Typology of driving-under-the-influence (DUI) offenders revisited: Inclusion of DUI-specific attitudes

Objectives

Much work remains to improve rehabilitative interventions for driving-under-the-influence (DUI) offenders. There is heterogeneity of patterns of alcohol use, personality, and driving behaviour within DUI offenders, but little is known about how their appraisal of DUI differs. This study investigated within-offender variability in DUI-specific attitudinal variables.

Method

Convicted male DUI offenders (N = 219) living in greater Tokyo were interviewed. Cluster analysis was undertaken using age, psychological distress, personality trait, alcohol use, and attitudes towards DUI. Discriminant function analysis explored the relative explanatory power of the grouping variables.

Result

Many offenders reported current excessive alcohol consumption. About 26–36% of the participants were potentially alcohol-dependent based on screening instruments/biomarkers. Cluster analysis identified five subgroups. The biggest subgroup considered their DUI a singular mistake and reported strong self-efficacy for avoiding further DUI (clusters 1 and 2). A small subgroup manifested alcohol dependence, psychological distress, higher impulsivity, and lower self-efficacy for avoiding DUI (cluster 3). Another subgroup exhibited a tendency to rationalise DUI, higher likelihood of future DUI, and lower self-efficacy for avoiding DUI (cluster 4). Most participants in another small subgroup abstained from alcohol use temporarily after their convictions (cluster 5).

Conclusion

The majority of DUI offenders regarded their DUI conviction as an exceptional mishap, while they continued consuming hazardous amounts of alcohol. DUI-specific attitudinal variables, including DUI rationalisation and self-efficacy for avoiding future DUI incidents, constituted a distinct aspect of the problem, suggesting the need to address this issue in addition to the underlying alcohol use problem.     

Retention of driving-under-the-influence offenders in alcoholism treatment

The race, age, education, marital status, employment status, occupational level, prior treatment status, and SCL-90-R Global Severity Index scores of 244 men admitted to a 90-day outpatient treatment program for alcoholism, following their arrests for driving under the influence (DUI) of alcohol, were analyzed to determine whether or not these psychosocial characteristics were related to completing treatment. A stepwise discriminant analysis indicated that age, the SCL-90-R Global Severity Index, and current employment differentiated between offenders who completed and did not complete treatment. Older employed men complaining of less intense symptoms were more likely to finish treatment than younger unemployed men complaining of more intense symptoms.     

A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway

BackgroundA large proportion of road traffic crashes are related to driving under the influence (DUI) of alcohol or drugs. The aim of this study was to compare the use of alcohol, illegal drugs and psychoactive medicinal drugs among random drivers in Brazil and Norway, two countries with the same legal limit for drunk driving, but with marked differences in legislation history, enforcement and penalties for DUI, and to discuss any differences found.MethodsRoadside surveys were conducted on Fridays and Saturdays between noon and midnight. Samples of oral fluid were collected for analysis of drugs, whereas alcohol was determined by breath testing or by analysis of oral fluid.ResultsHigh participation rates of 94–97% were obtained in both countries. The weighted prevalence of driving with alcohol concentrations in breath or oral fluid equivalent to blood alcohol concentrations (BAC) above 0.2 g/L was 2.7% (95% CI 2.2–3.3) in Brazil and 0.2% (95% CI 0.0–0.5) in Norway. Stimulants (amphetamines or cocaine) were found in samples from 1.0% (95% CI 0.7–1.4) of drivers in Brazil and 0.3% (95% CI 0.1–0.7) in Norway. The prevalence of amphetamines was highest among Brazilian truck drivers (3.6%; 95% CI 2.0–6.4). Tetrahydrocannabinol was found in samples from 0.5% (95% CI 0.3–0.8) of drivers in Brazil and 1.0% (95% CI 0.6–1.5) in Norway, whereas benzodiazepines or zopiclone were found in 1.0% (95% CI 0.7–1.4) and 1.7% (95% CI 1.2–2.4) of the samples from Brazil and Norway, respectively.ConclusionsThe difference in the prevalence of alcohol may be related to the fact that Norway has implemented steps to reduce drunk driving since 1936, whereas Brazil has attempted to do the same for only a few years. Differences for drugs may be related to different patterns in the use of stimulants, cannabis and medicines.     

