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Lalwani K, Sewell C, Frazier G, Abel W. Drunk driving: a secondary analysis of factors associated with driving under the influence of alcohol in Jamaica. BMJ Open 2023; 13:e073529. [PMID: 37438070 PMCID: PMC10347499 DOI: 10.1136/bmjopen-2023-073529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES To determine the prevalence of alcohol use patterns, sociodemographic factors and risk of alcohol dependence among vehicle drivers in Jamaica. DESIGN A secondary data analysis. SETTING This study was conducted using the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS This included 1060 vehicle drivers derived from the population sample of 4623. The participants from each household were randomly selected as the respondent for the survey. PRIMARY AND SECONDARY OUTCOME MEASURES Alcohol use and dependence were measured using the Alcohol Use Disorders Identification Test questionnaire. Driving under the influence of alcohol (DUIA) was assessed by questions regarding its use in the past 12 months. The analysis involved the use of Pearson's χ2 test and logistic regression. RESULTS 75% of Jamaicans reported lifetime alcohol use. Approximately 65% of drivers indicated that they currently drink alcohol. 18% of drivers who currently drink alcohol admitted to DUIA. Reportedly, 54.5% of these drivers were alcohol binge drinkers, with 41.5% also driving under the influence of cannabis. The bivariate analysis demonstrated that DUIA was higher among Christian participants and those who worked in non-machine operator jobs (p=0.002 and p=0.008, respectively). Vehicle drivers altogether and drivers who drive under the influence of alcohol had significant associations with hazardous drinking (p=0.011 and p<0.001, respectively). Logistic regressions highlighted drivers 34 years and under (p=0.012), male drivers (p=0.002) and the head of the household (p=0.050) were 1.82, 3.30 and 1.86 times more likely, respectively, to report driving under the influence of alcohol in the past year. CONCLUSIONS The prevalence of alcohol use among Jamaica's population and vehicle drivers is high. That one in five drivers, who currently consume alcohol, also admits to driving under the influence suggests the urgent need for mitigation strategies and legislative action as part of a preventative effort to reduce drunk driving.
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Affiliation(s)
- Kunal Lalwani
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | - Clayton Sewell
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | - Gralyn Frazier
- Deparment of Economics, Western Michigan University, Kalamazoo, Michigan, USA
| | - Wendel Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
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Governments' accountability for Canada's pandemic response. J Public Health Policy 2022; 43:222-233. [PMID: 35414692 PMCID: PMC9002035 DOI: 10.1057/s41271-022-00350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic—with its wide-reaching social, political, and economic implications—showcases the importance of public health governance. Governmental accountability is at the forefront of societal preoccupations, as state actors attempt to manage the pandemic by using sweeping emergency powers which grant them significant discretion. Though emergency measures have tremendous impacts on citizens’ lives, elected officials and civil society have little input in how governments wield these powers. We reviewed available mechanisms in Canadian private, constitutional, and criminal law and found them to be unlikely sources of much-needed accountability. Therefore, we propose that provincial and territorial legislatures modify public health legislation to expand mechanisms to foster public confidence in decision-makers, and bolster accountability to parliaments and citizens.
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Cheng WJ, Chen LY, Fang SC, Chang HM, Yang TW, Chang RC, Hsing TC, Huang MC. Examining factors associated with postintervention recidivism in DUI repeat offenders after alcohol treatment: One-year follow-up study. J Subst Abuse Treat 2021; 130:108426. [PMID: 34118707 DOI: 10.1016/j.jsat.2021.108426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Taiwan has deemed driving under the influence of alcohol (DUI) to be criminal, and offenders are subjected to fines and jail penalties without being offered alcohol-related treatment, although alcohol use problems are prevalent in this population. We followed the recidivism records of DUI repeat offenders for one year after they had received a newly established legal-medical joint intervention program for alcohol treatment and examined factors related to postintervention recidivism. In this study, 231 DUI repeat offenders with alcohol use problems screened out by the Alcohol Use Disorder Identification Test were referred from the prosecutors' office to one psychiatric hospital for SBIRT-based alcohol treatment. We divided the participants into two groups based on the official recidivism records within the year following the end of treatment. The study used a Cox proportional hazards model to examine the hazard ratio of the baseline clinical characteristics and intervention duration for post-treatment recidivism. The study used generalized estimation equation models to examine changes in psychological symptoms and drinking behaviors over time. We found that participants who recidivated in the next year after intervention did not differ from those without recidivism records in all measurements except for the length of duration they stayed in treatment. Survival analysis determined that participants who had received the intervention for >4 months showed significantly lower rates of one-year postintervention recidivism rates The study participants showed improved psychological symptoms and drinking behaviors during the follow-up period. In conclusion, adequate duration of alcohol treatment is a significant factor associated with a lower risk of postintervention recidivism. The results provide some insight into the design of a collaborative program between legal and medical systems to reduce DUI recidivism and improve mental health of DUI repeat offenders.
