Hardcore drinking drivers and other contributors to the alcohol-impaired driving problem: need for a comprehensive approach

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.

Does the inclusion of vehicle impoundment in provincial short-term administrative driver's license suspension programs reduce total and alcohol-related fatal collisions in Canada?

Objectives: To determine (1) whether the implementation of vehicle impoundment as part of provincial short-term administrative driver licensing suspension (ADLS) programs significantly reduced total and alcohol-related collision fatalities, and (2) if provinces with vehicle impoundment as part of their short-term ADLS programs see greater reductions in total and alcohol-related fatal collisions when compared to provinces without a vehicle impoundment law.Methods: Data on monthly total and alcohol-related fatal collisions from January 2005 to December 2016 are drawn from British Columbia (BC), Alberta (AB), Saskatchewan (SK), Manitoba (MB) and Ontario (ON). Changepoint time series analysis of fatal crashes is employed to detect within-province differences after implementing short-term impoundment programs, and between province differences comparing provinces with short-term impoundment programs (BC, introduced October 2010; AB, introduced July 2012; and SK, introduced July 2014) and those without (ON and MB). Outcome measures are the monthly per capita total and alcohol-related fatal collisions.Results: A significant reduction in per-capita alcohol-related fatal crashes was observed in British Columbia (-47.4%) in the period following the adoption of vehicle impoundment in their short-term ADLS. A significant decrease was also observed in Alberta (-37.5%), though this trend began prior to policy change; no significant effect was observed in per capita alcohol-related fatal crashes rates in Saskatchewan (-6.1%) in the two years following the introduction of vehicle impoundment. Ontario and Manitoba, two provinces without mandatory vehicle impoundment laws, also experienced significant reductions in per-capita alcohol-related fatal crashes between 2005 and 2016 (-36.4% and -35%, respectively).Conclusions: While mandatory vehicle impoundment programs for driving in the "warn" range (0.05%-0.08% BAC) have shown success in reducing fatal crashes in British Columbia, similar reductions in two other provinces with short-term vehicle impoundment were not observed. Moreover, large reductions in fatal crashes were observed in two provinces without vehicle impoundment as part of their short-term ADLS programs. Collectively, these findings suggest that vehicle impoundment, alone, has limited impact on fatal crash rates and that other factors help to explain the observed trends. Further analysis of new vehicle impoundment programs is warranted.

Ethical Acceptability of Reducing the Legal Blood Alcohol Concentration Limit to 0.05

Twenty-nine Americans die in alcohol-impaired driving crashes daily. The National Academies of Sciences, Engineering, and Medicine released a report that identified strategies to reduce alcohol-impaired driving deaths. One strategy suggests amending state laws to reduce the legal blood alcohol concentration (BAC) limit from 0.08 to 0.05. Although BAC 0.05 laws would likely reduce alcohol-related deaths, they are also controversial. Critics object to these laws because they restrict individual liberty and fail to consider that individuals value social drinking. We explored the ethical acceptability of BAC 0.05 laws. We made an ethical argument in support of BAC 0.05 laws, which include preventing harm to both drinking drivers and to others. We then considered and rejected liberty-based objections to BAC 0.05 laws. We concluded that BAC 0.05 laws are not only ethically defensible but desirable. States and Congress should work to promote them.

Drivers with alcohol use disorders and their risks of crash involvement

BACKGROUND

The relationship between driver blood alcohol concentration (BAC) and crash involvement is well understood. However, the role of alcohol use disorders (AUDs) (i.e., dependence or abuse) in crash occurrence, as distinguished from non-clinical heavy alcohol consumption, has not been adequately explored.

METHODS

Data from the 2010-2011 Crash Risk Study conducted in Virginia Beach, VA, were used in this study. Drivers involved in crashes were compared with control drivers, and four drinker groups were examined: alcohol dependent, alcohol abusers, heavy drinkers, and all other current (i.e., normative) drinkers. Logistic regression analyses were conducted on two outcomes: having a moderate BAC (≥0.05 g/dl), and crash involvement.

