RID: A COST EFFECTIVE INTERVENTION PROGRAM by. T.R. McGuirk, M.S., R.B. Donfeld, J.D. and J.B. Hallan, Dr.P.H. SUMMARY

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1 RID: A COST EFFECTIVE INTERVENTION PROGRAM by T.R. McGuirk, M.S., R.B. Donfeld, J.D. and J.B. Hallan, Dr.P.H. SUMMARY This paper describes the nature and impact of a novel yet highly effective drunk driver intervention program operated in Pima County, AZ by the RID Corporation. The program is highly structured, operates with the full cooperation of the judiciary and results in low client recidivism and significant savings for the county. A brief literature review is also provided. INTRODUCTION Alcohol has long been recognized as a major contributor to vehicular crashes and alcohol-related traffic deaths and injuries now constitute a major health burden in the United States. (Colquitt et al, 1987). While drunk driving is no longer a hidden issue in this country dealing effectively with persons who are charged with this offense is far more nebulous. It now appears that a significant proportion of the apprehended drunk driver population is dealt with by formal programs that are largely ineffectual. This paper describes an atypical drunk driver intervention program operated in Pima County Arizona by Reduction of Intoxicated Drivers, Inc.(RID)-atypical in the sense that it is highly cost effective in dealing with individual DUI cases and in turn reducing county handling costs associated with this problem. BACKGROUND The growing concern over the nature, extent and consequences of drunk driving is exacerbated by the lack of evidence demonstrating the efficacy of programs to intervene in this problem. An extensive literature review by Sanson-Fisher et al., identified fifty studies that concerned evaluation of these types of programs.(sanson-fisher, et al, 1987). Few studies were methodologically sound; the most widely used outcome measure was recidivism, the least frequently used outcome was cost-effectiveness. Only three studies involved prospective randomized control trials with sufficient sample sizes, follow-up periods longer than 24 months and adequately specified outcome measures.(neff and Landrum, 1983, Strachan 1973, and Malfetti and Simon, 1974) Interestingly, the lesser the period for follow-up, the lesser the recidivism rate. Conversely, the longer the follow-up period, the greater the rate of recidivism. Other studies have revealed a flawed system for dealing with the drunk driver. For example, in a study of 855 convicted drunk drivers who participated in an alcohol education program, those who needed the program most--the young and those with high blood alcohol contents at the time of arrest, were most likely to drop out of the program. No negative sanctions were utilized by the programs to motivate successful completion.(kern et al, 1977). Finally, state legislation to intervene with the problem is often ineffective. An evaluation of the State of Washington's drunk driver's legislation found that higher crash rates and more drunk driving recidivism 461

2 actually occurred under newer presumably more restrictive laws.(salzberg and Paulsrude, 1984). In summary, while there have been significant investments in public and private sector efforts to deal with drunken driving the overall results appear nondeterrent in nature and provide marginal returns to society. THE JUDICIAL ENVIRONMENT AND DEVELOPMENT OF THE RID PROGRAM The five consolidated Pima County Justices of the Peace serve a population of approximately 450,000 persons in metropolitan Tucson, Arizona. The City of Tucson has a population of approximately 350,000 and has its own municipal court system. Jurisdictionally, any individual cited for driving while under the influence of intoxicating liquor by a Tucson City police officer is cited into the Tucson City Court system. All violations cited by the Pima County Sheriff's Department, Department of Public Safety, and the University of Arizona Police Department, are filed with the Consolidated Pima County Justice Court. Significantly, all violations occurring on the major interstate highways through Pima County (Interstates 10 and 19) are cited into the Pima County Justice Court. For the calendar year 1988, the Consolidated Pima County Justice Court had a total of 700 DUI defendants. Prior to the institution of the RID program in August of 1983, the Pima County Justice Court utilized a program called the "Impaired Driver's Program" (IDP). IDP was associated with the Tucson City Court and was staffed primarily by Tucson City police officers. IDP was the only readily accessible program of its type in Pima County. There were however a number of problems associated with the use of this program (now successfully addressed by RID). First, there was no feedback from IDP to the judges regarding the progress of any individual defendant. Judges did whether or not a defendant attended class nor what, if any, progress was made. There was no recommendation for further Court intervention or whether or not substance abuse problems were discovered. Above any other consideration, this lack of knowledge regarding a defendant's compliance after sentencing to the IDP program needed to be addressed by any subsequent program. Second, there was no professional relationship between IDP with either the Judges or the Pima County Attorneys Office. Being an arm of the Tucson City Courts and its prosecutorial agency, IDP exhibited no special concern for the Justice Courts. There was no attempt to discern the particular needs of the judges nor the needs of the prosecutorial agency. In effect, there was a complete lack of control over the program by the judges and prosecutors making the referrals. Third, there was no knowledge by the Judges of the qualifications of the IDP instructors nor of the curriculum used in the program. The Judges had no ability to effect the quality and type of program offered. Consequently, the Judge could not rate the effectiveness of the program either on any individual defendant or on the community. Fourth, the large volume of referrals by both the Tucson City Court and the Justice Courts led to a mass classroom atmosphere. There was no attempt at individual counseling or assessment. Indeed, it was not clear whether IDP was even registering Justice Court referrals since there was no report to the court 462

