Impaired driving among rural female drug-involved offenders

Sex differences and driving impairment related to psychoactive substances

OBJECTIVE

The first aim of the study was to identify sex differences in the use of psychoactive substances among subjects with a previous driving under the influence (DUI) episode. The secondary objective was to propose specific strategies for medico-legal improvements.

METHODS

This was a retrospective observational study that took place between June 1, 2019, and August 31, 2023. It was conducted on DUI subjects examined for reinstatement of their driver's license using an integrated medico-legal and toxicological approach. Ethyl glucuronide (EtG) and illicit psychoactive substances were determined from hair samples. We performed descriptive statistical analyses for the entire sample as well as separately by sex. Additionally, we conducted binary logistic regression analyses separately for males and females to identify protective/risk factors associated with previous road accidents and judgments of unfitness to drive due to excessive alcohol consumption (EtG ≥ 30 pg/mg).

RESULTS

The study included 2,221 subjects, comprising 1,970 men and 251 women. Men exhibited a higher prevalence of tobacco, alcohol, and illicit psychoactive substance use. Women were more frequently co-users of alcohol and psychoactive substances and involved in road accidents at the time of DUI. Among the men, being married or having a partner was found to be a protective factor concerning past traffic accidents. For both sexes, a DUI episode with a blood alcohol concentration (BAC) exceeding 1.5 g/L or the co-ingestion of alcohol and drugs was identified as a risk factor for road accident involvement. For men, smoking more than 20 cigarettes per day and, for women, having a DUI episode with a BAC over 1.5 g/L were the main factors indicating unfitness to drive, as determined through high hair EtG levels (> 30 pg/mg). Women with a previous history of road accidents were less likely to have EtG levels of 30 pg/mg or more.

CONCLUSIONS

The study confirmed sex differences in subjects with a previous DUI episode. A BAC exceeding 1.5 g/L or the simultaneous use of alcohol and drugs at the time of DUI necessitate careful assessment of both men and women seeking driver's license reinstatement. In women, a BAC exceeding 1.5 g/L is considered a risk factor for a subsequent judgment of unfitness to drive. The medico-legal assessment should also involve a thorough investigation of smoking habits in men, as these habits could be related to an increased risk of excessive alcohol consumption.

Better understanding female and male driving offenders' behavior: Psychological resources and vulnerabilities matter!

Although driving risk taking appears to be mainly male, an increase in driving violations has been observed in recent years among French female drivers. The main objective of the present study was to explore the driving behaviors, psychological resources, and vulnerabilities of female and male driving offenders participating in a French driver rehabilitation program. The second aim was to examine to what extent females' and males' resources and vulnerabilities predicted their violations, engagement in distracting activities while driving, and prosocial driving behaviors. In the course of 110 rehabilitation programs, 1686 driving offenders (22.4% females) completed a paper-and-pencil questionnaire. Compared to male offenders, females were more likely to have received a higher education, be divorced, or separated, and drive fewer annual kilometers. They also had had fewer demerit points than males in the last three years. They were more empathetic but also more impulsive than their male counterparts and less self-compassionate and mindful. Regression and moderation analyses revealed that, across genders, certain psychological resources such as mindfulness can be considered as protective factors for driving offenders as they tend to decrease dangerous behaviors and increase prosocial ones, while vulnerabilities such as aggressive driving anger expression seem to have the opposite effect. Our results provide a better understanding of driving offenders' behavior and the influence of personal dispositions. They also open new interesting research avenues in the prevention of dangerous behaviors among this high-risk population.

Impaired driving and other risky drug use and sex behaviors: a cross-sectional examination of high-risk rural women incarcerated in jail

Background: Despite women accounting for an increasing proportion of impaired drivers and higher rates of impaired driving and road fatalities in rural areas, little is known about rural women who drive impaired and their other risky behavior.Objective: The present study assessed the association between impaired driving history, risky substance use, and other drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail.Methods: Four hundred women from three rural jails provided information about their impaired driving, drug use, injection drug use practices, and sex risk behaviors. Groups were stratified on whether they self-reported impaired driving in the year prior to incarceration. Impaired drivers (n = 260, M = 31.90 years old) were compared to women who did not drive impaired (n = 131, M = 34.42 years old) using MANCOVA and logistic regression analyses.Results: Impaired drivers had significantly (p < .05) higher substance use severity scores for cannabis, sedatives, and prescription opioids. Furthermore, impaired drivers were significantly (p < .05) more likely to have been the passenger of an impaired driver (78.08% vs. 53.44%), been an injection drug user (69.62% vs. 41.98%), had a casual sex partner (47.31% vs. 25.95%), and traded sex for drugs or money (31.15% vs. 15.27%) in the year prior to incarceration.Conclusions: This study found a consistent association between past year impaired driving and a range of drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. These findings highlight an opportunity to intervene in criminal justice settings to reduce multiple health risk behaviors.

