1
Drunk Driving: An Assessment of “What Works”
in the Areas of Classification, Treatment,
Prevention and Control
Prepared for:
The Council of Productivity and Management
State of Maryland
Department of Parole and Probation
Drinking Driver Monitor Program
Prepared by:
James M. Byrne, Professor
Department of Criminal Justice
University of Massachusetts Lowell
With the Assistance of:
Andrea Vey, Heather Madruga, Jennifer Teagarden, and Danielle Sparks
Graduate Program in Criminal Justice
University of Massachusetts Lowell
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Table of Contents
Introduction and Overview: Searching for Solutions to the Drunk Driving Problem…….1
1. Treatment Programs for Drunk Drivers………………………………………………..2
1A. What Works in the Area of Treatment……………………………………….4
1B. What Does Not Work in the Area of Treatment……………………………..4
1C. Promising Developments Vis-à-vis Drunk Driver Treatment………………..6
1D. What is “Unknown” About the Treatment of Drunk Drivers:
Directions for Future Research……………………………………………..11
2. Prevention Programs for Drunk Drivers: Individual and CommunityLevel Strategies……………………………………………………………………….15
3. The Identification and Classification of Drunk Drivers……………………………...20
4. Control-Oriented Strategies for Addressing the Drunk Driver Problem……………..25
4A. What Works in Controlling Drunk Drivers…………………………………26
4B. What Does Not Work in Controlling Drunk Drivers…………….…………26
4C. Promising Developments Vis-à-vis Drunk Driving Control………………..27
4D. What is “Unknown” About Control-Oriented Sanctions:
Directions for Future Research……………………………………………..29
Concluding Comments: An Application of our “What Works” Review
to MADD’s Rating the States 2002 Survey……………………………………………...34
Recommendations for Change…………………………………………………………...36
Appendix A………………………………………………………………………………38
3
Introduction and Overview: Searching for Solutions to the Drunk Driving Problem
The purpose of the following review is to identify promising solutions to the
drunk driving problem in this country, focusing on four broad areas of inquiry:
(1) Can effective treatment programs for drunk drivers be identified?
(2) Can effective prevention strategies for drunk drivers be identified?
(3) Can effective identification strategies for drunk drivers (utilizing
classification and prediction techniques) be identified?
(4) Can effective control strategies for drunk drivers (utilizing administrative
and/or criminal Justice interventions) be identified?
To complete this analysis, we conducted a review of all the available published
research on drunk driving released since 1990. Each of the articles we identify in our
review is included in the “what works” compendium accompanying this report. Not
surprisingly, the quality of the empirical research published during our review period
(1990-2002) is generally weak, with few experimental studies conducted on this
important problem. To make sense of this body of research, we have adopted a strategy
recommended by Welsh and Farrington (2003) in their recent article, “Toward an
Evidence–Based Approach to Preventing Crime”. First, we have ranked the “quality” of
each of the research studies included in this review on a scale of 1 (weakest) to 5
(highest), utilizing the same scaling criteria used in the recent research reviews completed
for the National Institute of Justice by the Campbell Collaboration Crime and Justice
Group (see Appendix A for a description of review criteria). Next, we used these
rankings to organize our assessment of what works, what does not work, what is
promising, and what is unknown in the area of drunk driving (see Appendix A for a
definition of key review terminology). Finally, we have attempted to examine the State
of Maryland’s drunk driving strategy by providing a critical review of MADD’s “Rating
the States 2002” report on drunk driving, which includes an overall grade for Maryland’s
drunk driving strategy (C) along with a breakdown of grading in each of the following
areas: (1) state political leadership, (2) statistics and records, (3) law enforcement, (4)
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administrative measures/criminal sanctions, (5) regulatory control/availability, (6) youth
legislation, prevention, and education, (7) victim issues, (8) laws, and (9) fatality trends.
(Note: the full text of the MADD report, along with a breakdown of what each state in the
country is currently doing to address the drunk driving problem, is included in our “what
works” compendium). Utilizing the results of our review of “what works” in the areas of
treatment, classification, prevention, and control, we offer our recommendations for
changes in MADD’s grading criteria and then discuss the implications of our findings for
drunk driver policies and practices in Maryland.
1.
Treatment Programs for Drunk Drivers
According to a recent Bureau of Justice Statistics, Special Report: DWI Offenders
Under Correctional Supervision (June 1999:1). “In 1997, an estimated 513,200
offenders were on probation or in jail or prison for driving while intoxicated by alcohol
(DWI): 454,500 on probation, 41,100 in Jail, and 17,600 in state prison”. It would be a
mistake to assume that every offender convicted of a DWI will receive some form of
treatment (e.g. education, self-help via Alcoholics Anonymous (AA), outpatient
counseling, detox, and/or residential treatment). In fact, a significant proportion of DWI
offenders in prison and on probation do not receive any form of treatment. According to
the BJS special report on this subject (June 1999:1), 46% of DWI offenders on probation
reported receiving alcohol treatment, while 62% reported that they had participated in an
alcohol-related self-help program. For DWI offenders in jail, only 4% reported receiving
alcohol treatment, while 17% reported participation in a self-help program. One possible
explanation for this “lack of treatment” finding is that probation and jail administrators
are taking a “triage” approach to limited treatment resources, reserving their availability
to a subgroup of “problem drinkers”. If this is the case, then the development of reliable
(and valid) classification tools that distinguish problem from social drinkers is critical.
Of course, another possible explanation for the failure to provide alcohol treatment to all
convicted drunk drivers is that probation and jail administrators simply do not believe
that existing alcohol treatment programs are effective recidivism reduction strategies.
Finally, it is certainly possible that probation and jail administrators are considering a
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combination of factors, (including treatment type, availability, and cost, treatment
effectiveness, and/or DWI offender amenability to treatment) when they develop specific
DWI policies and practices. In terms of the offender amenability (or readiness for
change) issue, research that compares the relative impact of voluntary versus mandatory
treatment options for DWI offenders would certainly be important to review.
Unfortunately, none of the research studies we reviewed empirically evaluated this issue.
Table 1 provides an overview of the available evaluation research on the
effectiveness of various forms of treatment for convicted DWI offenders. For the
purposes of this review, we have defined treatment broadly, including in our review any
planned intervention designed to reduce the offender’s reliance on alcohol and, in the
process, to reduce DWI recidivism. The National Academy of Sciences relied on the
same definition to organize their review of the effectiveness of offender rehabilitation
programs two decades ago. Among the ten program evaluations and four research
reviews included in table 1 are two evaluations of inpatient alcohol treatment (Kelly,
Myers and Brown, 2002; Shapiro, 2001), six evaluations focusing on outpatient treatment
and/or education (Taxman and Piquero, 1998;Wells-Parker, 1994; Pratt, Holsinger and
Latessa, 2000; Tonigan, Miller, Juarez, and Villanvera, 2002; Deyoung, 1997;
VanderWalde, Urgenson and Weltz, 2002), Three evaluations of victim impact panels
(C’DeBaca, Lapham, Liang, and Skipper, 2001, Polacsek, Rogers, Woodall, Delaney,
Wheeler and Rao, 2001; Fors and Rojack, 1999), one evaluation that combined electronic
monitoring and mandatory participation in outpatient treatment (Courtright, Berg, and
Mutchnick, 2000) and one evaluation that examined the importance of matching offender
problems to appropriate impatient and outpatient treatment programs (Project Match
Research Group, 1996). Although the overall quality of the evaluation research studies
included in this review of treatment effectiveness is quite low, it is possible to offer the
following assessment of what works, what doesn’t work, what is promising and what is
unknown about the treatment of drunk drivers.
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(1A) What Works in the Area of Treatment
The systematic review criteria for determining program effectiveness employed
by Sherman, et al (1997) requires that “for a program to be classified as working, there
must be a minimum of two level 3 studies with significance tests demonstrating