3 that any individuals failed to appear. It is now known through RID reporting data, that a certain percentage of referrals fail to appear for class. Finally, the Judges had no ability to effectuate any further intervention if needed. Due to the lack of progress information, the Judges were not able to order further education, A.A. meetings, substance abuse counseling, or to appropriately modify conditions of probation. There simply was no mechanism to bring defendants back into court. The RID program has addressed the problem areas previously described. RID provides the Court and the Pima County Attorneys Office with considerable information regarding the progress of referred individuals. Indeed, the RID program has developed into a quasi-probation department by furnishing the County Attorneys Office with information needed to file petitions to revoke and/or modify probation. The program director has built a relationship with the individual judges and prosecutors thereby facilitating the communication of the needs and desires of the criminal justice system. In addition the RID program has been able to maintain a relationship with individual referrals thereby encouraging the use of A.A. meetings and other substance abuse counseling. Finally, there has developed over the years a philosophy and attitude that a drunk driving intervention program is an integral part of the criminal justice system. It is this integration that has given the RID program its ability to impact on the individual referral. Defendants that are referred to RID know that the Judges consider it a critical part of the sentence. THE PROGRAM AND ITS OPERATION RID is a private non-profit corporation which became operational in Pima County, AZ in The goal of RID is to reduce intoxicated drivers in the State of Arizona through a highly structured, strongly coercive, intervention program. Built into RID is the key element of timely imposed sanctions for those convicted defendants who choose not to comply with the conditions of their sentence. The operation of RID involves several distinct yet closely related components. First, as indicated earlier the Pima County court system has set into policy a process of sentencing every drunk driver to RID. This includes a stipulation by the prosecuting attorney for alcohol abuse evaluation, education and treatment (if deemed necessary) by RID. It should be noted that at the time of sentencing by the court, the client is informed of a Review Hearing Date approximately 120 days post-sentencing at which time RID presents the results of its efforts and the status of the client. Second, the RID program then initiates extensive client evaluations. Diagnostic examinations utilize a validated 61-item drinking and driving inventory test battery and a drinking history questionnaire. The latter is a validated synthesis of various other instruments that have been utilized by alcohol treatment programs throughout the country, the client also completes a standard background information form which includes prior alcohol/drug treatment history, past and present employment history and arrest information. After these instruments are completed by the client and reviewed by RID, a detailed interview takes place at which time responses are addressed, follow-up questions are asked and assessments made. RID clients at this point may be referred directly to inpatient or outpatient treatment, and or Alcoholics 463

