ALCOHOL SAFETY PROGRAMS IN THE FEDERAL REPUBLIC OF GERMANY. Harms Christian Heinrich. Federal Highway Research Institute, Cologne

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1 ALCOHOL SAFETY PROGRAMS IN THE FEDERAL REPUBLIC OF GERMANY Harms Christian Heinrich Federal Highway Research Institute, Cologne Initial Situation In 1978, 2,405 fatal accidents occurred in the Federal Republic of Germany, reportedly caused by drinking and driving. Enforcement measures such as fines or imprisonment, suspension or revocation of the privilege to operate a motor vehicle and the resulting consequences for the life of the persons affected and their families do not seem to prevent conviction for drinking and driving of about 160,000 persons in Germany per year, a half of them in connection with having caused an accident. In evaluating these statistical figures it has to be taken into account that approx. only 1 out of 500 incidents of drinking and driving is estimated to be discovered and ends in a conviction (Muller, 1976). About 20 out of 100 impaired driving offenders per year are found to have had prior offenses. Enforcement measures of the type mentioned above are obviously incapable of preventing a relatively large part of impaired drivers from continuing to drive under the influence of alcohol in the time period following conviction. In view of this situation, it was felt that specific measures had to be conceived to improve the recidivism rate in the case of impaired driving offenses. 1271

2 In Germany a person whose driving license was revoked upon a second conviction for impaired driving has to report for a medico-psychological checkup before he is permitted to apply for renewal of his privilege. The number of persons undergoing such tests is considerable: in 1978, 35»854 persons, because of impaired driving offenses, underwent such tests at the medico-psychological departments of the Technical Control Boards. The project group set up by the. Ifederal Highway Research Institute (BASt) in 1976 for the elaboration of rehabilitation measures for impaired drivers has concentrated at first on the group of drivers having had prior offenses. This was done for two reasons mainly: there is more scientific knowledge available about this group and it is also easier to be taken hold of in organizational and legal terms. Considering the fact that the recidivism rate increases with an increasing number of impaired driving offenses and the danger to society and to the individual, the limitation seems Justified. 3h the meantime, approaches to treating first offenders have also been made. But these will not be discussed within the frame of this paper. Rehabilitation programs for this target group of impaired drivers have been in operation in the U.S. and Canada for a number of years. The experience reports on these Alcohol Safety Action Projects available at that time, the German experience with the Leer model (Winkler, /0 > general findings in the fields of group dynamics, changes in attitudes and behaviour, and laws of learning as well as economic and legal considerations played a role in laying down the formal characteristics of improvement programs for multiple impaired driving offenders: - Program participation requires prior diagnosis. This is to prevent persons from participating who presum 1272

3 ably will not undergo treatment successfully. Criteria for exclusion are a.o.: alcoholism, acute psychoses, certain illnesses, etc. However, the diagnosis has also the purpose of helping to detect persons who may be permitted to apply for renewal of their driver's license without having to participate in the progam (those considered to be fit to drive). - On the average, 8 to 10 persons should be permitted to participate in a course. - A course takes 15 sessions (26 hours) within at least 7 weeks. - A treatment contract is drawn up between the head of a course and each participant obliging both parties to secrecy and the participant to regular course attendance. - Heads of courses are psychologists who have had extensive additional training. - Individual therapy and chemotherapy are not permitted as forms of training, such as the mere information on the dangers of alcohol and the problems involved in drinking and driving with a large number of participants and the traditional form of teaching with the teacher in front of his class. Two different theoretical approaches to the treatment of multiple offenders were used to elaborate improvement programs: an approach based on the concept -of behavioural therapy (socalled behaviouristic a p p r o a c h ) and an approach based on Adler's concept of individual psychology. The behaviouristic approach Within the frame of programs oriented to the psychology 1273

4 of behaviour the specific aims pursued are the development or improvement of the ability to analyze one's own behaviour and formulate behavioural objectives, independent application of self-control measures, development of behavioural alternatives for drinking and driving and an increase in information on the problem of drinking and driving. The aims of the training shall be reached by means of the following actions: training in analyzing one's own behaviour; elaboration of individual aims of behaviour; training in self-control methods; training in the controlled consumption of alcohol, also in realistic situations; appropriately structured and controlled homework assignments. The indirect aims to be reached include improved selfconfidence, since alcohol abuse is often due to interpersonal problems, and training in appropriate forms of communication Approach based on individual psychology In individual psychology excessive consumption of alcohol is seen as a safekeeping mechanism, i.e., as protection against concrete inferiority experiences in coping with the tasks of life. Excessive consumption of alcohol is always seen as an indication of personal problems with feelings of inferiority. Viewed from this angle, the distinction between "problems drinkers" and "social drinkers" is idle. Persons who because of their excessive drinking repeatedly get involved in difficulties are problem drinkers, but many problem drinkers are social drinkers as well. Regular and, at the same time, excessive drinking in groups is therefore no indication of sociability or enjoyment in social gatherings, it is rather an indication for the obsession to be social. Whether we have a case of withdrawal into oneself or of socializing, the experienced inferiority and the lack of fellowship feeling are always the true motives for

