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Dougherty DM, Moon TJ, Liang Y, Roache JD, Lamb RJ, Mathias CW, Wasserman AM, Wood EE, Hill-Kapturczak N. Effectiveness of contingency management using transdermal alcohol monitoring to reduce heavy drinking among driving while intoxicated (DWI) arrestees: A randomized controlled trial. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1989-2001. [PMID: 37864527 PMCID: PMC11205128 DOI: 10.1111/acer.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Driving while intoxicated (DWI) is a serious public health problem. However, treatment for DWI arrestees is not readily available. This study examines the effectiveness of a contingency management (CM) procedure using transdermal alcohol concentration (TAC) monitoring to reduce drinking among DWI arrestees. METHOD The study participants were 216 DWI arrestees under pretrial and included both Mandated participants undergoing court-ordered TAC monitoring and Non-Mandated participants wearing a study-provided TAC monitor. Participants were randomly assigned to either a CM (Mandated = 35; Non-Mandated = 74) or a Control condition (Mandated = 37; Non-Mandated = 70) and completed the 8-week intervention. CM participants received $50/week for not exceeding a TAC of 0.02 g/dL during the previous week. Payments to Controls were yoked to the CM group. RESULTS Among Non-Mandated participants, the probability of meeting the contingency was higher and remained stable (about 65%) over time in the CM group, whereas the probability was lower and declined in the Control group, widening the gaps in the probability between the study conditions (16.7%-24.1% greater in the CM group from visit 4 to 8, all p < 0.05). Among Mandated participants, the probability was not significantly different between conditions (p = 0.06-0.95). Furthermore, among Non-Mandated participants, the percentage of heavy drinking days remained low (9.16%-11.37%) in the CM group, whereas it was greater and increased over time (17.43%-26.59%) in the Control group. In Mandated participants, no significant differences in percent heavy drinking days were observed between conditions (p = 0.07-0.10). CONCLUSION We found that contingency effects on alcohol use are more pronounced among frequent and heavy alcohol users, i.e., Non-Mandated DWI arrestees. However, for individuals whose drinking was already suppressed by existing contingencies (i.e., court-mandated TAC monitoring), our CM procedure did not produce additional reductions in drinking.
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Affiliation(s)
| | - Tae-Joon Moon
- Department of Health, Behavior, and Society, University of Texas School of Public Health San Antonio, San Antonio, Texas, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - John D. Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard J. Lamb
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Charles W. Mathias
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Erin E. Wood
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Wood EE, Liang Y, Moon TJ, Wasserman AM, Lamb RJ, Roache JD, Hill-Kapturczak N, Dougherty DM. Reduced alcohol use increases drink-refusal self-efficacy: Evidence from a contingency management study for DWI arrestees. Drug Alcohol Depend 2023; 242:109706. [PMID: 36493503 PMCID: PMC9784176 DOI: 10.1016/j.drugalcdep.2022.109706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several therapies and interventions to reduce drinking first target drink-refusal self-efficacy (DRSE) to influence drinking behavior. While higher self-efficacy scores are correlated with better outcomes, it is unclear that increased self-efficacy is the causative step leading to improved outcomes. Instead, this correlation may result from reduced drinking that increased self-efficacy. The current study sought to understand how changes in drinking behavior can influence DRSE. METHODS Data were from 211 driving while intoxicated (DWI) arrestees participating in an 8-week contingency management (CM) study to reduce drinking. Some of participants were mandated by the courts to wear transdermal alcohol monitoring devices (Mandated group) and some were not mandated (Non Mandated group). All wore a transdermal alcohol monitor during the 8-week study and were randomized to CM or a Control condition stratified by the mandate group. Participants completed weekly assessments of DRSE. Group-based trajectory-modeling identified three drinking behavior trajectory groups. RESULTS While there were no differences in baseline DRSE between the three trajectory groups, participants in the low- and moderate-frequency drinking behavior groups significantly increased DRSE across the study. CONCLUSION The present study indicates that being able to maintain abstinence or reduce heavy drinking may increase DRSE.