effectiveness and the preponderance of evidence in support of the same conclusion”
(Sherman, et. al, 1997 as summarized in Welsh and Farrington (2003:170)). Examination
of table 1 reveals that there were two level 5 studies, seven level 2 studies, and 1 level 1
study chosen for review. The two level 5 studies were randomized field experiments on
the effectiveness of two quite different drunk driving “treatment” strategies. In the first
level 5 study, Polacsek et al. (2001) conducted a randomized field experiment on the
effect of victim impact panels and DWI schools on both offender movement through
“stages of change” in their attitudes toward drinking and driving and on subsequent DWI
recidivism. In the second level 5 study, Project Match evaluators (1996) examined the
effectiveness of three separate treatment modalities in both outpatient and aftercare
settings. The three treatment modalities included: (1) cognitive behavioral coping skills
therapy; (2) motivational enhancement therapy; and (3) twelve-step facilitation. Since
only one of these field experiments reported positive overall findings, we are left one
“good” evaluation, plus several weak level 2 studies on which to base our assessment of
what works in the area of drunk driving treatment. For this reason, we conclude that
there is no sound body of recent empirical evidence (1990-2002) available to determine
the effectiveness of various forms of offender treatment for drunk drivers.
(1B) What Does Not Work in the Area of Treatment
Further review of table 1 reveals that three evaluations of the effectiveness of
victim impact panels have been conducted in the past decade (actually 1990-2002). As
we noted earlier, one of these evaluations was a randomized field experiment (Polacsek,
et al, 2001), while the other two evaluations employed (level 2) quasi-experimental
designs. The authors of the randomized field experiment concluded that “participation by
DWI offenders in a Victim Impact Panel [following attendance in a DWI school] in
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comparison with participants in a DWI school only did not (1) more effectively move
them though the stages-of-change toward maintenance of drunk driving prevention, or (2)
result in lower rates of DWI recidivism (Polacsek, et. al., 2001:354).
A similar finding was reported by C’deBaca, Lapham, Liang and Skipper (2001)
in their assessment of 5,238 first-time and 1,464 repeat convicted DWI offenders who
were convicted of a DWI offense in New Mexico between 1989 and 1994 and who were
subsequently interviewed by the Lovelace Comprehensive Screening Program in
Bernalillo, New Mexico. Comparisons were made between those DWI offenders who
reported (self-report) being referred to a victim impact panel (67% of all respondents)
and those DWI offenders who were not referred to a VIP (33%). The authors of this
report concluded that referral to a victim impact panel (VIP) was not associated with
drunk driving recidivism for either male or female first-time offenders or male repeat
offenders. Among female repeat offenders, it was found that referral to a VIP actually
doubled the probability of re-arrest.
A different view of the importance of victim impact panels is offered by Fors and
Roject (1999), in their examination of DWI recidivism patterns (12 month follow-up)
among two cohorts of DWI offenders convicted in Athens/Clarke County, Georgia.
Members of one cohort of offenders (n=404) were required to attend a VIP presentation
as part of their sentence (i.e. those convicted between February and July 1994), while
offenders included in the comparison group (n=431) were arrested for drunk driving in
the same county prior to the initiation of victim impact panels in this jurisdiction.
Although questions can certainly be raised about this type of pre/post (no control group)
comparison, the differences between the recidivism rates of the VIP and pre-VIP groups
(5.94% vs. 15.08%) do suggest a possible intervention effect.
Overall, however, the weight of the empirical evidence certainly favors the
conclusion that victim impact panels – as currently designed – may not have the desired
effect on subsequent offender behavior; in some cases, attendance at a victim impact
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panel may actually exacerbate the problem behavior. C’deBaca, et al. (2001:620) offer
an explanation for this finding:
“VIPs are thought to influence DWI offenders on an emotional level, by
means of confronting them with the consequences of drinking and
driving… There is evidence that confrontational approaches are
ineffective in the treatment of alcohol problems (Hodgson, 1994; Miller,
et.al.1993, 1995) and conceivably could result in the opposite of the
intended effect. VIP participation may exacerbate feelings of guilt and
shame, which may in turn lead to increased alcohol use and, ultimately,
re-offense”.
Although it is certainly possible that Victim Impact Panels could be redesigned in
ways that would result in more positive findings (e.g. changes in panel composition
length, format, timing, etc.), it appears that other intervention strategies offer much more
promising results. We discuss these treatment-based strategies in the following section.
(1C) Promising Developments Vis-À-Vis Drunk Driver Treatment
According to the criteria developed by Sherman and his colleagues (and
summarized in Welsh and Farrington, 2003), “promising” strategies are defined in the
following manner: “For the classification of promising, at least one level 3 study is
required with significance tests showing effectiveness and the preponderance of evidence
in support of the same conclusion” (170). Our review of the evaluation research
identified one level 5 study, which reported positive treatment-related outcomes for three
separate treatment modalities in both outpatient and aftercare settings (see Project Match,
1996), along with several level 2 studies reporting positive treatment outcomes (see
Taxman and Piquero (1998), Pratt, Holsinger and Latessa (2000), and Deyoung, 1997).
The results from this latest wave of research on drunk driving are consistent with the
results of meta-analyses of treatment effectiveness conducted by Wells-Parker (1994) and
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Wells-Parker and Bangert-Drowns (1995), which examined program evaluations
completed before 1992.
Overall, it appears that some form of mandatory treatment delivered in an
outpatient setting, combined with license restrictions (i.e. suspension or revocation)
represents the most promising strategy for addressing our drunk driving problem.
Deyoung (1997) offers a succinct summary of the current research on both license
restrictions and treatment: “License curtailment reduces driving exposure and prompts
more cautious driving (Ross and Gonsales, 1988; Sadler, et al., 1991), while alcohol
education/treatment programs allow offenders to address their alcohol problems. There
are both logical and empirical reasons for combining the two” (995). Wells-Parker and
Bangers-Drowns (1995) have estimated that the impact of providing some form of
alcohol education/treatment to offenders was an 8-9 percent reduction in drinking/driving
recidivism. They go on to observe that the somewhat modest recidivism reduction effect
identified in their meta-analysis of 215 drunk driving evaluations published between
1955-1992 is probably a conservative estimate, due to the large number of “treatment’
programs that relied on alcohol education as the sole treatment modality. If their
assessment is correct, jurisdictions that offer both alcohol education and treatment to
offenders should experience even greater reductions in both drunk driving recidivism and
alcohol-related crashes/fatalities.
The evaluations included in table 1 offer a preliminary assessment of the likely
impact of a broad range of treatment-based drunk driver intervention strategies. Pratt,
Holsinger, and Latessa (2000) conducted a long-term (10 year) follow-up study of the
recidivism patterns of a cohort of chronic drunk driving offenders who participated in
Turning Point, a residential treatment program that combined both cognitive and
behavioral treatment modalities, and an aftercare component. They found that
participation in this alcohol treatment program resulted in reductions in recidivism
between 10 and 30 percent. Similarly, Shapiro (2001) examined the research on the
therapeutic community (TC) model’s use with drunk drivers and substance abusers in
both residential and outpatient settings and found that the residential TC model is the
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“most effective treatment available for long-term criminal alcohol and substance abusers”
(28). Unfortunately, most jurisdictions appear to spend little time and only a small
proportion of drunk driving treatment resources on the residential treatment of the
chronic drunk driver.
For many jurisdictions across the country, alcohol treatment comes in one of the
following three generic forms: (1) alcohol education programs, (2) self-help programs,
