Multiple Treatment Experiences as a Predictor of Continued Drinking- Driving

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1 Multiple Treatment Experiences as a Predictor of Continued Drinking- Driving WF Wieczorek 1 TH Nochajski 2 1 Center for Health and Social Research, Classroom Building, Buffalo State College, Buffalo, NY14226: 2 School of Social Work, University at Buffalo SUNY, Baldy Hall, Amherst, NY 14260, USA Background The effectiveness of treatment options for drinking-driving offenders has been an area of contention for quite some time. Despite initial reservations regarding the utility of alcohol/drug treatment to improve traffic safety, research has indicated that treatment can have a positive influence in reducing official recidivism by convicted drinking-drivers (1, 2). However, drinking-drivers, especially repeat offenders, commonly have had more than a single treatment experience (3). There is no research available focusing on the potentially additive effect of multiple treatment episodes. The question is one of whether recycling drinking-drivers through treatment programs has any observable benefits. This is an important issue because an unsuccessful single episode of treatment may discourage offenders and the criminal justice system from further utilization of treatment options. If there is an additive or cumulative impact of multiple treatment experiences, further treatment experiences should be encouraged rather than discouraged for drinking-driving offenders. Objective The examination of treatment history, especially a record of multiple treatment experiences, as a predictor of continued drinking and driving was the main objective of this paper. The study took advantage of a relatively large sample of convicted drinking-drivers that included an over-representation of repeat offenders. The nature of the sample ensured that treatment experiences were common, including many individuals with multiple treatment episodes. The study also included a follow-up interview that allowed drinking-and-driving to be directly assessed rather than relying on record/re-arrest data to identify those who continued to drink and drive. Methods Sample: The sample was recruited through Buffalo City Court records (n=200), Erie County Probation Department (n=311), and the Drinking Driver Program (n=145). Virtually all of the probationers were repeat drinking-driving offenders. The entire sample was recruited using pamphlets distributed to the DWI offenders by probation officers, the DDP staff, or mailed directly to them (court sample). The mean age of the sample was 34 (SD=10.1), with the sample being mostly male (86%) and white (84%). The majority of the sample was never married (51%), with 26% being separated, divorced or widowed. While 50% of the sample had gone beyond high school and only 17% did not have a high school diploma, only 56% were employed. A follow-up interview was conducted with the offenders months subsequent to the initial interview. Of the 656 individuals initially interviewed, 515 were re-interviewed for the

2 follow-up study. There were no significant differences between the 515 individuals who completed the follow-up and the 135 who did not, across demographics, criminal history, alcohol-related, or drug-related characteristics. Measures: Demographic Characteristics: A broad assessment of demographics (e.g., age, education, employment, marital status, gender, etc.) was included. Alcohol-Related Measures: To measure drinking style, consequences, perceived benefits, and concerns, the general alcoholism score of the Alcohol Use Inventory, or AUI (4) was used. Family History for Alcohol/Drug Problems: We used the family history questions from the Research Diagnostic Criteria to assess familial alcoholism (5). Drug Use: Lifetime drug use was assessed using a procedure similar to that used in the National Household Survey. Victimization: A history of victimization experiences during adulthood was obtained, including sexual and physical assaults. Criminal History: A series of questions pertaining to arrests and convictions for charges other than DWI were used to assess the criminal history of the DWI offenders. Driving: Official Department of Motor Vehicles records and a self-report of driving incidents were used to assess driving skills. Psychiatric Severity: The nine dimensions of the Symptom Checklist-90 Revised (SCL-90- R) was used to measure psychiatric severity (6). Sociopathy and/or Anti-Social Personality: The 53-item Socialization Scale of the California Psychological Inventory (7) was used to measure sociopathy. Sensation Seeking: The general scale of the Sensation Seeking Scale (SSS) Form V was used to assess the respondents risk taking propensities (8). Locus of Control: Levenson's (9) Internal, Powerful Others, and Chance scales were used to assess the respondents locus of control. Social Desirability: A five-item measure developed by Hays et al. (10) was used to check for socially desirable response sets. Self-Esteem: A modified version of Rosenberg's (11) measure of self-esteem was used to assess self-concept. Stages of Change: The stages of change scale (URICA) developed by DiClemente et al. (12) was used to assess current potential motivation for changing drinking-driving behavior. Driving and Drinking-Driving Measures: The driving-related attitude measures developed for use with DWI populations by Donovan (13) were used to assess respondents driving attitudes. Knowledge of Drinking-Driving Laws: The respondents' knowledge of drinking-driving laws and the amount of alcohol needed to be consumed to reach proscribed levels were assessed through questions asking (1) the blood alcohol levels for driving while impaired and driving while intoxicated (using New York State statutes); (2) the number of drinks required in one hour to reach.10 BAC in a 160-pound man; and (3) the number of bottles of beer that equal a 1-ounce shot of liquor. Respondent s also reported the number of drinks that could be consumed and still drive safely. Self-Report Drinking-Driving: Subjects were asked to report the number of times they drove after drinking in the thirty days prior to the interview. This question was asked at the initial and follow-up interviews. The results from the follow-up interview are the primary dependent measure in this study. For purposes of the current paper, the outcome was dichotomized into any reported drinking-driving versus none reported.