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Affiliation(s)
- Erin E Wood
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, 660 W. Redwood Street, Baltimore, MD 21201, USA
| | - Tae-Joon Moon
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Alexander M Wasserman
- Department of Psychology, Ohio State University, Lazenby Hall 226, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - R J Lamb
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Donald M Dougherty
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
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Frantzen D. Modeling Repeat DUI Offender Probation Outcomes Using the Wisconsin Risk Need Assessment. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2021; 65:1316-1334. [PMID: 32456501 DOI: 10.1177/0306624x20923255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Moon TJ, Mathias CW, Mullen J, Karns-Wright TE, Hill-Kapturczak N, Roache JD, Dougherty DM. Social Support and the Rehabilitation of Alcohol-Impaired Drivers: Drinking Motives as Moderators. HEALTH COMMUNICATION 2021; 36:540-550. [PMID: 32091242 PMCID: PMC7483183 DOI: 10.1080/10410236.2020.1731914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Alcohol-impaired driving is a common and costly public health problem associated with alcohol misuse. This investigation aims to understand the role of social support and drinking motives in motivating alcohol-impaired drivers to reduce alcohol use. One hundred nineteen participants with a history of driving-while-intoxicated arrest were recruited from either a correctional treatment facility (n = 59) or the community (n = 60) and asked about their motivation to change alcohol use. Motivation to change was tested in relationships with two types of social support (i.e. Abstinence-Specific Social Support and General Social Support) and drinking motives (Coping, Enhancement, and Social Motives). The results showed: (1) only Abstinence-Specific Social Support was positively associated with motivation to change; (2) Coping and Social Motives had a negative association with motivation to change; (3) the impact of Abstinence-Specific Social Support on motivation to change was greater among those with a stronger Enhancement Motives. In other words, those who drink primarily for pleasure showed a greater increase in motivation to change when more Abstinence-Specific Social Support is available, compared to those with lower Enhancement Motives. The findings of this investigation contribute to our knowledge of the roles of communication in the rehabilitation of alcohol-impaired drivers.
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Affiliation(s)
- Tae-Joon Moon
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Charles W. Mathias
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Jillian Mullen
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Tara E. Karns-Wright
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | | | - John D. Roache
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Donald M. Dougherty
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
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Nochajski TH, Manning AR, Voas R, Taylor EP, Scherer M, Romano E. The impact of interlock installation on driving behavior and drinking behavior related to driving. TRAFFIC INJURY PREVENTION 2020; 21:419-424. [PMID: 32783636 PMCID: PMC7879393 DOI: 10.1080/15389588.2020.1802020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE There is a substantial body of evidence that the recidivism of impaired-driving offenders is reduced while an ignition interlock device (IID) is on their vehicles. This study examines changes in driving behaviors and drinking behaviors used by DWI offenders to manage driving with the IID. METHODS A total of 166 IID participants who completed two surveys covering the period from arrest to IID installation (T1) and during IID use (T2) were examined. Four domains were covered: demographics, driving environments and transportation needs, reported driving activity, and reported drinking activities. Participants were on average 38 years old, 43% were female, 35% completed college, 34% had an income of more than $50,000, and 83% were employed. For those who provided it, the mean blood alcohol content (BAC) at arrest was .184 g/dL, with only 8 (5%) individuals below .08 g/dL, and 93 (56%) at over .18 g/dL. About 45% were repeat DWI offenders. RESULTS Between T1 and T2 there was a slight increase in acknowledging public transportation was available (p=.001), an increase in other individuals driving the interlock-equipped vehicle (p=.002), an increase in the number of vehicles in the household not registered to the DWI offender (p< .001), and an increase in the number of participants who reported that driving was important to their lifestyle (p=.008). Initial (T1) expectations about whether the interlock would be a problem were significantly different from actual experiences reported in T2 (p<.001). With respect to alcohol consumption, 14% reported abstinence at T2 compared to 2% at T1 (p=.001) and the number of drinks per drinking occasion decreased from a mean of 4.90 at T1 to 3.14 at T2 (p=.001), but the number of drinking occasions increased by a third (p=.003). The number of drinking locations (p=.001), the frequency of stopping after work for a drink (p=.001), and drinking at a bar all decreased (p<.001). CONCLUSIONS Interlock users make some adjustments in how they drink, the amount they drink, and where they drink. This finding suggests that there may be methods that can be used to extend the benefits of the IID beyond the sanction period.