Drug-abusing offenders with comorbid mental disorders: problem severity, treatment participation, and recidivism

This study examined problem severity, treatment participation, and recidivism among 1,016 offenders with co-occurring mental disorders who participated in California's Proposition 36. Participants were assessed using the Addiction Severity Index (ASI) at baseline, and their records on mental health diagnoses, drug treatment participation, and arrests were also obtained. Participants' co-occurring disorder (COD) severity was classified as mild or severe based on specific mental health diagnoses. Predictors of recidivism were examined among mild-COD and severe-COD participants separately using ordinal logistic regression. Results indicate that although previous arrests, education, and treatment retention length are predictors of recidivism generally, gender, age, primary drug, ASI drug severity score, and treatment modality are differentially important depending on COD status. These results underscore the need for COD-focused intervention strategies among offenders, taking into consideration the severity of their COD status.     

Alcohol stigma and persistence of alcohol and other psychiatric disorders: A modified labeling theory approach

Background

We sought to apply modified labeling theory in a cross-sectional study of alcohol use disorder (AUD) to investigate the mechanisms through which perceived alcohol stigma (PAS) may lead to the persistence of AUD and risk of psychiatric disorder.

Methods

We conducted structural equation modeling (SEM) including moderated mediation analyses of two waves (W1 and W2) of data from the National Epidemiologic Survey on Alcohol and Related Conditions. We analyzed validated measures of PAS, perceived social support, social network involvement, and psychiatric disorders among (n = 3608) adults with two or more DSM-5 AUD symptoms in the first two of the three years between the W1 and W2 survey. Cross-sectional analyses were conducted owing to the assessment of PAS only at W2.

Results

Per mediation analyses, lower levels of perceived social support explained the association of PAS with past-year AUD and past-year internalizing psychiatric disorder at W2. The size of the mediated relationship was significantly larger for those classified as labeled (i.e., alcoholic) per their prior alcohol treatment or perceived need (n = 938) as compared to unlabeled (n = 2634), confirming a hypothesis of moderated mediation. Unexpectedly, mediation was also present for unlabeled individuals.

Conclusions

Lower levels of social support may be an important intermediate outcome of alcohol stigma. Longitudinal data are needed to establish the temporal precedence of PAS and its hypothesized intermediate and distal outcomes. Research is needed to evaluate direct measures of labeling that could replace proxy measures (e.g., prior treatment status) commonly employed in studies of the stigma of psychiatric disorders.     

Operating a motor vehicle after marijuana use: Perspectives from people who use high-potency marijuana

ABSTRACT

Background: With advancing marijuana legalization in the United States, a primary concern is the possible increase in consequences relating to marijuana driving impairment, especially among people who use high-potency marijuana (i.e., extracts). In this study, the research team assessed the risk perception and experiences of driving under the influence of marijuana by investigating people who use extracts. Methods: Participants from 2 studies were queried about driving after using marijuana. In Study 1, phone interviews (n = 19) were conducted with people who use extracts. In Study 2, people who use extracts (n = 174) were recruited to participate in a nationwide survey via an online existing panel. Responses to marijuana and driving–related questions were qualitatively coded for themes (e.g., riskiness, engagement in behavior) developed by the research team. Results: Prominent themes identified in Study 1 suggested a belief that driving risk following marijuana use is dependent on the individual (i.e., response/tolerance) or the amount/type of marijuana consumed. This theme was corroborated by Study 2 participants. Those who perceived no or minimal risk from driving following marijuana use were more likely to report engagement in driving following extracts use. Conclusions: More research is needed to understand how marijuana, especially in its concentrated form, impacts driving ability in order to develop appropriate and scientifically sound regulations. Such research could subsequently fill the need to improve and more widely disseminate prevention messages on marijuana use and driving risks.     

Alcohol, drugs, and condom use among drug offenders: an event-based analysis

BACKGROUND: Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well. GOAL: This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders. DESIGN: Participants in court-ordered drug diversion programs (n=536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner. RESULTS: In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use. CONCLUSIONS: In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.     

