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A comparison of actual and perceived problem drinking among driving while intoxicated (DWI) offenders.

ABSTRACT

Problem drinkers account for a large proportion of those convicted of driving while intoxicated (DWI). Nevertheless, specific rates of problem drinking among D WI offenders have been shown to exhibit wide variability. Therefore, we seek to (a) present the rate and severity of problem drinking among a sample of DWI offenders, (b) contrast offender-perceived proportion of problem drinking against two separate indicators of problem drinking, and (c) determine demographic characteristics affecting the likelihood an offender would self-identify as a problem drinker. The sample consisted of DWI offenders (n=199) participating in a court-mandated education program. Results highlight a significant discrepancy between DWI offenders "perceptions of their drinking problems, compared to other, more objective measures. The objective measures revealed that offenders were much more likely to be problem drinkers than shown by self-ratings. These stark differences highlight potential focus/refinement areas for DWI rehabilitative programs.

Key Words: DWI, Offenders, Drinking Problem, Intoxicated Driving

INTRODUCTION

Despite a consistent decline in the prevalence of alcohol-related traffic fatalities in the United States throughout the 1980s and 1990s (Williams, 2006), drinking and driving remains an important public health concern (UDHHS, 2010). Consequently, new substance abuse objectives proposed for Healthy People 2020 (a set of science-based ten-year national objectives designed to promote health and prevent disease) include decreasing the rate of alcohol-impaired driving fatalities (SA HP2020-20) and !ncreasing the number of driving while impaired (DWI) courts m the United States (SA HP2020-17). A national emphasis on drinking and driving behaviors seems prudent considering conservative estimates report 159 million alcohol-impaired driving episodes annually (Quinlan et al., 2005), resulting in an alcohol-related traffic fatality every 48 minutes (NHTSA, 2010a). For that reason, it is not surprising the vast majority (81%) of the American public judge drinking and driving by others as a threat to their safety, as well as their families (NHTSA, 2010b).

Individuals who report driving within two hours of drinking in the past year not only drink in greater frequency but also consume significantly greater quantities per sitting than those who do not drive after drinking (Royal, 2003). Moreover, Voas & Fisher (2001) contend "more than two-thirds of all DWI offenders who come before the court can be classified as hard core drinking drivers" (p33). Categorized as multiple offenders and/or first-time offenders with blood alcohol concentrations (BACs) of 0.15 or greater at the time of arrest, "hard core" drinking drivers are at particularly high risk of being involved in an alcohol-related crash (Simpson, Mayhew, Beimess, 1996). When compared to fatally injured drivers with a zero BAC, fatally injured drivers with BACs of 0.15 or higher were much more likely to be classified by informants (e.g., spouses, parents, siblings, children) as problem drinkers (Baker, Braver, Chen & Williams, 2002). Together, these findings echo the Highway Safety Bureau's (now the National Highway Traffic Safety Administration) earlier assertion that problem drinkers account for as much as 66% of those involved in fatal alcohol-related crashes (U.S. Department of Transportation, 1968).

Even though problem drinking is common among DWI offenders, specific rates across studies exhibit wide variability (Stasiewicz, Nochajski, Homish, 2007). In a review of literature published between 1955 through 1981, between 4-87% of DWI offenders were classified as meeting the criteria for 'alcoholism' (Vingillis, 1983). Reviews of literature published between 1990 through 2004 document similar dispersion, reporting alcohol use disorders among 4-92% of DWI offenders (Stasiewicz, Nochajski, Homish, 2007). Therefore, the purpose of the current study is threefold. First, we will present the rate and severity of problem drinking among a sample of DWI offenders. Second, the proportion of DWI offenders who self-identify as a problem drinker will be compared against two separate, objective indicators of problem drinking. Lastly, we will determine the demographic and personal characteristics affecting the likelihood that an offender would self-identify as a problem drinker.

METHODS

In an effort to supplement the various state-level legal sanctions enacted to dissuade impaired driving (Hingson, 1996; Voas & Fisher, 2001), Texas also implemented a court-mandated, comprehensive DWI education program (TCADA, 2001). Designed as an educational curriculum to positively influence one's alcohol-related decision-making, this twelve-hour course spans a period of three four-hour sessions or four three-hour sessions. Overall, the course seeks to present accurate, straightforward information covering four major content areas. The four major components include (a) the alcohol/drug traffic safety problem, (b) effects of alcohol/drugs on the driving task, (c) alcohol/drug abuse and dependency, and (d) personal actions to avoid future DWI behavior. In addition to attending and participating in educational sessions, offenders also complete pre and postknowledge tests, drinking profiles, and an exit interview with the course instructor. Data for the current investigation will focus on the self-reported drinker profile and overall instructor evaluation of the offender's drinking problem. Specifics regarding both of these measures are provided herein.