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Affiliation(s)
| | - Amy R Manning
- School of Social Work, University at Buffalo, Buffalo, New York
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Robert Voas
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Eileen P Taylor
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Michael Scherer
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- Chicago School of Professional Psychology, Washington, DC, Washington
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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Treatment Initiation and Alcohol Use Violations Among Adults with DWI Arrests Who Received a Tailored Brief Intervention. ADDICTIVE DISORDERS & THEIR TREATMENT 2020; 19:7-15. [PMID: 33424458 DOI: 10.1097/adt.0000000000000171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective This program evaluation examined rates of treatment initiation and alcohol related violations among adults who completed a brief motivational interviewing (BMI) session after a driving while intoxicated arrest. Method Adults attending orientation for pretrial bond supervision were assessed for eligibility to receive services by counselors in an outpatient clinic. A total of 118 male and female adults with DWI arrests completed a single BMI session. Treatment initiation was assessed one-week after the BMI session and alcohol-related violations were assessed 6-months later. Results Fifty-three percent of those with DWI arrests who received the BMI session-initiated treatment and of those who initiated treatment, alcohol-related violations were significantly lower than for those who did not initiate treatment. Conclusions The results provide preliminary support that a single session BMI delivered soon after arrest and before pretrial conditions are implemented has promise for spurring clients to take steps to initiate treatment and is related to better rates of compliance with alcohol-related pretrial conditions.
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Mathias CW, Moon TJ, Karns-Wright TE, Hill-Kapturczak N, Roache JD, Mullen J, Dougherty DM. Estimating resource utilization demands in implementing statewide screening, brief intervention, and referral to treatment for alcohol-impaired drivers. TRAFFIC INJURY PREVENTION 2019; 20:15-22. [PMID: 30715916 PMCID: PMC6445674 DOI: 10.1080/15389588.2018.1528500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The Alcohol Use Disorders Identification Test (AUDIT) is used to assess the level of alcohol use/misuse and to inform the intensity of intervention delivered within screening, brief intervention, and referral to treatment (SBIRT) programs. Policy initiatives are recommending delivery of SBIRT within health care settings to reduce alcohol misuse and prevent alcohol-impaired driving. Recent reports are considering extending delivery of SBIRT to criminal justice settings. One consideration in implementing SBIRT delivery is the question of resource utilization; the amount of effort required in delivering the 4 different intensities of intervention in SBIRT: Alcohol education, simple advice, brief counseling and continued monitoring, and brief counseling and referral to specialist (from least to most intense in terms of delivery time, the skill level of the provider, and personnel resources). METHODS In order to inform expectations about intervention intensity, this article describes the AUDIT scores from 982 adults recently arrested for alcohol-impaired driving. The distribution of scores is extrapolated to state rates for individuals arrested for alcohol-impaired driving by intervention level. RESULTS Though alcohol education was the most common intervention category, about one quarter of the sample scored in a range corresponding with the more intensive interventions using the brief counseling, continued monitoring for ongoing alcohol use, and/or referral to specialist for diagnostic evaluation and treatment. CONCLUSIONS This article provides local distribution of AUDIT scores and state estimates for the number of individuals scoring in each level of risk (AUDIT risk zone) and corresponding intervention type. Routine criminal justice practice is well positioned to deliver alcohol screening, education, simple advice, and continued alcohol monitoring, making delivery of SBIRT feasible for the majority of alcohol-impaired drivers. Challenges to implementing the full range of SBIRT services include resource demands of brief counseling, identifying the appropriate providers within a criminal justice context, and availability of community providers for referral to diagnostic and specialty care. Solutions may vary by state due to differences in population density and incidence rates of alcohol-impaired driving.
