Prevalence of psychiatric disorders among persons convicted of driving while impaired.

BACKGROUND: Large numbers of convicted drunk drivers are entering alcohol treatment programs, yet little information is available about their need for psychiatric treatment. This study of convicted drunk drivers estimates lifetime and 12-month prevalence of DSM-III-R psychiatric disorders (alcohol and drug abuse and dependence, major depressive disorder, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder, and antisocial personality disorder) and compares rates with estimates from a US population-based survey. METHODS: Six hundred twelve women and 493 men, aged 23 to 54 years, convicted of driving while impaired, who had been referred to a screening program in Bernalillo County, New Mexico, were located and interviewed using the Diagnostic Interview Schedule between January 25, 1994, and June 30, 1997. Psychiatric diagnoses were compared with findings from the National Comorbidity Survey for the western region of the United States, conducted between September 14, 1990, and February 6, 1992. RESULTS: Eighty-five percent of female and 91% of male offenders reported a lifetime alcohol-use disorder, compared with 22% and 44%, respectively, in the National Comorbidity Survey sample. Thirty-two percent of female and 38% of male offenders had a drug-use disorder, compared with 16% and 21%, respectively, in the National Comorbidity Survey sample. For offenders with alcohol-use disorders, 50% of women and 33% of men had at least 1 additional psychiatric disorder other than drug abuse or dependence, mainly posttraumatic stress disorder or major depression. CONCLUSION: Drunk-driving offenders need assessment and treatment services not only for alcohol problems but also for drug use and the other psychiatric disorders that commonly accompany alcohol-related problems.

Victim impact panels: do they impact drunk drivers? A follow-up of female and male, first-time and repeat offenders.

OBJECTIVE: To examine gender differences and re-arrest rates of first-time and repeat offenders following referral to Victim Impact Panels (VIPs). METHOD: Study participants (N = 6,702; 79% men) were first-time and repeat driving-while-impaired offenders who were referred to and completed a screening program in Bernalillo County, New Mexico, from 1989 to 1994. Whether subjects were mandated to attend a VIP was self-reported in a personal interview. Multivariate Cox proportional hazards analysis was used to test the effects of VIP referral and other predictors of recidivism. Separate models were developed for female and male first-time and repeat offenders. RESULTS: After controlling for multiple risk factors, VIP referral was not statistically associated with recidivism for female or male first offenders. However, female repeat offenders referred to VIPs were significantly more likely to be re-arrested compared with those not referred, with an odds of rearrest more than twice that of females not referred. CONCLUSIONS: Although many factors influence recidivism, this study raises the possibility that VIPs may have a negative impact on female repeat offenders.

Alcohol use inventory: screening and assessment of first-time driving-while-impaired offenders. II. Typology and predictive validity.

This study evaluated the use of Alcohol Use Inventory (AUI) for driving-while-impaired (DWI) screening, by determining whether DWI offenders (n = 1644), grouped according to their reported alcohol involvement on the AUI, would have different rates of recidivism in a 5-year follow-up. Cluster analysis using the six second-order scales produced six groups (clusters 1-6) described as the Low-Profile (50%), Alcohol-Preoccupation (14%), Enhanced (22%), Enhanced-Disrupt (9%), Anxious-Disrupt (3%), and High-Profile (1%) types. They were characterized by different sociodemographic profiles. Members of cluster 4 were associated with the highest DWI recidivism rate (40%), committing one or more further DWI, and clusters 5 and 6 were associated with the highest rate of committing two or more DWIs. Rates of subsequent traffic convictions and crashes were, however, not statistically different among the clusters. Predictors of DWI recidivism included male gender, young age, less-educated, high blood-alcohol concentration at arrest, and clusters of 3 and 4. Different typologies indicated that the needs for treatment might be different. Evaluators should keep in mind the strength of AUI, use risk factors identified in the study, and take measures of test-taking defensiveness to enhance overall predictive validity.

Alcohol use inventory: screening and assessment of first-time driving-while-impaired offenders. I. Reliability and profiles.

This study evaluated the use of the Alcohol Use Inventory (AUI) in a drink-driving offender population court-mandated to attend a screening programme. We compared offenders' scale scores, reliability statistics and profiles to those from two clinical populations on which the AUI was normed. Among offenders, males and females had similar levels of involvement with alcohol, and Native Americans had higher scale scores than other ethnic groups. Comparisons with the normative population revealed lower mean scale scores and lower reliability scores among offenders. Differences between the offender and normative populations were most pronounced for the primary scales. We also found inconsistencies in offenders' responses to certain questions. To address this, we recommend that, when using the AUI for screening offenders: (1) screeners place more emphasis on second- and third-order scales than primary scales; (2) lower cut-off points be used for identifying problem drinkers; (3) counsellors conduct in-person interviews with clients to develop rapport and encourage self-disclosure.