Assessing DUI risk: examination of the Behaviors & Attitudes Drinking & Driving Scale (BADDS)

Despite research findings indicating attitudinal differences among drivers with and without a history of driving under the influence (DUI) offenses, there are no well-established instruments specifically designed to clinically assess drinking and driving attitudes and behaviors among adults. The purpose of this current series of three studies was to investigate the psychometric properties of the Behaviors & Attitudes Drinking & Driving Scale (BADDS). The BADDS was developed in previous studies by the authors and assesses respondents' rationalizations for drinking and driving, likelihood of future drinking and driving, drinking and driving behaviors, and riding with a drinking driver behavior in the previous month. Study 1 (N=179) and Study 2 (N=338) assessed college participants, while Study 3 gathered data from adult DUI offenders (N=160) and non-DUI offenders (N=166). Results indicate good to excellent test-retest reliability and internal consistency estimates for BADDS scale scores. Support for the construct validity as well as concurrent and predictive criterion validity of BADDS scores was also demonstrated. Potential applications for the measure, as well as need for future research are described.     

Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: Antisocial behavioral syndromes, including antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD ("CD only") are highly comorbid with drug use disorders (DUDs). Among patients in DUD treatment, antisocial syndromes are associated with greater severity and poorer outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of DUDs among general population adults have not previously been available. This study describes associations of antisocial syndromes with clinical characteristics of lifetime Diagnostic and Statistical Manual-Version IV DUDs in the general U.S. adult population. METHODS: This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093, response rate=81%). Respondents (n=4068) with lifetime DUDs were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome. Associations of antisocial syndromes with clinical characteristics of DUDs were examined using logistic regression. RESULTS: Antisocial syndromes were significantly associated with the phenomenology of DUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to those with ASPD; those with "CD only" were weak, inconsistent, and not statistically significant. Patterns of associations differed little between men and women. CONCLUSIONS: Both ASPD and AABS, but not "CD only," appear to identify greater clinical severity of DUDs among adults in the general U.S. population.     

Alcohol and drug use among homosexual men and women: epidemiology and population characteristics

Homosexual men and women have been described as at high risk for alcohol and drug abuse, due to psychosocial variables such as stress levels or the cultural importance of bar settings. However, there are few actual data in this regard. This paper presents the findings of a large (n = 3400) survey of a homosexual population regarding population characteristics and patterns of alcohol and drug use. Psychosocial variables that may account for substance use patterns both generally and in this population are discussed in an accompanying paper. Substantially higher proportions of the homosexual sample used alcohol, marijuana, or cocaine than was the case in the general population. Contrary to other reports, this was not accompanied by higher rates of heavy use, although homosexuals did show higher rates of alcohol problems. In the general population women consume less drugs and alcohol than do men, and substance use substantially declines with age. Neither of these patterns were found for the homosexual sample, thus creating overall higher rates of substance abuse. This may reflect differences between homosexuals and the general population in their adherence to sex-role stereotypes and age-related social role changes, as well as culturally specific stressors and vulnerability to substance use.     

The comorbidity of substance use disorders and eating disorders in women: Prevalence,etiology, and treatment

Substance use disorders often co-occur with eating disorders in female populations. This review addresses the prevalence and etiology of this comorbidity in women. Thirteen peer-reviewed journal articles are reviewed. Conclusions are drawn concerning prevalence rates, theory, and implications for treatment. Current research supports distinct etiologies and growth trajectories for both disorders. Thus, comorbidity presents with unique challenges, and often, worse outcomes. Though comorbidity rates are high, little research has been done concerning treatment. Given the high prevalence rates of these comorbid disorders, a specific treatment needs to be developed that targets both disorders simultaneously.     

Alcohol and drug disorders in the International Classification of Diseases: a shifting kaleidoscope

This paper considers the development of the alcohol and drug categories in the mental disorders section of successive editions of the International Classifications of Diseases, and the current definitions of the key categories. With respect to "dependence", it is argued that the concept was originally defined with respect to culturally close societies, but even between those societies there remain differences in nuance; that in current definitions dependence is not unitary; that there are difficulties in applying the concept across drugs; that technical definitions have drifted far from lay concepts; and that there are substantial questions about its cross-cultural applicability. As practitioners struggle to keep up with the shifts in nosological terminology and definitions over the last 30 years, the terms and criteria may well be quite vague in application despite their concreteness in appearance.     

