A Prospective Study of Psychiatric Comorbidity and Recidivism Among Repeat DUI Offenders

Effectiveness of contingency management using transdermal alcohol monitoring to reduce heavy drinking among driving while intoxicated (DWI) arrestees: A randomized controlled trial

BACKGROUND

Driving while intoxicated (DWI) is a serious public health problem. However, treatment for DWI arrestees is not readily available. This study examines the effectiveness of a contingency management (CM) procedure using transdermal alcohol concentration (TAC) monitoring to reduce drinking among DWI arrestees.

METHOD

The study participants were 216 DWI arrestees under pretrial and included both Mandated participants undergoing court-ordered TAC monitoring and Non-Mandated participants wearing a study-provided TAC monitor. Participants were randomly assigned to either a CM (Mandated = 35; Non-Mandated = 74) or a Control condition (Mandated = 37; Non-Mandated = 70) and completed the 8-week intervention. CM participants received $50/week for not exceeding a TAC of 0.02 g/dL during the previous week. Payments to Controls were yoked to the CM group.

RESULTS

Among Non-Mandated participants, the probability of meeting the contingency was higher and remained stable (about 65%) over time in the CM group, whereas the probability was lower and declined in the Control group, widening the gaps in the probability between the study conditions (16.7%-24.1% greater in the CM group from visit 4 to 8, all p < 0.05). Among Mandated participants, the probability was not significantly different between conditions (p = 0.06-0.95). Furthermore, among Non-Mandated participants, the percentage of heavy drinking days remained low (9.16%-11.37%) in the CM group, whereas it was greater and increased over time (17.43%-26.59%) in the Control group. In Mandated participants, no significant differences in percent heavy drinking days were observed between conditions (p = 0.07-0.10).

CONCLUSION

We found that contingency effects on alcohol use are more pronounced among frequent and heavy alcohol users, i.e., Non-Mandated DWI arrestees. However, for individuals whose drinking was already suppressed by existing contingencies (i.e., court-mandated TAC monitoring), our CM procedure did not produce additional reductions in drinking.

Psychopathic Traits Are Associated with Lifetime History of Nicotine Dependence among Incarcerated Offenders

Background: Individuals scoring high on psychopathy engage in problematic patterns of alcohol and illicit substance use. However, our understanding regarding the association between psychopathy and nicotine use remains limited, which is surprising, given the detrimental consequences associated with such use. Previous studies have observed significant correlations between psychopathic traits (particularly Factor 2 scores assessing lifestyle/behavioral and antisocial traits from the Psychopathy Checklist - Revised [PCL-R]) and increased frequency of nicotine use. However, no study has investigated whether individuals scoring high on psychopathy are characterized by problematic patterns of nicotine use, including lifetime history of nicotine dependence.Objectives: The current study aimed to address this gap, specifically investigating whether PCL-R scores were associated with higher total scores from the Fagerström Test for Nicotine Dependence (FTND).Results: Across both incarcerated men and women, PCL-R total, Factor 2, and Facet 3 (measuring lifestyle/behavioral psychopathic traits) scores were positively correlated with FTND total scores. Additionally, across both samples, hierarchical linear regression analyses revealed these same psychopathy scores remained associated with higher FTND total scores when controlling for additional covariate measures (e.g., age, severity of alcohol and illicit substance use, race, ethnicity, and IQ).Conclusions/Importance: Though associated with small effect sizes, our results support the notion that lifestyle/behavioral psychopathic traits represent a general risk factor for engaging in risky behavior associated with deleterious health consequences, including nicotine use. Our results hold implications for the development of treatment approaches, designed to reduce problematic levels of substance use among individuals scoring high on psychopathy.

Recidivism prevention for impaired driving: Longitudinal 5-year outcomes from Quebec's severity-based intervention assignment program

INTRODUCTION

Driving while impaired by alcohol (DWI) is a persistent problem. Tailoring intervention modality to client risk and needs (i.e., risk/needs) is posited to both reduce recidivism more efficiently than uniform approaches and circumvent overtreatment or undertreatment. DWI drivers in Quebec must participate in a severity-based intervention assignment program to be relicensed, but like most tailoring programs it has yet to undergo systematic scrutiny. The current longitudinal cohort study tests two main hypotheses underpinning this approach: 1) drivers classified at higher recidivism risk based on their arrest characteristics (DWI_R) show poorer outcomes over up to 5-years postassessment compared to drivers classified at lower risk (DWI_F); and 2) for both DWI_R and DWI_F groups, assignment of drivers with greater risk/needs to intensive intervention (II) will be advantageous for reducing recidivism risk compared to assignment into brief intervention (BI) for those with lower risk/needs.

METHODS

Drivers who entered the program from 2012 to 2016 were followed to the end of 2018 (N = 37,612). Survival analysis examined the predictive validity of the initial classification into DWI_R or DWI_F groups for documented recidivism over a follow-up of up to 5 years. Logistic regression discontinuity evaluated the relative outcomes of drivers who were assigned to either BI or II. The study explored interaction effects between classification and intervention assignment with age and sex.

