A recently published study suggest most first-time offenders for driving while intoxicated have more going on than just a problem with alcohol. Many first-time DWI offenders also have high rates of other substance-use disorders as well as other psychiatric disorders.
Accordingly, current DWI intervention programs would benefit from an expanded approach incorporating broad-based intervention programs to improve care for individuals who display multiple disorders. Development of prevention programs, while a difficult task because of the unique complexion of each case, is a public health priority.
Driving while intoxicated (DWI) is a significant public-health problem in the US. In 2005, according to the Department of Transportation, there were 16,885 alcohol-related fatalities; roughly 40 percent of all fatal car accidents are alcohol-related.
“While other studies have examined symptoms of depression as a predictor of change during interventions for DWI offenders, ours is the first to examine formal diagnoses of drug use and other psychiatric problems,” said Rebekka S. Palmer, associate research scientist at Yale University School of Medicine and corresponding author for the study.
The study is published in the journal Alcoholism: Clinical & Experimental Research.
Palmer and her colleagues wanted to know if a history of psychiatric disorders and drug abuse or dependence among first-time DWI offenders could affect their treatment outcomes.
Researchers recruited study participants (n=290) between October 1992 and September 1994 from referrals to Connecticut group-counseling intervention services for first-time DWI offenders. Participants were assessed at program admission for two subgroups of diagnostic variables – drug abuse or dependence, and mood or anxiety disorder – as well as for alcohol use, negative consequences, and life stressors. Alcohol use, negative consequences, and life stressors were also assessed at program completion (10 weeks later), and then six and 12 months later.”
“We found that 42 percent of first-time DWI offenders reported a lifetime history of drug abuse or dependence,” said Palmer. “Marijuana abuse or dependence was the most prevalent, followed by hallucinogen abuse or dependence, and then cocaine abuse or dependence. Approximately 30 percent of the participants also indicated a lifetime history of anxiety or mood disorder. Social phobia was the most frequent anxiety diagnosis, and major depression was the most common mood disorder.”
The good news, said Palmer, was that they found significant reductions in drinking and alcohol-related problems during the study. Yet certain subgroups appear less responsive, observed Mary E. Larimer, associate professor of psychiatry and behavioral sciences, and director of the Center for the Study of Health and Risk Behaviors at the University of Washington.
“The programs we use to treat DUI offenders to help them stop using alcohol are less effective in the long run for those who have a psychiatric disorder or a drug-use disorder than they are for those who are only experiencing problems with their drinking,” said Larimer.
“This means those who have another disorder in addition to their drinking problems are at greater risk to drive under the influence of alcohol again in the future, or to be involved in other accidents or harmful situations related to their drinking.”
This would suggest, said both Palmer and Larimer, that current DWI treatment approaches could be modified, enhanced or extended to better serve these subgroups.
“For those with psychiatric disorders,” said Larimer, “it may be that treatments need to be longer and more intensive, and/or have specific additional components designed to improve coping resources, teach skills for mood management to counteract the tendency to use alcohol as a way to cope with mood, and help these individuals improve their confidence that they can change. This study indicates these individuals are actually more willing and ready to change than those without other psychiatric diagnoses, but they are not sure how and have low confidence in their ability to change, which is reflected in their poorer outcomes.”
For those with other substance disorders, Larimer added, “results suggest the need to extend the aftercare components of treatment,” she said. “Perhaps clinicians can target additional situations associated with relapse to other drugs that might not be covered in alcohol-focused treatment, and address the ways in which alcohol- and other drug-use are related for these individuals.”
Larimer added that even though this particular research focuses on those convicted of DWI, findings could very well be applied to other individuals receiving treatment for combined alcohol and drug and/or psychiatric disorders outside of a court-ordered context.
“Those seeking treatment for multiple disorders might consider investigating the extent to which treatments address issues beyond the cessation of alcohol use alone, and also the extent to which follow-up care is available and easily accessible to meet their needs,” she said.
“Also, moving these programs into the prevention arena, to reduce rates of DUI prior to citation and conviction, is an urgent public health priority. This is not a simple problem, and one-size-fits-all treatments are not likely to be the solution.”