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Affiliation(s)
- Charles W. Mathias
- Department of Psychiatry The University of Texas Health Science Center at San Antonio San Antonio, TX
- Center for Research to Advance Community Health (ReACH) The University of Texas Health Science Center at San Antonio San Antonio, TX
| | - Tae-Joon Moon
- Department of Psychiatry The University of Texas Health Science Center at San Antonio San Antonio, TX
| | - Tara E. Karns-Wright
- Department of Psychiatry The University of Texas Health Science Center at San Antonio San Antonio, TX
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry The University of Texas Health Science Center at San Antonio San Antonio, TX
| | - John D. Roache
- Department of Psychiatry The University of Texas Health Science Center at San Antonio San Antonio, TX
- Institute for Integration of Medicine and Science The University of Texas Health Science Center at San Antonio San Antonio, TX
- Department of Pharmacology The University of Texas Health Science Center at San Antonio San Antonio, TX
| | | | - Donald M. Dougherty
- Department of Psychiatry The University of Texas Health Science Center at San Antonio San Antonio, TX
- Institute for Integration of Medicine and Science The University of Texas Health Science Center at San Antonio San Antonio, TX
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Smart R, Osilla KC, Jonsson L, Paddock SM. Differences in alcohol cognitions, consumption, and consequences among first-time DUI offenders who co-use alcohol and marijuana. Drug Alcohol Depend 2018; 191:187-194. [PMID: 30130715 PMCID: PMC6309328 DOI: 10.1016/j.drugalcdep.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/04/2018] [Accepted: 07/09/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND A significant portion of alcohol-related DUI offenders engage in co-use of alcohol and marijuana (AM). Given expanding marijuana legalization and the impaired driving risks associated with co-use, it is of increased importance to understand how characteristics of AM co-users compare to those who use alcohol only (AO) in order to inform DUI interventions and prevent recidivism. METHODS Participants were 277 first-time DUI offenders enrolled in a first-time DUI offender program across three locations. Using well-established measures, we evaluated differences in alcohol-related cognitions (positive expectancies and self-efficacy), frequency and quantity of alcohol consumption, and alcohol-related consequences between AO users and AM co-users by running a series of multivariate generalized linear models. RESULTS Compared to AO users, AM co-users reported lower self-efficacy to achieve abstinence and avoid DUI. Differences in abstinence self-efficacy largely explain higher relative rates of average and peak drinking quantity and higher odds of binge drinking among AM co-user. Despite lower self-efficacy and higher drinking quantity, there were no significant differences between AM and AO-users on alcohol-related consequences and past month reports of drinking and driving. CONCLUSIONS Our results provide preliminary evidence that DUI offenders who co-use alcohol and marijuana have higher alcohol use and lower self-efficacy than AO-users, and long-term consequences for this group should be monitored in future research. DUI programs may screen and identify co-users and consider tailoring their interventions to build self-efficacy to address the risks associated with AM co-use uniquely.
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Affiliation(s)
- Rosanna Smart
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States.
| | - Karen Chan Osilla
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States
| | - Lisa Jonsson
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States
| | - Susan M Paddock
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States
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Mathias CW, Hill-Kapturczak N, Karns-Wright TE, Mullen J, Roache JD, Fell JC, Dougherty DM. Translating transdermal alcohol monitoring procedures for contingency management among adults recently arrested for DWI. Addict Behav 2018; 83:56-63. [PMID: 29397211 DOI: 10.1016/j.addbeh.2018.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
Recent developments in alcohol monitoring devices have made it more feasible to use contingency management (CM) procedures to reduce alcohol use. A growing body of literature is demonstrating the effectiveness of CM to reduce alcohol use among community recruited adults wearing transdermal alcohol concentration (TAC) monitoring devices. This article describes the quality improvement process aimed at adapting TAC-informed CM aimed at minimizing alcohol use and maximizing treatment completion. This extends literature to a high-risk population; adults arrested and awaiting trial (pretrial) for criminal charge of driving while intoxicated (DWI). Participants were enrolled during their orientation to pretrial supervision conditions of DWI bond release. At enrollment, participants completed a screening, brief intervention, and referral to treatment; those with high risk alcohol histories were enrolled in an 8-week CM procedure to avoid TAC readings. Four Plan-Do-Study-Act (PDSA) quality improvement cycles were conducted where the TAC cutoff for determining alcohol use, the quantity of reinforcer, and handling of tampers on the transdermal alcohol monitor were manipulated. Across four PDSA cycles, the retention for the full 8-weeks of treatment was increased. The proportion of weeks with alcohol use was not decreased across cycles, the peak TAC values observed during drinking weeks were significantly lower in Cycles 1 and 4 than 3. CM may be developed as a tool for pretrial supervision to be used to increase bond compliance of those arrested for DWI and for others as a method to identify the need for additional judicial services.