Sample

Data were collected from DWI offenders enrolled in a court-mandated, postoffense program within the state of Texas. Spanning two years of classes, the final sample for this investigation consisted of 199 total offenders.

Instruments/Measures

Offender Self-Identified Drinking Problem

To determine whether participants would self-identify as a problem drinker, offenders were asked to complete a drinking profile. One item from that drinking profile served as the measure determining offender self-report problem drinking: "Have you ever thought you might have a drinking problem?" The response scale consisted of dichotomous yes/no options.

Numerical Drinking Profile (NDP)

In order to objectively assess the extent of each participating offender's drinking problem, the Numerical Drinking Profile (NDP) (Winter, 1979) was employed. The NDP was considered appropriate for this investigation, since it was originally developed to be used in educational programs designed for DWI offenders. In all, the NDP consists of six distinct factors. Intended to determine one's status along a problem-drinking continuum, these six factors include personal data items (5 total) and a cumulative score from an adapted version of the Michigan Alcoholism Screening Test (MAST). Personal data items include (a) "How many time have you been arrested on charges involving alcohol (not including the present DWI charge)?" (b) "Is someone close to you concerned about your drinking?" (c) "With whom did you do most of your drinking before this arrest?" (d) "Do you believe your drinking may be causing you problems?" and (e) "Do you want help for a drinking problem?" (Winter, 1979).

One's overall NDP score is interpreted on a continuum from one to seven, with the severity of a drinking problem increasing as scores become greater. NDP scores are categorized in the following manner:

--No Problem: indicates a NDP score of 1. These individuals have no prior arrests, do not believe any individuals are concemed about their drinking, and have a MAST score ranging from 0 to 3.

--Potential Problem: indicates a NDP score ranging from 2 to 5. These individuals must indicate one or more of the following: one alcohol-related arrest, drank alone or with strangers prior to arrest, answered "yes" or "not sure" alcohol is causing problems in your life, believed someone close to them was concerned with your drinking, and had a MAST score ranging from 4 to 6. A greater number of responses meeting these parameters resulted in a higher NDP score and also indicated a more severe drinking problem.

--Evident Problem: indicates a NDP score of 6 or 7. These individuals must meet one or more of the following criteria: two or more alcohol-related arrests, a MAST score of seven or greater, and an acknowledgment that the offender wants help for a drinking problem (Winter, 1979).

For this investigation the NDP exhibited acceptable internal consistency (Cronbach's alpha coefficient = 0.71), supporting previous evidence indicating the scale's reliability among a DWI offender population (Barry, Misra, Dennis, 2006; Malfetti & Winter, 1976).

Course Exit Interviews

To provide an additional measure of each offender's drinking problem, DWI course instructor evaluations were used. At the conclusion of each court-mandated DWI education course, the instructor conducts an exit interview with each offender. Exit interviews are required of all participating offenders. If not fulfilled, offenders will not receive acknowledgement of their participation in and completion of the course, which is required by the court system.

During the exit interview process, offenders identify extenuating circumstances surrounding their arrest and discuss strategies they can implement in their personal lives to prevent another DWI incident/conviction. In addition, the instructor reviews each offender's pre and post test scores, NDP score, and overall behavior/participation throughout the course. At the conclusion of this exit interview, the instructor determines the extent of each offender's drinking problem (considering all the aforementioned facets jointly), and makes one of the following recommendations:

--Low risk of drinking problem indicated at this time.

--Potential problem. Evaluation needed to determine if further counseling is require.

--Evident problem. Referral to counseling is necessary.

--Other problems indicated, which may require counseling.

Data Analysis

The Predictive Analytics SoftWare (PASW) (version 18.0) was utilized to generate descriptive statistics regarding the sample's demographic characteristics. In addition, a chi-square test for goodness of fit was employed to compare the proportion of offenders that self-identified as problem drinkers with the two separate measures of problem drinking (e.g., offender NDP score and course instructor evaluation). A univariate logistic regression was subsequently conducted to assess the impact of each independent variable and various demographic characteristics on the likelihood an offender would self-identify as a problem drinker.

RESULTS

Offenders in this sample were an average of 29 years of age (SD = 10.7) and began drinking at an average age of 18 (SD = 3.2). The vast majority of offenders were males (80%) of Caucasian decent (65%) who had earned a high school education or equivalent (73%). Table 1 provides a complete breakdown of the sample's demographic characteristics and prevalence of problem drinking.

