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Evaluating the 'hard-core drinking driver': Illinois prioritizes the identification of offenders who need services the most.

A Icohol-related fatalities have significantly decreased over the past 25 years, but alcohol-impaired driving continues to kill more than 17,000 individuals per year--accounting for 40% of all traffic fatalities. (1) Sustained public education campaigns and toughened laws have led to dramatic decreases in the number of social drinking drivers. As the pool of social drinking drivers decreases, "hard-core drinking drivers" constitute a larger portion of the impaired driving offender population. (2)

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States have called upon addiction professionals to evaluate those arrested for impaired driving in order to identify high-risk drivers, but the accuracy of these evaluations has often been compromised by reliance on self-report data and imperfect instruments. Particularly troublesome is that the percentage of retrospective alcohol dependence diagnoses triples when impaired drivers are re-evaluated Five years following their first arrest. (3) This article describes efforts in the state of Illinois to enhance the quality of such evaluations, and highlights a recent study that sheds light on the profile of the hard-core drinking driver.

One state's response

Illinois has a long history of collaboration across multiple agencies to reduce alcohol-related driving fatalities. Between 1982 and 2001, toughened laws, assertive law enforcement and prosecution, an informed judiciary, assertive monitoring by probation officers, rigorous gatekeeping of licensure reinstatement by administrative hearing officers in the Secretary of State's office, and mandated professional evaluation and treatment all contributed to a 60% reduction in Illinois' alcohol-related fatalities. (4) Even in the face of such success, calls grew for a more sophisticated approach to the evaluation and management of the state's driving under the influence offenders.

Historically, evaluators have been asked to answer three questions related to the DUI offender: 1) Does this offender have a problem in his/her relationship with alcohol and/or other drugs? 2) If so, what is the duration and level of severity of this problem? 3) What combination of educational and treatment services has the greatest probability of resolving these problems? While such questions are appropriate in the context of addiction treatment, they do not in and of themselves answer two broader questions: 1) What degree of risk does this offender pose to the safety of the public (risk defined as DUI recidivisim and future involvement in alcohol-related crashes involving damage to property, personal injury, and death)? 2) What community strategies can best be combined to lower the threat to public safety posed by this offender?

In an effort to provide better answers to these questions, the Illinois Department of Transportation, in collaboration with the Administrative Office of the Illinois Courts, the state Division of Alcoholism and Substance Abuse, and the Illinois Secretary of State, created a DUI Task Force and a Risk Reduction Work Group. The latter was charged in 2000 with the responsibility of examining the state's DUI evaluation process. This committee's work was performed under the direction of the Institute for Legal and Policy Studies at the University of Illinois.

Over the ensuing years, the Risk Reduction Work Group conducted a literature review of the DUI evaluation process, (5) created a scientific advisory panel, conducted a 2001 national survey of state DUI evaluation processes/instruments (47 states participated), and conducted focus groups with Illinois prosecutors, judges, probation officers, evaluators, treatment specialists, and administrative hearing officers.

Two major findings stemmed from these early steps. First, we found that states varied widely in their evaluation protocol. There were differences in which state agency was responsible for alcohol-related public safety, in who conducted the evaluation of DUI offenders (e.g., a private contractor versus a probation officer), and in DUI evaluation instruments. Twenty-three of 47 states mandated use of one or more instruments, with the Driver Risk Inventory-II (DRI-II) and the Mortimer-Filkins test being the most commonly mandated evaluation tools. We found a total of 33 evaluation instruments in use, with only half the states reporting that they were satisfied with the instrument they were using.

Second, multiple stakeholders shared concerns that the integrity of DUI evaluations was being compromised by reliance on self-reports, inconsistent access to criminal and driving/insurance records, and instruments that did not collect critical areas of information (e.g., histories of drug use other than alcohol). There was also concern in states in which DUI evaluation was the province of the private sector that competition for defense attorney referrals downgraded the rigor of the evaluation process (i.e., those agencies with reputations for rigorous assessment were not getting referrals). There was a particular concern that existing evaluation instruments/processes did not identify those offenders who posed the greatest threat to public safety and there fore should receive the greatest intensity of supervision resources. This led the Risk Reduction Work Group to identify those qualities of an ideal evaluation instrument and to explore whether any existing instrument met those criteria.

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When the group found no instruments that met all the desired criteria for an evaluation instrument, it identified an instrument that met the highest number of criteria--The Adult Substance Use and Driving Survey (ASUDS). It then contracted with the instrument's developers (Kenneth Wanberg, PhD, and David Timken, PhD) to modify the instrument to include additional data collection elements desired by Illinois DUI stakeholders. The revised instrument, the ASUDS-RI (Revised for Illinois), was then piloted in 2004 with 486 offenders at 10 evaluation sites.

The ASUDS-RI is a self-administered assessment instrument comprising 113 questions arranged into 15 scales and sub-scales. The scales are designed based on research related to DUI risk and risk prediction. Scales related to drug use and criminal history were added or modified for the Illinois version of the instrument based on the feedback received from multiple DUI constituency groups. The scales include the following:

* Alcohol Involvement. Measures the extent of alcohol use.