RESULTS

In line with the hypothesis, the average hazard of recidivism was 58 % greater in DWI_R drivers compared to DWI_F drivers. In both DWI_F and DWI_R drivers, assignment of drivers with greater risk/needs to II was associated with reduced recidivism compared to assignment of drivers with lower risk/needs to BI, with 57 % and 35 % decreased probability of recidivism, respectively. Younger age was more strongly associated with recidivism risk in DWI_F drivers than in DWI_R drivers.

CONCLUSIONS

The current study found that Quebec's severity-based intervention assignment approach accurately identifies DWI drivers who: i) by their arrest characteristics pose a greater risk for recidivism, which may require expeditious exposure to preventative countermeasures; and ii) as a function of their greater risk/needs, benefit from assignment to more intensive intervention to mitigate their recidivism risk.

Evaluating the Computerized Assessment and Referral System (CARS) Screener: Sensitivity and Specificity as a Screening Tool for Mental Health Disorders among DUI Offenders

Background/Purpose: A growing body of evidence suggests that people who are arrested for driving under the influence (DUI) of alcohol are more likely to screen positive for psychiatric disorders than the general population. Additionally, psychiatric comorbidity has been shown to increase vulnerability to criminal re-offense. However, DUI programs face many barriers to screening for psychiatric disorders. This paper evaluates the sensitivity and specificity of a screening tool developed for these programs, the Computerized Assessment and Referral System (CARS) Screener. Methods: We used data from 381 DUI offenders in Massachusetts, as well as a secondary data source, the National Comorbidity Survey-Replication (NCS-R: N = 9,282) to examine the accuracy of the CARS Screener when compared to full assessment. Results: Based on both sets of analyses, we found that the CARS Screener offers a sensitive and specific method to screen for many psychiatric disorders. Specifically, the CARS Screener has a high sensitivity and specificity for bipolar disorder, intermittent explosive disorder, depressive disorders, generalized anxiety disorder, alcohol and drug use disorders, gambling disorder, post-traumatic stress disorder, panic attacks, and social phobia. Conclusion: The CARS Screener appears to be an effective tool that will help DUI programs better understand and address the mental health issues facing their clients.

Psychiatric comorbidity among first-time and repeat DUI offenders

Driving under the influence of alcohol or other substances is a serious public health concern. Previous research has shown that psychiatric comorbidity is more prevalent for repeat offenders than the general population, and that first-time offenders exhibit elevated rates of psychiatric comorbidity, but few studies have directly compared first-time and repeat DUI offenders. The current study compares psychiatric comorbidity among repeat and first-time DUI offenders. First-time and repeat DUI offenders completed the screener module of the Computerized Assessment and Referral System (CARS), adapted from the Composite International Diagnostic Interview (CIDI: Kessler & Ustun, 2004), to measure potential psychiatric comorbidity. For 16 of 19 psychiatric disorders, repeat DUI offenders were more likely to screen positive during their lifetime compared with first-time DUI offenders. Similarly, repeat DUI offenders were more likely to screen positive during the past year for 11 of 16 assessed psychiatric disorders. Overall, repeat DUI offenders screened positive for an average of 6.3 disorders during their lifetime, compared to first-time offenders who screened positive for an average of 3.7 disorders. Repeat DUI offenders also screened positive for more past-year disorders (M = 3.3) than first-time offenders (M = 1.9). Compared to first-time offenders, repeat DUI offenders evidence more severe and pervasive psychiatric comorbidity. Further research is necessary to determine whether psychiatric comorbidity among first-time offenders directly predicts re-offense. If so, screening for mental health issues among first-offenders could provide valuable information about how best to allocate resources for these offenders.

Randomized Clinical Trial Examining Cognitive Behavioral Therapy for Individuals With a First-Time DUI Offense

BACKGROUND

Driving under the influence (DUI) programs are a unique setting to reduce disparities in treatment access to those who may not otherwise access treatment. Providing evidence-based therapy in these programs may help prevent DUI recidivism.

METHODS

We conducted a randomized clinical trial of 312 participants enrolled in 1 of 3 DUI programs in California. Participants were 21 and older with a first-time DUI offense who screened positive for at-risk drinking in the past year. Participants were randomly assigned to a 12-session manualized cognitive behavioral therapy (CBT) or usual care (UC) group and then surveyed 4 and 10 months later. We conducted intent-to-treat analyses to test the hypothesis that participants receiving CBT would report reduced impaired driving, alcohol consumption (drinks per week, abstinence, and binge drinking), and alcohol-related negative consequences. We also explored whether race/ethnicity and gender moderated CBT findings.

