Multiple and single location drinking among DWI offenders referred for alcoholism evaluation.

Problem-drinker drivers who drank at multiple locations differ substantially from those who drank at only one location. Persons who drank at more than one location prior to their DWI arrest exhibit the most severe alcohol problems. Multilocation drinkers consumed significantly greater amounts of alcohol--for nearly all alcohol measures including consumption per drinking day, consumption averaged over 30 days, and consumption on the day of the DWI arrest--than single location drinkers. The multilocation group experienced more alcohol problems in their lives, had higher Mortimer-Filkins test scores, were intoxicated more frequently, and had a greater probability of a DSM-III-R alcohol-dependence diagnosis. Compared to the single location drinkers, the multilocation group had more bad driving incidents, frequently (once a week) drove while drunk, and expressed the attitude that the DWI had less of an impact on their lives. The findings suggest that multilocation drinkers require intensive interventions.     

Concurrent and predictive validity of drug use and psychiatric diagnosis among first-time DWI offenders

BACKGROUND: Previous studies have found that driving while intoxicated (DWI) offenders report high rates of substance dependence and other psychiatric disorders. METHOD: The current study evaluated the prevalence, clinical correlates at program admission, and prognostic significance over a 1-year follow-up of 2 diagnostic subgroup variables (drug abuse or dependence; mood or anxiety disorder) among 290 first-time DWI offenders receiving group counseling interventions. RESULTS: A lifetime diagnosis of drug abuse or dependence (42% of sample) was associated with higher levels of alcohol consumption, lower coping confidence, greater readiness to change, increased alcohol, drug, and legal problems, and more alcohol-related negative consequences at the initiation of DWI intervention. Significant decreases in drinking were noted at intervention termination for the drug diagnoses subgroup, but were not sustained at 1-year follow-up. The presence of a lifetime diagnosis of anxiety or mood disorder (30% of sample) was associated with lower coping confidence, greater readiness to change, and with greater and more enduring negative consequences of drinking during the DWI intervention and 1-year follow-up period. CONCLUSIONS: Results suggest that a psychiatric diagnosis might guide the intervention and aftercare planning for DWI offenders to reduce recidivism and drinking.     

The use of vignette analysis of dangerous driving situations involving alcohol to differentiate adolescent DWI offenders and high school drivers

Adolescent drivers are commonly involved in a variety of dangerous driving situations involving alcohol and drug use. Both situational and personality factors contribute to the adolescent DWI phenomenon. Little is known about young drivers' ability to analyze common potentially dangerous alcohol-involved driving situations, or in what respects differing patterns of analysis differentiate adolescent drivers at risk for DWI. Three groups of adolescent drivers (N = 153) completed an analysis of vignettes questionnaire to assess their decision-making skills and attitudes with respect to drinking and driving. The three comparison groups consisted of high school drivers, young DWI offenders, and juvenile offenders without DWI citations. Subjects were demographically similar except for academic performance, employment, family intactness, car ownership, and drug and alcohol use, with DWI offenders and non-DWI offenders showing significant differences in these measures (p less than .001). Situation analysis showed that adolescent DWI offenders more often than controls drink prior to driving (p less than .001), associate alcohol with many social events and dating (p less than .001), become angry when questioned about driving ability (p less than .001), play drinking games (p = .1), drive fast to resolve stress (p = .001), are less likely to recruit parents when faced with driving intoxicated (p less than .001), and a number of other situational characteristics indicating differential risk between groups for DWI. In many cases, other juvenile offenders matched responses of DWI offenders. Important aspects of these findings are discussed in the context of intervention strategies and the use of vignette analysis as one tool to identify high-risk adolescent drivers for DWI.     