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Affiliation(s)
- Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, 2 Yude Road, 40447 Taichung, Taiwan; Department of Public Health, China Medical University, 91 Hsueh-Shih Road, 40402 Taichung, Taiwan; Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, 2 Yude Road, 40447, Taichung, Taiwan
| | - Lian-Yu Chen
- Kunming Prevention and Control Center, Taipei City Hospital, 100 Kunming Street, 10844 Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, 17 Xu-Zhou Road, 100 Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, 46 Sec. 3 Zhongzheng Rd., 252 New Taipei City, Taiwan
| | - Hu-Ming Chang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan
| | - Tien-Wei Yang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan
| | - Ru-Chi Chang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan
| | - Tai-Chao Hsing
- Taiwan Supreme Prosecutors' Office, 131, BoAi Road, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Songde Road, 110 Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 110 Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, 250 Wu-Hsing Street, 110 Taipei, Taiwan.
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Blair AL, Chiaf AL, Crockett EK, Teague TK, Croff JM. Validation of hair ethyl glucuronide using transdermal monitoring and self-reported alcohol use in women of childbearing potential. Neuropsychopharmacol Rep 2021; 41:144-151. [PMID: 33650766 PMCID: PMC8340845 DOI: 10.1002/npr2.12151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022] Open
Abstract
Aim The present study aimed to evaluate the validity of hair ethyl glucuronide concentrations compared with transdermal alcohol concentration and self‐reported alcohol use. Methods This trial included 25 adolescent and young adult females, aged 16‐24, who reported at least one heavy drinking episode (≥4 drinks) in the two weeks prior to baseline. All participants were asked to wear an alcohol biosensor over a one‐month prospective study. Detailed self‐report of drinking behaviors was assessed weekly. Estimates of blood alcohol concentration were computed from self‐report data using the National Highway and Transportation Safety Administration equation. Transdermal alcohol concentration and estimated blood alcohol concentration data were categorized into at‐risk (>0.05 g/dL alcohol) and high‐risk (>0.08 g/dL alcohol) drinking events. Hair ethyl glucuronide concentration, total number of drinking events, moderate (>0.05 g/dL) and high level (>0.08 g/dL) of transdermal alcohol concentration, and estimated blood alcohol concentration drinking events were analyzed with Spearman's rank correlation test for validity comparisons. Results No significant correlations were found between hair ethyl glucuronide values and total number, and moderate or high levels of detected drinking events by estimated blood alcohol concentration or transdermal alcohol concentration. Total number of drinking events detected and number of drinking events >0.08 g/dL using estimated blood alcohol concentration and transdermal alcohol concentration methods were significantly correlated with each other (respectively, R = .33, P < .05; R = .42, P < .05). Conclusion Our findings indicate that, due to the number of false negatives, hair ethyl glucuronide concentrations should be used with caution for monitoring abstinence from alcohol use.
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Affiliation(s)
- Andrea L Blair
- Oklahoma State University Center for Health Sciences, National Center for Wellness & Recovery, Tulsa, OK, USA
| | - Ashleigh L Chiaf
- Oklahoma State University Center for Health Sciences, National Center for Wellness & Recovery, Tulsa, OK, USA
| | - Erica K Crockett
- Oklahoma State University Center for Health Sciences, National Center for Wellness & Recovery, Tulsa, OK, USA
| | - Tracy Kent Teague
- Integrative Immunology Lab, Department of Surgery, University of Oklahoma-Tulsa, Tulsa, OK, USA
| | - Julie M Croff
- Oklahoma State University Center for Health Sciences, National Center for Wellness & Recovery, Tulsa, OK, USA.,Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Roache JD, Karns-Wright TE, Goros M, Hill-Kapturczak N, Mathias CW, Dougherty DM. Processing transdermal alcohol concentration (TAC) data to detect low-level drinking. Alcohol 2019; 81:101-110. [PMID: 30179708 DOI: 10.1016/j.alcohol.2018.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/17/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several studies have objectively quantified drinking through the use of Alcohol Monitoring System's (AMS) transdermal alcohol concentration (TAC) device known as SCRAM CAM. Criteria that AMS uses to detect drinking are known to be conservative and only reliably detect heavy drinking equivalent to 5 or more standard drinks. Our group has developed Research Rules used to process TAC data in a manner that will detect low-level and moderate drinking even though it is below the AMS criteria for detection. METHODS Sixteen male and 14 female paid research volunteers wore TAC monitors for 28 days in their natural environments and responded daily to text message prompts to self-report the previous day's drinking. Current analyses describe the Research Rules that we developed and how use of those rules impacts the detection of self-reported drinking treated as the standard in sensitivity/specificity analysis. RESULTS We observed 606 occurrences of positive TAC events over a total of 867 days and processed the TAC data to retain 345 as possible drinking events, even though AMS criteria confirmed drinking for only 163 of these events. The kinds of TAC events removed or retained by our rules are illustrated as cases of low and moderate drinking days that were detected by our rules but not by the conservative AMS criteria. AMS-confirmed TAC events have a high specificity (99.8%) to detect primarily heavy drinking, but have a poor sensitivity to detect lower-level drinking and a poor specificity as an indicator of alcohol abstinence. In contrast, our Research Rules detected 100% of TAC events detected by AMS but also detected 31% of the lower-level drinking events not detected by AMS, with 91% specificity. CONCLUSIONS Reliance upon the AMS criteria for alcohol detection affords a high specificity for detection of heavy drinking but is a poor indicator of abstinence rates. In contrast, use of our Research Rules provides more sensitive means to quantify either any drinking or low-moderate levels of drinking while still maintaining good specificity.