Do risk factors for re-arrest differ for female and male drunk-driving offenders?

BACKGROUND: The present study investigated gender differences in factors affecting recidivism among 628 female and 659 male drunk-driving offenders. The study population included residents from New Mexico who completed a screening program for offenders and who were still residents when contacted 5 years later. METHOD: Risk factors for re-arrest in the 5-year period after screening referral were examined using multiple logistic regression models. Predictor variables included gender, age, ethnicity, education, marital status, blood alcohol concentration at arrest, parental alcohol problems, spousal alcohol problems, lifetime use of cannabis, cocaine, or amphetamines, abusive behavior toward spouse, and scores on two standardized assessments. RESULTS: Risk factors for re-arrest were similar for males and females except that young age predicted higher recidivism among males but not females. The overall 5-year re-arrest rate was 26%-20% for women, 38% for males age 30 and under, and 24% for males age 31 and older. CONCLUSIONS: Young age predicts re-arrest for males but not for females. Neither the type of risk factors nor the number of risk factors fully explained female offenders' disproportionately lower recidivism rates, compared with young males.

Victim impact panels: who is sentenced to attend? Does attendance affect recidivism of first-time DWI offenders?

BACKGROUND: Victim Impact Panels (VIPs) have been implemented widely in the United States by judges as a deterrent to drinking and driving, but there is little evidence of their utility in preventing recidivism. OBJECTIVES: The objectives of this study were to examine judges' referral patterns to the VIPs among a multiethnic population of convicted first-time driving while impaired (DWI) offenders and to compare 5-year recidivism rates of those mandated and not mandated to attend the VIP. METHODS: Study participants included 5,238 convicted first-time DWI offenders who were referred to a screening program in Bernalillo County, New Mexico, and who completed a personal interview with a master's-level counselor between April 1989 and October 1995. Logistic regression analysis was used to evaluate judges' preferences in mandating offenders to attend a VIP. The percent of subjects reoffending in the 5 years following their referral for screening was calculated by standard life-table analyses. Cox proportional hazards analysis was used to test the effects of known independent predictors for recidivism. Separate models were developed for the entire population, non-Hispanic offenders, and Hispanic/Mexican national subgroups. RESULTS: Female judges who regularly adjudicated DWI offenders were more likely to refer offenders to a VIP. Judges were less likely to refer men and offenders with less than 12 years of education and an unknown arrest blood alcohol concentration (BAC), and of Hispanic/Mexican national or other race/ ethnicity. Judges were more likely to refer unmarried offenders to a VIP. After controlling for multiple risk factors, referral to VIP was not a strong predictor of recidivism in Hispanic and non-Hispanic ethnic groups, with 95% confidence limits ranging from 0.8 to 1.0, compared to those not referred. CONCLUSIONS: Female judges were more likely than male judges to refer offenders to a VIP, and referral patterns varied by offender characteristics. The VIP referral did not increase rearrest rates but lowered them marginally to not at all. This study should be followed up with a randomized design to control for referral patterns and to further define the impact of mandating offenders to the VIP.

Substance abuse intervention for health care workers: a preliminary report.

The Workplace Managed Care Cooperative Agreement project targets 3,300 health care professionals in hospital, specialty clinic, and primary care settings located in metropolitan New Mexico communities. This project will evaluate whether enhancements to existing substance abuse prevention/early intervention programs can prevent the onset of risky drinking, reduce prevalence of risky drinking, better identify employees who abuse alcohol and drugs, and improve employee wellness. This article describes one such enhancement (Project WISE [Workplace Initiative in Substance Education]), implemented at Lovelace Health Systems. Project WISE includes relatively low-cost elements such as substance abuse awareness training, information on how to reduce drinking, and brief motivational counseling. Evaluation will consist of baseline comparisons of the intervention and comparison sites, a process evaluation, a qualitative analysis using focus groups, and an outcome evaluation using health and work records. Methodological challenges, solutions, and implications for researchers undertaking similar projects are presented.

Use of AUDIT for alcohol screening among emergency room patients in Thailand. Alcohol Use Disorders Identification Test.

This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.

Prevalence of alcohol problems among emergency room patients in Thailand.

