Self-efficacy and motivation for controlling drinking and drinking/driving: an investigation of changes across a driving under the influence (DUI) intervention program and of recidivism prediction

Alcohol mixed energy drink usage and risk-taking among college students in Western New York State

Alcohol mixed energy drinks (AmED) may promote excessive alcohol intake and risk-taking among college students. Objective: To understand the relationship between AmED use and risky behavior as well as attitudes and motivations for AmED use. Participants: Undergraduate college students N = 422 (Study 1), N = 37 (Study 2). Methods: Using a mixed-methods approach, we first surveyed undergraduate students about their AmED and alcohol consumption and a series of risk behaviors, self-efficacy, and beliefs (Study 1). We then conducted focus groups within the same population to better understand attitudes, knowledge, and motivations for using AmED (Study 2). Results: Recent AmED use was significantly associated with an increased number of reported binge drinking occasions and self-reported driving while intoxicated events. Our qualitative data analyses revealed two major themes associated with AmED consumption: factors encouraging AmED use and decisions about driving while under the influence of alcohol. Conclusions: These findings add to the literature of beliefs and motivations for AmED use among college students.

How do fatalistic beliefs affect the attitudes and pedestrian behaviours of road users in different countries? A cross-cultural study

This paper reports on an exploratory investigation of the influence of five different fatalistic belief constructs (divine control, luck, helplessness, internality, and general fatalism) on three classes of self-reported pedestrian behaviours (memory and attention errors, rule violations, and aggressive behaviours) and on respondents' general attitudes to road safety, and how relationships between constructs differ across countries. A survey of over 3400 respondents across Bangladesh, China, Kenya, Thailand, the UK, and Vietnam revealed a similar pattern for most of the relationships assessed, in most countries; those who reported higher fatalistic beliefs or more external attributions of causality also reported performing riskier pedestrian behaviours and holding more dangerous attitudes to road safety. The strengths of relationships between constructs did, however, differ by country, behaviour type, and aspect of fatalism. One particularly notable country difference was that in Bangladesh and, to a lesser extent, in Kenya, a stronger belief in divine influence over one's life was associated with safer attitudes and behaviours, whereas where significant relationships existed in the other countries the opposite was true. In some cases, the effect of fatalistic beliefs on self-reported behaviours was mediated through attitudes, in other cases the effect was direct. Results are discussed in terms of the need to consider the effect of locus of control and attributions of causality on attitudes and behaviours, and the need to understand the differences between countries therein.

Treatment Initiation and Alcohol Use Violations Among Adults with DWI Arrests Who Received a Tailored Brief Intervention

Objective

This program evaluation examined rates of treatment initiation and alcohol related violations among adults who completed a brief motivational interviewing (BMI) session after a driving while intoxicated arrest.

Method

Adults attending orientation for pretrial bond supervision were assessed for eligibility to receive services by counselors in an outpatient clinic. A total of 118 male and female adults with DWI arrests completed a single BMI session. Treatment initiation was assessed one-week after the BMI session and alcohol-related violations were assessed 6-months later.

Results

Fifty-three percent of those with DWI arrests who received the BMI session-initiated treatment and of those who initiated treatment, alcohol-related violations were significantly lower than for those who did not initiate treatment.

Conclusions

The results provide preliminary support that a single session BMI delivered soon after arrest and before pretrial conditions are implemented has promise for spurring clients to take steps to initiate treatment and is related to better rates of compliance with alcohol-related pretrial conditions.

A theoretical perspective on road safety communication campaigns

This paper proposes a theoretical perspective on road safety communication campaigns, which may help in identifying the conditions under which such campaigns can be effective. The paper proposes that, from a theoretical point of view, it is reasonable to assume that road user behaviour is, by and large, subjectively rational. This means that road users are assumed to behave the way they think is best. If this assumption is accepted, the best theoretical prediction is that road safety campaigns consisting of persuasive messages only will have no effect on road user behaviour and accordingly no effect on accidents. This theoretical prediction is not supported by meta-analyses of studies that have evaluated the effects of road safety communication campaigns. These analyses conclude that, on the average, such campaigns are associated with an accident reduction. The paper discusses whether this finding can be explained theoretically. The discussion relies on the distinction made by many modern theorists between bounded and perfect rationality. Road user behaviour is characterised by bounded rationality. Hence, if road users can gain insight into the bounds of their rationality, so that they see advantages to themselves of changing behaviour, they are likely to do so. It is, however, largely unknown whether such a mechanism explains why some road safety communication campaigns have been found to be more effective than others.