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Bainbridge L. Transferring 24/7 sobriety from South Dakota to South London: the case of MOPAC's Alcohol Abstinence Monitoring Requirement Pilot. Addiction 2019; 114:1696-1705. [PMID: 30851219 PMCID: PMC6767369 DOI: 10.1111/add.14609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/01/2018] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS During the past three decades an expansive literature has emerged that is dedicated to analysing the processes of policy transfer. One neglected pathway involves subnational agents emulating crime control innovations that have emerged in subnational jurisdictions of other nations. This paper presents the case of the London Mayor's Office for Policing and Crime's (MOPAC) Alcohol Abstinence Monitoring Requirement (AAMR) Pilot to examine the multi-level factors that facilitate and/or constrain international-subnational crime and justice policy transfer. METHODS A qualitative case study design reconstructed the (in)formal events that led to components of the South Dakota 24/7 Sobriety Project (USA) being either abandoned or integrated into MOPAC's AAMR Pilot. Evidence is drawn from elite interviews and documentary materials. RESULTS A series of inter/transnational-, macro-domestic-, meso- and micro-level factors enabled and/or obstructed processes of complete international-subnational policy transfer. Exclusion of domestic violence perpetrators from the London Pilot was fuelled by interest-group hostility and mobilization. Use of alcohol tags rather than breathalysers to monitor compliance was a result of political-economic constraints, concern surrounding intrusion, technological innovation and policy-orientated learning. The decision to omit an 'offender pays' funding mechanism was a consequence of legal incompatibility and civil service reluctance, while 'flash incarceration' for breach was not implemented due to European policy harmonization. CONCLUSIONS The London Alcohol Abstinence Monitoring Requirement Pilot was a policy 'synthesis' that combined ideas, goals, vocabulary, principles, technology and practices from the South Dakota model with the existing English and Welsh criminal justice framework. Structural factors and the actions of particular agents limited the extent to which policy transfer occurred.
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Affiliation(s)
- Laura Bainbridge
- Department of Social PolicyLondon School of Economics and Political ScienceLondonUK
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Outcome Assessment in Trials of Pharmacological Treatments for Alcohol Use Disorders: Fair and Strict Testing. CNS Drugs 2019; 33:649-657. [PMID: 31240634 DOI: 10.1007/s40263-019-00644-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Outcome assessment in the pharmacological treatment of alcohol use disorders (AUDs) faces specific challenges resulting from low adherence to treatment, high rates of dropout, and the susceptibility of patient self-reports to bias. This review discusses methodological issues in planning, conducting, and interpreting clinical trials on AUD treatment against the background of the principle of 'strictness and fairness' of testing. Threats to fairness include factors that limit the implementation of an intervention, such as low compliance and early treatment termination. In turn, fairness of testing is increased by factors that support the degree to which an intervention is implemented, such as the use of adequate pretreatments and the matching of psychosocial and pharmacological treatment strategies. Furthermore, selecting outcomes on the basis of an intervention's mechanism of action and including continuous outcomes as sensitive measures of drinking change further increases fairness by increasing the likelihood that the data will adequately reflect the effects of the intervention. On the other hand, strictness of testing is increased by all measures that limit the influence of confounders that could potentially lead to an overestimation of effects. The use of a side effect-mimicking placebo to prevent an unmasking of blinding and the repeated assessment of alcohol biomarkers to validate drinking self-reports might be valid strategies to further increase the strictness of testing by limiting risks of bias in trials of AUD treatment.
