The State of DUI Treatment — What
We Know from Latest Research
Kelly Cowger
DUI, NTP, CJ (DNCJ) Branch
Substance Use Disorder Compliance Division
Department of Health Care Services
Sacramento, CA 95899-7413
Why DUI Sanctions
• Deterrence
– Quick, certain, sufficient to deter general public
from drinking and driving
• Retribution
– Punishment that expresses social disapproval of
DUI and exacts ‘justice’
• Incapacitation
– Preventing offender from repeating offense
• Rehabilitation
– Creating long-term change in offender behavior
Variety of Sanctions
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Incarceration
Drivers License suspension
Vehicle impounding
Monitoring (ignition interlock)
Mandated substance abuse treatment
DUI Courts
Victim Impact Panels
Dealing with DUI Offenders
• Depending on several factors
– Underage vs. adult
– First offense or repeat offenses
– BAC level
• Education-based programs (varied widely from state to state)
• Counseling/psychosocial programs (varied widely from state to
state)
• In-patient and out-patient programs (varied widely from state to
state)
• Jail time
• Vehicle immobilization devices
• Fine
• Often a combination of punishment/treatment
CHALLENGES TO MEASURING
SUCCESS
Challenges to Measuring ‘Success’
• Programs vary state by state
• Difficult to use random assignment in studies
• Multiple definitions of ‘effectiveness’ based on
chosen outcome measures
• Multiple types of deterrents, sometimes used
in conjunction—difficult to tease out individual
pieces
• Not all offenders complete programs
• Offenders are varied
Outcome Measures
• Studies use varying outcome measures
including subsequent…
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Crashes
Alcohol-related crashes
Alcohol convictions
Fatal or injury crashes
Traffic convictions
• Studies take post-treatment measures at
different times (some at 1 year,
some at 3 year, etc.)
More Than One Type of Offender
• First time offenders may be different from
multiple offenders
• Some studies suggest different types of
offenders
– Social drinkers
– Alcoholics
– Problem drivers
• Offenders may have varying comorbid factors
– Depression, anxiety disorders, mood disorders,
PTSD, etc.
A BRIEF HISTORY OF DUI
PREVENTION TOOLS
Brief History of DUI Tools
• Pre-1950:
– Principal tools:
• Fines
• License suspension
• Jails (primarily applied to multiple offenders or
offenders who caused injury or death)
Brief History: 1970s
• DOT founded in 1966
– First publication was on Alcohol and Highway Safety
• Congress authorized national program of 35 Alcohol
Safety Action Projects mandating treatment programs
– Key feature of program:
• Identified 2 levels of offenders:
– Social drinkers (first time offenders)
– Problem drinkers (multiple offenders or those with high BAC or prior
alcohol problems
• ASAP evaluated, but not shown to be effective
• Continued because low cost
Brief History: 1980s
• Emergence of MADD changed environment
– Strong opposition to letting offenders off with
fine
– Pressure for longer and more certain license
suspension penalties
• Emphasis on incarceration of both first and
multiple offenders
– However, jail not found to be effective beyond
time of incarceration
Brief History: 1990s
• Emergence of monitoring technologies
reducing need for jail facilities
– Electronically monitored home confinement
– Portable GPS to monitor location of criminal
offenders
– Vehicle alcohol ignition interlock
• Extensive evidence for interlock
effectiveness (while in use)
Current Developments
• Advances in monitoring technology
– Transdermal alcohol monitoring systems
– Advances in ability to monitor alcohol consumption in
