk and needs (i.e., risk/needs) is posited to both reduce recidivism more efficiently than uniform approaches and circumvent overtreatment or undertreatment. DWI drivers in Quebec must participate in a severity-based intervention assignment program to be relicensed, but like most tailoring programs it has yet to undergo systematic scrutiny. The current longitudinal cohort study tests two main hypotheses underpinning this approach: 1) drivers classified at higher recidivism risk based on their arrest characteristics (DWI_R) show poorer outcomes over up to 5-years postassessment compared to drivers classified at lower risk (DWI_F); and 2) for both DWI_R and DWI_F groups, assignment of drivers with greater risk/needs to intensive intervention (II) will be advantageous for reducing recidivism risk compared to assignment into brief intervention (BI) for those with lower risk/needs.

METHODS

Drivers who entered the program from 2012 to 2016 were followed to the end of 2018 (N = 37,612). Survival analysis examined the predictive validity of the initial classification into DWI_R or DWI_F groups for documented recidivism over a follow-up of up to 5 years. Logistic regression discontinuity evaluated the relative outcomes of drivers who were assigned to either BI or II. The study explored interaction effects between classification and intervention assignment with age and sex.

RESULTS

In line with the hypothesis, the average hazard of recidivism was 58 % greater in DWI_R drivers compared to DWI_F drivers. In both DWI_F and DWI_R drivers, assignment of drivers with greater risk/needs to II was associated with reduced recidivism compared to assignment of drivers with lower risk/needs to BI, with 57 % and 35 % decreased probability of recidivism, respectively. Younger age was more strongly associated with recidivism risk in DWI_F drivers than in DWI_R drivers.

CONCLUSIONS

The current study found that Quebec's severity-based intervention assignment approach accurately identifies DWI drivers who: i) by their arrest characteristics pose a greater risk for recidivism, which may require expeditious exposure to preventative countermeasures; and ii) as a function of their greater risk/needs, benefit from assignment to more intensive intervention to mitigate their recidivism risk.

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.

The dilemma of re-licensing DWI offenders: The offenders' point of view

In many jurisdictions, drivers convicted for the first-time of driving while impaired by alcohol undertake a risk assessment that will determine the severity of sanctions and the remedial measures they must follow as requisites for re-licensing. There is uncertainty inherent in the assessment of risk for recidivism, however, many offenders feel unfairly assessed and discommoded by the decision-making process and its consequences. The objective of this qualitative study was to gain insight into the perspectives of offenders regarding re-licensing decision making and sanctioning. Specifically, in focus groups first-time offenders and recidivists were probed as to whether they favoured erring on the side of road safety in decision making, with its consequent greater risk of false positive assessments, or erring on the side of maintaining driving privileges, with its consequent greater risk of false negative assessments. In general, participants preferred a higher probability of false negative vs. false positive assessments. Most cited the consequences of sanctions and remedial measures as too severe to impose them on potentially low-risk drivers, as the assessment and monitoring protocols' limitations could lead to non-equitable treatment. At the same time, recidivists evoked a greater preference for a higher probability of false positive assessments compared to first-time offenders, as they believed that recidivism was more likely to follow a first conviction than did first-time offenders. This information can be useful for a more comprehensive and societally coherent exercise of DWI prevention policies.

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.

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.

Decision-making capacities and affective reward anticipation in DWI recidivists compared to non-offenders: a preliminary study

OBJECTIVES

Impaired decision making is seen in several problem behaviours including alcoholism and problem gambling. Decision-making style may contribute to driving while impaired with alcohol (DWI) in some offenders as well. The Somatic Marker Framework theorizes that decision making is the product of two interacting affective neural systems, an impulsive, rapid, amygdala-dependent process for emotionally signalling the immediate negative or positive consequences of an option, and a reflective, longer-lasting, ventral medial prefrontal cortex dependent system for emotionally signalling the future negative or positive prospects of an option. This study tested the hypothesis that offenders who showed disadvantageous decision-making would be at higher risk for recidivism than those who showed more advantageous decision-making. In addition, in line with the Somatic Marker Hypothesis, offenders who showed disadvantageous decision-making would exhibit a distinct pattern of somatic activation compared to offenders who showed more advantageous decision-making.

METHODS

A sample of 21 DWI offenders with from 2 to 7 past DWI convictions and a reference group consisting of 19 non-offender (N-O) drivers were recruited and administered the Iowa Gambling Task (IGT), as well as evaluated on sociodemographic, driving and alcohol use dimensions. In addition, anticipatory skin conductance response (aSCR) was measured in the 5s prior to each of a 100 card draws on the IGT.

RESULTS

Median split of the DWI offender sample based upon overall performance on the IGT yielded two subgroups (IGT-R Hi and IGT-R Lo). Hypothesis 1 was supported, as the IGT-R Lo group possessed significantly greater frequency of past DWI convictions and severity of past drinking. Descriptive analyses revealed that on the IGT, IGT-R Hi group performed similarly to the N-O reference group while the IGT-R Lo group performed significantly worse. Hypothesis 2 was not supported.

CONCLUSIONS

Decision making is a plausible explanatory neurocognitive pathway to severer forms of DWI. The role of emotional processing in DWI risk is uncertain. Subtyping DWI offenders using neurocognitive criteria seems a promising avenue for improving clinically meaningful methods of DWI risk assessment and intervention.

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.

DUI offenders delay license reinstatement: a problem?

BACKGROUND

We examined the extent to which driving under the influence (DUI) offenders delay reinstatement, the reasons for that delay, and the relationship of the delay to recidivism. Analyzed were the driving records of 40 million drivers (3 million convicted of DUI) from 7 of the largest states spanning 7 to 14 years. License suspension effectively reduces, but does not eliminate, impaired driving. Apparently, many feel they can avoid apprehension for unlicensed driving; the limited research to date suggests that up to 75% of convicted offenders continue to drive and up to 84% delay reinstatement for 3 or more years.

METHODS

ANOVA and regression procedures were used to determine the relationship of prior driving record and sentence length to the DUI offender's delay in reinstatement. Meta-analysis was used to summarize results across the 7 states and survival analysis to determine the effect of the delay on recidivism.

RESULTS

Forty-two percent of first offenders and 55% of multiple offenders convicted for DUI delay reinstatement for more than a year. For a third of the offenders, there were no records of their having reinstated within 5 years of becoming eligible. Both factors-more than one prior offense and the length of suspension imposed-were related to delay in reinstatement. Offenders who delayed reinstatement were more likely to recidivate both while they delayed before reinstating and after they reinstated.

CONCLUSIONS

DUI offenders who delay reinstatement after they become eligible are high-risk drivers. Offenders who reinstate, however, have lower recidivism rates than those who do not. This suggests that encouraging reinstatement but with continued controls, as some states have provided through laws requiring interlocks as a condition of reinstatement, may be effective if they do not motivate extended delays.

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.