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Park JY, Wu LT. Trends and correlates of driving under the influence of alcohol among different types of adult substance users in the United States: a national survey study. BMC Public Health 2019; 19:509. [PMID: 31054563 PMCID: PMC6500580 DOI: 10.1186/s12889-019-6889-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Despite a decrease in driving under the influence of alcohol (DUIA) prevalence over the past decades, DUIA prevalence still remains high in the United States. To date, there is limited research examining whether different types of substance users have different trends in DUIA. This study sought to assess trends and variables associated with DUIA by substance use type. Methods National Survey on Drug Use and Health (NSDUH) is a cross-sectional, nationally representative population-based survey. By using the NSDUH 2008–2014, we performed the Joinpoint analysis to identify time trends of DUIA in each group of substance users (aged ≥18 years). Logistic regression analysis was used to explore association between substance use type and DUIA and to identify variables associated with DUIA. Results Adults who reported alcohol or drug use in the past year were classified into different groups based on past-year substance use status: alcohol use only (n = 141,521) and drug use regardless alcohol use. Drug users included prescription opioids only (n = 5337), marijuana only (n = 32,206), other single drug (n = 3789), prescription opioids-marijuana (n = 3921), multiple prescription drugs (n = 1267), and other multiple drugs (n = 18,432). The Joinpoint analysis showed that DUIA prevalence decreased significantly from 2008 to 2014 among alcohol only users (Average Annual Percent Change [AAPC] = − 2.8), prescription opioids only users (AAPC = -5.4), marijuana only users (AAPC = -5.0), prescription opioids-marijuana users (AAPC = -6.5), multiple prescription drug users (AAPC = -7.4), and other multiple drug users (AAPC = -3.2). Although the estimate was not statistically significant, other single drug users showed a decreasing trend (AAPC = -0.9). Substance use type was significantly associated with DUIA in the adjusted logistic regression. All drug use groups, relative to the alcohol only group, had elevated odds of DUIA, and the odds were especially elevated for the multiple drug use groups (prescription opioids-marijuana, adjusted odds ratio [AOR] = 2.71; multiple prescription drugs, AOR = 2.83; and other multiple drugs, AOR = 3.68). Additionally, younger age, male sex, being white, higher income, and alcohol abuse/dependence were positively associated with DUIA. Conclusions DUIA prevalence decreased over time and the magnitude of this reduction differed by substance use type. DUIA interventions need to be tailored to substance use type and individual characteristics.
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Affiliation(s)
- Ji-Yeun Park
- Department of Psychiatry and Behavioral Sciences, BOX 3903, Duke University School of Medicine, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, BOX 3903, Duke University School of Medicine, Durham, NC, USA. .,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. .,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. .,Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
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Cheng WJ, Pien LC. A Comparison of International Drunk-Driving Policies and the Role of Drinking Patterns. Am J Prev Med 2018; 55:263-270. [PMID: 29606527 DOI: 10.1016/j.amepre.2018.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Effective drunk-driving policies are not adopted consistently in many countries. To understand how drinking behaviors influence national drunk-driving policymaking, the associations between drunk-driving policies and country-level drinking volumes and patterns were examined. METHODS Data for 194 countries were obtained from the WHO 2012 Global Information System on Alcohol and Health. Country-level drinking behaviors were measured using average drinking volumes and patterns of drinking scores based on six attributes of risky drinking. Drunk-driving policies were categorized into preemptive measures (random breath testing, breath alcohol concentration limits for driving a vehicle, and sobriety checkpoints), penalties (community service, short- or long-term detention, fines, suspension or revocation of license, and vehicle impoundment), mandatory treatment, and ignition interlock. Data analysis was conducted in 2017. The percentages of each policy adoption were examined in countries with different drinking behaviors. The internal consistencies of preemptive measures were calculated using Cronbach's α. A structural equation model was established to examine the associations between drinking behaviors and drunk-driving policy categories, after adjusting for national income levels and general alcohol policies. RESULTS Mandatory treatment and preemptive measures were less commonly adopted than penalties were. The adoption of preemptive measures had a low consistency level, and the consistency level decreased with drinking pattern riskiness. Risky drinking patterns were negatively associated with mandatory treatment policy. CONCLUSIONS Drinking patterns are associated with national drunk-driving policymaking. Accessible medical treatment and comprehensive preemptive measures should be advocated in countries with risky drinking patterns.