urine, oral fluid, hair, and blood
– Portable alcohol test equipment allowing multiple daily
tests
• DUI courts
– Supervised intervention program for 12 months or
more
– Regular court appearances
– Initial evaluations suggest DUI courts can be effective
EFFECTIVENESS OF CURRENTLY
USED SANCTIONS
Jail
• Unclear whether has general deterrent
effect
• Has specific deterrent effect during time
offenders are incarcerated
• Does not reduce likelihood of re-offending
Chodrow & Hora, 2011
BAC Laws
• Effective at general level in reducing
(overall) drunk-driving casualties
• No effect found on recidivism
Anderson et al, 2009; Shults et al, 2001; Wieczorek, 2013
Sobriety Checkpoints and Random
Breath Testing
• Effective in reducing
– overall numbers of alcohol-related crashes
– fatal and nonfatal injuries
Anderson et al, 2009; Elder et al, 2002; Kilmer et al, 2013
Vehicle Sanctions
• Vehicle Sanctions include:
– Ignition interlock devices
– Vehicle, registration or license plate
confiscation
– Special license plates identifying offenders
Ignition Interlocks
• Based on evidence from multiple studies,
interlocks are effective while in place
• Effects dissipate after interlocks are
removed
Elder et al, 2011
License Suspension
• Both a general and a specific deterrent
• Mixed evidence re: effectiveness
• Limitations:
– Is widely violated
– Up to 75% of those with suspended licenses continue
to drive
– Does not break pattern of problem drinking
Chodrow & Hora, 2011
Victim Impact Panels
• Designed to increase offender’s empathy for
victims
• No conclusive evidence of effectiveness in
reducing recidivism
Chodrow & Hora, 2011
DUI Courts: Description
• Provide coordinated judiciary, prosecution,
probation, defense, law enforcement, social
services, mental health and treatment
• Include
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Regularly scheduled judicial status hearings
Sanctions and rewards for compliance
Collaborative treatment
Legal team case decision-making
Individualized alcohol treatment
Regular alcohol testing
10 Guiding Principles of DWI Court
1.
2.
3.
4.
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Determine the population
Perform a clinical assessment
Develop the treatment plan
Supervise the offender
Forge agency, organization and community
partnerships
6. Take a judicial leadership role
7. Develop case management strategies
8. Address transportation issues
9. Evaluate the program
10. Ensure a sustainable program
http://www.dwicourts.org/learn/about-dwi-court/-guiding-principles
DUI Courts: Effectiveness
• Some studies have found promising
outcome results including
– Reduced DUI recidivism
– Increased time to re-arrest
– Fewer traffic accidents
– Lower rate of drivers license
suspensions/revocations
– Reduced levels of substance abuse
Breckenridge et al, 2000; Chodrow and Hora, 2011; Fell et al, 2011; Marlowe et al, 2009; Petrucci, 2011
Dedicated Detention Facilities
• Provide confinement with supervised
treatment services
• Statistics indicate facilities have substantial
effect on recidivism
• Examples:
– Baltimore County DWI Correctional Treatment
Facility
– Suffolk County DWI Alternative Facility
– North Coast Correctional Treatment Facility
– New Hampshire’s Multiple DWI Offender
Intervention Detention Center
National Hardcore Drunk Driver Project, 2003
TREATMENT
Evidenced-Based Clinical Interventions
for Substance Abuse
Brief Interventions
Motivational Interviewing
CBT/Coping-Skills Training
Contingency Management/Community
Reinforcement
• 12-Step Approaches
• Pharmacotherapy
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Eight Evidence-Based Principles for
Effective Interventions*
1.
2.
