The first major federal effort to address the treatment of
"problem" drinking drivers began in the 1970s with the development of Alcohol
Safety Action Projects (ASAPs) in 35 states. Those programs attacked the
drunk driver dilemma at the community level with an emphasis on rehabilitation.
Prior to that time, a few judges ordered integrated treatment programs for
problem drinkers, but most legislation relied on deterring the drunk driver
through the use of licensing and jail sanctions.
From their inception, the ASAPs established a common operational definition
of the problem drinker primarily based on BAC and prior offenses. Additional
indicators included a record of prior treatment for alcohol problems, admission
of drinking problems, or an alcohol-related criminal record. This ambitious
project established the principle that an effective sanctioning system required
a provision for treatment.
Treatment programs, in general, can range from brief classroom discussion
to participation in self-help groups such as Alcoholics Anonymous, to outpatient
counseling sessions, to long-term residential programs. Offenders with serious
alcohol problems require more intensive and longer rehabilitation programs.
Treatment may be combined with confinement or close monitoring ordered by
the courts to ensure compliance with the treatment requirements.
At present, there seems to be no one treatment approach that is clearly
the most effective with the hardcore offender. However, some general characteristics
of treatment have been found to be associated with more successful outcomes.
Research focused on the hardcore drunk driver (Wiliscowski 1996; TRB 1995)
suggests treatment should:
- Be based on a personalized assessment process, which is needed to
accurately evaluate an individual’s use of, or dependence on, alcohol.
It may be valuable for the clinical assessment to be different from
any assessment conducted by the courts, so offenders will not feel there
is any benefit to be obtained from distorting information;
- Be individualized to meet the needs of each offender. Components of
the treatment plan could include a combination of elements, such as
residential treatment programs, outpatient treatment programs, interlock
devices, AA meetings, or other follow-up. However, any form of treatment
activity can be individualized through focusing on the specific needs
and plans of each offender;
- Be based on a combination of strategies, such as education and therapy
with follow-up. Treatments combining strategies, such as education plus
therapy plus follow-up, are most effective for hardcore drunk drivers;
- Be provided over a sufficient period of time for meaningful behavior
change to occur and be monitored. This may require a minimum of 9 to
12 months, when follow-up or monitoring is included; and
- Not be used as a substitute for other sanctions, especially license
suspensions. Instead, treatment has its largest impact on recidivism
when it is combined with sanctions, such as license suspensions and
interlock requirements.
The vast majority of treatment programs suitable for hardcore offenders
are considered outpatient programs. In a typical outpatient program, offenders
regularly meet (either individually or in group sessions) with a therapist
or counselor once a week for a period of three months to a maximum of one
year.
Researchers also point to a need for treatment of the multiple problems
facing most repeat offenders. A U.S. Department of Justice report states
over half of DWI offenders in jail or on probation reported a domestic dispute
while under the influence of alcohol. These same DWI offenders also had
high incidences of losing their jobs and getting into fights while drinking
(Maruschak 1999).
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Although treatment is sometimes given short shrift,
on average, education and treatment have a significant positive influence
in reducing drunk driving, resulting in a 7–9 percent reduction in DWI recidivism
and alcohol-related crashes (Wells-Parker 1995). Although the reduction
might appear somewhat small, the benefits are similar to the deterrence
effects of other strategies to address drunk driving and other traffic safety
measures as well: 6–9 percent for administrative license revocation (Hedlund
1995); and 6–8 percent for .08 BAC per se limit laws (NHTSA 2001).
Treatment appears to be most effective when it is combined with long-term
counseling, education, and closely monitored supervision, including probation,
education, and structured interaction in self-help groups. Best results
are produced by this kind of treatment strategy combined with fines, penalties,
and sanctions. Under these conditions, research suggests the impact of treatment
can be larger, with a reduction in recidivism and related problems of 20
percent or more (Mann et al. 1994).
- A 1997 study in California found a combination of treatment and driver’s
license action was associated with reduced recidivism for both repeat
offenders and first offenders.
- In California, second offenders could be sentenced to attend an
18-month program of at least 12 hours of education, 52 hours of
counseling and bi-weekly face-to-face interviews.
- Third and subsequent offenders were mandated to participate in
a 30-month program with a minimum of 18 hours education, 117 hours
counseling, 120-300 hours of community service, and frequent face-to-face
interviews.
- For repeat offenders with one prior conviction, those receiving
license revocation alone were about 50 percent more likely to recidivate
as those receiving license revocation and the 30-month program.
- For repeat offenders with three or more prior convictions, those
receiving license revocation alone had about a 70 percent greater
risk of recidivating than those receiving license revocation and
the 30-month program (DeYoung 1997).
- A 2001 study of recidivism of offenders receiving assessment and
treatment in North Carolina found offenders completing their mandated
programs were 64 percent less likely to re-offend in one year (Baker
2001).
- A 2002 meta-analysis of treatment programs throughout the United States
found evidence of reductions in crashes and DWI convictions after the
completion of substance abuse treatment. A Kentucky treatment outcome
report found a 66 percent reduction in DWI arrests post-treatment. In
Montana, DWI arrests declined from 45 percent in the 24 months prior
to the program to 6 percent in the six months following treatment. Programs
in South Dakota and Wisconsin also demonstrated a decline in arrests
and crashes (National Association of State Alcohol and Drug Abuse Directors
2002).
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