3 Results Of the 515 drinking-driving offenders who participated in both interviews, a substantial proportion (22.7%) reported drinking-driving in the 30 days prior to the follow-up interview. Initial analyses considered associations between the follow-up dichotomous measure of selfreport drinking-driving and initial interview measures for demographic, criminal history, personality, psychiatric distress, alcohol, and drug-related characteristics. Significant findings, except for the AUI scales) are shown in Table 1. Table 1. Significant Associations With Self-Report Drinking-Driving No (n=398) Yes (n=117) Test of sig. Mean Age t(206)=3.06 p=.003 Never Married 47.7% 57.3% X 2 [1,515] = 3.28 p=.070 Div/Sep/Widowed 26.9% 17.9% X 2 [1,515] = 3.87 p=.049 Unemployed 48.0% 30.2% X 2 [1,512] = p=.001 Total Household Income 28, , t(163)= p=.047 Repeat DWI Offender 36.2% 11.5% X 2 [1,514] = p<.001 Total Number of Prior DWI t(340)= 8.27 p<.001 Criminal History other crimes 59.5% 42.7% X 2 [1,515] = p=.001 Total Number of Arrests t(274)= 3.36 p=.001 Victim of Physical Assault 57.0% 45.3% X 2 [1,515] = 5.02, p=.025 Refused Breathtest 29.7% 16.4% X 2 [1,515] = 8.09 p=.004 BAC < % 42.5% X 2 [1,491] = p<.001 Number of Traffic Violations t(308)= 3.01 p=.003 Number of Crashes t(316)= 2.53 p=.012 Lifetime Alcohol Dependence 34.3% 19.6% X 2 [1,515] = p=.002 Lifetime # DSM-IIIR Criteria t(204)= 3.85 p<.001 Lifetime # DSM-IIIR Items t(241)= 5.37 p<.001 Last 12-months # DSM-IIIR items t(259)= 2.46 p<.001 No Prior Treatment 35.2% 68.4% X 2 [1,515] = p<.001 URICA Precontemplation t(189)= p=.003 URICA Contemplation t(195)= 4.21 p<.001 URICA Action t(177)= 5.20 p<.001 URICA Maintenance t(193)= 3.89 p<.001 CPI Socialization t(202)= p<.001 Global Psychiatric Severity Index t(220)= 2.41 p=.017 Attitudes concerning DWI t(193)= 2.34 p=.020 # Drinks and Still Drive Safely t(183)= p=.011 The results indicate that relative to the individuals who indicated no drinking-driving, the selfreported recidivists were younger, more likely to have never been married, had larger incomes, were more likely to have a BAC at arrest below.15, had higher scores on the precontemplation scale of the URICA, had no prior treatment for alcohol problems, had higher scores on the CPI Socialization scale, and reported a larger number of drinks they could consume and still drive safely. In contrast, the individuals who reported no drinkingdriving, relative to the self-report recidivists, were more likely to have been divorced,