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Assess risk/needs
Enhance intrinsic motivation
Target interventions
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Prioritize supervision and treatment resources for high-risk
offenders
Target interventions to criminogenic needs
Be responsive to temperament, learning style, motivation, culture
and gender when assigning programs
Prescribe adequate dosage (3-9 months)
Integrate treatment into sentence/sanctions
Use CBT skills training
Increase positive reinforcement
Engage in ongoing support in natural communities
Measure relevant processes/practices
Provide measurement feedback
*Recommended by the National Institute of Corrections and the Crime and Justice Institute
TREATMENT TYPES
Brief Interventions
• Designed to identify current or potential
alcohol problem and motivate change
• Consists of short (5-10 min) counseling
session
– Discussion of alcohol use and consequences
– Negotiation of behavior change plan
• Evidence of effectiveness with offenders
with less severe alcohol problems
Traffic Injury Research Foundation, 2011; Brown et al, 2010
Education
• Used for ‘social drinkers’ not assessed with
alcohol use disorder
• Appears to be most effective for first time
offenders/“social drinkers”
Chodrow & Hora, 2011
Motivational Interviewing
• Non-confrontational counseling
• Encourages offender to
– Accept their alcohol problem
– Understand treatment benefits
– Access needed services
– Supporting self-efficacy
• Evidence of effectiveness in improving
drinking outcomes
Traffic Injury Research Foundation, 2011
Coping Skills Training (CBT)
• Emphasizes teaching new strategies and
skills to address problem thoughts and
behaviors, using:
– Modeling
– Behavioral practice
– Homework assignments
• Assumes offender is motivated to change
• Much evidence of effectiveness
Emmelkamp and Vedel, 2006; Little et al, 2010; Moore et al, 2008
Alcoholics Anonymous
(12-Step Approach)
• Self-help support groups
• Not much literature on mandated AA
attendance as DUI intervention
– 2 studies of mandated AA participation alone
showed no effect
– Other studies suggest that AA in combination
with other treatments were effective
Dill and Wells-Parker, 2006; Wells-Parker et al, 1995
2012 Annual Report of the CA DUI
Management System
• Evaluation of CA DUI programs for reckless
offenders and 1st offenders
– 3 month program resulted in significant
reduction in subsequent DUI incidents in year
following program
– 9 month program did not improve results
further
• No evaluation included for repeat offender
programs
California Department of Motor Vehicles, 2012
Treatment Effectiveness
• Treatment is effective in reducing recidivism
• Treatment is most effective when used in
combination with long-term counseling,
education and supervision, probation,
structured interaction with self-help groups,
fines, penalties and sanctions
• Effective treatment requires compliance
National Hardcore Drunk Driver Project; Chodrow & Hora, 2011
Proposed Model for Managing DUI
Offenders*
• Voas et al., 2011 proposed that a national model with the
following seven points:
– Emphasis on replacement of jail with low-cost monitoring
programs paid for by offender
– Sanction alternatives maximized to increase flexibility in meeting
offender’s needs
– Behavioral triage used to create performance-based sanctions
– Control of consumption emphasized
– Treatment focused on offender’s needs in meeting monitoring
requirements
– Monitoring data are available to enhance offender screening and
assessment
– Rapid development of new technologies will increase requirement
for program evaluation.
Voas et al, 2011
Takeaways
• 1st offenders and repeat offenders benefit from different treatment
protocols
• To date, no individual program deemed to be most effective
• Research indicates that most effective sanction is combination of
vehicle/license-based sanctions with alcohol treatment
• Treatment programs based on varying theories have proven effective
• Effective treatment should include
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Education
Motivational enhancement
Skills training
Brief interventions
Sanctions
Celerity (close proximity to arrest)
Efforts to ensure compliance
DeYoung, 1997; Dill & Parker, 2006; Warren et al, 2010; Chodrow & Hora, 2011
References
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Anderson, P., Chisholm, D., & Fuhr, D. C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. The Lancet, 373(9682), 22342246.
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Breckenridge, J. F., Winfree, J. L. T., Maupin, J. R., & Clason, D. L. (2000). Drunk Drivers, DWI" Drug Court" Treatment, and Recidivism: Who Fails?. Justice Research and Policy, 2(1), 87106.
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Brown, T. G., Dongier, M., Ouimet, M. C., Tremblay, J., Chanut, F., Legault, L., ... & Kwong, N. M. (2010). Brief motivational interviewing for DWI recidivists who abuse alcohol and are
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California Department of Motor Vehicles (2012). Annual Report Of The California DUI Management Information Systems to The Legislature of the State of California.
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Chodrow, B., & Hora, H. P. F. (2011). DWI/DUI Interventions. In Handbook of Evidence-Based Substance Abuse Treatment in Criminal Justice Settings (pp. 103-122). Springer New York.
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Dill, P. L., & Wells-Parker, E. (2006). Court-mandated treatment for convicted drinking drivers. Alcohol Research and Health, 29(1), 41.
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