Implementation of the first comprehensive state oral fluid drug testing program for roadside screening and laboratory testing in DUID cases-A 5-year review

Oral fluid (OF) is a valuable specimen for driving under the influence of drugs (DUID) applications. This study demonstrates the implementation of the first comprehensive OF drug testing program in the United States, including approved roadside screening OF devices for law enforcement and validated liquid chromatography-tandem mass spectrometry (LC-MS-MS) confirmation methods. Three roadside OF screening devices were evaluated: the Dräger DrugTest® 5000, Abbott SoToxa®, and Randox Evidence MultiSTAT™. Two qualitative LC-MS-MS confirmation methods were validated per ASB Standard 036. The first method utilized an automated dispersive pipette extraction extraction using Integra and Hamilton STARlet platforms for drugs of abuse. The second method used a liquid-liquid extraction to detect cannabinoids. The prevalence of drugs in blood and OF was monitored over 5 years of casework. Calibration curves were analyzed with each batch to monitor OF concentrations for research purposes. Three roadside OF screening devices were deemed fit for purpose. Devices demonstrated appropriate sensitivity, specificity, positive and negative predictive values, and accuracy above 80% for targeted drugs except for benzodiazepines (DrugTest® 5000) and amphetamine (SoToxa®). The validated LC-MS-MS OF confirmation methods met the National Safety Council-recommended cutoffs for 18/21 (86%) of the targets. Over 5 years of casework, THC and cocaine were detected at a positivity rate of 90% and 97% in OF versus 75% and 44% in blood, respectively. OF:blood ratios exceeded unity for parent drugs. Median concentrations of THC in OF and blood were 31 and 3.5 ng/mL, respectively. OF is a viable alternative or supplemental specimen for DUID investigations. Collecting OF close to the driving event increases the opportunity to identify pharmacologically active substances, and when combined with blood analysis results, an elevated OF:blood ratio provides valuable information for DUID investigation purposes.

Self-Report Survey Measures of Alcohol-Impaired Driving: A Systematic Review

OBJECTIVE

Alcohol-impaired driving is a major contributor to motor vehicle crash deaths and injury. Many survey studies include self-report measures of alcohol-impaired driving, but no guidance is available to help researchers select from among available measures. The aims of this systematic review were to compile a list of measures that researchers have used previously, to compare performance between measures, and to identify the measures with highest validity and reliability.

METHOD

Literature searches of PubMed, Scopus, and Web of Science identified studies that assessed alcohol-impaired driving behavior through self-report. The measures from each study and, if available, indices of reliability or validity were extracted. Using the measures' text, we developed 10 codes to group similar measures and compare them. For example, the "alcohol effects" code refers to driving while feeling dizzy or lightheaded after drinking, and the "drink count" code pertains to the number of drinks someone consumed before driving. For measures with multiple items, each item was categorized separately.

RESULTS

After screening according to the eligibility criteria, 41 articles were included in the review. Thirteen articles reported on reliability. No articles reported on validity. The self-report measures with the highest reliability coefficients contained items from multiple codes, namely alcohol effects and drink count.

CONCLUSIONS

Self-report alcohol-impaired driving measures with multiple items evaluating distinct aspects of alcohol-impaired driving show better reliability than measures using a single item. Future work investigating the validity of these measures is needed to determine the best approach for conducting self-report research in this area.

A descriptive analysis of drivers under the influence of opioids in Kentucky

Despite the ongoing opioid epidemic and evidence of the increasing prevalence of driving under the influence of opioids, particularly in rural communities, there remains a limited understanding of those who drive under the influence of opioids. The current study aims to fill this gap in the literature by examining drivers under the influence of opioids (DUIOs) using the clinical substance use assessment records of a statewide sample of drivers convicted of driving under the influence (N = 15,917); first identifying differences between DUIOs and drivers under the influence of other, non-opioid substances, followed by an examination of factors associated with driving under the influence of opioids in combination with other substances, and finally, comparing rural and urban DUIOs (N = 1,571). Bivariate analyses were used to compare groups, while a logistic regression model was used to identify correlates of other substance involvement. DUIOs differed from drivers under the influence of other, non-opioid substances, such as being more likely to be convicted in a rural community (65.7% vs 53.6%) and to be under the influence of multiple substances at the time of arrest (42.0% vs 7.1%). Among DUIOs, a rural conviction (p =.016) and meeting DSM criteria for an alcohol (p <.001) and drug use disorder (p <.001) were positively associated with driving under the influence of opioids in combination with other substances. Results also highlighted a number of differences between rural and urban DUIOs, including other substance involvement. Urban DUIOs were more likely to report alcohol involvement in their DUI arrest (16.7% vs 9.1%), and rural DUIOs were more likely to report other, non-opioid drug involvement (36.9% vs 29.1%). Results suggest a possible need for different prevention and treatment approaches depending on rural/urban environment, which is noteworthy given limited treatment availability and other barriers to substance use treatment in rural communities.