With regard to alcohol use, both indicators of problem drinking (NDP score and DWI instructor evaluations) classify the majority of participants as exhibiting a potential drinking problem (see Table 1). Conversely, offenders were nearly universal (90%) in responding "no" to the question "Have you ever thought you might have a drinking problem?" This personal assessment drastically contradicted both of the problem drinking indicators employed in the court-mandated DWI offender course. Specifically, NDP scores classify approximately 78% of the offenders as having a potential (score between 2-5) to evident (score between 6-7) drinking problem. Course instructors evaluated 72% of the sample as having a potential to evident drinking problem.

In order to assess inherent differences between the level of problem drinking perceived by the offenders against actual proportion of problem drinking (determined utilizing NDP scores and course instructor evaluations), two separate one-sample chi-square tests were performed. In the first test, NDP scores were used to establish the expected proportion of offenders having a potential drinking problem. Based on their respective NDP scores, this chi-square goodness-of-fit test indicated there was a significant difference in the proportion of offenders in the current sample who thought they had a drinking problem (10%) as compared to the actual percentage of offenders who exhibited problem drinking (78%) [[chi square] (1, n=199) = 496.79, p < .0001]. To further examine the accuracy of offenders in self-identifying a personal drinking problem, a second one-sample chi-square test was performed using exit interview instructor evaluations as the expected proportion of offender drinking problems. This chi-square goodness-of-fit test also indicated there was a significant difference in the proportion of offenders who thought they had a drinking problem (10%) versus the percentage of offenders course instructors identified as having a drinking problem (72%) [[chi square] (1, n=181) = 381.27,p < .0001].

Direct logistic regression was subsequently performed to assess the impact of the independent variables, as well as a number of demographic and personal factors, on the likelihood that an offender would self-identify as having a drinking problem. In all, the model contained seven variables: NDP score, instructor evaluation of drinking problem, age, age of initiation into alcohol use, gender, ethnicity, highest level of education completed. Prior to conducting the analysis, correlations among the independent variables were assessed to determine if multicollinearity would impact the logistic regression analysis. The only correlation among model variables above .291 was the Pearson correlation between NDP score and instructor evaluation/recommendation (.598). However, this bivariate correlation still fell below the recommended cut-off of .70 (Huck, 2004; Tabachnick & Fidell, 2007). The full model was statistically significant ([chi square] with 15 df = 41.900,p < .0001), indicating that the predictor variables included were able to distinguish between offenders who self-identified as problem drinkers, and those who had not. The Homer and Lemeshow test was not statistically significant ([chi square] with 8 df = 5.831, p < .666), further substantiating the model's reliability and overall goodness-of-fit. The model as a whole explained between 25.9% (Cox & Snell R Square) and 54.1% (Nagelkerke R Square) of the variance in offenders self-identifying as a problem drinker, and correctly classified 95% of all cases. As evident in Table 2, only three variables made a unique statistically significant contribution to the model (NDP score, age, and age of initiation into alcohol use). The strongest predictor of self-identifying a drinking problem was offender's NDP score, recording an odds ratio of 2.069 (Wald = 5.172, df = 1, p < .023). This indicated that offenders who self-identified as problem drinkers were two times more likely to have a higher NDP score than those who did not self-identify as problem drinkers. The odds ratio of .650 for age of initiation to alcohol use (Wald = 3.929, df = 1, p < .047) was less than 1, indicating that, for each additional year an individuals put-off initiating alcohol use, they were .65 times less likely to self-identify as problem drinkers. Age was also significantly related to self-identifying as problem drinkers (OR = 1.159, Wald = 4.626, df = 1,p < .031), in that older offenders (B = .147) were more likely to identify themselves as problem drinkers. Table 2 summarizes the contributions of all independent variables included in the logistic regression analysis.