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Affiliation(s)
- Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
| | - Li-Chung Pien
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Sindian District, New Taipei City, Taiwan
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Chihuri S, Li G, Chen Q. Interaction of marijuana and alcohol on fatal motor vehicle crash risk: a case-control study. Inj Epidemiol 2017; 4:8. [PMID: 28286930 PMCID: PMC5357617 DOI: 10.1186/s40621-017-0105-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concurrent use of marijuana and alcohol in drivers is of increasing concern but its role in crash causation has not been well understood. METHODS Using a case-control design, we assessed the individual and joint effects of marijuana and alcohol use on fatal crash risk. Cases (n = 1944) were drivers fatally injured in motor vehicle crashes in the United States at specific times in 2006, 2007 and 2008. Controls (n = 7719) were drivers who participated in the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. RESULTS Overall, cases were significantly more likely than controls to test positive for marijuana (12.2% vs. 5.9%, p < 0.0001), alcohol (57.8% vs. 7.7%, p < 0.0001) and both marijuana and alcohol (8.9% vs. 0.8%, p < 0.0001). Compared to drivers testing negative for alcohol and marijuana, the adjusted odds ratios of fatal crash involvement were 16.33 [95% confidence interval (CI): 14.23, 18.75] for those testing positive for alcohol and negative for marijuana, 1.54 (95% CI: 1.16, 2.03) for those testing positive for marijuana and negative for alcohol, and 25.09 (95% CI: 17.97, 35.03) for those testing positive for both alcohol and marijuana. CONCLUSIONS Alcohol use and marijuana use are each associated with significantly increased risks of fatal crash involvement. When alcohol and marijuana are used together, there exists a positive synergistic effect on fatal crash risk on the additive scale.
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Affiliation(s)
- Stanford Chihuri
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Guohua Li
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY USA
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11
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Segmented regression analysis of interrupted time series data to assess outcomes of a South American road traffic alcohol policy change. Public Health 2017. [DOI: 10.1016/j.puhe.2017.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Karns-Wright TE, Roache JD, Hill-Kapturczak N, Liang Y, Mullen J, Dougherty DM. Time Delays in Transdermal Alcohol Concentrations Relative to Breath Alcohol Concentrations. Alcohol Alcohol 2016; 52:35-41. [PMID: 27522029 DOI: 10.1093/alcalc/agw058] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 11/15/2022] Open
Abstract
AIMS Monitors of transdermal alcohol concentration (TAC) provide an objective measurement of alcohol consumption that is less invasive than measurements in blood, breath or urine; however, there is a substantial time delay in the onset of TAC compared to blood or breath alcohol concentrations (BrACs). The current study examined the characteristics of the delay between peak TAC and peak BrAC. METHODS Data was aggregated from three experimental laboratory studies (N = 61; 32 men, 29 women) in which participants wore a TAC monitor and BrAC was monitored while drinking one, two, three, four and five beers in the laboratory. Analyses examined the sex- and dose-related differences in peak BrAC and TAC, the time-to-peak BrAC and TAC, and time lag between the peak BrAC and TAC values. RESULTS The times-to-peak were an increasing function of the number of beers consumed. At each level of beer consumption the peak TAC averaged lower than peak BrAC and times-to-peak TAC were longer than for BrAC. The time-to-peak BrAC and TAC was longer for women than men. The congruence between peak TAC and BrAC increased as a function of the beers consumed. No sex difference in the time lag between peak BrAC and TAC was detected. CONCLUSIONS The congruence between TAC and BrAC and time lags between TAC and BrAC are related to the number of beers consumed. Peak values of TAC and BrAC became more congruent with higher doses but the time lag increased as a function of the amount of alcohol consumed. SHORT SUMMARY The time delay (or lag) and congruence between transdermal vs. BrACs increases as the number of beers increases. Though sex differences are evident in peak transdermal and BrACs, no sex differences were evident in the time lag and the congruence between transdermal and breath alcohol concentrations.
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Affiliation(s)
- Tara E Karns-Wright
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - John D Roache
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jillian Mullen
- Department of Psychiatry, 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
- Department of Psychiatry, 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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Gowensmith WN, Peters AJ, Lex IA, Heng AKS, Robinson KP, Huston BA. New Frontiers for Conditional Release: Applying Lessons Learned from Other Offenders with Mental Illness. BEHAVIORAL SCIENCES & THE LAW 2016; 34:407-422. [PMID: 26989858 DOI: 10.1002/bsl.2217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
There is relatively little research in the literature on insanity acquittees as compared with the large number of studies focused on the supervision and treatment of probationers and parolees with mental illness. Ideally, the latter literature could be successfully applied to insanity acquittees discharged from an inpatient hospital on "conditional release." This article describes the challenges faced by persons on conditional release as well as the gaps in extant conditional release literature. Then, five evidence-based models for the supervision and/or treatment of probationers and parolees with mental illness are applied to a theoretical conditionally released population (mental health courts, forensic assertive community treatment teams, the risk-need-responsivity model, informed supervision practices, and HOPE probation). Benefits and limitations are noted, and recommendations for such crossover are given. Copyright © 2016 John Wiley & Sons, Ltd.