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

OBJECTIVES

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

METHOD

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

RESULT

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

CONCLUSION

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

The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers

OBJECTIVES

This study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics.

METHODS

A nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information-advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change.

RESULTS

Recidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type.

CONCLUSIONS

The results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.

Measurement of readiness to reduce driving speed: a pilot study

Speeding is a preventable risky behavior that contributes to risk of accident. Readiness to change reflects an individual's recognition of and desire to change behavior. No measure to identify readiness to change has yet been validated for speeding. The Readiness to Change Questionnaire appraises readiness to change drinking behavior. The questionnaire was adapted to speeding and its psychometric properties examined. Participants (N = 112) completed the questionnaire and reported their usual driving speed. A clear component structure and acceptable internal consistency and test-retest reliability were found. Convergent validity was indicated by an association between higher readiness to change and lower driving speed. Results support the questionnaire's potential as a measure of readiness to change speeding, and advance research into the role of motivation in speeding behavior.

Kidney patients' intention to receive a deceased donor transplant: development of stage of change, decisional balance and self-efficacy measures

In order to sustain life, patients whose kidneys fail must receive dialysis or obtain a transplant. This study reports on the development and validation of measures of Stage of Change, Decisional Balance and Self-efficacy based on the Transtheoretical Model (TTM) to assess patients' readiness to receive a deceased donor transplant. We surveyed 293 transplant-eligible kidney patients about their deceased donation readiness. Exploratory and confirmatory analyses for all measures demonstrated factor structures similar to previous application of the TTM to other health behaviors, excellent model fit and good internal and external validity. These brief, reliable instruments with good psychometric properties can guide the development of improved, individually-tailored transplant education for patients.

Substance use as a predictor of driving under the influence (DUI) rearrests. a 15-year retrospective study

BACKGROUND

Recidivism is a major problem in the prevention of DUI offenses. It is suggested that impairing substances used by drivers may relate to a higher risk of recidivism. This study aims to determine rearrest rates in different groups of arrested drivers focusing on different substances found in the blood.

MATERIAL AND METHODS

The data utilized were obtained from the register of suspected DUI offenders maintained by the Finnish National Institute for Health and Welfare (THL). Data were available for the 15-year period between 1993 and 2007. The number of rearrests was traced from the individuals' ID codes. The mean blood alcohol concentration (BAC) of the DUI offenders was studied as well as their age at the time of the first arrest. Rearrest rates according to alcohol and drug findings were estimated using survival analysis methods.

RESULTS

At the time of the first arrest, the drivers with a single DUI arrest were older and had a lower BAC than those who had a later arrest. The proportion of female drivers decreased as the number of rearrests increased. Drivers with drugs only or a combination of drugs and alcohol had a significantly higher rearrest rate than drivers with alcohol alone. Drivers with amphetamines only had the highest rearrest rates. Findings of benzodiazepine and opioids alone did not increase the risk of rearrest in the long run. Young age, male sex, high blood alcohol level, and arrest during the nighttime and during weekdays constituted a higher risk for rearrest.

CONCLUSIONS

A third of those suspected of driving under the influence of alcohol and/or drugs are rearrested within 15 years. Drugs, especially amphetamines, are a risk factor for faster rearrest. These results show that the groups at risk of recidivism can be pinpointed. Interventions to prevent recidivism should be developed particularly for drugged drivers. Substance abuse beginning in adolescence seems to be a greater risk.