(such as AA), and (3) alcohol treatment programs. In most instances, participation in one
or more of these programs is mandatory (Wells-Parker, 1994). By far the most common
sanction for first time convicted drunk drivers is participation in an alcohol education
program. Taxman and Piquero (1998) found that for offenders in the Maryland program
they evaluated, offenders who completed an alcohol education program had a recidivism
rate that was 22 percent lower than for comparable offenders who did not attend these
programs. Deyoung’s (1997) evaluation revealed that for first time drunk drivers in
California, a combination of mandatory education (10 hours education on the effects of
alcohol on the body, the ability to drive, and applicable DWI laws) and counseling (10
hours of individual counseling and 10 hours of (group) education/counseling) is effective
as a recidivism reduction strategy, especially when used in conjunction with license
restrictions. Similar findings were reported for second-time DWI offenders who were
“sentenced by the court to attend an 18 month SB38…program. SB38 programs are 18
months in length and require at least 12 hours of education, 52 hours of counseling and
bi-weekly face-to-face interviews” (Deyoung, 1997:990). These findings are consistent
with the results reported in Wells-Parker’s meta-analysis of treatment programs (WellsParker, 1994), where multimodal treatment programs were found to be more effective
recidivism reduction strategies (by 10 percent or more) than any one of the following
“stand-alone” sanctions: (1) alcohol education, (2) psychotherapy or counseling, (3)
probation monitoring and follow-up by treatment providers, or (4) aftercare by treatment
providers.
In addition to alcohol education, many jurisdictions mandate participation in
“self-help” programs, such as alcoholics anonymous (AA). This type of mandatory
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referral is not surprising, especially given the resource constraints facing most corrections
administrators today. AA programs are inexpensive to run and they are readily available
in most jurisdictions. Kelly, Myers and Brown (2002) report that “AA is the most
commonly accessed source of help for an alcohol-related problem, with an estimated 9%
of the U.S. population having attended an AA meeting, 3% for help with their own
problems” (293). However, even a cursory review of the AA literature reveals that it is
one thing for an offender to attend an AA meeting; it is quite another for an offender to
affiliate him/herself with the 12-step recovery process. Stated simply, we can mandate
attendance, but not affiliation. As we highlight in table 1, the affiliation issue is critical
to understand, especially when it is viewed in the broader context of matching different
types of offenders to appropriate treatment programs.
For example, Kelly, Myers and Brown (2002) interviewed adolescents (14-18)
who participated in an inpatient alcohol abuse treatment program and at 3 and 6 month
intervals after discharge in order to examine the relative effects of 12-step
attendance/affiliation on subsequent alcohol problems. They concluded that “more
severely substance-involved youth were more motivated for abstinence and more likely
to attend and affiliate with 12 step groups (2002:293). They recommend that, “for youths
with less severe problems, focus could be placed on increasing motivation for abstinence
and 12-step group attendance” (304), and on developing alternative strategies for
addressing alcohol-related problems that do not involve attendance at an AA meeting.
Importantly, Kelly, Myers and Brown (2002) have also reviewed the adult-based research
on the impact of AA programs and their observations are worth noting here. First, many
researchers make the same distinctions between AA attendance and AA affiliation when
discussing the impact of AA on adults with alcohol problems, although there are certainly
mixed results on this topic (see, e.g. Snow, et. al., 1994; Tonigan, et. al., 1996, 2000).
Second, research on adults with alcohol problems also suggests that the more severe
substance abusers are the most likely to affiliate with the 12-step AA process. And third,
“motivation for change” is critical to the success of AA programs for both adults and
juveniles.
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Focusing on the application of these findings to statewide drunk driving
initiatives, it seems obvious to us that probation departments play a critical role in the
development of effective drunk driving interventions for two basic reasons: (1) it is
probation personnel who will be responsible for assessing the extent of the offender’s
drinking problem and making the appropriate referral, which will not include attendance
at self-help programs for a significant number of offenders convicted of drunk driving in
most states; and (2) it is probation personnel who are the most likely to have an impact on
an individual offender’s motivation for change, utilizing a combination of formal and
informal control techniques (Taxman and Byrne,2001). In Maryland, probation officers
are currently being trained on the application of motivational interviewing techniques to
the probation supervision and offender change process. This strategy certainly makes
sense for offenders convicted of drunk driving. However, for probation-based drunk
driving sanctions to be effective, it is essential that probation departments focus less on
offender “processing” strategies (e.g. counting the number of times and offender attends
AA) and more on the real work of offender change (e.g., helping the offender recognize
(1) the extent of his/her drinking problem, (2) the need to address this problem, and (3)
the ability to change).
One final caveat on the effectiveness of AA programs needs to be considered.
Our review suggests that AA programs may not be particularly effective for many female
offenders convicted of drunk driving, because women with drinking problems are often
categorized as multiple problem offenders (alcohol, drugs, mental illness), requiring a
multimodal treatment setting (VanderWalde, Urgenson and Weltz, 2002). Tonigan,
Miller, Juarez and Villanueva (2002) have found that Hispanic clients respond differently
to twelve-step AA programs than other groups. For Hispanic clients, attendance at AA
meetings did not predict either degree of affiliation with the AA program or subsequent
drinking behavior. This finding highlights the futility of monitoring an offender’s
treatment progress by simply collecting AA attendance slips, since for some groups of
offenders, attendance may not be related to affiliation. Despite these limitations, it
appears that AA and other self-help programs represent one of several “treatment”
options that need to be considered for DWI offenders with drinking problems.
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In addition to alcohol education and participation in self-help groups, our research
review identified several “promising strategies” in the area of alcohol treatment. Taxman
and Piquero (1998) found that offenders receiving alcohol treatment conditions
(including either inpatient or outpatient treatment) had a 17 percent lower risk of
recidivism than similar offenders who did not receive this condition (of probation). Pratt,
Holsinger and Latessa (2000) also reported significant, long term reductions in recidivism
among a cohort of chronic DUI offenders who completed a residential treatment program
(Turning Point) that incorporated both cognitive and behavioral treatment modalities to
each phase of treatment, including aftercare. These findings are consistent with the metaanalyses conducted by Wells-Parker (1994-1995), who concluded that jurisdictions
interested in reducing drunk driving recidivism need to develop multimodal treatment
strategies (e.g. education, counseling, probation monitoring and follow-up, aftercare)
utilizing both residential and outpatient programs.
(1D) What is “Unknown” About the Treatment of Drunk Drivers:
Directions for Future Research
Our review of the research on treatment strategies vis-à-vis the drunk driver
reveal only a handful of comparatively weak evaluations of specific treatment programs.
At minimum, future treatment-focused research needs to examine a number of basic
drunk driving program design issues, such as treatment type, treatment length, and
treatment setting/size. In addition, we need much better evaluation research on the
individual and/or combined effects of participation in alcohol education, self-help groups
(such as AA), and various forms of inpatient and outpatient alcohol treatment. Finally,
we know remarkably little about the ability of local probation officers, in conjunction
with treatment providers, to develop/affect an offender’s motivation to change (Taxman
and Byrne, 2001). It is within this broad context of offender change that proactive
community supervision strategies need to be systematically evaluated.
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Table 1: Evaluations of Treatment Programs for Drunk
Drivers 1990-2002
Author (year)
(1) Taxman and Piquero (1998)
Scientific Method
Score
2