RESULTS

Overall, 2411 crash-involved and 5514 control drivers provided useable data, 52.4% of which were men and 70.8% Whites. The prevalence of drivers with AUDs was lower for the crash-involved drivers (8.7%) than for the control drivers (12.7%). Only heavy drinkers, but not abusive or dependent drinkers, were over four times more likely to drive with moderate BACs at nighttime. More important, at nighttime, the odds of crash involvement for dependent drinkers were only one third of those for normative drinkers. Daytime crashes, however, were more likely to involve normative drinkers than any of the other three drinker types.

CONCLUSIONS

Drivers with AUDs are not more likely than normative drinkers to drive with moderate BACs at night. After accounting for the influence of BAC, dependent drinkers have a lower risk of being involved in a crash, at any time of the day.

Alcohol-impaired driving in the United States: contributors to the problem and effective countermeasures

OBJECTIVE

To review the effectiveness of current countermeasures in alcohol-impaired driving.

METHOD

This article provides an overview of the contributors to the alcohol-impaired driving problem in the United States and reviews the effectiveness of alcohol-impaired driving countermeasures.

RESULTS

Many effective countermeasures have been used during the past few decades both to deter drivers from driving when they are over the legal limit for alcohol and to discourage driving while intoxicated (DWI) offenders from reoffending once they have been caught and convicted. In recent years, greater attention has been given to the problem of "hardcore" drinking drivers, a term coined to refer to those who repeatedly drive with high blood alcohol concentrations and are resistant to changing their behavior. Although such individuals are a legitimate target for attention, focusing predominantly on this group will result in missed opportunities to address a large portion of alcohol-impaired driving crashes. This article provides a review of the primary countermeasures that have been used to reduce alcohol-impaired driving and summarizes evidence for their effectiveness. It asks the question of where, in an environment of limited resources, attention should be focused.

CONCLUSIONS

General deterrent approaches, such as frequent and highly publicized sobriety checkpoints, have the greatest potential to save lives and should be the mainstay of state and local efforts. Specific deterrent approaches, aimed at deterring DWI offenders from reoffending, such as alcohol ignition interlocks, should be applied to all apprehended drivers, whatever their drinking history. Evidence suggests that they could benefit from them. In the future, advanced in-vehicle technologies that would prevent vehicles from being driven when their drivers are over the legal limit may hold the key to drastically reducing the alcohol-impaired driving problem.

Decision-making capacities and affective reward anticipation in DWI recidivists compared to non-offenders: a preliminary study

OBJECTIVES

Impaired decision making is seen in several problem behaviours including alcoholism and problem gambling. Decision-making style may contribute to driving while impaired with alcohol (DWI) in some offenders as well. The Somatic Marker Framework theorizes that decision making is the product of two interacting affective neural systems, an impulsive, rapid, amygdala-dependent process for emotionally signalling the immediate negative or positive consequences of an option, and a reflective, longer-lasting, ventral medial prefrontal cortex dependent system for emotionally signalling the future negative or positive prospects of an option. This study tested the hypothesis that offenders who showed disadvantageous decision-making would be at higher risk for recidivism than those who showed more advantageous decision-making. In addition, in line with the Somatic Marker Hypothesis, offenders who showed disadvantageous decision-making would exhibit a distinct pattern of somatic activation compared to offenders who showed more advantageous decision-making.

METHODS

A sample of 21 DWI offenders with from 2 to 7 past DWI convictions and a reference group consisting of 19 non-offender (N-O) drivers were recruited and administered the Iowa Gambling Task (IGT), as well as evaluated on sociodemographic, driving and alcohol use dimensions. In addition, anticipatory skin conductance response (aSCR) was measured in the 5s prior to each of a 100 card draws on the IGT.