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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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15
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Roache JD, Karns TE, Hill-Kapturczak N, Mullen J, Liang Y, Lamb RJ, Dougherty DM. Using Transdermal Alcohol Monitoring to Detect Low-Level Drinking. Alcohol Clin Exp Res 2015; 39:1120-7. [PMID: 25988708 DOI: 10.1111/acer.12750] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/30/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several studies demonstrate the utility of Alcohol Monitoring Systems' (AMS) transdermal alcohol concentration (TAC) monitor to objectively quantify drinking. AMS standard criteria (i.e., TAC >0.02 g/dl) used for drinking detection are deliberately conservative, but consequently only detect drinking equivalent to 5 or more standard drinks. Our study sought to characterize the sensitivity of TAC measurement to detect low-level drinking defined as the consumption of 1 to 3 beers. METHODS Data were pooled from 3 studies giving controlled doses of 1, 2, 3, 4, and 5 Corona© beers (12 oz = 0.92 standard units) to 32 male and 29 female research volunteers wearing TAC monitors under controlled conditions. Analyses describe the sensitivity to detect drinking at various peak TAC thresholds beginning with any positive reading >0 g/dl, and then using TAC thresholds of 0.02 and 0.03 g/dl. RESULTS Nearly 40% of participants drinking 1 beer did not have a positive TAC reading. However, positive TAC readings were observed in more than 95 and in 100% of participants drinking 2 and 3 or more beers, respectively. The probability of peak TAC detection was a positive function of the number of beers consumed and a negative function of the minimum TAC threshold for detection. Drinking was somewhat more likely to be detected in females than males drinking 2 to 5 beers, but not after 1 beer. Use of AMS standard criteria only reliably detected the consumption of 5 beers, and 45.9% of all occasions of drinking 1 to 3 beers were undetected using 0.02 g/dl as a threshold. CONCLUSIONS Peak TAC levels between 0 and 0.02 g/dl must be considered to detect the low-level drinking of 1 to 3 standard drinks, and such thresholds are necessary when researchers and clinicians want to detect low-level drinking.
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Affiliation(s)
- John D Roache
- Department of Psychiatry , The University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Pharmacology , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tara E Karns
- Department of Psychiatry , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jillian Mullen
- Department of Psychiatry , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Yuanyuan Liang
- Department of Epidemiology and Biostatistics , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Richard J Lamb
- Department of Psychiatry , The University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Pharmacology , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Donald M Dougherty
- Department of Psychiatry , The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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16
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Salomonsen-Sautel S, Min SJ, Sakai JT, Thurstone C, Hopfer C. Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug Alcohol Depend 2014; 140:137-44. [PMID: 24831752 PMCID: PMC4068732 DOI: 10.1016/j.drugalcdep.2014.04.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Legal medical marijuana has been commercially available on a widespread basis in Colorado since mid-2009; however, there is a dearth of information about the impact of marijuana commercialization on impaired driving. This study examined if the proportions of drivers in a fatal motor vehicle crash who were marijuana-positive and alcohol-impaired, respectively, have changed in Colorado before and after mid-2009 and then compared changes in Colorado with 34 non-medical marijuana states (NMMS). METHODS Thirty-six 6-month intervals (1994-2011) from the Fatality Analysis Reporting System were used to examine temporal changes in the proportions of drivers in a fatal motor vehicle crash who were alcohol-impaired (≥0.08 g/dl) and marijuana-positive, respectively. The pre-commercial marijuana time period in Colorado was defined as 1994-June 2009 while July 2009-2011 represented the post-commercialization period. RESULTS In Colorado, since mid-2009 when medical marijuana became commercially available and prevalent, the trend became positive in the proportion of drivers in a fatal motor vehicle crash who were marijuana-positive (change in trend, 2.16 (0.45), p<0.0001); in contrast, no significant changes were seen in NMMS. For both Colorado and NMMS, no significant changes were seen in the proportion of drivers in a fatal motor vehicle crash who were alcohol-impaired. CONCLUSIONS Prevention efforts and policy changes in Colorado are needed to address this concerning trend in marijuana-positive drivers. In addition, education on the risks of marijuana-positive driving needs to be implemented.