The Use of Vignette Analysis of Dangerous Driving Situations Involving Alcohol to Differentiate Adolescent DWI Offenders and High School Drivers

Abstract

Adolescent drivers are commonly involved in a variety of dangerous driving situations involving alcohol and drug use. Both situational and personality factors contribute to the adolescent DWI phenomenon. Little is known about young drivers' ability to analyze common potentially dangerous alcohol-involved driving situations, or in what respects differing patterns of analysis differentiate adolescent drivers at risk for DWI. Three groups of adolescent drivers (N = 153) completed an analysis of vignettes questionnaire to assess their decision-making skills and attitudes with respect to drinking and driving. The three comparison groups consisted of high school drivers, young DWI offenders, and juvenile offenders without DWI citations. Subjects were demographically similar except for academic performance, employment, family intactness, car ownership, and drug and alcohol use, with DWI offenders and non-DWI offenders showing significant differences in these measures (p < ?001). Situation analysis showed that adolescent DWI offenders more often than controls drink prior to driving (p <. 001), associate alcohol with many social events and dating (p <. 001), become angry when questioned about driving ability (p <. 001), play drinking games (p = A), drive fast to resolve stress (p =. 001), are less likely to recruit parents when faced with driving intoxicated (p <. 001), and a number of other situational characteristics indicating differential risk between groups for DWI. In many cases, other juvenile offenders matched responses of DWI offenders. Important aspects of these findings are discussed in the context of intervention strategies and the use of vignette analysis as one tool to identify high-risk adolescent drivers for DWI.     

Functioning of alcohol use disorder criteria among men and women with arrests for driving under the influence of alcohol

Background: Many states require screening of individuals arrested for driving under the influence (DUI) of alcohol to determine recidivism risk and the need for treatment based on severity of alcohol problems. Several screening instruments use DSM‐IV criteria for alcohol abuse and dependence to assess alcohol problems in this population, but whether they adequately measure alcohol problems in individuals with DUIs has not been examined. In addition, gender differences in DUI samples suggest that female offenders have more severe alcohol problems than male offenders. The current study examines differences in alcohol criteria functioning by DUI history and gender using an item response theory (IRT) approach. Methods: Data from diagnostic interviews with 8,605 participants in the Collaborative Study on the Genetics of Alcoholism, including 1,655 who ever reported a DUI arrest (20% women), were used to examine differences in alcohol criteria functioning between men and women with and without DUIs. The factor underlying item response was conceptualized as unidimensional, representing alcohol problem severity. Results: Social/interpersonal problems, larger/longer, and inability/persistent desire to quit displayed greater discrimination of IRT‐defined alcohol problem severity among individuals with DUIs than those without. Irrespective of DUI status, women had a higher threshold than men for time spent drinking or recovering. Women without DUIs had a higher threshold than similar men for social/interpersonal problems. Taken as a whole, the criteria yielded similar amounts of information in all groups. Conclusions: DSM‐IV criteria for alcohol abuse and dependence adequately detect alcohol problem severity in individuals with DUIs, and some are better at detecting severity in this particularly high‐risk group than in individuals without DUIs. However, the criteria as a whole are equally effective in measuring alcohol problem severity among individuals with and without DUIs and may be used with confidence in screening DUI offenders.     

A randomized trial of a DWI intervention program for first offenders: intervention outcomes and interactions with antisocial personality disorder among a primarily American-Indian sample

BACKGROUND: Randomized trial evidence on the effectiveness of incarceration and treatment of first-time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI. METHODS: A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first-time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self-reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis. RESULTS: Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non-ASPD participants. CONCLUSIONS: Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American-Indian sample.     

Are Relations Between Parental History of Alcohol Problems and Changes in Drinking Moderated by Positive Expectancies?