AIMS: To determine prevalence rates of alcohol problems among emergency room patients. DESIGN: This was a cross-sectional survey including patient interviews and record reviews. The questionnaire included the Alcohol Use Disorders Identification Test to screen for hazardous or harmful alcohol use (alcohol problems). It also contained questions regarding the chief complaint and factors precipitating the admission. SETTING: Emergency rooms of three regional hospitals in Thailand. PARTICIPANTS: Consecutive emergency room admissions aged 14 and older, admitted from 18.00-02.00 h. FINDINGS: Risk factors for alcohol problems included male gender, age 20-49, higher monthly income, less than university graduate education status and admission to the northeast regional ER. Among non-trauma patients, those with alcohol-related diagnoses and certain gastrointestinal disorders had the highest rates of alcohol problems. Patients with transportation injuries were twice as likely, and those with assault-, fall-, or burn-related injuries were at least three times more likely to screen positive compared to the non-injured comparison group. The estimated overall prevalence rate of alcohol problems for this population, adjusted for age and diagnostic classification, was 0.39 for males and 0.08 for females. CONCLUSION: Especially among patients with specified diagnoses, the emergency room is an ideal setting for implementing alcohol screening and intervention programmes in Thailand.

Drive-up liquor windows and convicted drunk drivers: a comparative analysis of place of purchase.

This study examined alcohol purchase locations of convicted drunk drivers to determine the characteristics and arrest circumstances of offenders who bought alcohol at a drive-up liquor window compared with those who obtained alcohol elsewhere. Logistic regression analyses were used to assess the relationship between purchase location and the characteristics of 2,544 drunk drivers convicted in Santa Fe, NM, from 1986 to 1995. Analyses were performed to determine whether the place of purchase was related to arrest circumstances. The results revealed that drive-up windows were the preferred place of purchase of package liquor by offenders who bought the alcohol that they drank prior to arrest. The odds of being Hispanic (p < 0.0001), a high-risk problem drinker (p < 0.01), and drinking in the vehicle prior to arrest (p < 0.01) were significantly higher for drive-up window users than for offenders who purchased package liquor elsewhere. Based on these analyses, this study concludes that a statistically significant relationship exists between the use of drive-up windows and certain high-risk drinking behaviors. This increased use among vulnerable populations suggests that drive-up windows may facilitate alcohol misuse in these populations and thereby contribute to drunk driving.

Factors related to miles driven between drinking and arrest locations among convicted drunk drivers.

The objectives of the study were to estimate the distance driven between drinking and arrest locations among 3,107 offenders convicted of driving while impaired and to determined whether the drinking location, the driver's appearance (factors such as race, age, gender), or age of the vehicle account for any differences in the estimated distance driven. Statistical models were used to determine odds ratios for being arrested in the immediate vicinity of the drinking location, and for miles driven impaired. The independent sociodemographic and arrest variables included: age, gender, ethnicity/race, vehicle age, drinking location, whether the arrest followed a crash, time of arrest, blood alcohol concentration, and drinking in areas with varying levels of arrest intensity. The variables associated with arrest in the immediate vicinity of the drinking location (less than one half mile) were drinking in high or medium-high arrest intensity areas, Hispanic/Mexican ethnicity/nationality, Native American race, and drinking at home. Among those who were not arrested in the immediate vicinity, the number of miles driven ranged from 0.5 to 18.2, with a mean of 3.4 miles (median = 2.6). Analysis of covariance demonstrated that among those arrested outside the immediate vicinity of their drinking locations, persons who drank in a high or medium-high arrest intensity area, those with blood alcohol concentrations of > or = 200 mg/l, and those drinking at bars, restaurants, or private parties, drove fewer miles compared to other offenders. Our findings are mixed regarding ethnicity/race. Traits such as age, gender, and vehicle age are unrelated to how far drunk drivers travel before their arrests.

A prospective study of the utility of standardized instruments in predicting recidivism among first DWI offenders.

OBJECTIVE: The present study investigated the utility of four instruments--the MacAndrews scale of the MMPI-2 (MAC), four scales of the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST) and the Skinner's Trauma Scale (STS)--in assessing risk for rearrest among first driving while impaired (DWI) offenders. METHOD: Subjects were clients (N = 1,384, 80% male) convicted of a DWI offense who were referred to the Lovelace Comprehensive Screening Program for evaluation and who completed a court-mandated screening program. Stratified life table analysis was used to determine rearrest rates in the period following the screening referral. RESULTS: After 4 years of follow-up the overall rearrest rate was 21.0%. The best predictors of recidivism were a MAC score of 23 or above, elevated scores on AUI scales, young male status (age 30 or under) and arrest blood alcohol concentration (BAC) of .200% or above. The best schematic for classifying first offenders into risk groups was determined using the risk factors above and defined groups with recidivism rates ranging from 13.0% to 38.8%. CONCLUSIONS: We were able to identify cohorts of first offenders at relatively low and high risk for recidivism using a stratified analysis with six strata defined from four variables. The MAC was the best, single variable for classifying offenders' future recidivism risk, indicating that, in addition to evaluating for the presence and severity of alcohol and drug use, screening programs for DWI offenders should carefully evaluate personality factors in making referral and sentencing recommendations.