(2) Kelly, Meyers, and Brown (2002)
1

(3) VanderWalde, Urgenson and
Weltz (2002)
*

(4) Tonigan, Miller, Juarez, and
Villanueva (2002)
2


(5) C’DeBaca, Lapham, Liang and
Skipper (2001)
2

Key Findings
For offenders receiving alcohol
education, the risk of recidivism
was 22 percent less (than for
offenders without alcohol
education).
Offenders receiving alcohol
treatment had a 17 percent
lower risk of recidivism than
offenders without this
condition.
Among adolescents (14-18) in
an inpatient treatment program
for alcohol abuse, motivation
(to change) was found to
influence the relationship
between 12-step affiliation and
future substance use outcome.
Women with
alcoholism/drinking problems
are often influenced by a range
of biological and psychological
factors that must be addressed
in a multimodal treatment
setting (e.g. individual
counseling, group counseling,
support groups).
Hispanic clients assigned to
twelve-step affiliation (TSA)
reported significantly less AA
attendance 6 months after
treatment than non-Hispanic
whites
Overall, specific AA-related
practices were not associated
with increased abstinence.
Victim Impact Panel (VIP)
referral was not associated with
drunk driving recidivism for
either male or female first time
15

(6) Polacsek, Rogers, Woodall,
Delaney, Wheeler, and Rao
(2001)
5

(7) Coutright, Berg, and Mutchnick
(2000)
2

(8) Fors and Rojack (1999)
2

(9) Wells-Parker (1994)
*


offenders.
Female repeat offenders
referred to VIP’s were twice as
likely to be rearrested as female
repeat offenders who were not
referred.
Participation by DWI offenders
in a Victim Impact Panel (VIP)
in comparison with participants
in a DWI school only did not
(1) more effectively move them
through stages of change toward
maintenance of drunk driving
prevention, or (2) result in
lower rates of DWI recidivism.
Among offenders on electronic
monitoring, attendance at
treatment was not related to
overall parole success, although
it was related to a lower rate of
technical violations.
DUI offenders who attended a
Victim Impact Panel (VIP)
presentation had lower rearrest
rates at 3 month, 6 month, and
12 month follow-up intervals
than a comparison group of DUI
offenders who did not attend a
VIP presentation.
Results of meta-analysis of DUI
treatment programs revealed
that (across all types of
treatment) treatment had a
consistently small but positive
effect on reducing DUI
recidivism and involvement in
alcohol related crashes. In the
studies reviewed , “treatment”
was compared with no
treatment, punishment (e.g.
fines or jail), or licensing
sanctions (e.g. suspension).
Multimodal treatments were
more effective (by at least 10
16
(10) Shapiro (2001)
*

(11) Project Match Research Group
(1996)
5

(12) Pratt, Holsinger and Latessa
(2000)
2

(13) Wells-Perker and BangertDowns (1995)
*

percent) in reducing DUI
offender recidivism than any
one of the following methods
alone: (1) education, (2)
psychotherapy or counseling,
(3) probation monitoring and
follow-up by treatment
providers, and (4) treatment
provider aftercare.
The evaluation research on
therapeutic communities (TC)
cited in this review supports the
continued development on the
TC model for drunk drivers.
The “Matching hypothesis” is
tested in two randomized field
experiments: one focusing on
inpatient and the other on
outpatient treatment. With the
sole exception of psychiatric
safety and outpatient treatment
assignments, it appears that
client characteristics do not
need to be considered when
matching offenders to the three.
treatment modalities examined:
(1) cognitive behavioral coping
skills therapy, (2) motivational
enhancement therapy, and (3)
twelve step facilitation therapy,
Clients in all three groups
demonstrated “significant and
sustained” improvements in
drinking outcomes (1 year post
treatment).“
Ten-year follow-up on a cohort
of turning point participants
revealed a consistently strong
(between 10 and 30 percent)
treatment effect for the
program, which combines both
cognitive and behavioral
treatment modalities, and an
aftercare component.
Meta-analysis of 215 drunkdriving evaluation studies
17
(14) Deyoung (1997)
2

conducted between 1955 and
1992 revealed that “the average
effect of remediation on
drinking/driving recidivism was
an 8-9% reduction over no
remediation” (1), with a similar
effect size for alcohol - involved
crashes.
Quasi-experimental design used
to examine the effectiveness of
alcohol treatment, driver license
actions, and jail terms in
reducing drunk driving
recidivism among 1st time and
repeat drunk drivers in
California. For both groups, a
combination of license
curtailment and participation in
an alcohol treatment program
resulted in the lowest recidivism
rate of any sanctions. Jail terms
were found to be the most
ineffective sanction for both
groups.
* These research/literature reviews were included for informational purposes; they do
not represent original research studies.
2. Prevention Programs for Drunk Drivers: Individual and
Community-Level Strategies
Up to this point we have focused our review on research that evaluates the
effectiveness of treatment strategies targeting convicted drunk drivers. In this section we
examine the available research on individual and community-level prevention strategies.
We begin by asking a deceptively simple question: why do individuals drink and drive?
For adults over the minimum drinking age, the answer appears to be two-fold: (1) it is
legal, and (2) it is socially acceptable, to drink and drive in this country. In order to
prevent adults from drinking and driving, it seems logical to suggest that we need to
change the law and/or change the general public’s attitudes towards drinking and driving.
In a recent review of the research on alcohol prevention programs, Holder (2000:844)
18
observed that “For the most part, local prevention strategies have been programs that
target individual problem drinkers, not the total community. Results from evaluations of
these individual-focused strategies have not been particularly encouraging (see Casswell,
1995)”. Our examination of the research on prevention-based research on drunk drivers
revealed only two evaluations conducted during our review period (1990-2002). For this
reason, we conclude that much is currently unknown about the prevention of drunk
driving, both at the individual level (e.g., strategies targeting individuals with drinking
problems, school-based education programs, media campaigns, etc.) and at the
community level (e.g., programs targeting changes in community structure).
One example of a prevention strategy targeting “problem” drinkers is Newcomb,
Rybow, Hernandez, and Monto’s (997) study of the influence of peers on the drunk
driving behavior of their friends. As we have highlighted in table 2, this study found that
when “friends” intervene to stop a potential drunk driving incident, they are usually
successful. Of the 388 UCLA college students who participated in the (self-report) study,
303 (78%) indicated that they had witnessed a potential drunk driving incident/situation
in the past year. About two-thirds of these “observers” (N=206,68%) actually decided to
get involved. Interestingly, 63% of those who decided to get involved were women,
which may be an indicator of possible gender differences in either the perceived risk or
the behavior, and/or the perceived need for intervention. Since respondents indicated that
73% of all interventions were successful, it certainly appears that peer intervention
represents an important, front-line drunk driving prevention strategy. Unfortunately, we
know very little – outside of laboratory research – about the dynamics of this type of
drunk driving intervention.
Given the limited scope and design of the one individual-level research study
cited here, it seems apparent that much more basic research on individual decisions to
drink and drive, conducted in conjunction with research on societal reaction to drivers
who drink, needs to be conducted. At this point, the saying “friends don’t let friends
drive drunk”, appears to be a media-driven myth, in most communities.
19
We do not presume that positive peer influence (and direct peer intervention) will
eliminate the drunk driving problem in this country. Consider, for a moment, the number
of “problem” drinkers among us who either drink alone or in social contexts (e.g., bars,
restaurants), without direct peer observation. Nonetheless, we do suspect that it is exactly
this type of informal social control that offers the most promising individual-level
strategy for preventing individuals from driving while intoxicated. As Grasmick and his
colleagues (1993) have suggested, changes in individual decisions to drink and drive may
reflect changes in social values regarding drunk driving, which result in shame and
embarrassment for individuals who violate this norm.
A review of the recent public opinion research on drunk driving (see, e.g.
Knutsson and Kuhlhorn, 1996) reveals that the vast majority (90%) of the general public
believe that “drunk driving can never be justified” (217). Consistent with this prevailing
social value, several jurisdictions across the country have developed comprehensive,
community-wide drunk driving prevention strategies (see Holder, 2000, for an overview
of these community-level approaches). According to Holder (2000:844),
“The rationale for targeting communities, as opposed to individuals, is
compelling. First, substance use occurs largely within community
contexts. That is, particularly in the case of alcohol, communities provide
structures(e.g. zoning of alcohol establishments) through which alcohol is
typically obtained. Second, many of the costs associated with alcohol are
borne collectively at the community level in the form of car crashes and
alcohol-related violence.”
Table 2 includes a summary of the results from Holder’s recent multi-site evaluation of a
five part community-level drunk driving prevention program. The 5-year research
project included three “experimental” communities (one in Northern California, one in
Southern California, and one in South Carolina) and three “control” communities that did
not employ the five part prevention strategy.
The Community Trials Project described by Holder (2000) utilized the following
components: (1) community mobilization (utilizing local groups and the local media); (2)
20
responsible beverage service (“to change the serving practices among on-premise alcohol
licensees” (2000:849); (3) drinking and driving law enforcement (via changes in police
training and new methods of testing for DWI); (4) underage drinking law enforcement
(via improved training of retailers, increased enforcement, and media advocacy targeting
problem establishments/retailers, and (5) alcohol access restrictions (via zoning law
revisions). While the results of the process evaluation revealed community-specific
variations in the full implementation of this community-level change strategy, the initial
outcome evaluation findings were quite positive. Holder (2000) estimates that there was
approximately a 10% annual reduction (1993-1995) in alcohol-involved crashes for the
three experimental sites. According to Holder (2000), “The introduction of special and
highly visible drink and drive enforcement – with new equipment and special training –
produced the significant reduction” (853). While the above findings are consistent with
earlier research conducted on the deterrent effects of increased and/or improved law
enforcement (see, e.g. Welsh and Farrington, 2003, for an overview), we must caution
against making any generalizations from this one study about the impact of communitylevel strategies generally, and on law enforcement in particular, on the decision to drink
and drive. In this regard, it is important to consider the fact that most states report a
significant decline in drunk driving arrests during the 1990’s, a period of time during
which alcohol-related fatalities also declined dramatically (Bureau of Justice Statistics,
1999). Have improvements in law enforcement changed the actual and/or perceived risk
of drunk driving apprehension during this period or are other factors (e.g., informal social
controls) coming into play that explain these findings (e.g. improved emergency response
capabilities by local hospitals, police and fire departments)? Unfortunately, we cannot
answer this question based on the research conducted to date.
21
Table 2: Evaluations of Prevention Programs for Drunk
Drivers: 1990-2002
Author (year)
Scientific Method
Key Findings
Score
(1) Newcomb, Rybow, Hernandez,
1