BACKGROUND: Risk factors of alcohol abuse generally have been examined for their additive or direct effects on the development of alcohol-related problems. This study was designed to assess the interaction between two important predictors: parental history of alcohol problems and positive expectancies regarding alcohol consumption. METHODS: The positive expectancies, reported parental alcohol problems, and alcohol use and problems of 169 first-year college students were assessed at their entrance to college, and their alcohol use and problems were assessed again approximately 3 months later. The main effects of positive family history and expectancies as well as their interaction in predicting changes in alcohol use and problems were examined in hierarchical regression analyses. RESULTS: A parental history of alcohol-related problems was related to greater alcohol problems at the two assessment times, and positive expectancies for the effects of alcohol were related to both alcohol problems and alcohol use. The parental history x positive expectancies term significantly added to the prediction of changes in alcohol problems (8% incremental increase in explained variance) even after baseline problems were entered in a prior step in the equation. Follow-up exploration revealed that the interaction was accounted for by high levels of alcohol problems at time 2 being reported by those high in positive expectancies and reporting high parental alcohol problems. The parental history x positive expectancies interaction term also added slightly to the prediction of changes in alcohol use amounts but accounted for a modest 1% incremental variance. CONCLUSIONS: Reported parental history and positive alcohol expectancies interacted to predict increases in alcohol problems over the course of the first semester of college. These results suggest that risk factors for alcohol problems may conjointly interact to confer heightened risk. Such interactive models may further assist in identifying at risk young adults. Limitations such as the reliance on self-report measures and the predominantly female sample are discussed.     

Blow and Go: The Breath-Analyzed Ignition Interlock Device as a Technological Response to DWI

Driving while intoxicated rates have declined substantially in the last 20 years. This is as a result of public opinion combined with increased law enforcement efforts. A recent tool has been the Breath Analyzed Ignition Interlock Device. This new technology is designed to prevent persons with excessive blood alcohol levels from operating the interlocked vehicle. This 3-year recidivism study of the ignition interlock revealed 17.5% recidivism rates for the interlock group compared to 25.3% recidivism rates for the non-interlock group, a 31% decrease. Multiple offenders and younger (under 30) offenders had significantly lower rates of subsequent arrests. The multi-offenders in the comparison group were more than twice as likely as the interlock group to have a subsequent conviction within 3 years. The difference was nearly the same for the under 30 age group. There was almost no difference for first offenders. Accordingly, the ignition interlock appears to significantly reduce recidivism for repeat and younger DWI offenders but offers almost no improvement for first offenders. One driver of 315 (0.32%) was charged with DWI with an interlock in place. This offender had a child provide the breath sample while she drove the vehicle.     

Blow and go: the Breath-Analyzed Ignition Interlock Device as a technological response to DWI

Driving while intoxicated rates have declined substantially in the last 20 years. This is as a result of public opinion combined with increased law enforcement efforts. A recent tool has been the Breath Analyzed Ignition Interlock Device. This new technology is designed to prevent persons with excessive blood alcohol levels from operating the interlocked vehicle. This 3-year recidivism study of the ignition interlock revealed 17.5% recidivism rates for the interlock group compared to 25.3% recidivism rates for the non-interlock group, a 31% decrease. Multiple offenders and younger (under 30) offenders had significantly lower rates of subsequent arrests. The multi-offenders in the comparison group were more than twice as likely as the interlock group to have a subsequent conviction within 3 years. The difference was nearly the same for the under 30 age group. There was almost no difference for first offenders. Accordingly, the ignition interlock appears to significantly reduce recidivism for repeat and younger DWI offenders but offers almost no improvement for first offenders. One driver of 315 (0.32%) was charged with DWI with an interlock in place. This offender had a child provide the breath sample while she drove the vehicle.     

Brief Motivational Interviewing for DWI Recidivists Who Abuse Alcohol and Are Not Participating in DWI Intervention: A Randomized Controlled Trial

Background: Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6‐ and 12‐month follow‐up compared to an information‐advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Methods: Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30‐minute BMI session or information‐advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., ≥3 standard drinks/d for males; ≥2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse‐related behaviors using the MMPI‐Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Results: Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12‐month follow‐up, which compared to the control intervention (n = 92) represented a significant decline from 6‐month levels. Exposure to BMI also produced significantly greater improvement at 6‐month follow‐up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Conclusions: Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings.     