* Driving Risk. Evaluates general risk-taking behavior while driving.

* Antisocial. Assesses antisocial behavior and attitudes.

* Mood Disruption. Measures-depression, anger, and/or anxiety problems.

* Alcohol/Drug Involvement. Measures drug use across 10 major categories.

* Disruption. Measures the problems/consequences encountered by the respondent as a result of drugs or alcohol; identifies symptoms of abuse or dependence.

* Involvement/Disruption One-Year. Measures the scope and intensity of alcohol and drug use and negative consequences related to such use in the past 12 months.

* Global A composite of Involvement, Disruption, Antisocial, and Mood Disruption scales that provides an overall risk profile for each offender.

* Motivation. Measures the degree to which the respondent is willing to make necessary changes related to alcohol or drug use.

* Benefits. Utilizes components of the Involvement scales to measure social or psychological benefits gained from use and self-treatment of depression or anxiety.

* Antisocial (community). Sub-scale of Antisocial; identifies general attitudes linked to antisocial behavior.

* Antisocial (criminal justice). Subscale of Antisocial; measures past and current involvement with the criminal justice system.

* Psycho-social Disruption. Sub-scale of Disruption; measures physical and psychological problems related to alcohol or drug use.

* Social-behavioral Disruption. Sub-scale of Disruption; identifies social problems such as inability to work and problems with family resulting from use.

* Defensiveness. Measures the degree to which the respondent is willing to disclose sensitive information.

The output from the instrument provides a raw score for each scale and a percentile rank showing where the respondent falls in relation to other DUI offenders, and a composite score with cut points indicating the level of service needed.

A major goal in refining the ASUDS-RI was to develop an instrument that could differentiate first-time DUI offenders who are unlikely to be involved in future DUI offenses from first-time DUI offenders whose problems are likely to escalate into increased risk of DUI recidivism and alcohol/drug-related crashes. We will use this Phase One pilot data from Illionis to illustrate growing understanding of the hard-core drinking driver. (6)

Driver's profile

The hard-core drinking driver is an individual who, following repeated sanctions, continues to drive at least once a month with a blood alcohol content of .15 or greater.(7) Such drivers make up only about 3% of licensed drivers, but contribute 80% of the total impaired driving trips. (8) Because of the frequency with which they drive while impaired and the degree of that impairment, hard-core drinking drivers pose a very significant threat to public safety. One of the tasks of the addiction professional serving as a DUI evaluator is to recognize this individual and recommend interventions that can lower the public safety threat.

A profile of the hard-core drinking driver is emerging from multiple studies that compare DUI non-recidivists with DUI recidivists. (9) Several components dominate that profile and are illustrated by the Illinois ASUDS-RI data.

First, as a group, DUI recidivists are predominantly single, separated, or divorced Caucasian or Hispanic males between the ages of 25 and 45. They have fewer than 12 years of education, are transiently employed in blue-collar jobs, and are part of social groups whose members are heavy drinkers and drinking drivers. In the Illinois pilot study, repeat offending peaked between ages 31 and 35. The fact that recidivism risk declines with age suggests the need to mobilize community resources to contain hard-core drinking drivers until they age out of this high-risk group.

Compared to the non-recidivist, the DUI recidivist is more likely to believe that he/she can drive safely after drinking and to see his/her DUI arrest as a function of bad luck or police harassment. These individuals are also more likely to have past histories of high-risk driving (e.g., failure to wear seatbelts, moving violations, accidents, injuries). (10) In the Illinois pilot, recidivists were more likely to have prior arrests for speeding, failure to yield/stop, improper lane rage, and seatbelt or child safety violations, as well as being nearly twice as likely as first-time offenders to have at least one prior collision on their driving record.

Also, DUI recidivists are distinguished from non-recidivist offenders by an increased propensity for family histories of alcohol-and other drug-related problems. Many recidivists reported early exposure to drinking and driving by their parents, and adolescent exposure to drinking and driving within their peer group. They also are more likely to report early age of onset of alcohol, tobacco, and other drug use. In the Illinois pilot, recidivists were more likely to be heavy smokers (one to two packs a day) and less likely to have successfully quit smoking, and they reported a greater number of episodes of past illicit drug use.

Multiple offenders were substantially more likely to have previously attended treatment and, to a lesser extent, self-help groups--a factor likely influenced by mandated treatment or AA exposure linked to earlier DUI arrests. Research reviews note that recidivists are more likely to have dropped out of prior treatment and to have failed to complete earlier court-ordered services?; this factor was not tested in the Illinois pilot.

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DUI arrests of recidivists, when compared to those of non-recidivists, were more likely to be characterized by a high blood alcohol content (greater than. 15) without gross signs of intoxication; collateral charges; and refusal to take a Breathalyzer test. More than half (55.6%) of the DUI recidivists in the Illinois pilot study refused the Breathalyzer, compared with only 30% of first-time offenders. Even with this high rate of refusal, the remaining recidivists still had a significantly higher BAC (mean of. 159) than first-time offenders, as well as self-reports of drinking more hours and more drinks.