and Monto (1997)
This study examined “personal
characteristics and contextual
factors among 338 college
students who had made an
attempt to prevent someone
from driving drunk” (1997:1).
73% of all interventions were
successful (median 3); 57% of
assertive interventions and 47%
of passive interventions were
successful.
(2) Holder (2000)
2

This 5 year study assessed the
impact of a community-level
alcohol prevention strategy in
three separate jurisdictions.
Results “show that the project
reduced alcohol-involved
crashes, lowered sales to
minors, increased the
responsible alcohol serving
practices of bars and
restaurants, and increased
community support and
awareness for alcohol problems
(2000:84f3).
22
3. The Identification and Classification of Drunk Drivers
Our review of the empirical research on the effectiveness of current classification
strategies identified only four studies that directly examined this issue: the Project Match
randomized field experiments (a level 5 study) discussed earlier in this report (see project
summary in table 1); and three non-experimental (level 1) studies focusing on model
development/testing issues (C’deBaca, Miller and Lapham, 2000; Williams, Simmons
and Thomas, 2000; Marowitz, 1998). Based on the studies we identified and reviewed,
we must conclude that no definitive statements can be offered either about “what works”
or “what doesn’t work” in the area of drunk driving classification. However, a review of
these three studies does suggest a number of avenues for future research, focusing
specifically on the techniques used to match DWI offender problems to specific types of
inpatient and/or outpatient treatment.
The Project Match Research Group (1997) developed “two parallel but
independent matching studies, one with clients recruited at five outpatient sites, the other
at five sites with clients who received aftercare treatment following an episode of
inpatient or day hospital treatment” (8). The objective of the study was to test a
commonly held assumption in the rehabilitation field, that different types of offenders
(with alcohol problems) will respond differently to different types of treatment (defined
in this study as (1) cognitive behavioral coping skills therapy (CBT), (2) motivational
enhancement therapy (MET), and (3) twelve-step facilitation therapy (TSF). With the
exception of a measure of psychiatric severity (based on the completion of the Addiction
Severity Index), the researchers found that treatment “providers need not take…client
characteristics into account when triaging clients to one or the other of these three
individually delivered treatment approaches, despite their different treatment
philosophies” (1997:7).
Our review of this study revealed four possible explanations for this finding.
First, it is certainly possible that the three different “types of treatment examined in this
study were, in fact, not all that different. Second, it is also possible that the two primary
23
outcome measures used in this evaluation-percent days abstinent and average number of
drinks per drinking day – did not adequately capture the actual drinking behavior of
participants (due to reliability/validity problems). Third, perhaps the ten part, multiple
classification criteria used in the study did not actually distinguish different types of
clients with different types of drinking problems. And fourth, the researchers may be
correct in concluding that, in general, matching clients to specific treatments doesn’t
really matter, because they do well in a variety of treatment modalities. Our inability to
rule out the first three explanations makes it difficult, if not impossible, to accept the
conclusions of this study without a body of collaborative research challenging the
“matching hypothesis”.
Unlike the Project Match evaluation, the three studies included in table 3 focus
specifically on the classification of convicted drunk drivers. C’deBacca, Miller, and
Lapham (2001) conducted a study of the recidivism patterns of close to 1,500 convicted
DWI offenders in New Mexico. These offenders, convicted between 1989and 1991,
were tracked for up to 4 years by researchers using data from the New Mexico Traffic
Safety Bureau. The goal of this study was to devise a simple, reliable method to
distinguish each offender’s risk of recidivism, based on the notion that intervention
strategies need to be targeted to specific “risk levels”, rather than applied universally to
all convicted drunk drivers.
The researchers developed a model that combined 5 risk factors in an additive
scale (scores 0-5) and reported differences in predicted recidivism ranging from 11% (0
risk factors present) to 53% (5 risk factors present). Risk factors included the following:
age (under 29 years old), education level (less than 12 years of education), arrest BAC
(200 or higher), AUI receptive-awareness scale score (7 or higher), and The MacAndrew
Alcoholism Scale (MAC) score from the MMPI-2 (raw score of 23 or higher).
According to the authors (2001:208), the AUI (Horn, Wanburg, and Foster, 1990) is a
228-item self-report instrument that assesses alcohol-related problems. It has been
lauded as the strongest comprehensive paper-and-pencil instrument for evaluating alcohol
problems (Miller, Westerberg, and Waldron, 1995). Unfortunately, no data were
24
included in this evaluation on either the length of time it takes (on average) to complete
the AUI assessment process or the overall reliability of the self-report instrument.
Finally, it is unclear from this evaluation why five levels of recidivism risk needed to be
isolated and whether different intervention strategies were applied to the offenders
included in the current classification study, possibly confounding the results of the
classification study itself.
The third evaluation included in this section of our review is Williams, Simmons
and Thomas’ (2000) evaluation of an “alcohol safety action” program (VASAP)
implemented in rural areas of Virginia. According to Williams, et al. (2000:135), “The
VASAP evaluates DWI offenders referred by local court systems and assigns these
individuals to either education classes, intensive education classes, outpatient counseling,
or inpatient counseling programs depending on the offender’s identified need for
services”. To assess the need for services among study participants (a sample of 377
mostly male convicted drunk drivers), offenders completed the Michigan Alcohol
Screening Test (MAST) “a twenty-four item instrument designed to diagnose
alcoholism” (Williams, et al., 2000:135). The two primary conclusions of the study were
that (1) the MAST classification instrument was effective in its identification of “high
risk” drunk drivers, and (2) the VASAP program reduced DWI recidivism. Although
exploratory in design (a level 1, non-experimental study), the authors of this study do
raise the “matching hypothesis” once again, which suggests that this may be one of the
most important questions for researchers to address in the next wave of drunk driving
evaluations. In addition, the simplicity of the twenty-four item classification instrument
presented in this evaluation may be attractive to corrections administrators attempting to
reduce classification-related workload while increasing contact standards by line staff.
Finally, Marowitz (1998) offers a simple alternative to the more complex
screening protocols described previously, focusing on three main factors associated with
DWI recidivism: BAC level at time of arrest, prior traffic convictions (2 years), and
conviction status (1st time vs. repeat offender). All offenders arrested for DUI in
California between Jan. 1, 1993 and June 1993 who were subsequently convicted of
25
either DUI or reckless driving were included in the original analyses. The results of this
study suggest that a simple classification scheme can be devised in many jurisdictions if
the primary goal of the classification scheme is identifying offenders “at risk”, rather than
assessing the level/type of an individual offender’s alcohol problem.
Table 3: Highlights of Recent Research on Classification of
Drinking Problems and the Prediction of Drunk
Driving Recidivism
Author (year)
(1) deBaca, Miller, and Lapham
(2001)
Scientific Method
Score
1