Social pressure, coercion, and client engagement at treatment entry: a self-determination theory perspective

Research on coercion in addiction treatment typically investigates objective sources of social pressure among legally mandated clients. Little research has examined the impact of clients' perceptions of social pressures in generalist addiction services. Clients seeking substance abuse treatment (N=300; 221 males and 79 females; M age=36.6 years) rated the extent to which treatment was being sought because of coercive social pressures (external motivation; alpha=.89), guilt about continued substance abuse (introjected motivation; alpha=.84), or a personal choice and commitment to the goals of the program (identified motivation; alpha=.85). External treatment motivation was positively correlated with legal referral, social network pressures to enter treatment, and was inversely related to problem severity. In contrast, identified treatment motivation was positively correlated with self-referral and problem severity, and was inversely related to perceived coercion (ps<.05). Hierarchical multiple regression analyses showed that referral source (i.e., mandated treatment status), legal history, and social network pressures did not predict any of 6 measures of client engagement at the time treatment was sought. However, treatment motivation variables accounted for unique variance in these outcomes when added to each model (DeltaR(2)s=.06-.23, ps<.05). Specifically, identified treatment motivation predicted perceived benefits of reducing substance use, attempts to reduce drinking and drug use, as well as self (and therapist) ratings of interest in the upcoming treatment episode (betas=.18-.31, ps<.05). Results suggest that the presence of legal referral and/or social network pressures to quit, cut down, and/or enter treatment does not affect client engagement at treatment entry.

"I'll never drink like that again": characteristics of alcohol-related incidents and predictors of motivation to change in college students

OBJECTIVE

Alcohol use and its associated behaviors are among the most common reasons for medical treatment and disciplinary infractions among college students. The purpose of this study was to describe the characteristics of students who had recent serious alcohol-related incidents and to identify predictors of motivation to change alcohol use and heavy drinking in particular, with specific attention to gender.

METHOD

Students (N = 227; 52% female) who had been mandated to attend a session of alcohol education following alcohol-related medical treatment and/or a disciplinary infraction were assessed on their alcohol use, alcohol problems, characteristics of their alcohol-related incident, reactions to the incident, attributions about the incident, and motivation to change drinking and heavy drinking. Path and regression analyses were used to identify the individual and incident-related characteristics that were related to motivation to change.

RESULTS

Perceived aversiveness of the incident was directly and positively related to motivation to change drinking and heavy drinking. Alcohol consumption in the month before the incident and past-year alcohol problems were negatively related to motivation to change heavy drinking, and women were more motivated to change heavy drinking than men. The more students consumed in the incident, the more likely they were to feel responsible for it, and the more responsible they felt about the incident, the greater its aversiveness.

CONCLUSIONS

Individual and incident-related characteristics are both directly and indirectly associated with motivation to change following an alcohol-related incident, and therefore have implications for interventions with college drinkers who have experienced an alcohol-related incident.

Relapse to driving under the influence (DUI): A review

Driving under the influence (DUI) is a major public health problem. In 2003, there were 17,401 alcohol-related crash fatalities. Although there has been a large decrease in the fatality rates over the past two decades, further progress has stalled in recent years. This plateau in the injury and death rates resulting from impaired driving has been attributed, in part, to the persistent or repeat DUI offender. Broadly defined, repeat offenders are those individuals who, following an initial DUI arrest, relapse to driving under the influence of alcohol and other drugs. In this paper, we first provide a brief overview of several models of DUI relapse. We then review the empirical literature on DUI relapse, the data describing characteristics of first-time and repeat DUI offenders, and, especially, studies that have evaluated the impact of legal sanctions and rehabilitation programs on subsequent DUI behavior. The data reveal that DUI offenders are a heterogeneous group, and that simple models relying on only one or two behavioral domains (e.g., driving characteristics, demographics) to explain DUI relapse are insufficient to account for the DUI behavior of offenders. To advance our understanding of DUI relapse, we argue for development and testing of multifactorial models focusing on the interplay of legal, social and psychological factors that describe and explain relapse among DUI offenders. By recognizing the heterogeneity within the offender population it will be easier for researchers and clinicians to identify subgroups that are at high-risk for relapse and which should be targeted by prevention and intervention programs.

Are depressed drinking/driving offenders more receptive to brief intervention?