5 excessive drinking. With problem drinkers we always face a combined fear of being unpopular and of being a failure. It is therfore the aim of Iiie program based on individual psychology to help participants to gain a better knowledge of oneself, to strive less for personal superiority, for cooperation (fellowship feeling), to gain a better insight into the problems of others because this would lead to relativizing one's own problems and to a better feeling of competence. These are efforts towards broadening the personality. The treated person shall be encouraged to tackle his or her tasks without drinking. The combination of self-discovery and relevant and comprehensible information on drinking and driving shall eventually lead to the avoidance of operating one's car while under the influence of alcohol. It is the task of a life-style a&alysis relative to the problem of drinking and driving to point out these aspects to the driver by means of individual and typical techniques and enable him to experience them. In order to be successful it is important that the analysis of the style of living is carried out in depth with each individual and within the group as well. Impaired drivers will then be able to recognize and experience that alcohol for them is a means of avoiding certain tasks, of finding relief in difficult situation, or escaping into the illusion of having coped. In this process, they will also learn to recognize that avoidance, relief and escape are forms of behaviour they are using in many tasks of daily life. Recognition and experience of one's own safekeeping mechanisms will enable participants to find different ways of considering and estimating the tasks and problems they have been used to avoid or shun from and tackle them directly, without delay and with better results. In addition, written material is used which enables participants to study the matter in more 1275

6 depth outside the group. Leer model The third improvement model used for multiple offenders in the Federal Republic of Germany since 1971» predominantly in the county Leer (East Friesland), is commonly known as the Leer model. The main distinction is that it is much shorter than the models mentioned before: group discussions take place on two successive weekends and consist of six meetings of two hours each. The program includes: 1. Analysis of the drinking and driving behaviour 2. Information on driving under the influence of alcohol 3. Training in self-observation and self-control measures. The analysis of drinking and driving behaviour starts out with the elaboration of a socalled drinking pattern over an observation and recording period of four weeks prior to the treatment proper. At the same time driving habits associated with typical drinking occasions are identified to formulate individual defence strategies and develop alternative modes of behaviour. The analysis of drinking behaviour further includes a description of the drinking habits throughout the life of each participant, the conditions of acquiring the habits and their motives. Information on driving under the influence of alcohol include the following subjects and are given within the frame of group discussions using simple media: danger of driving under the influence of alcohol, interindividual and intraindividual differences of blood alcohol concentrations with the same amounts of alcohol, recidivism rate, importance of residual alcohol, costs of recidivism, dangerous triggering mechanisms, learning processes involved in the formation of dangerous driving 1276

7 and drinking habits, information on further treatment possibilities. Group discussion includes elements of client-centered therapy and analytical group therapy. The aim of the discussions and the need for talk and information of the participants justify doing justice to both concentrating on the subjects as well as on the participants. The moderator is present to help the group in finding solutions to their individual problems. The moderator puts things more precisely, collects and categorizes the views and suggestions put forward by the participants, provokes contradictions and antitheses, controls the pursuance of the aim of program and assists with information when required. Evaluation At the end of 1979, a total of about 3,000 persons participated in programs according to the three models described (model based on the behaviouristic approach: 1,4975 model based on individual psychology: 470; and the Leer model: 994). However, few reports on systematic companion studies are available for the time being. The oldest experiences are available on the Leer model. Winkler (1977) reported that after an average observation period of 42 months (3 1/2 years) 9*2% of 141 persons having participated in a program were caught again for impaired driving. Of a control group of 107 who underwent a medico<-psychological checkup, were considered fit to drive, and received renewed licenses, 20.5% lost the license once more in the sane period of observation because of impaired driving. The results available with respect to the model on the psychology of behaviour come from an early experience report based on a very small sample (N = 17)» but carried 1277