Key Findings
Initially a total of six variables
were found to predict DWI
recidivism: age, education level,
arrest BAC, prior DWIs, the
receptive-awareness scale from
the AUI, and the MAC raw
score from the MMPI-2. A
model combining 5 of these risk
factors (minor prior DWIs) was
found to accurately predict
offender DWI recidivism. In
general, the greater the number
of risk factors in a given case,
the greater the likelihood of
recidivism.
Predictions followed the
following pattern:

# of risk facts
0
1
2
3
4
5
(2) Williams, Simmons and Thomas
(2000)
1

Probability of
Recidivism
11%
16%
23%
32%
42%
53%
The authors reviewed the
available research on DUI risk
factors and identified the
following key risk factors; (1)
26
(3) Marowitz (1998)
1

The degree of the offenders
substance abuse problem; (2)
“A number of personality,
behavioral and attitudinal traits
predict drunk drivers”; (3)
“Multiple offenders were more
likely to have higher blood
alcohol concentrations at the
time of arrest, more non-traffic
arrests, and more accidents than
first time offenders”
(2000:131). The research
presented in this study
identified two strong predictors
of recidivism (reconviction for
DUI) among DUI offenders: (1)
failure to complete the VASAP
treatment program, and (2)
higher scores on the Michigan
Alcohol Screening Test
(MAST), “A 24 item test
designed to diagnose
alcoholism” (2000:135).
Using data on DUI offenders in
California, the probability of
DUI recidivism was estimated
by a simple 3 variable
assessment, including: (1) level
of BAC at arrest, (2) prior 2
year traffic convictions, and (3)
offender conviction status (1st or
repeat offender). According to
this research, “first offenders
with high BAC levels and prior
2 year traffic convictions are at
as high a risk of recidivating as
many repeat offenders and
might therefore benefit from
similar sanctions and/or
remedial treatment” (1998:545).
27
4.
Control-Oriented Strategies for Addressing The Drunk Driver
Problem
A wide range of administrative and/or criminal sanctions have been included in
recent drunk driving legislation (Note: see MADD’s recent summary of applicable laws,
included in our compendium). A staggering number of drunk driving laws have been
adopted by legislatures across the country in recent years (MADD, 2002). As a result,
drunk drivers are now subject to a variety of control-oriented criminal justice sanctions,
including jail terms, house arrest (via electronic monitoring), day reporting/intensive
supervision, and mandatory treatment. In many jurisdictions, these criminal sanctions are
likely to be combined with one or more administrative sanctions, such as license
suspension, license revocation, vehicle impoundment, vehicle immobilization (via “the
boot” or some other device), vehicle forfeiture, and/or the use of vehicle interlock
devices. While it is difficult to distinguish the effects of any one control strategy when
such “sanction-stacking” occurs (Byrne, 1990), a number of recent evaluations of specific
control oriented criminal justice and administrative sanctions have been completed during
our review period (1990-2002) and are available for review. Table 4 highlights the major
findings from 11 separate impact evaluations and 2 research reviews on this topic area,
including 3 evaluations of the impact of license suspension/revocation (and per se laws),
1 evaluation of the impact of jail terms in conjunction with other sanctions, 3 evaluations
of ignition interlock devices, 3 evaluations of vehicle impoundment/immobilization,
and/or forfeiture and 1 evaluation of the implementation of a license plate sticker law
targeting drunk drivers.
28
4A) What Works in Controlling Drunk Drivers
Examination of table 4 reveals that the evaluation research on control-oriented
sanctions is uniformly weak, consisting entirely of Level 1 and Level 2 quality studies.
Once again, we must conclude that there is no sound body of recent empirical evidence
(1990-2002) on which to base an assessment of which (if any) control-oriented drunk
driver intervention strategies are effective, either as a general or specific deterrent to
drunk driving.
4B) What Does Not Work in Controlling Drunk Drivers
We simply do not have sufficient evidence to offer any firm statements either
about “what works” or about “what doesn’t work” in this important policy area.
However, our review of the research studies included in Table 4 does suggest that jailbased sanctions are likely to be an ineffective specific deterrent, which we suspect is due
to the lack of available treatment for DWI offenders with alcohol-related problems in
most jail settings (see, e.g., Hingson, 1993 and Deyoung, 1997), as well as the negative
life course changes typically associated with a period of incarceration (e.g., breakdown of
family ties, reduced employment prospects, and changes in intimate relationships). Since
none of the studies we reviewed attempted to measure the general deterrent effect of jail
terms for either first-time or repeat drunk drivers, we simply don’t know about how the
threat of a jail term affects the general public in jurisdictions where “jail time” is an
option. In general, negative findings reported here for the use of jail-based sanctions with
drunk drivers are consistent with the findings from previous research reviews on the
impact of control-oriented intermediate sanctions: surveillance and/or control-oriented
29
sanctions do not work as a recidivism reduction strategy (Byrne and Pattavina, 1992).
Nonetheless, it is certainly possible that the threat of jail (or even house arrest) may
increase the offender’s level of compliance with treatment-oriented conditions/sanctions
(see, e.g., Courtright, Berg and Mutchnick, 2000; and Voas, Blackman, Timmits, and
Marques, 2000). If this tentative finding is supported by the results of more
methodologically rigorous evaluations, then jail terms (and other intermediate sanctions
such as house arrest, day reporting, and intensive supervision) may play an important role
in “motivating” offenders who refuse to comply with treatment.
4C) Promising Developments Vis-à-vis Drunk Driver Control
In order to offer an evidence-based assessment of promising developments in the
use of control-based sanctions, at least one of the evaluations included in our review
would have to be a Level 3 study and the preponderance of the evidence from the
remaining studies would have to support this conclusion (see Welsh and Farrington,
2003). As we noted earlier, none of the studies conducted in this area met this minimum
quality threshold. However, we do think it is still possible to identify a number of
promising developments regarding the use of control-based sanctions, particularly when
these sanctions (both criminal and administrative) are used in conjunction with either
individual-level treatment or community-level prevention strategies (see, e.g., WellsParker and Bangert-Drowns, 1995, for an overview of findings from (multimodal)
combined treatment and control-oriented interventions with drunk drivers; and see
Holder’s 2000 review of research on community crime prevention of alcohol problems).
30
First, it does appear that license suspension/revocation may work as a specific
deterrent to subsequent drunk driving, particularly when used in conjunction with alcohol
treatment. Deyoung (1997) found that license curtailment and participation in an alcohol
treatment program resulted in the lowest recidivism rate of any sanction (or combination
of sanctions). Importantly, this finding was reported for both first-time and repeat drunk
drivers in California. When researchers have evaluated the effects of administrative per
se laws alone (see McArthur and Kraus, 1999 for a review) the results were mixed, with
three states showing significant reductions in recidivism (North Dakota, Nevada, and
California) and two states showing no difference.
Second, there is some evidence of a specific deterrent associated with vehicle
impoundment/immobilization or forfeiture. Voas and Deyoung (2002:263) reviewed the
evaluation research on this type of vehicle program and their analysis “reveals for
relatively large recidivism reductions, from denying offenders the use of their vehicles
for 1-6 months”. A similar conclusion was reached by Voas, Tippits, and Taylor (1997,
1998) in their evaluation of the use of a vehicle impoundment sanction in Hamilton
County and Franklin County, Ohio.
Third, the use of ignition interlock devices represents another promising, controloriented strategy, in particular when corrections administrators use the threat of criminal
sanctions—such as jail or house arrest—to increase the number of offenders who
“volunteer” to participate in the program (Voas, Blackman, Tippits, and Marques, 2002).
In fact, Morse and Elliot (1992) found that interlock devices actually were a more
effective recidivism reduction strategy for DWI offenders than license suspension. More
31
recently, Weinrath (1997) reported that interlock cases were almost three times less likely
than the comparison group to drink and drive again.
4D) What Is “Unknown” About Control-Oriented Sanctions: Directions for Future
Research
Perhaps the most important avenue for future research on drunk driving
interventions is the study of both the formal and informal social control mechanisms
affecting the decision to drink and drive. In this regard, the recent research linking recent
reductions in (self-reported) drunk driving to an increased threat of “shame or
embarrassment” is quite interesting (see, e.g., Grasmick, Bursik, and Arnekley, 1993).
According to the authors,
“Our surveys revealed a significant increase in the perceived certainty and
severity of shame…for drunk driving between 1982 and 1990…The
increased threat of shame and its relatively strong deterrent effect appear
to be the primary source of reduction in drunk driving in our two surveys”
(61).
In addition to research examining the relative importance of formal and informal social
control mechanisms, it is apparent that the field is in need of randomized experiments
testing the individual and combined effects of treatment and control-oriented sanctions.
This recommendation is underscored by even a cursory review of the quality of the
evaluation research conducted to date on this topic (see, Wells-Parker and BangertDrowns (1995) for a critical review of this literature).
32
Table 4: Evaluations of Control-Oriented Strategies for
Reducing Drunk Driving Recidivism
Author (year)
Scientific Method
Score
(1) Voas, Blackman, Tippits and
Marques (2002)
2