Alcohol and drug use disorders among homeless veterans: Prevalence and association with supported housing outcomes

This study examines the prevalence of alcohol and drug disorders among homeless veterans entering the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program and its association with both housing and clinical outcomes. A total of 29,143 homeless veterans were categorized as either having: no substance use disorder, only an alcohol use disorder, only a drug use disorder, or both alcohol and drug use disorders. Veterans were compared on housing and clinical status prior to admission to HUD-VASH and a smaller sample of 14,086 HUD-VASH clients were compared on their outcomes 6 months after program entry. Prior to HUD-VASH, 60% of program entrants had a substance use disorder and 54% of those with a substance use disorder had both alcohol and drug use disorders. Homeless veterans with both alcohol and drug use disorders had more extensive homeless histories than others, and those with any substance use disorder stayed more nights in transitional housing or residential treatment in the previous month. After six months in HUD-VASH, clients with substance use disorders continued to report more problems with substance use, even after adjusting for baseline differences, but there were no differences in housing outcomes. These findings suggest that despite strong associations between substance use disorders and homelessness, the HUD-VASH program is able to successfully house homeless veterans with substance use disorders although additional services may be needed to address their substance abuse after they become housed.     

Gender differences in drunk driving prevalence rates and trends: a 20-year assessment using multiple sources of evidence

This research tracked women's and men's drunk driving rates and the DUI sex ratio in the United States from 1982-2004 using three diverse sources of evidence. Sex-specific prevalence estimates and the sex ratio are derived from official arrest statistics from the Federal Bureau of Investigation, self-reports from the Centers for Disease Control and Prevention, and traffic fatality data from the National Highway and Transportation Safety Administration. Drunk driving trends were analyzed using Augmented Dickey Fuller time series techniques. Female DUI arrest rates increased whereas male rates declined then stabilized, producing a significantly narrower sex ratio. According to self-report and traffic data, women's and men's drunk driving rates declined and the gender gap was unchanged. Women's overrepresentation in arrests relative to their share of offending began in the 1990s and accelerated in 2000. Women's arrest gains, contrasted with no systematic change in DUI behavior, and the timing of this shift suggest an increased vulnerability to arrest. More stringent laws and enforcement directed at less intoxicated offenders may inadvertently target female offending patterns.     

Risk of hospitalization for psychiatric disorders among siblings and parents of probands with psychotic or affective disorders: A population-based study

Relatives of people diagnosed with psychotic and affective disorders have a higher risk of developing psychiatric disorders compared to the general population. This study examined the risk of hospitalization for psychiatric disorders among siblings and parents of patients affected with major psychiatric disorders. In this large population-based case-control study, 17,895 siblings and parents of 7671 hospitalized subjects with a diagnosis of narrowly defined schizophrenia (SZ), broadly defined SZ, schizoaffective disorder (SAD), bipolar disorder (BD) or unipolar depression (UD) were identified from the Israeli Psychiatric Hospitalization Registry and compared to 71,580 age and gender-matched controls from the Israeli Population Registry. Results indicated that siblings of people diagnosed with broadly defined SZ had a significantly higher risk of hospitalization for broadly (OR=11.06, 95% CI=7.93–15.41) and narrowly defined SZ (OR=10.59, 95% CI=6.8–16.33), SAD (OR=9.69, 95% CI=4.76–19.73), BD (OR=7.46, 95% CI=21.8–25.52), UD (OR=2.84, 95% CI=1.01–8.00), and other psychiatric disorders (OR=1.85, 95% CI=1.16–2.93), compared to controls. Siblings of patients with BD had a significantly higher risk of hospitalization for broadly defined SZ (OR=2.92, 95% CI=1.11–7.71) and for other psychiatric disorders (OR=6.67, 95% CI=2.17–20.50), compared to controls. Parents of probands with SZ were at significantly increased risk for all disorders examined, except for UD and ¨other psychiatric disorders¨, which was not significant in parents of probands with BD. This large, population-based study provides evidence for common genetic risk across different psychiatric disorders.     