Substanzmissbrauch im mittleren und höheren Erwachsenenalter – Allgemeiner Missbrauch

The problems of drug-addicted middle- and older-aged people have been disregarded for a long time. However, results show a risky consumption of illegal drugs in the 18- to 59-year-old German population. The following paper will analyse the substance abuse of alcohol, sedatives, cannabis, stimulants, cocaine, opiates and other drugs not described more closely (all of which lead to health problems) using the Interdisciplinary Longitudinal Study of Adulthood (ILSE). Data collection is based on two cohorts (1930-1932 and 1950-1952) at two measurement points (1. MMP: N = 1006, 2. MMP: N = 900) in centres of investigation in Heidelberg and Leipzig. The "Substance Abuse Section" of the Structured Clinical Interview for DSM-III-R (SCID) was used for the evaluation. The abuse of alcohol can be registered as the focal point. Men consume more alcohol, while women tend to take sedatives, stimulants, opiates and other substances more often. The East-West comparison shows the importance of accessibility. At both measurement points, abuse of more substance groups was determined in the Heidelberg centre. As for as the abuse rates are concerned, a reduction of all the substance groups can be registered for the second measurement point.     

Risk of alcohol abuse in urban versus rural DUI offenders

Background: Research concerning driving under the influence (DUI) offenses in rural populations is scarce and has often been carried out in the context of substance abuse and illicit drug use. Although previous studies have suggested that rural individuals are more likely to abstain from alcohol use, recent trends suggest that alcohol and substance abuse problems in rural areas are occurring at rates similar to urban areas. It is possible that urban and rural DUI offenders may differ on psychological and behavioral characteristics associated with heavy alcohol consumption. Objective: The aim of this study was to examine alcohol use differences between urban and rural DUI offenders. Methods: Data from 11?066 DUI offenders in a Midwestern state were used for this study. The Alcohol subscale of the Driver Risk Inventory II was used to assess the risk of problem alcohol use. Results: Higher levels of alcohol risk were associated with rural DUI offenders after adjusting for several demographic variables and blood-alcohol content level at time of arrest [Medium Risk OR?=?1.43, 95% CI: (1.20, 1.71); Problem Risk OR?=?1.43, 95% CI: (1.19, 1.72); Severe Risk OR?=?1.38, 95% CI: (1.14, 1.67)]. Conclusions: The results of this study indicate that rural DUI offenders have a significantly greater risk of heavy alcohol use when compared to urban DUI offenders. Practical implications of these results suggest that evaluators and assessors should be aware of an increased likelihood of alcohol problems in rural DUI individuals relative to those in urban areas.     

1994 Draft DSM-IV Criteria for Alcohol Use Disorders: Comparison to DSM-III-R and Implications

In 1994, DSM-IV will be published, with new criteria for alcohol abuse and dependence. Implications of the changes in criteria for alcohol use disorders were investigated by comparing the diagnoses made by the DSM-IV criteria and DSM-III-R criteria. The study was conducted in a sample of 424 patients in an inpatient alcohol rehabilitation unit in the New York metropolitan area. DSM-III-R and DSM-IV criteria showed similar results and high agreement for any alcohol use disorder (abuse and dependence combined). Alcohol dependence was also consistently diagnosed with DSM-III-R and DSM-IV criteria. Agreement between DSM-III-R and DSM-IV abuse diagnoses was very low. Compared with DSM-III-R, DSM-IV classified over three times as many patients as alcohol abusers, although those with alcohol dependence still overwhelmingly dominated the sample. With some fluctuations, the results were stable over Black, Hispanic, and White subgroups of patients. The direction of the findings was consistent with results from a national general population survey in that the prevalence of alcohol abuse increased in both studies. However, the clinical results alone would not have suggested the marked changes in relative prevalence of abuse and dependence that occurred in the general population when DSM-IV criteria were used in place of DSM-III-R. Research on diagnostic criteria limited to patient samples omits important information on the implications of changing aspects of the diagnostic criteria. The need for a coherent theory of alcohol abuse is highlighted.     