4 Anonymous meetings for a prescribed period. All eventually must attend a 14 hour educational program provided by RID staff. This program is a series of didactic yet interactive presentations on alcohol and its effects, responsible and problem drinking and drinking and driving. Following the RID educational program, clients repeat the drinking-driving test battery, are evaluated and findings concerning the evaluation are presented at the formal Court Review Hearing. Clients then receive the sentencing of the Court; the outcomes are largely based on RID recommendations which also encompass the degree of compliance by the client during the presentencing period. IMPACT OF THE RID PROGRAM RID has initiated several short and long range efforts to evaluate the impact of its programming efforts. Its short range efforts have examined recidivism among its clients, change in the number of total DUI's processed by Pima County and potential savings in the costs of handling DUI clients by Pima County. Its long range evaluation efforts will involve examination (pre and post Rid Program) of the driving records of all Rid clients. Short range evaluation efforts have revealed that to date that less than five percent of Rid clients have returned to the Rid program as a result of a another DUI. Notwithstanding the possibility of the former client receiving a DUI in another area of the state or country, this apparent recidivism rate is extremely low. Rid has also examined the costs of handling a typical DUI by Pima County judiciary, law enforcement and probation services through examination of annual reports of expenditures and processing of cases. In calendar year 1987, the costs expended by these service areas for processing or handling of DUI's totaled about $719,000 (see Figure 1). This represented an average expenditure of about $890. for each of the DUI's (806) processed that year. This costing data coupled with changes in the number of DUI's processed in the Pima County over time is revealing. Since the full scale implementation of RID in 1985, the number of DUI's processed in Pima County has decreased each year (see Figure 2) by about 17 percent. This represent an annual decrease in DUI handling costs of about $134,000. While not all of this decrease may be directly attributable to RID efforts it is clear that the program has resulted in significant savings for Pima County. The long term evaluation now underway by Rid involves examination of the actual driving record of all those clients who have completed the RID program. The Arizona State Department of Transportation has agreed to furnish Rid with the complete driving records of its clients. Using this data Rid will construct a pre and post program driving incident and cost profile. RID will ultimately predict the individual and aggregate cost savings accrued by Pima County and the State of Arizona as the result of this programmatic effort. Based on the findings of the short term evaluation efforts, the ultimate savings will in all likelihood be highly significant. In summary, the RID program operating in Pima County, AZ represents a novel and highly effective drunk driving intervention effort. The program is well conceptualized, operates with the full cooperation of the county judiciary, results in minimal recidivism by its clients, and incurs significant savings for the public sector. The program by current standards of operation is clearly unusual and suggests that the field is capable of considerable improvement. 464

5 REFERENCES 1. Colquitt, Mark, Fielding, L. Peter, and Cronan, John F., Drunk Drivers and Medical and Social Injury. (1987). N Eng J Med. 317: Sanson-Fisher, R., Redman, S. and Osmand, C. (1987). Rehabilitation of Drunk Drivers in Australia and New Zealand. Federal Department of Transport, Federal Office of Road Safety, Canberra, Australia , Neff, R. L. and Landrum, J.W. (1983). The Life Activities Inventory As a Countermeasure for Driving-While-Intoxicated. Jour of Stud on Alcohol.k No Strachan, J.G. (1973). The Alberta Impaired Drivers' Project. The Canadian Psychologist. No. 1, Malfetti, J.L. and Simon, K.J. (1974). Evaluation of a Program to Rehabilitate Drunken Drivers. Traffic Quarterly. No Kern, J.C., Schmelter, W.R. and Paul, S.R. (1977). Drinking Drivers Who Complete and Drop Out of an Alcohol Education Program. Jour of Stud on Alcohol. No Salzberg, P.M. and Paulsrude, S.P. (1984). An Evaluation of Washington's Driving-While-Intoxicated Law: Effect on Drunk-Driving Recidivism. Jour of Safety Research. No $ IN 1000 S FIGURE 1 PIMA COUNTY DUI COSTS/YR LAW ENFNT PROBATION JUDICIAL (AVERAGE COST PER DUI $450.) FIGURE 2 DUI CASES IN PIMA COUNTY COURTS NUMBER OF CASES TIME 465