(2) Voas, and Deyoung (2002)
*

(3) Hingson (1993)
*

Key Findings
Previous research suggests that
“two factors limit the
effectiveness of the interlock:
(A) relatively few offenders
volunteer to install interlocks,
and (B) the offenders driving
behavior while on the interlock
does not carryover to postinterlock driving” (2002:449).
To address the first of these two
problems, program developers
in one Indiana county
(Hancock) decided to create a
greater “incentive” for first time
and multiple DUI offenders to
volunteer – threat of jail or
house arrest for nonparticipants. This strategy
resulted in a 62% participation
rate and substantial reduction in
DUI recidivism for both first
time and multiple offenders.
A review of the existing
evaluation research on vehicle
action programs (i.e. including
impoundment, immobilization,
or forfeiture) reveals “some
relatively large recidivism
reductions, from denying
offenders the use of their
vehicles for 1-6 months”
(2002:263).
Reviews the available research
on legislations restricting
drinking among minors,
legislation to deter impaired
driving, enforcement strategies,
and informal control
33

(4) Weinrath (1997)
2

(5) Morse and Elliot (1992)
2

mechanisms.
It is estimated that raising the
drinking age to 21 has resulted
in a 12% decline in teenage fatal
crashes since 1988. (2) Lower
BACs for minors have been
linked to a 30% decline in
nighttime fatal crashes among
teenagers. (3) Mixed results
reported for curfews on
nighttime driving by teenagers.
(4) Negative findings on the
impact of jail sentences on first
time and repeat drunk drivers.
(5) License
suspensions/revocations have
been found to reduce both DWI
recidivism and alcohol-related
crashes. It appears that this
strategy, when combined with
mandatory treatment options,
may have a significant impact
on both DWI recidivism and
crash involvement. (6)
Administrative license
suspensions have a greater
effect on drunk driving
recidivism than jail sentences.
(7) Mixed results for research
on lowering BAC for adults.
Ignition interlock cases were
almost 3 times less likely than
the comparison group to drink
and drive again. Program
participants were 6.5 times less
likely to record a new serious
driving violation and about 5.8
times less likely to be involved
in an injury collision.
The failure rate for ignition
interlock cases was 3.4% (after
30 months) compared to 9.8%
for a comparison group of DUI
offenders who received license
suspensions.
34
(6) Deyoung (1997)
2

(7) McArthur and Kraus (1999)
*

(8) Deyoung, Peck and Helander
(1997)
1

Quasi-experimental design used
to examine the effectiveness of
alcohol treatment, driver license
actions, and jail terms in
reducing drunk driving
recidivism among first time and
repeat drunk drivers in
California. For both groups, a
combination of license
curtailment and participation in
an alcohol treatment program
resulted in the lowest recidivism
rate of any sanctions. Jail terms
were found to be the most
ineffective sanction for both
groups.
A detailed review of three (level
2 pre-post evaluations of
administrative per se laws
(Stewart, et. al., 1992; Lacey, et.
Al., 1990; and Rogers, 1997)
revealed mixed results with
three states (North Dakota,
Nevada, and California)
showing significant reductions
in recidivism and two states
(Mississippi and Louisiana)
showing no difference in
recidivism in the period prior to
or post law implementation.
Using data on fatal passenger
car and pickup truck crashes
that occurred in California
between 1987 and 1992,
estimates of the involvement of
both suspended/revoked (S/R)
drivers and unlicensed drivers
in fatal car crashes can be
calculated (using the quasiinduced exposure method).
Overall, it is estimated that
35.4% of all fatal crashes during
the review period involved S/R
35

(9) Voas, Tippits and Taylor (1998)
(10) Voas, Tippits and Taylor (1997)
2

(11) Deyoung (2000)
2

and/or unlicensed drivers.
Compared to validly licensed
drivers, S/R drivers are over
involved in fatal crashes by a
factor of 3.7:1, while unlicensed
drivers are over involved by a
factor of 4.9:1.
All offenders receiving a
vehicle impoundment sanction
in Hamilton County, Ohio
between 1993 and 1995 under
either existing DUI (Driving
under the influence) Or DWS
(Driving while suspended) laws
were compared to a
(nonequivalent) comparison
group of offenders who were
eligible for-but did not receivethe impoundment sanction.
Overall, the authors reported a
significant reduction is repeat
DUI offenses among all groups
of DUI offenders (1st time, 2nd
time, and 3rd time), but
contradictory results for 1st time
DWS (no effect) and repeat
DWS offenders (strong effect).
Using a quasi-experimental,
post-test only control group
design, researchers compared
the recidivism patterns (19931995) of offenders in Franklin
County, Ohio who had their
vehicles impounded (or
immobilized) to a group of
similar offenders who did not
receive a vehicle sanction. It
was found that the recidivism
rates of offenders with
impounded/immobilized cars
were lower than the comparison
groups both while the car was
impounded and after the car was
reclaimed.
Using an interrupted time series
design, the evaluator compares
36
(12) Deyoung (1999)
2