RESULTS

Participants were 72.3% male and 51.7% Hispanic, with an average age of 33.2 (SD = 12.4). Relative to UC, participants receiving CBT had lower odds of driving after drinking at the 4- and 10-month follow-ups compared to participants receiving UC (odds ratio [OR] = 0.37, p = 0.032, and OR = 0.29, p = 0.065, respectively). This intervention effect was more pronounced for females at 10-month follow-up. The remaining 4 outcomes did not significantly differ between UC versus CBT at 4- and 10-month follow-ups. Participants in both UC and CBT reported significant within-group reductions in 2 of 5 outcomes, binge drinking and alcohol-related consequences, at 10-month follow-up (p < 0.001).

CONCLUSIONS

In the short-term, individuals receiving CBT reported significantly lower rates of repeated DUI than individuals receiving UC, which may suggest that learning cognitive behavioral strategies to prevent impaired driving may be useful in achieving short-term reductions in impaired driving.

Externalizing and self-medicating: Heterogeneity among repeat DUI offenders

AIM

Despite significant reductions in Driving Under the Influence (DUI) in the United States during recent decades, DUI continues to be a major public health threat. The current study investigated the intersection of two domains known to influence DUI: criminal history and psychiatric comorbidity.

METHODS

DUI recidivists (N = 743) attending a court-mandated two-week inpatient DUI program completed a computerized mental health assessment as part of their intake to that program. Participants' criminal records were obtained 4-5 years after program attendance.

FINDINGS

This study identified three primary repeat DUI offender subtypes with distinct patterns of criminal behavior and psychiatric comorbidity: (Type I) those whose DUI emerges from a pattern of drinking to cope with mood and anxiety problems, (Type II) those whose DUI emerges as part of a larger pattern of externalizing and criminal behavior, and (Type III) those whose DUI offenses reflect more acute triggers and isolated episodes of excessive drinking.

CONCLUSION

These findings suggest that current treatment models used in DUI programs are inadequate to address the heterogeneity in the population of DUI recidivists and that earlier and more comprehensive screening would allow for better targeting of resources to DUI offender subtypes.

Characteristics of Prescription-Opioid-Impaired and Other Substance-Impaired Drivers in Rural Appalachian Kentucky

Previous studies have highlighted the prescription opioid epidemic in rural Appalachia and its associated risk behaviors; however, no studies have examined prescription-opioid-impaired driving as a consequence of this epidemic. The purpose of the present study was to describe prescription-opioid-impaired drivers in rural Appalachian Kentucky and examine how they are similar to and different from other substance-impaired drivers from the region. A sample of convicted DUI offenders from rural Appalachian Kentucky completed a confidential research interview focused on their substance use, mental health, and criminal activity. Prescription-opioid-impaired drivers (n = 33) were compared to other drug-impaired drivers (n = 29) and to alcohol-only-impaired drivers (n = 44). Overall, prescription-opioid-impaired drivers had a similar prevalence of illicit substance use and criminal activity, including impaired driving frequency, to other drug-impaired drivers, but had a higher prevalence of illicit substance use and more frequent impaired driving when compared to alcohol-only-impaired drivers. Study implications include the importance of comprehensive substance abuse assessment and treatment for DUI offenders and the need for tailored interventions for prescription-opioid-impaired and other drug-impaired drivers.

Prevalence of psychiatric disorders, comorbidity patterns, and repeat offending among male juvenile detainees in South Korea: a cross-sectional study

BACKGROUND

High rates of psychiatric disorders and comorbidities have been reported in juvenile detainees, and both phenomena are thought to contribute to repeat offending. However, research on this topic has been limited in Asian countries, like South Korea. The purpose of this study was to examine the prevalence of psychiatric disorders, comorbidity patterns, and the relationship between psychiatric disorders and repeat offending among a cross-section of youths detained in a male juvenile detention center in South Korea.

METHODS

One hundred seventy-three juvenile detainees were recruited. The distribution of psychiatric disorders within the sample was estimated by applying criteria from the Diagnostic and Statistical Manual of Mental Disorders IV. Logistic regression was used to assess significant comorbidity patterns and relationships between psychiatric disorders and repeat offending.

RESULTS

In all, 90.8% of the detainees had at least one psychiatric diagnosis, and 75.1% had psychiatric comorbidities. The most common psychiatric disorder was alcohol use disorder, followed by conduct disorder and attention-deficit hyperactivity disorder. Among the comorbidities present, alcohol use disorder with disruptive behavior disorder was the most common combination. The presence of two psychiatric disorders was associated with a higher rate of recidivism, and alcohol use disorder was also associated with repeat offending when combined with disruptive behavior disorders, but not with anxiety disorders, major depression, or psychotic disorders.

CONCLUSIONS

Juvenile detainees evidence high rates of psychiatric disorders and comorbidities. Assessment of and intervention in psychiatric disorders, especially alcohol use disorder and comorbid alcohol use disorder with disruptive behavior disorders, may help prevent further offenses.