Recidivists also were more likely to have been arrested on Monday, Wednesday, and Thursday. It is unclear why the trend toward an increased likelihood for repeat offender arrests during non-weekend nights does not hold true for Tuesday, unless this reflects a pattern of brief reprieve among daily, heavy drinkers whose consumption peaks over the course of extended weekend drinking episodes.

Those with one or more prior DUI offenses are significantly more likely to have a prior non-DUI arrest on their criminal history report than are first-time DUI offenders. Nearly half of the multiple offenders have two or more prior non-DUI arrests, compared to less than 20% for first-time offenders. Nine percent of repeat offenders have five or more previous non-DUI arrests. Multiple offenders had a history of crimes against persons at a rate twice that of first-time offenders (30% versus 15%). In addition, person crimes of repeat offenders were more likely to be related to domestic violence, with 56% of the person crimes for multiple offenders being for domestic violence.

The difference between first-time and repeat offenders is less pronounced in terms of previous charges related to controlled substances, with rates of 11% and 19%, respectively. The overrepresentation of cannabis and controlled substance violations in the multiple offenders group is consistent with the finding that multiple offenders are almost three times more likely to have a collateral charge of cannabis possession at their DUI arrest than are first offenders (9% compared with 3.2%).

DUI recidivists are more likely than non-recidivists to have prior treatment for psychiatric illness as well as medical treatment reflecting injury to self via risk-taking. Recidivists also are distinguished by diminished capacity for empathy, a marked absence of guilt and remorse, a failure to take personal responsibility for decisions and their outcomes, and a general pattern of impulsivity and risk-taking. (9) Evaluation instruments such as the ASUDS-RI that focus on global assessment will increase our ability to identify such risk factors and to tailor specific interventions to address them.

The future

The ASUDS-RI pilot study was able to obtain completed evaluations on 486 individuals and to analyze the evaluation data to establish Illinois norms for the ASUDS-RI. The pilot study also added information on the profile of the Illinois DUI offender and DUI recidivist population. This preliminary study confirms a number of risk factors for DUI recidivism that have been noted in the national profile literature. Nearly all of the ASUDS-RI scales revealed significant differences between the first-time DUI offender and the multiple DUI offender.

Continued follow-up of this and other populations of DUI offenders will reveal increasingly precise delineations of those factors that predict DUI recidivism and broader threats to public safety. Once we have defined this highest-risk population of impaired drivers, it could be possible to develop specialized treatment protocols designed to enhance their recovery rates and to lower their threat to communities across the country.

William L. White, MA, is a Senior Research Consultant at Chestnut Health Systems and a Consultant to the Illinois Risk Reduction Work Group. He is also the author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. His e-mail address is billlwhite@aol.com. Joy Syrcle, MA, is the former Assistant Director of the Institute for Legal and Policy Studies at the University of Illinois.

References

(1.) National Highway Traffic Safety Administration. Alcohol Involvement in Fatal MotorVehicle Traffic Crashes, 2003 Washington, D.C.: NHTSA National Center for Statistics and Analysis; 2005.

(2.) Simpson HM, Mayhew DR. The Hard Core Drinking Driver. Ottawa, Canada: Traffic Injury Research Foundation; 1991.

(3.) Lapham SC, C'de Baca J, McMillan G, et al. Accuracy of alcohol diagnosis among DWI offenders referred for screening. Drug Alcohol Dependence 2004;76:135-41.

(4.) National Highway Traffic Safety Administration. State Alcohol Related Fatality Rates (Technical Report DOT HS 809 528). Washington, D.C.: 2002.

(5.) White W. Management of the High Risk DUI Offender. Springfield, Ill.: Illionis Department of Transportation; 2004.

(6.) Syrcle J, White W. DUI Risk Reduction Project: ASUDS-RI Pilot Phase I (Statistical Summary). Springfield, Ill.: University of Illinois-Springfield Institute for Legal and Policy Studies; 2006.

(7.) Simpson HM, Beirness DJ, Robertson RD, et al. Hard core drinking drivers. Traffic Injury Prev 2004;5:261-9.

(8.) Beirness DJ, Simpson HM, Desmond K. The Road Safety Monitor 2003: Drinking and Driving. Ottawa, Canada: Traffic Injury Research Foundation; 2003.

(9.) White W, Gasperin D. The "hard core drinking driver": identification, treatment and community management. Alcoholism Treatment Quarterly (in press).

(10.) Begg DJ, Langely JD, Stephenson S. Identifying factors that predict persistent driving after drinking, unsafe driving after drinking, and driving after using cannabis among young adults. Accid Anal Prev 2003;35:669-75.

BY WILLIAM L. WHITE, MA, AND JOY SYRCLE, MA
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Author:White, William L.; Syrcle, Joy
Publication:Addiction Professional
Date:Jan 1, 2008
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