Use of computer interview data to test associations between risk factors and pregnancy outcomes.

Computer interviews have been used in a variety of settings as a means of gathering data and providing health education information. The objective of this study was to determine whether data gathered from a computer interview have predictive validity in determining pregnancy outcomes. Pregnant women (N = 190) completed a computer-assisted interview to provide risk factor information. Medical records were reviewed to obtain prenatal and birth outcome information. Twenty-nine percent experienced prenatal complications and nearly half experienced problems related to labor and delivery. After known risk factors were controlled for, self-reported psychosocial problems, low social support, and substance abuse by the father were associated with pregnancy complications. An unbalanced diet and low social support were associated with lower infant birth weight. Findings suggest that data collected via computer interviews can provide useful risk factor screening information.

Use of computerized prenatal interviews for assessing high-risk behaviors among American Indians.

The objectives of this study were to determine the prevalence of risk factors for adverse pregnancy outcomes among American Indians and to compare self-reported information collected under two computer interview conditions: an "anonymous" (N = 183) versus a "confidential" (N = 210) format. Results indicated that under 10% in both groups reported either use of cigarettes or other drugs of abuse, 16% reported risky drinking, 39% reported psychological distress, and 8% reported physical abuse during the current pregnancy. We concluded that confidential computer interviews were appropriate vehicles for obtaining risk information in this population.

Drinking environment and sociodemographic factors among DWI offenders.

OBJECTIVE: This study was designed to identify issues for public health/traffic safety in prevention of DWI and alcohol-related traffic injuries/deaths by investigating the relationships among drinking locations, sociodemographic characteristics and drinking-environment-related factors of convicted DWI offenders. METHOD: Subjects were clients (N = 5,154, 79% male) referred to the Lovelace Comprehensive Screening Program for alcohol-related assessment and were interviewed by counselors using a structured, computer-based questionnaire. Differences among ethnic/racial and gender categories were analyzed by logistic regression. RESULTS: (1) Some groups showed a higher rate of DWI convictions, compared to the adult county population: young, single male: Hispanic and Mexican National; divorced/ separated/widowed (increasing with age): (2) older, educated or employed offenders reported drinking more in bars/lounges, while younger offenders were more likely drinking in private parties; (3) Hispanic and Mexican National men showed equal likelihood of drinking with friends and relatives in bars/lounges, whereas non-Hispanic white males reported drinking more with friends; and (4) Native Americans were associated with higher blood alcohol concentration (BAC) and alcohol-related problems. CONCLUSIONS: (1) Young offenders' drinking and social behavior in private parties has implications for traffic safety; (2) divorced/separated offenders suggest a need for attention to underlying emotional problems; (3) strong family ties among Hispancies and Mexican Nationals may be a factor in remedial treatment; (4) Native American BAC statistics showed a need for further study; (5) multiple offenders' association with away-from-home drinking locations increased their risk of being involved in fatal crashes; and (6) server intervention programs should be emphasized to minimize intoxication of customers in commercial establishments.

Validity of self-reported criminal offences and traffic violations in screening of driving-while-intoxicated offenders.

Many jurisdictions in the USA, Canada and some European countries use diagnostic methods to assess substance abuse problems of driving-while-intoxicated (DWI) offenders, to address the concern that, during DWI screening, offenders may not give accurate information on their criminal history and traffic violations to avoid referral to treatment. This study was designed to validate self-reported data, to assess the need for DWI agencies to access court records, and to obtain an offence profile for this population. DWI offenders (n = 274, mostly first-time) were randomly selected from those who attended the Lovelace Comprehensive Screening Program (LCSP). The self-reported data were compared with records retrieved from the Metropolitan Court in Albuquerque, New Mexico, USA. Three-quarters of the offenders had had at least one offence or traffic violation before this DWI arrest. Sixty-five per cent of the offenders with court records underreported their records. The high percentage of false self-reporting for a primarily first-time offender population indicates the need to use court records to verify self-reported data. For multiple offenders, who have a much higher rate of criminal offences and traffic violations, checking self-reported data against court records becomes more important. In addition, a questionnaire based on offence information could be used to obtain a more complete history of those offences.

Alcohol abuse screening instruments: normative test data collected from a first DWI offender screening program.