4 unemployed, a repeat DWI offender, arrested for other crimes, involved in more crashes and given more traffic tickets, qualified for a lifetime alcohol dependence diagnosis, scored higher on the URICA contemplation, action and maintenance subscales, and scored higher on the SCL-90-R global severity index for psychiatric distress. Not shown in table 1 are the substantial number of AUI subscales that were also significant (i.e., Improve social functioning, improve mental functioning, drink to manage moods, compulsive obsession about drinking, loss of control over behavior when drinking, perceptual withdrawal symptoms, somatic withdrawal symptoms, Guilt and worry associated with drinking, prior attempts at help, readiness for help, awareness of drinking problems, anxious concern over drinking, uncontrolled life disruption directly stated, acknowledgement and awareness of drinking problems and alcohol involvement all p s<.05). Of specific interest in the current paper was whether the number of prior treatments would remain a significant predictor of continued drinking-driving after controlling for these other factors. A stepwise logistic regression was performed using all variables that showed a significant association with self-reported recidivism (i.e., self-reported drinking-driving at follow up). The stepwise regression entered the most significant predictor at each step until no significant predictors remained in the variable pool. Results are shown in Table 2. The treatment variable was divided into four categories: no treatment (reference category), one treatment experience, two treatment experiences, and three or more treatment experiences. Self-esteem, CPI socialization, repeat DWI offender status, number of drinks that can be consumed and drive safely, and number of prior treatments were the measures that remained significant, representing the most parsimonious group of predictors for drinking-driving. Antisocial characteristics (CPISOC) and a higher estimate of the number of drinks that can be consumed and still drive safely were associated with continued drinking and driving. Higher self-esteem and total number of DWI arrests were associated with not drinking and driving at follow up. Any treatment was associated with not drinking and driving; however, the effect increased substantially with the number of treatment episodes. Discussion The bivariate comparisons indicated that there were a large number of differences between those who continued and those who desisted from drinking and driving. Interestingly, those who desisted appeared to have greater problem severity than those who continued to drink and drive (e.g., dependence, number of offenses, psychiatric severity). However, the differences between the two groups suggested that treatment (e.g., treatment history, higher scores on contemplation, action, and maintenance scales), or other factors related to maturation from DWI offending such as age, were key components of desistence. The multivariate logistic regression highlighted the role of treatment, especially multiple treatment experiences, in desistence from drinking-driving. The total number of DWI offenses in the multivariate analysis may be an indicator of a general maturation factor that tends to reduce drinking-driving. Self-esteem appears to be increased among those who desisted from drinking-driving, suggesting that this may be an outcome of treatment participation and could be a marker of improved personal competence. Moreover, the fact that the most powerful predictor of not drinking and driving was having three or more treatment experiences clearly provides strong support for a continued role of treatment in conjunction with sanctions regardless of the number of previous offenses. Further research is needed to determine whether the effect of treatment persists over time, particularly in the repeat offender group.

5 Acknowledgements This research was supported in part by grants from the Alcohol Beverage Medical Research Foundation and the National Institute on Alcohol Abuse and Alcoholism. References 1. Wieczorek, W.F. (1995). The role of treatment in reducing alcohol-related accidents involving DWI offenders. In Watson, R.R. (Ed.), Alcohol, Cocaine, and Accidents, pp , Totowa, NJ:Humana Press. 2. Wells-Parker, E., Bangert-Drowns, R., McMillen, R., & Williams, M. (1995). Final results from a meta-analysis of remedial interventions with drink/drive offenders. Addiction, 90, Wieczorek, W.F. (1993). Treatment histories of severe DWI offenders. In Utzelmann, H.-D., Berghaus, G., and Kroj, G. (Eds.), Alcohol, Drugs and Traffic Safety - T92, pp , Cologne:Verlag TUV Rheinland. 4. Horn, J. L. Wanberg, K. W., & Foster, F. M. (1987). Guide to the Alcohol Use Inventory (AUI). Minneapolis, MN: National Computer systems, Inc. 5. Andreasen, N.C., Rice, J., Endicott, J., Reich, T., & Coryell, W. (1986). The family history approach to diagnosis. Archives of General Psychiatry, 1986, 43, Derogatis, L. R. (1983). SCL-90-R: Administration, Scoring & Procedures Manual-II. Towson, Maryland: Clinical Psychometric Research 7. Megargee, E. I. (1972). The California Psychological Inventory Handbook. Jossey Bass, London. 8. Zuckerman, M. (1971). Dimensions of sensation seeking. Journal of Consulting and Clinical Psychology, 1971, 36, Levenson, H. (1981). Differentiating among internality, powerful others, and chance. In H. M. Lefcourt (ed.), Research with the locus of control construct (Vol 1). New York: Academic Press, pp Hays, R. D., Hayashi, T., & Stewart, A. L. (1989). A five-item measure of socially desirable response set. Educational and Psychological Measurement, 49, Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. 12. DiClemente, C. C. & Prochaska, J. O. (1982). Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behaviors, 7, Donovan, D. M. & Marlatt, G. A. (1982). Personality subtypes among driving-whileintoxicated offenders: relationship to drinking behavior and driving risk. Journal of Consulting and Clinical Psychology, 50,

6 Table 2. Results for wise Logistic Regression B S.E. Wald df Sig. Exp(B) 95.0% C.I.for EXP(B) Lower Upper 1(a) TXCATS <.001 TXCATS(1) < TXCATS(2) TXCATS(3) < Constant < (b) TOTDWI < TXCATS TXCATS(1) TXCATS(2) TXCATS(3) Constant (c) TOTDWI < SAFEN TXCATS TXCATS(1) TXCATS(2) TXCATS(3) Constant (d) TOTDWI < SAFEN TXCATS TXCATS(1) TXCATS(2) TXCATS(3) ESTEEM Constant (e) TOTDWI CPISOC SAFEN TXCATS TXCATS(1) TXCATS(2) TXCATS(3) ESTEEM Constant a Variable(s) entered on step 1: TXCATS (Referent category is no treatment). b Variable(s) entered on step 2: TOTDWI. c Variable(s) entered on step 3: SAFEN. d Variable(s) entered on step 4: ESTEEM. e Variable(s) entered on step 5: CPISOC.