DISCUSSION

Results from this investigation highlight a clear discrepancy between DWI offender's perceived drinking behaviors compared to other, more objective measures. While being in a court-mandated DWI education course is not the quintessential factor for determining if a person has a drinking problem, some contend, "an arrest for DWI in and of itself can signal a need for treatment" (Lapham, C'de Baca, McMillan, Hunt, 2004, p135). Overall, published research suggests a large proportion of DWI offenders exhibit signs of alcohol abuse and/or dependence (Caetano & Rasberry, 2000; McCord, 1984; Pristach, Nochajski, Wieczorek, Miller, Greene, 1991; Lapham et al., 2001). Moreover, problem drinkers account for nearly half (46%) of all annual drinking-driving trips (Royal, 2003). Reports estimate problem drinkers drive with BACs of more than twice that of other drinking-drivers. Specifically, problem drinkers were estimated to have a BAC of 0.05 on their most recent drinking-driving trip, compared to that of 0.02 for drivers who drink alcohol (Royal, 2003). Furthermore, problem drinkers and people with alcohol dependence account for a large portion of alcohol-related crashes, including those that are fatal (Hingson & Winter, 2003). Thus, our sample's interpretation of personal alcohol consumption contradicts not only the indicators employed as a part of a court-mandated DWI course but also prevalence rates established by previous research.

Such a stark difference between offender-perceived problem drinking and actual problem drinking levels highlight potential focus/refinement areas for DWI rehabilitative programs. Since it is unlikely DWI offenders would enact strategies to curtail their drinking behaviors if they did not consider their personal alcohol consumption to be problematic, future efforts should attempt to neutralize this misperception by establishing accurate social norms and prevalence rates. Additionally, efforts should be made to (a) determine how offenders personally define problem drinking, and (b) establish what behaviors/characteristics are common across offender-provided definitions. Once established, approaches can be developed to bridge the gap between offender definitions/perceptions of problem drinking and the definitions/ interpretations of researchers. It is important to note, however, that published definitions/characterizations of problem drinking vary. Specifically, some definitions of problem drinking focus upon quantity [e.g., binge drinking (Wechsler, Dowdall, Davenport, & Rimm, 1995)] or frequency (Paradis, Demers, Picard & Graham, 2009) of consumption while others primarily emphasize alcohol-related consequences (Perkins, 2002). The NDP measure used in the current investigation more closely aligns with a definition of problem drinking that focuses on consequences resulting from personal alcohol consumption.

Misperceptions stemming from one's alcohol consumption are not restricted to the offender population. Among the general public there is failure to accurately discern the amount of alcohol that can safely be consumed prior to operating a motor vehicle. Specifically, among drivers who drink polled by the most recent National Survey of Drinking and Driving Attitudes and Behaviors, 40% felt it was safe for them to have three drinks within a two-hour period before driving (NHTSA, 2010b). These beliefs are discerning considering driving-related performance skills are impacted by alcohol at the lowest measurable levels (Moskowitz, Burns, Fiorentino, Smiley, Zador, 2000; Ogden & Moskowitz, 2004). Moreover, the relative risk of involvement in a fatal traffic crash rises exponentially as one's BAC increases (Zador, Krawchuck, & Voas, 2000).

Previous research examining the drinking behaviors of DWI offenders identifies age of alcohol initiation as a significant predictor of problem drinking (Barry, Misra, Dennis, 2006). Among the current sample, those who delay the age of alcohol onset were less likely to report being a problem drinker. Considering individuals who begin drinking at an earlier age are significantly more likely to report impaired driving ever in their life, and within the past year (Hingson, Heeren, Levenson, Jamanka, Voas, 2002), it is important that alcohol-related prevention efforts focus on delaying drinking onset. Thus, future drinking and driving prevention efforts should consider tailoring messages or programs to young people who have not yet engaged in alcohol use and/or driving. By initiating into alcohol use prior to the minimum legal drinking age, as the average offender in our sample did, individuals place themselves at elevated risk for developing alcohol dependence at some point in their life (Grant & Dawson, 1997).

The contributions of this research should be considered in unison with several limitations. Foremost, this investigation is limited by the self-report nature of the collected data. Thus, it is possible offenders did not accurately represent their alcohol consumption behaviors due to fear of perceived negative consequences if identified as a problem drinker. Also, it is noteworthy that NDP scores are interpreted across a continuum. Even though individuals with scores ranging from 2-5 were categorized as having a potential drinking problem, scores within the same category are not necessarily equivalent. Thus, higher NDP scores are much more indicative of problematic drinking behaviors than lower scores. In this investigation, the majority of offenders scored a 3 (out of a possible 7) on the NDP. Although the current sample consists of a disproportionate number of males, this overrepresentation is consistent with the elevated risk of males to be involved in alcohol-related traffic fatalities (Hnigson & Winter, 2003) and their propensity to drive longer distances while intoxicated when compared to females (Royal, 2000). Furthermore, the demographic distribution of the offenders in our sample (overwhelmingly male, Caucasian, young adults) parallels the characteristics of those most likely to (a) drive after drinking (Royal, 2003), (b) be involved in alcohol-related fatal crash (Hingson & Winter, 2003), and (c) drive with BACs at or above 0.05 (Voas, Wells, Lestina, Williams, Greene, 1998). Consequently, the homogenous distribution among our sample mirrors previously documented characteristics of the "typical" drinking driver.