OBJECTIVE: A variety of instruments are used by Driving While Impaired (DWI) screening programs nationwide to assess offenders for alcohol- or drug-related problems. This study presents normative data from five standardized instruments administered by a DWI screening program: the MAC scale of the MMPI, the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST), the Drug Abuse Screening Test (DAST) and the Skinner's Trauma Scale (STS). METHOD: The population under study were 2,317 first DWI offenders who completed screening evaluations in 1989-91. The sample included 24% women; the racial distribution was 46% Hispanic, 43% non-Hispanic white, 8% Native American and 3% other races. A statistical model was developed to determine associations among scores on the various instruments and age, gender, ethnicity, education, blood alcohol concentration (BAC) and validity measures on the MMPI-2 (L and K scale scores) RESULTS: There were significant differences in test scores among the ethnic- and gender-specific client groups. Test scores were significantly higher among men than women for the MAST, the D1 and D2 scales of the AUI, the MAC, and the STS. Correlations among the instruments were generally low, and the percentage of persons who scored above instrument cut-points varied significantly. The MAST identified the highest percentage of persons as alcoholic. MMPI profile validity was the most significant independent variable associated with test scores. Persons with scores in the valid range had higher mean scores on each of the instruments. CONCLUSIONS: The choice of instruments used in the DWI assessment can greatly influence the percentage of offenders assessed as having alcohol-related problems.

Homelessness and substance use among alcohol abusers following participation in project H&ART.

Project H&ART was a randomized intervention trial for homeless alcohol abusers in Albuquerque, N.M. Interventions were four months in duration and included: a high intensity program (case management plus peer-supervised housing), a medium intensity group (peer-supervised housing only); a housed, and a nonhoused control group. Clients were interviewed at baseline and re-interviewed ten months following program entry to determine substance use, housing stability and employment status. Program graduation rates were about 25% for the three housed groups. The outcome evaluation revealed significant within groups improvements in all of the outcomes, no between groups or racial outcome differences, and more favorable alcohol use and housing stability outcomes among program graduates than dropouts. On follow-up, women in the study had fewer days of alcohol use and had more days of stable housing, but were less likely to be employed, compared with men. We suggest that clients' personal motivation for recovery, rather than program-related factors, were most influential in determining outcomes.

Prenatal behavioral risk screening by computer among Native Americans.

BACKGROUND AND OBJECTIVES: Computer interviews have potential value in screening pregnant patients for substance abuse and other behavioral risk factors linked to adverse pregnancy outcomes. The focus of this study was to determine whether a patient-interactive computerized assessment and education program was an acceptable and valid means of obtaining behavioral risk data. METHODS: Study participants completed a computer interview, and computer-generated reports of substance use and physical abuse within the past year were compared with information in the participants' prenatal records. The accuracy of computer interview reports of substance use was evaluated by performing urine drug screens. RESULTS: More than 95% of the 265 women who completed the computer interview rated it favorably. Drug use and physical abuse were reported significantly more often during the computer interview, compared with information obtained from the patients' medical records. Results of urine drug screens demonstrated a high concurrence rate between self-reports of drug use and the results of urine analyses. CONCLUSIONS: Results indicated that the computerized assessment was well received by patients and yielded valid information regarding risk factors for adverse pregnancy outcomes.

Prenatal behavioral risk screening by computer in a health maintenance organization-based prenatal care clinic.

Cigarette smoking, alcohol and drug abuse, and stressful life events are significant contributors to prematurity and low birth weight in the United States. Identification and treatment of pregnant women with these risk factors require obtaining complete and accurate psychosocial histories. The purpose of this study was to determine whether a computer interview developed by our staff is appropriate for assessing behavioral risk factors for adverse pregnancy outcomes and for educating pregnant women about healthy behaviors during pregnancy. This computer interview asks about pregnant patients' perceived life stressors, diet, use of cigarettes and alcohol, and abuse of drugs. The study population consisted of 201 medically insured Hispanic and non-Hispanic white women attending a health maintenance organization--based prenatal clinic. Almost all subjects rated the computer interview favorably. Medical record reviews were conducted to compare participants' reports of cigarette, alcohol, and drug use obtained from paper-and-pencil interviews with behaviors reported during the computer interview. Although self-reported rates of smoking did not differ between the two interview techniques, a much higher percentage of women reported alcohol and drug use during the computer interview. Study participants scored significantly higher on a test measuring knowledge of the effects of stress, diet, and substances of abuse on pregnancy than did a control group. Results demonstrated the potential value of computer-interactive software programs for assessing high-risk behaviors among pregnant women in this population and educating them about healthy behaviors during pregnancy.