The relationship between depressed mood and interest in additional counseling was examined in three samples of adjudicated first DUI (drinking/driving) offenders who were participating in a court-mandated program. Based on prior research suggesting a relationship between depressed mood, higher motivation to change drinking and drinking/driving, and greater effectiveness of additional supportive brief intervention during the program, it was hypothesized that offenders expressing a depressed mood would be more receptive and less resistant to counseling than would offenders not expressing a depressed mood. In three sub-studies using several different measures of depressed mood, depressed mood was related to higher receptivity/lower resistance to counseling. Resistance rates were lowest for counseling that would occur within the program at no additional cost and highest when counseling required extra sessions or extra cost. Overall, Caucasian males were more resistant to counseling than were females or African-American males, although a differential relationship between depression and counseling resistance was not confirmed in comparisons of gender by ethnic groups.

Social control and coercion in addiction treatment: towards evidence-based policy and practice

BACKGROUND

Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research.

APPROACH

Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic.

FINDINGS

Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views.

CONCLUSIONS

Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion.

Self-reported motivations to change and self-efficacy levels for a group of recidivist drink drivers

The present study reports on a group of 132 recidivist offenders' stages of change and self-efficacy levels for changing and controlling both their drinking and drink driving behaviours. The majority of the sample reported being motivated to change their drink driving, but not their drinking behaviours. The sample also indicated high self-efficacy levels for the two behaviours, although a notable finding was that participants reported higher levels of control over their drinking rather than drink driving behaviours. Examination of the self-reported frequency of drink driving revealed that both motivations and self-efficacy levels were predictors of past offences and future intentions to drink and drive. The findings have direct implications for the management of repeat offenders, such as the inclusion of rehabilitation and alcohol treatment programs in sentencing outcomes for individuals who appear resistant to change.

Alcohol-related expectancies are associated with the D2 dopamine receptor and GABAA receptor beta3 subunit genes

Molecular genetic research has identified promising markers of alcohol dependence, including alleles of the D2 dopamine receptor (DRD2) and the GABAA receptor beta3 subunit (GABRB3) genes. Whether such genetic risk manifests itself in stronger alcohol-related outcome expectancies, or in difficulty resisting alcohol, is unknown. In the present study, A1+ (A1A1 and A1A2 genotypes) and A1- (A2A2 genotype) alleles of the DRD2 and G1+ (G1G1 and G1 non-G1 genotypes) and G1- (non-G1 non-G1 genotype) alleles of the GABRB3 gene were determined in a group of 56 medically ill patients diagnosed with alcohol dependence. Mood-related alcohol expectancy (AE) and drinking refusal self-efficacy (DRSE) were assessed using the Drinking Expectancy Profile (Manual for the Drinking Expectancy Profile, Behaviour Research and Therapy Centre, Brisbane, 1996). Patients with the DRD2 A1+ allele, compared with those with the DRD2 A1- allele, reported significantly lower DRSE in situations of social pressure. Similarly, lower DRSE was reported under social pressure by patients with the GABRB3 G1+ allele when compared to those with the GABRB3 G1- alleles. Patients with the GABRB3 G1+ allele also revealed reduced DRSE in situations characterized by negative affect than those with the GABRB3 G1- alleles. Patients carrying the GABRB3 G1+ allele showed stronger AE relating to negative affective change (for example, increased depression) than their GABRB3 G1- counterparts. Biological influence in the development of some classes of cognitions is hypothesized. The clinical implications, particularly with regard to patient-treatment matching and the development of an integrated psychological and pharmacogenetic approach, are discussed.

Relationships between drinking problems and drinking locations among convicted drinking drivers

This study examines relationships between drinking problems and the frequency of drinking in eight types of places within a sample of convicted drinking drivers. Drinking problems were measured by two instruments, the Mortimer-Filkins Questionnaire (MFQ) and the Alcohol Use Disorders Identification Test (AUDIT) Core Questionnaire. Data were collected from convicted drinking drivers who were ordered by the court to attend the Mississippi Alcohol Safety Education Program (MASEP). Both the MFQ and the AUDIT were found to be more strongly related to the frequency of drinking in moving automobiles than to the frequency of drinking in any other type of place. This suggests that drinking drivers with severe drinking problems are more likely to drink in moving automobiles than are those with less severe problems. The strong linkage between severe alcohol problems and drinking in automobiles has important implications with respect to highway safety.