8 out with the greatest of care (Kraemer & Kunert, 1979). A pre-after-study (interviews with subjects) shows positive treatment effects in terms of the variables "controlled drinking and "self-control measures to avoid excessive drinking". The initial experience seem to confirm the feasibility of courses based on individual psychology and the usefulness of the material employed. Studies of changes in attitudes as a result from participation are not yet available. In the spring of 1980 a nationwide comparative trial run of the three models started. It is expected to be completed in 1985 at the latest. Important intermediate results are expected to become available at the end of 1982 and 1983* The size of sample for each model shall be at least 500, i.e., a total of 1,500 subjects, and a control group of 2,500 impaired drivers who will remain untreated. Within the frame of the medico-psychological checkups extensive preparatory tests will be undertaken, such as drinking behaviour, life situation, medical indications of alcohol abuse, personal characteristics, among others socio-economic status and marital status of potential participants, other offenses and psychophysical capacity. The study of these organismic variables has the following main objectives: (a) Differentiation of the effectiveness of the programs according to the groups of participants; (b) further empirical examination of selection criteria for the purpose of optimization and with the objective of differential assignment in the future to specific improvement models for specific deficiencies; (c) development of differential assignment criteria for 1278

9 specific improvement models for specifics deficiencies. In the course of a program both the change in knowledge on drinking and driving is measured and the changes in attitudes and behaviour of participants predicted by the theory underlying the specific improvement model. The measurements of changes, which are carried out by means of identical questionnaires at the beginning and end of each course, are not used to evalute participants' fitness to drive. The aim of the interview action is additional confirmation of a later conclusion indicating the improvement program as having caused the expected change in the recidivism rate after the training. lithe course of evaluation it will also be checked whether the expected decrease in the frequency of driving under the influence of alcohol really takes place. The frequency of driving under the influence of alcohol after having passed the program is estimated by means of: 1. New entries in the Central Traffic Registry; 2. Interview actions after the end of the course; 3. Information from responsible road traffic licensing departments. The standard of comparison to be used is the recidivism rate of drivers, determined on the basis of data from the central traffic registry, who, upon a second impaired driving offense, were reissued driving licenses without improvement programs. It is to be expected that, apart from participation in a course, other conditions will also influence the frequency of driving under the influence of alcohol. To separate the influence of the program proper from other influences additional control studies are therefore required. The following control variables will be taken into account in the plan of investigation: - difference among moderators; 1279

10 - differences among evaluation habits of assigning experts at the medico-psychological departments; - residential area of participants; - density of traffic surveillance; - regional drinking habits. In addition to generally determining effectiveness the following questions will be studied too: which are the psychological processes which improve or reduce the success of the courses at which participants? Are previous reasons for admittance to or exclusion from a course sufficient or would it be better to refine the assignment procedure? The experiences gained from the Alcohol Safety Action Projects cannot be applied to conditions in the Federal Republic of Germany as a whole since considerable differences exist between the USA and Germany with respect to jurisdiction, driving habits, drinking patterns, traffic surveillance and other characteristics. However, it is our hope that we succeeded in making the corresponding adjustments to apply the most successful U.S. American approaches to German conditions and to avoid the most important mistakes. However, we can only be certain on this point when the evaluation is completed. 1280

11 References HEBENSTREIT, B.v. et. al.: Kurse fur auffallige Kraftfahrer- Zwischenbericht Empfehlungen zur Durchfiihrung von Modellkursen. Projektgruppenberichte der Bundesanstalt fur StraBenwesen, Bereich Unfallforschung, Koln 1978 HEBENSTREIT, B.v. et. al.: Kurse fiir auffallige Kraftfahrer - Zwischenbericht Erfahrungen und Perspektiven. Projektgruppenberichte der Bundesanstalt fiir StraBenwesen Bereich Unfallforschung, Koln '79 KRAEMER, S. & KUNERr' Verfahren zur Verhaltensanderung alkoholauffalliger Kraftfahrer. In: Driver Improvement - Erster Internationaler Workshop "Psychologische Behandlungsmodelle fiir verkehrsauffallige Kraftfahrer". Tagungsbericht, herausgegeben von Wolf-Dietrich ZUZAN; Kuratorium fiir Verkehrssicherheit, Wien und Salzburg, 1975 MULLER, A.: Der Trunkenheitstater im StraBenverkehr der Bundesrepublik Deutschland. Beitrage zur empirischen Kriminologie, Bd. 3, Frankfurt/ Main und Bonn, 1976 Projektgruppe "Beeinflussung und Behandlung alkoholauffalliger Kraftfahrer": Beeinflussung und Behandlung alkoholauf falliger Kraftfahrer. Forschungsberichte der Bundesanstalt fiir StraBenwesen, Bereich Unfallforschung, Koln

12 WINKLER, W. Gruppengesprache nach wiederholter Trunkenheit am Steuer. Blutalkohol Vol. 11,3, , 1974 WINKLER, W.: Erprobung eines Rehabilitationsprogramns fur alkoholauffallige Kraftfahrer. Vortrag auf dem 23. Internationalen Seminar zur Verhutung und Behandlung des Alkoholismus vom 6. bis in Dresden 1282