Correspondence concerning this article should be addressed to: Adam E. Barry, PhD, Assistant Professor, Purdue University, Department of Health and Kinesiology, 800 W. Stadium Avenue, West Lafayette, IN 47907-2046; Phone: (765) 496-6723; E-mail: aebarry@purdue.edu.

Additional author is: Maurice Dennis, PhD, Professor Emeritus, Director of Center for Alcohol and Drug Education Studies, Texas A&M University, P.O. Box S-5, College Station, TX 77844-9175; Phone: (979)845-3046, Fax: (979)847-9579

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Adam E. Barry, PhD

Purdue University

&

Maurice Dennis, PhD

Texas A&M University
TABLE 1.
Demographic and Personal Characteristics

Demographic Items Percentage

Gender
Male 80.2
Female 19.8

Age
18-20 11.1% (n = 22)
21-34 68.2% (n = 135)
35-54 15.1% (n = 30)
55+ 5.6% (n = 11)

Race/Ethnicity
African-American 6.3
Anglo-American 64.6
Asian 1.1
Hispanic 15.9
Native-American 5.8
Other

Highest Grade Completed
None 7.8
GED/HS Diploma 72.8
Associates Degree 5.6
Bachelors Degree 11.1
Masters Degree 1.1
Doctorate 1.7

Offender Self-Identified Drinking Problem
No 90.6
Yes 9.4

Instructor Evaluation of Offender Drinking
Problem
Low Risk of Drinking Problem 26.1
Potential Drinking Problem 63.3
Evident Drinking Problem 8.5
Other Problems Indicated 2.1

NDP Score
No Problem: 1 22.6
Potential Problem: 2 19.6
3 41.2
4 4.5
5 1.0
Evident Problem: 6 6.0
7 5.0

TABLE 2.
Logistic Regression Predicting Offender Self Identifying Drinking
Problem

 95% C.I. for Odds Ratio

 Odds Ratio Lower Upper B

NDP Score 2.069 1.106 3.871 .727
Instructor Evaluation 1.107 .240 5.117 .102
Age 1.159 1.013 1.325 .147
Age of Alcohol Initiation .650 .425 .995 -.431
Gender .323 .048 2.173 -1.130
Race *
 African-American (1) .257 .000 3135.242 -1.359
 Anglo-American (2) 1.592 .064 39.447 .465
 Asian (3) .000 .000 -- -37.402
 Hispanic (4) 1.217 .024 60.475 .196
 Native-American (5) 1.037 .016 66.367 .036
Highest Education Attained **
 GED/HS Diploma (1) 1.246E9 .000 -- 20.943
 Associates Degree (2) 2.742 .000 -- 1.009
 Bachelors Degree (3) 3.784E8 .000 -- 19.751
 Masters Degree (4) 1.769E18 .000 -- 42.017
 Doctorate (5) 1.258E18 .000 -- 41.676
Constant .000 -- -- -21.585

 95% C.I. for Odds Ratio

 S.E. Wald df Sig.

NDP Score .320 5.172 1 .023
Instructor Evaluation .781 .017 1 .896
Age .069 4.626 1 .031
Age of Alcohol Initiation .217 3.929 1 .047
Gender .972 1.350 1 .245
Race * .290 5 .998
 African-American (1) 4.801 .080 1 .777
 Anglo-American (2) 1.638 .081 1 .777
 Asian (3) 56841.444 .000 1 .999
 Hispanic (4) 1.993 .010 1 .921
 Native-American (5) 2.122 .000 1 .986
Highest Education Attained ** .785 5 .978
 GED/HS Diploma (1) 11134.633 .000 1 .998
 Associates Degree (2) 15964.398 .000 1 1.000
 Bachelors Degree (3) 11134.633 .000 1 .999
 Masters Degree (4) 70501.097 .000 1 1.000
 Doctorate (5) 41706.773 .000 1 .999
Constant 11134.634 .000 1 .998

* Those classifying themselves as "Other" served as the reference
group for this analysis.

** Those with no formal education served as the reference group for
this analysis.
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Author:Barry, Adam E.; Dennis, Maurice
Publication:Journal of Alcohol & Drug Education
Geographic Code:1U7TX
Date:Apr 1, 2011
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