(13) Voas, Tippits and Lange (1997)
2

crash rates of
suspended/revoked drivers prior
to the implementation of the
impoundment and forfeiture
laws in California (Jan. 1, 1995)
to crash rates for
suspended/revoked drivers after
the law went into effect. A
control group of California
drivers not suspended/revoked
was included for the same
period (pre/post). The study did
not find a general deterrent
effect for the vehicle
impoundment law in California.
This study demonstrates the
specific deterrent effect of
vehicle impoundment on the
subsequent driving behavior of
suspended/revoked drivers in
California. Compared o similar
offenders whose vehicles were
not impounded, there were
“23.8% fewer driving while
suspended/revoked or
unlicensed convictions; 18.1%
fewer traffic convictions; and
24.7% fewer crashes”
(1999:45).
The authors evaluated sticker
laws for vehicles used by
suspended/revoked drivers
convicted of drunk driving in
two states. Results suggest that
the law had both a general and a
specific deterrent effect in
Oregon, but no effect (specific
or general) in Washington.
Concluding Comments: An Application of our “What Works” Review to MADD’s
Rating the States 2002 Survey
According to a recent survey review by Shults, Sleet, Elder, Ryan, and Sehgal
(2002), “The most comprehensive source of information about state level DUI
37
countermeasures is Mothers Against Drunk Driving (MADD’s) Rating the States
Survey,” (p. 106). Utilizing 2000 survey data, these authors evaluated the link between
MADD’s state level grades (A-F) and the self-reported drinking and driving behavior of
residents of each state. They found that “those living in states with a MADD grade of
‘D’ were 60% more likely to report alcohol-impaired driving than those from states with
a MADD grade of ‘A’…the association existed for men and women” (Shults, et al., 2002:
106). These findings certainly suggest that MADD’s rating system can be used to gauge
a state’s response to its drunk driving problem. For this reason, we conclude our review
of the research on drunk driving interventions by examining the empirical basis for the
specific drunk driving policy recommendations included in the MADD Rating the States
survey.
A copy of Maryland’s drunk driving report card is included at the end of this
section (Note: A detailed review of all 50 states’ report cards, along with a listing of all
applicable DUI laws and legislation, is included in the Research Compendium
accompanying this report). Maryland received an overall grade of “C” for its efforts
against drunk driving according to the most recent 2002 survey, compared to a 2000
survey grade of B-. According to the MADD grading system:
“thirty percent of each state’s MADD grade represented the state’s trend
in alcohol related traffic fatalities, 30% presence of DUI laws, 10% to DUI
enforcement and 30% to the remaining six components of the survey...To
retain a straight “A” aggregate grade, a state had to have an administrative
license revocation law, a 0.08 BAC law, and a primary enforcement safety
belt law” (Shults, et al., 2002: 107).
After examining these review criteria we conclude that the MADD rating system
has overestimated the importance of administrative measures (such as license revocations
and vehicle impoundment, criminal sanctions (such as jail) and victim impact panels,
while underestimating the importance of individual offender classification and treatment.
In fact, the MADD survey does not even attempt to evaluate the quantity and quality of
“treatment” available to each state’s first-time convicted DUI and repeat DUI offender
population. Given the research findings highlighted in this report concerning the
combined effect of treatment (i.e., alcohol education, self-help programs, and a variety of
38
inpatient and outpatient treatment modalities) and control-oriented sanctions (in
particular, license actions) on subsequent DUI recidivism, it seems obvious that the
current MADD grading system is seriously (and fundamentally) flawed. While there is
certainly much to learn from reviewing MADD’s assessment of Maryland’s response to
its drunk driving problem, it appears that in several critical areas the recommendations
for change advocated by MADD are not based on a sober assessment of the drunk driving
research literature.
Recommendations for Change
Based on our review of the recent research on drunk driving (1990-2002), we
offer the following recommendations for changes in current policies and practices in
Maryland vis-à-vis drunk drivers:
1.
Treatment programs for drunk drivers need to be expanded to include a full
range of individual and group treatment strategies, including alcohol
education, self-help (AA/NA) programs, and a variety of multi-model
inpatient and outpatient treatment programs;
2.
Participation in treatment programs must be mandatory for both first time
and repeat drunk drivers. For noncompliant offenders, a structured hierarchy
of sanctions— including jail—should be established and fully implemented;
3.
Probation line staff workloads needs to be redefined, allowing significantly
more time for staff and DUI offender interaction, emphasizing offender selfassessment, motivation, and change in drinking/driving behavior (via such
techniques as motivation interviewing);
4.
Existing DUI offender classification systems need to be revised,
incorporating the most recent research on (1) alcohol (and substance abuse)
problem assessment, (2) the factors associated with subsequent DUI
recidivism, and (3) the factors predicting the subgroup of chronic drunk
drivers (e.g., prior driving record, BAC concentration);
5.
The “matching hypothesis”— linking specific offender problems to specific
types of treatment modalities— needs to be field-tested at selected Maryland
39
sites. Research suggests that these field tests should examine such issues as
(1) the response of different ethnic groups to different treatment modalities
(e.g., Hispanic DUI offenders and AA), (2) age-specific differences in
treatment effectiveness, and (3) the unique treatment “challenges” posed by
the multiple-problem female DUI offender in Maryland;
6.
Prevention strategies need to be developed focusing on “communities at
risk” rather than “at-risk” individuals (e.g., binge drinkers, teenagers who
drink and drive). Research on community-level prevention strategies (e.g.,
community mobilization, zoning law revisions, restricting alcohol sales,
increased enforcement of underage drinking laws, changes in serving practices
in local bars and restaurants) suggests that this approach works better (in
terms of all alcohol-related outcomes) than individual-level strategies
targeting subgroups of at risk, problem drinkers;
7.
A range of control-oriented administrative and criminal sanctions need to
be developed and field tested, in conjunction with the individual offender
treatment options identified earlier. Promising administrative sanctions
include: license suspension/revocation, vehicle impoundment,
immobilization, and the use of ignition interlock devices. Although not
effective as stand-alone sanctions, both the use of jail terms and house arrest
(or other intermediate sanctions) appear to show promise as strategies
reinforcing mandatory treatment conditions for DUI offenders;
8.
And finally, Maryland’s Drinking Driver Monitor Program needs to be
redesigned, emphasizing the goal of offender change in drinking attitudes and
behavior (e.g., drunk driving) through the strengthening of informal social
controls (e.g., peers, community) and informal sanctions (e.g., shame,
embarrassment).
40
Appendix A: Study Inclusion Criteria For Our Review
Of The Evaluation Research On Drunk Driving
According to the University of Maryland research review protocol, “The scientific
methods scale ranks evaluation studies from 1=weakest to 5=highest on overall internal
validity:
1.
2.
3.
4.
5.
Correlational evidence (low offending correlates with the program at a single
point in time);
No statistical control for selection bias but some kind of comparison (for
example, program group compared with nonequivalent control group;
program group measured before and after intervention, with no control
group);
Moderate statistical control (for example, program group compared with
comparable control group, including pre-post and experimental-control
comparisons);
Strong statistical control (for example, program group compared with control
group, with control of extraneous influences on the outcome, by matching,
prediction scores, or statistical controls); and
Randomized experiment: units assigned at random to program and control
groups prior to intervention” (as summarized in Welsh and Farrington, 2003:
169).
Definition Of Key Terms Used In The Evaluation Review
Welsh and Farrington (2003:169-170) provide the following description of the
key terms used in the University of Maryland review of evidence-based crime prevention:
“What works. These are programs that the authors (Sherman et al. 1997) were
reasonably certain prevent crime or reduce risk factors for crime in the kinds of social
contexts in which they have been evaluated and for which the findings can be generalized
to similar settings in other places and times. For a program to be classified as working,
there must be a minimum of two level 3 studies with significance tests demonstrating
effectiveness and the preponderance of evidence in support of the same conclusion.
What does not work. These are programs that the authors were reasonable certain fail to
prevent crime or reduce risk factors for crime, using the identical scientific criteria used
for deciding what works. For the classification of not working, there must be a minimum
of two level 3 studies with significance tests showing ineffectiveness and the
preponderance of evidence in the same direction.
What is promising. These are programs for which the level of certainty from available
evidence is too low to support generalizable conclusions but for which there is some
empirical basis for predicting that further research could support such conclusions. For
41
the classification of promising, at least one level 3 study is required with significance
tests showing effectiveness and the preponderance of evidence in support of the same
conclusion.
What is unknown. Any program not classified in one of the three above categories is
considered to have unknown effects.”
Source: Welsh and Farrington, (2003:169-170)