Single room occupancy (SRO) hotels as mental health risk environments among impoverished women: The intersection of policy,drug use,trauma, and urban space

BackgroundDue to the significantly high levels of comorbid substance use and mental health diagnosis among urban poor populations, examining the intersection of drug policy and place requires a consideration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key urban built environment used to house poor populations with co-occurring drug use and mental health issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma, which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and depression when compared to stably housed women.MethodsWe report data from a qualitative interview study (n = 30) and four years of ethnography conducted with housing policy makers and unstably housed women who use drugs and live in SROs.ResultsWomen in the study lived in a range of SRO built environments, from publicly funded, newly built SROs to privately owned, dilapidated buildings, which presented a rich opportunity for ethnographic comparison. Applying Rhodes et al.’s framework of socio-structural vulnerability, we explore how SROs can operate as “mental health risk environments” in which macro-structural factors (housing policies shaping the built environment) interact with meso-level factors (social relations within SROs) and micro-level, behavioral coping strategies to impact women's mental health. The degree to which SRO built environments were “trauma-sensitive” at the macro level significantly influenced women's mental health at meso- and micro-levels. Women who were living in SROs which exacerbated fear and anxiety attempted, with limited success, to deploy strategies on the meso- and micro-level to manage their mental health symptoms.ConclusionStudy findings underscore the importance of housing polices which consider substance use in the context of current and cumulative trauma experiences in order to improve quality of life and mental health for unstably housed women.     

Risk factors for a first-time drink-driving conviction among young men: a birth cohort study of all men born in Denmark in 1966

Using a complete birth cohort of all young men born in 1966 in Denmark (N = 43,403), the prevalence of a first-time drink-driving conviction among young men is estimated. More than 7% of the total male birth cohort was so convicted before the age of 27 years. In an examination of risk factors for a first-time drink-driving conviction, young adults coming from potentially vulnerable groups have an increased risk. Earlier criminal convictions of various types were also significant predictors of drink driving. Situational pressures also play a part and are controlled for, with the risk of a drink-driving conviction increased substantially in rural areas compared to metropolitan areas. The study concludes that disadvantages during adolescence, including parental substance abuse, having a teenage mother, and domestic violence, are associated with a first-time drink-driving conviction.     

Associations with drug use and sexualised drug use among women who have sex with women (WSW) in the UK: Findings from the LGBT Sex and Lifestyles Survey

IntroductionStudies indicate that women who have sex with women (WSW) report greater levels of drug use than heterosexual women, but globally few studies have looked at sexualised drug use among WSW. This study investigated the factors associated with drug use and sexualised drug use (SDU) among WSW.MethodsPotential participants across the UK were invited to take part in a cross-sectional anonymous online survey between April-June 2018. The LGBT Sex and Lifestyles Survey recruited participants through Facebook advertising and social media posts from community organisations. Multivariate logistic regression was used to compare WSW who had engaged in any drug use in the past 12 months with those who had not, and those who engaged in sexualised drug use in the past 12 months with those who engaged in other drug use.Results1501 WSW could be included in the analyses (mean age = 28.9, 97% white ethnicity). Any drug use was reported by 39% of WSW (n = 583), 44% of which (17% of total, n = 258) reported SDU. Factors associated with drug use were identifying as queer (aOR = 1.86, 95%CI 1.08, 3.23), younger age (aOR = 0.96, 95%CI 0.95, 0.98), being born outside the UK (aOR = 1.75, 95%CI 1.15, 2.66), recent sexual assault (aOR = 2.35, 95%CI 1.43, 3.86), > = 5 female sexual partners (aOR = 3.81, 95%CI 1.81, 8.01), and psychological distress (aOR = 1.75, 95%CI 1.15, 2.67). SDU was associated with identifying as bisexual (aOR = 2.55, 95%CI 1.69, 3.86), > = 5 female sexual partners (aOR = 4.50, 95%CI 1.91, 10.59), and highest education achieved at 16 or lower (aOR = 2.46, 95%CI 1.24, 4.90).ConclusionsSome WSW may have negative experiences in relation to drug use and SDU. Harm reduction and health services that provide services for WSW should be aware of potentially compounding factors related to drug use, such as sexual assault and psychological distress, providing a safe and LGBT-friendly environment to discuss these issues.