Multivariate Typology of Adolescents With Alcohol Use Disorder

Adolescent patients qualifying for a DSM-III-R diagnosis of alcohol use disorder were studied to determine whether a multidimensional schema could classify subjects into subgroups. The Drug Use Screening Inventory was administered to 151 subjects. To test the concurrent validity of the subtypes, subjects also received a structured diagnostic psychiatric evaluation along with measures of personality, academic achievement, and drinking behavior. Two clusters were identified for each gender. Differences between clusters were reflected primarily on indicators of severity of disorder. Young women were more inclined toward affective disturbances, whereas conduct disorder was the most frequent disorder in young men. This study underscores the heterogeneity of the adolescent population qualifying for a diagnosis of alcohol use disorder. The differential pattern of alcohol involvement and comorbid psychopathology within clusters and between genders demonstrates the need for interventions tailored to specific clinical presentation.     

Prevalence of female alcohol dependence and abuse in Sweden

Data on prevalence of female alcoholism are scarce, especially outside North America. It is even more rare that prevalence is estimated using clinical interviews, as well as by utilizing multiple sources of information. Our sample consisted of five cohorts of adult women (n = 3130) in a mainly suburban area. In a first phase we screened for alcohol-related problems. In a second phase a strategic sample was interviewed (n = 399). Prevalence was calculated for clinical and CIDI-SAM diagnoses, both according to DSM-III-R, also taking medical record data into consideration. It was found that life-lime prevalence of alcohol dependence and abuse was 3.27% and 12-month prevalence was 1.49%. Agreement over alcohol dependence was very high for the different diagnostic methods, but lower for alcohol abuse. Prevalence of dependency/abuse was not higher in the attrition group. The alcohol abuse concept was found to be relevant, both in epidemiological research and for clinical purposes.     

DSM-III-R and the Proposed DSM-IV Alcohol Use Disorders, United States 1988: A Nosological Comparison

The purpose of the present study was to compare DSM-III-R and the proposed DSM-IV diagnostic criteria for alcohol abuse and dependence in a representative sample of the United States general population. Alcohol abuse and dependence diagnostic categories were contrasted in terms of prevalence and overlap. The prevalence of DSM-III-R diagnoses of alcohol abuse and dependence combined (8.63%) was greater than the corresponding DSM-IV diagnoses (6.00%). Disaggregation of abuse and dependence diagnoses showed that the major discrepancy between the classification systems resided between the abuse categories. Reasons for the discrepancies are discussed in terms of differences in the content of the DSM-III-R and DSM-IV abuse categories, in the relationship that each abuse category shares with its respective dependence category, and the impact of the DSM-III-R duration criterion.     

DSM-IV, DSM-III-R, and ICD-10 Alcohol and Drug Abuse/Harmful Use and Dependence, United States, 1992: A Nosological Comparison

This study assessed agreement between DSM-IV, DSM-III-R, and ICD-10 diagnoses of alcohol and drug use disorders using data from a large representative sample of the United States population. Agreement between the three diagnostic systems for dependence was good to excellent for past year, prior to the past year, and lifetime diagnoses, for both genders, each ethnic group, and younger and older respondents. Cross-system comparisons between DSM-IV and DSM-III-R abuse were good to excellent, but concordance was consistently poor when ICD-10 harmful use diagnoses were compared with DSM-IV and DSM-III-R abuse diagnoses. Implications of these results are discussed in terms of the degree to which future research findings could be integrated with one another and the results from earlier studies using older versions of the DSM, to advance scientific knowledge in the drug and alcohol fields.     

Prevalence of the proposed DSM-IV alcohol use disorders: United States, 1988

Data from a 1988 survey on United States drinking practices and related problems teas used to derive the proposed DSM-IV definitions of alcohol abuse and dependence. The prevalence of DSM-IV alcohol abuse and dependence combined, incorporating the DSM-III-R duration criterion, was 6.00% in this general population sample. The majority of respondents were classified as alcohol dependent (5.93%), dependent without abuse (5.24%), and dependent with physiological dependence (5.06%). The rate for DSM-IV alcohol abuse was negligible (0.06%) while elimination of the duration criterion had little impact on the prevalence of DSM-IV alcohol use disorders. Reasons for the extremely low prevalence of DSM-IV alcohol abuse and the slight increase in the prevalence of DSM-IV alcohol use disorders as the result of eliminating the duration criterion are discussed in terms of the content of the abuse category and its relationship to the dependence definition.