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Affiliation(s)
- Charles W Mathias
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tara E Karns-Wright
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jillian Mullen
- EASL International Liver Foundation, Geneva, Switzerland
| | - John D Roache
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Institute for Integration of Medicine and Science, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James C Fell
- NORC at the University of Chicago, Bethesda, MD, USA
| | - Donald M Dougherty
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Institute for Integration of Medicine and Science, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Bender AK, Bucholz KK, Heath AC, McCutcheon VV. Comparison of Characteristics of Female Drivers with Single and Multiple DUI Convictions. Alcohol Clin Exp Res 2018; 42:646-653. [PMID: 29437240 DOI: 10.1111/acer.13590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Annah K Bender
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO
| | - Kathleen K Bucholz
- Department of Psychiatry, Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO
| | - Andrew C Heath
- Department of Psychiatry, Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO
| | - Vivia V McCutcheon
- Department of Psychiatry, Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO
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Bean P, Brown G, Hallinan P, Becerra S, Lewis D. Improved recovery of repeat intoxicated drivers using fingernails and blood spots to monitor alcohol and other substance abuse. TRAFFIC INJURY PREVENTION 2017; 18:9-18. [PMID: 27285956 DOI: 10.1080/15389588.2016.1190014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study reports the results of a pilot program in Kenosha County that used a combination of direct biomarkers extracted from blood spots and nails to monitor repeat intoxicated drivers for their use of alcohol and drugs with a detection window spanning from 3 weeks to several months. The objectives were to test whether the direct biomarkers phosphatidylethanol (PEth), ethylglucuronide (EtG), and 5 drug metabolites would (1) help assessors obtain a more objective evaluation of repeat offenders during the assessment interview, (2) allow for timely identification of relapses and improve classification of drivers into risk categories, and (3) predict recidivism by identifying offenders most likely to obtain a subsequent operating while intoxicated (OWI) offense within 4 years of enrollment in the program. METHODS All (N = 261) repeat offenders were tested using PEth obtained from blood spots and EtG obtained from fingernails; 159 participants were also tested for a 5 drugs of abuse nail panel. Drivers were tested immediately after the assessment interview (baseline) and at 3, 6, 9, and 12 months after baseline. Based on biomarker results and self-reports of abstinence, offenders were classified into different risk categories and required to follow specific testing timelines based on the program's decision tree. RESULTS The baseline analysis shows that 60% of drivers tested positive for alcohol biomarkers (EtG, PEth, or both) at the assessment interview, with lower detection rates (0-11%) for the 5 drug metabolites. The comparison of biomarkers results to self-reports of abstinence identified 28% of all offenders as high risk and assigned them to more frequent testing and more intense monitoring. The longitudinal analysis shows that 56% (completers) of participants completed the program successfully and the remaining 44% (noncompliant) terminated prematurely. Two thirds (68%) of the completers were able to reduce or control their drinking and one third relapsed at least one time during their mandated monitoring periods. After a brief intervention by the assessors, 79% of relapsers tested negative for biomarkers in their repeat tests. The rearrest analysis showed that offenders classified in the noncompliant and relapsers groups were 7 times more likely to receive a new OWI 4 years after enrollment compared to drivers classified as abstainers or controllers. Refractory drivers were monitored the longest and reported no subsequent rearrests. CONCLUSION These findings demonstrate the benefits of more individualized interventions with repeat OWI offenders and calls for further development of multimodal approaches in traffic medicine including those that use direct alcohol biomarkers as evidence-based practices to reduce recidivism.
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Affiliation(s)
| | - Guida Brown
- b Hope Council on Alcohol & Other Drug Abuse, Inc. , Kenosha , Wisconsin
| | | | | | - Doug Lewis
- d U.S. Drug Testing Laboratories , Des Plaines , Illinois
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Ahlner J, Holmgren A, Jones AW. Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving. Forensic Sci Int 2016; 265:138-43. [PMID: 26901639 DOI: 10.1016/j.forsciint.2016.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem. METHODS This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma. RESULTS Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p<0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p<0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p<0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p<0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids. CONCLUSIONS This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes.
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Affiliation(s)
- Johan Ahlner
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Anita Holmgren
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden
| | - Alan Wayne Jones
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
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Mullen J, Ryan SR, Mathias CW, Dougherty DM. Feasibility of a computer-assisted alcohol screening, brief intervention and referral to treatment program for DWI offenders. Addict Sci Clin Pract 2015; 10:25. [PMID: 26553284 PMCID: PMC4640391 DOI: 10.1186/s13722-015-0046-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jillian Mullen
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Stacy R Ryan
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Charles W Mathias
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Donald M Dougherty
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
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