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Affiliation(s)
- Stacy Salomonsen-Sautel
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Sung-Joon Min
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
| | - Joseph T. Sakai
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
| | - Christian Thurstone
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045,Denver Health and Hospital Authority, Denver, CO, 80204
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
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Brady JE, Li G. Trends in alcohol and other drugs detected in fatally injured drivers in the United States, 1999-2010. Am J Epidemiol 2014; 179:692-9. [PMID: 24477748 PMCID: PMC3939850 DOI: 10.1093/aje/kwt327] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022] Open
Abstract
Drugged driving is a safety issue of increasing public concern. Using data from the Fatality Analysis Reporting System for 1999-2010, we assessed trends in alcohol and other drugs detected in drivers who were killed within 1 hour of a motor vehicle crash in 6 US states (California, Hawaii, Illinois, New Hampshire, Rhode Island, and West Virginia) that routinely performed toxicological testing on drivers involved in such crashes. Of the 23,591 drivers studied, 39.7% tested positive for alcohol and 24.8% for other drugs. During the study period, the prevalence of positive results for nonalcohol drugs rose from 16.6% in 1999 to 28.3% in 2010 (Z = -10.19, P < 0.0001), whereas the prevalence of positive results for alcohol remained stable. The most commonly detected nonalcohol drug was cannabinol, the prevalence of which increased from 4.2% in 1999 to 12.2% in 2010 (Z = -13.63, P < 0.0001). The increase in the prevalence of nonalcohol drugs was observed in all age groups and both sexes. These results indicate that nonalcohol drugs, particularly marijuana, are increasingly detected in fatally injured drivers.
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Affiliation(s)
| | - Guohua Li
- Correspondence to Dr. Guohua Li, Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, NY 10032 (e-mail: )
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Pickard H, Fazel S. Substance abuse as a risk factor for violence in mental illness: some implications for forensic psychiatric practice and clinical ethics. Curr Opin Psychiatry 2013; 26:349-54. [PMID: 23722099 PMCID: PMC3907744 DOI: 10.1097/yco.0b013e328361e798] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent research on the relationship between substance abuse, crime, violence and mental illness, and suggest how this research could aid forensic psychiatrists, psychologists and other mental health professionals in assessing and managing risk, and balancing patient care and public protection. RECENT FINDINGS Substance abuse in mentally ill forensic psychiatric patients should be considered an important risk factor for violence and re-offending. SUMMARY Improved treatment for substance abuse in forensic psychiatric patients and other mentally disordered offenders together with the offer of monitored abstinence as a condition of leave or discharge could be usefully considered as a means of reducing and managing risk. This may improve patient care by addressing mental health needs and increasing opportunity and likelihood of successful re-integration into the community and better life prospects; protect the public by reducing risk of re-offending and offering real time monitoring and potential intervention when risk is heightened; and help forensic psychiatrists strike a balance between patient care and public protection, potentially alleviating some of the difficulty and anxiety that decisions to grant leave or discharge can create.
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Affiliation(s)
- Hanna Pickard
- aDepartment of Philosophy, Oxford Centre for Neuroethics, University of Oxford, Oxford, UK.
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19
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Marques P, Voas R. Are we near a limit or can we get more safety from vehicle alcohol interlocks? Addiction 2013; 108:657-8. [PMID: 23173623 DOI: 10.1111/add.12002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul Marques
- Pacific Institute for Research and Evaluation; 11720 Beltsville Drive; Suite 900; Calverton; MD; 20705-3111; USA
| | - Robert Voas
- Pacific Institute for Research and Evaluation; 11720 Beltsville Drive; Suite 900; Calverton; MD; 20705-3111; USA
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20
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Flam-Zalcman R, Mann RE, Stoduto G, Nochajski TH, Rush BR, Koski-Jännes A, Wickens CM, Thomas RK, Rehm J. Evidence from regression-discontinuity analyses for beneficial effects of a criterion-based increase in alcohol treatment. Int J Methods Psychiatr Res 2013; 22:59-70. [PMID: 23165605 PMCID: PMC6878298 DOI: 10.1002/mpr.1374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/23/2011] [Accepted: 01/17/2012] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Rosely Flam-Zalcman
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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21
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Brady JE, Li G. Prevalence of alcohol and other drugs in fatally injured drivers. Addiction 2013; 108:104-14. [PMID: 22725100 PMCID: PMC3467360 DOI: 10.1111/j.1360-0443.2012.03993.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/15/2012] [Accepted: 06/15/2012] [Indexed: 11/28/2022]
Abstract
AIM This study aims to examine the prevalence of alcohol and/or other drugs (AOD) in a large sample of fatally injured drivers. DESIGN Using data from the Fatality Analysis Reporting System for 2005-09, the authors examined the prevalence of AOD detected in fatally injured drivers in the United States. SETTING Fatal motor vehicle crashes occurring on public roads. PARTICIPANTS Drivers who died within 1 hour of the crash in 14 states that performed toxicological testing on more than 80% of these drivers. MEASUREMENTS The prevalence of AOD and multivariable-adjusted prevalence ratios (aPR). FINDINGS Of the 20,150 fatally injured drivers studied, 57.3% tested positive for AOD, including 19.9% being positive for two or more substances. Alcohol was the most commonly detected substance, present in 40.2% of the fatally injured drivers, followed by cannabinols (10.5%), stimulants (9.0%), narcotics (5.7%) and depressants (4.0%). Multivariable analysis revealed that AOD was significantly more prevalent among drivers who died in single-vehicle crashes [aPR 1.69, 95% confidence interval (CI): 1.62-1.76] or night-time crashes (aPR 1.43, 95% CI: 1.39-1.47), or who had a driving-while-intoxicated conviction within the past 3 years (aPR 1.41, 95% CI: 1.35-1.47), and less prevalent among drivers who were 65 years or older (aPR 0.45, 95% CI: 0.42-0.49), Asian (aPR 0.47, 95% CI 0.41-0.53) or female (aPR 0.88, 95% CI: 0.85-0.91) or who were operating a motor carrier (aPR 0.41, 95% CI 0.34-0.48). CONCLUSIONS More than half of fatally injured drivers in the United States had been using AOD and approximately 20% had been using polydrugs. The prevalence of AOD use varies significantly with driver and crash characteristics.
