Negative affect and drinking drivers: a review and conceptual model linking dissonance, efficacy and negative affect to risk and motivation for change.

This review summarizes evidence on negative affect among drinking drivers. Elevations in negative affect, including depressed mood, anxiety and hostility, have long been noted in convicted drinking drivers, and recent evidence suggests an association between negative affect and driving after drinking in the general population. Previous efforts to understand the significance of this negative affective state have ranged from suggestions that it may play a causal role in drinking driving to suggestions that it may interfere with response to treatment and remedial interventions. Recent studies have uncovered an important paradox involving negative affect among convicted drinking drivers (hereafter DUI offenders). DUI offenders with high levels of negative affect recidivated more frequently following a DUI program than did those reporting no or minimal negative affect. However, when a brief supportive motivational intervention was added to the program, offenders with high negative affect levels showed lower recidivism rates than did those with no or minimal negative affect. The review includes studies from the general literature on alcohol treatment in which the same negative affect paradox was reported. In an attempt to understand this paradox, we present a conceptual model involving well-established psychological processes, with a focus on salient discrepancy, the crucial component of cognitive dissonance. In this model, negative affect plays an important role in motivating both continued high-risk drinking as well as therapeutic change. This model suggests that links between motivational states and negative affective processes may be more complex than previously thought. Implications for intervention with DUI offenders are discussed.

Examining the link between drinking-driving and depressed mood.

OBJECTIVE: Because both alcohol and depressed mood exert deleterious effects on psychomotor performance, the possibility that people with depressed mood may be more likely to drive after drinking may have important implications for traffic safety. In this work, we examine the association between depressed mood and self-reported driving after drinking in a large representative sample of adults in Ontario. METHOD: Data are based on the 2001-2004 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults ages 18 and older (N=3,979). Logistic regression analysis was performed to identify the risk of driving after drinking two or more drinks in the previous hour within the past 12 months associated with scores on a screening measure of depressed mood (depression-anxiety and social functioning subscales of the 12-item General Health Questionnaire), while controlling for alcohol-use measures (weekly volume and frequency of heavy drinking), driving exposure, and demographic factors. RESULTS: Logistic regression analysis revealed that the odds of reporting driving after drinking within the past year increase significantly as depressed mood (specifically, depression-anxiety scores) increases. CONCLUSIONS: Additional research on the nature of the link between depressed mood and impaired driving should be undertaken, including assessing whether there exists any synergistic effects of depressed mood and alcohol on collision risk and considering the implications of this relationship for prevention and remedial activities.

The relationship between depressed mood, self-efficacy and affective states during the drinking driving sequence.

Relationships between depressed mood, abstinence confidence and temptation, and experienced emotions just before and during recent drinking driving sequences (drinking driving emotional states: DDES) were examined in a sample of DUI (Driving Under the Influence) offenders. Depressed mood offenders (41% of sample) reported lower abstinence confidence, higher temptation, and higher DDES, especially in association with negative affective states. Implications for interventions with depressed mood DUI offenders are discussed.

Predictive validity of the RIASI: alcohol and drug use and problems six months following remedial program participation.

The ability of screening instruments for convicted drinking drivers to predict subsequent alcohol and drug-related problems rarely has been studied. The predictive validity of the Research Institute on Addictions Self-Inventory (RIASI) was investigated in a sample of 6,003 convicted drinking drivers who were participating in Back on Track (BOT), Ontario's remedial measures program for convicted drinking drivers. All BOT participants complete an assessment (which includes the RIASI), followed by a brief education or treatment program, and concluded 6 months later by a follow-up interview. The follow-up interview collects information on self-reported alcohol and other drug use and problems, and contacts with other health care providers in the 90 days prior to the follow-up contact. The ability of scores on the RIASI to predict these measures was assessed. The results revealed that, for almost all comparisons, individuals who used alcohol and other drugs, reported more substance-related problems at follow-up, and reported more contacts with other health and addictions providers had significantly higher scores on the RIASI total score and the RIASI recidivism scale at the initial assessment. The data indicate that this instrument appears to be able to identify individuals who will experience alcohol and drug related problems in the future.

Predictors of completion status in a remedial program for male convicted drinking drivers.

OBJECTIVE: Rates of attrition in alcohol and drug treatment programs are often greater than 50%, and completion of treatment has been shown to be a potent predictor of posttreatment outcome. The current study examined both rates and predictors of completion among male participants in a remedial measures program for convicted drinking drivers. METHOD: Male individuals (n = 5,409) convicted of a drinking driving offense in Ontario between October 2000 and December 2002 who did and did not complete a mandatory rehabilitation program were described in terms of demographic, drug use and legal variables collected at time of assessment. RESULTS: The program completion rate was extremely high (97.3%). In multivariate analyses, noncompleters-relative to completers-were younger; drank more frequently; were less likely to own a home; and were more likely to live in urban centers, have two or more lifetime impaired driving convictions and have experienced more than one adverse consequence of substance use. CONCLUSIONS: Ontario's remedial measures program for convicted drinking drivers, in which the return of a suspended license after the period of mandatory suspension is contingent on the completion of the program, demonstrates a very low level of client attrition. Individuals who do not complete the program bear many similarities to those at high risk for persistent drink-drive behavior and its associated negative health consequences.