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Affiliation(s)
- Joanne E Brady
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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22
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Abstract
In recent years, Anglophone countries are increasingly resorting to individualized control of drinkers. Thus, the Australian Northern Territory government has implemented legislation for electronically verifiable identification that must be checked against a list of adults prohibited from purchasing alcohol. For another example, alcohol-purchase banning orders were instituted in England and Wales by the Blair government. This article considers the earlier history of such individualized drinking controls, particularly in the alcohol-control regimes of the 1920s-1960s, which succeeded prohibition regimes, or were set up in response to prohibition movements. Questions addressed include: what were the rationales of such individualized controls, how were they enforced, why were they largely abandoned, and what evidence is available on their effects? The present-day resurgence of individualized controls is interpreted as the path of least resistance for politicians who need to be seen to do something about alcohol problems without substantially impinging upon the alcohol market.
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23
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Maxwell JC. Drunk versus drugged: how different are the drivers? Drug Alcohol Depend 2012; 121:68-72. [PMID: 21925803 DOI: 10.1016/j.drugalcdep.2011.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/07/2011] [Accepted: 08/07/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Driving under the influence (DUI) of drugs is increasing in the U.S., but little is known about the differences based on their patterns of use and abuse of alcohol and other drugs. METHODS This paper uses a large dataset to study patients admitted to Texas substance abuse treatment programs with one or more past-year DUI arrests. t-Tests are used for comparisons between normally distributed continuous data and chi square for categorical data. RESULTS First-time DUI offenders not only differ from those reporting more than one past-year DUI, but they differ among themselves in terms of demographics, treatment participation, substance use problems, and mental health disorders. Those with primary problems with methamphetamine, crack cocaine, powder cocaine, other opiates, sedatives, and heroin reported more days of problems and more daily use than those with problems with alcohol, while offenders with primary problems with cannabis were less impaired. CONCLUSIONS The most impaired clients were less likely to be referred to treatment from the justice system, and the differences in drug and alcohol offenders show the need to tailor approaches with education and treatment programs. More attention should be given to the needs of drivers impaired through use of prescription drugs such as the opiates and sedatives, as well as female drivers, and the role of acculturation should be recognized in programs for Hispanic drivers. In addition, specific programs should be targeted to young cannabis abusers and underage offenders. All first-time DUI arrestees should be assessed for their levels of impairment.
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Affiliation(s)
- Jane Carlisle Maxwell
- Addiction Research Institute, School of Social Work, The University of Texas at Austin, 1717 West 6th Street, Suite 335, Austin, TX 78703, United States.
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Strang J, Babor T, Caulkins J, Fischer B, Foxcroft D, Humphreys K. Drug policy and the public good: evidence for effective interventions. Lancet 2012; 379:71-83. [PMID: 22225672 DOI: 10.1016/s0140-6736(11)61674-7] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence. Fortunately, evidence-based interventions are increasingly being identified that are capable of making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users. We review relevant evidence and outline the likely effects of fuller implementation of existing interventions. The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good.
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Affiliation(s)
- John Strang
- King's College London, National Addiction Centre, London, UK.
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Gil Kerlikowske R, Sabet K. Commentary on Voas et al. (2011): drug-free roadways - can we get there from here? Steps to reducing drugged driving in the United States. Addiction 2011; 106:1228-9. [PMID: 21635595 DOI: 10.1111/j.1360-0443.2011.03470.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Gil Kerlikowske
- Office of National Drug Control Policy, Executive Office of the President, Washington, DC 20503, USA
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