RESULTS

Median split of the DWI offender sample based upon overall performance on the IGT yielded two subgroups (IGT-R Hi and IGT-R Lo). Hypothesis 1 was supported, as the IGT-R Lo group possessed significantly greater frequency of past DWI convictions and severity of past drinking. Descriptive analyses revealed that on the IGT, IGT-R Hi group performed similarly to the N-O reference group while the IGT-R Lo group performed significantly worse. Hypothesis 2 was not supported.

CONCLUSIONS

Decision making is a plausible explanatory neurocognitive pathway to severer forms of DWI. The role of emotional processing in DWI risk is uncertain. Subtyping DWI offenders using neurocognitive criteria seems a promising avenue for improving clinically meaningful methods of DWI risk assessment and intervention.

Reducing impaired driving through the identification of Repeat Target Vehicles: A case study

INTRODUCTION

One of the most persistent groups of impaired drivers that are seemingly unaffected by social pressure, moral appeals, and the fear of arrest is that of the repeat impaired driver. This smaller group accounts for a disproportionate number of all impaired driving trips, often with high blood alcohol contents. New approaches are needed to identify and deal with the repeat impaired driver.

METHOD

We propose a method based on the discovery that almost 10% of all impaired driving calls for service involve repeat vehicles. Using the number of times a vehicle appears in our data, the average time to repeat, and the personality characteristics of the repeat impaired driver, we are able to create a comprehensive and predictive description of a Repeat Target Vehicle (RTV).

CONCLUSIONS

Our method provides an opportunity to explore new and innovative crime reduction strategies that were never before possible.

Do components of current 'hardcore smoker' definitions predict quitting behaviour?

AIMS

It has been hypothesized that the smoking population is represented by an increasingly 'hardcore' group of smokers who are resistant to quitting. Many definitions of 'hardcore smokers' have been used, but their predictive validity is unknown. To evaluate whether 'hardcore smoker' definition components predict quitting behaviours and which combinations of 'hardcore' components are most predictive.

DESIGN, SETTING AND PARTICIPANTS

Longitudinal, random telephone survey of a representative sample of adult smokers in Ontario, Canada (n = 4130, recruited 2005-08 and followed for 1 year).

MEASUREMENTS

Multiple logistic regression models were compared to evaluate the predictive ability of 'hardcore' components (high daily cigarette consumption, high nicotine dependence, being a daily smoker, history of long-term smoking, no quit intention and no life-time quit attempt) on three outcomes [continued smoking, not attempting to quit and having unsuccessful quit attempt(s)].

FINDINGS

All 'hardcore' components predicted having no quit attempt and continued smoking during follow-up (P < 0.05), except for history of long-term smoking and no life-time quit attempt (for continued smoking). Among respondents who made 1 + quit attempts during follow-up, only high nicotine dependence, high daily cigarette consumption and being a daily smoker were predictive of quitting failure (P < 0.01). The best combination of components depended on the outcome.

CONCLUSIONS

Measures of 'hardcore' include a mixture of motivational, dependence and behavioural variables. As found previously, motivational and behavioural measures, such as intention to quit, predict failure to make quit attempts. However, dependence components best predicted continued smoking and thus would be best for further exploring the hardening hypothesis.

A study of alcohol use by designated drivers among college students

OBJECTIVE

College students tend to drink while serving as a designated driver (DD). The predictors of alcohol use by DDs among college students were examined.

PARTICIPANTS

Participants were 119 undergraduate students in introductory psychology courses who had experience with DD use.

METHODS

Survey data were analyzed to examine the predictors of planning components of DD use, such as choosing a DD before drinking and choosing an abstinent DD, and the relations of these components to alcohol use by DDs.

RESULTS

History of DD use, friends' willingness to be the DD, frequency of riding with a driver who drank and drove, and age of drinking onset were associated with planning components of DD use. Among the planning components of DD use, choosing a DD before drinking was significantly related to less alcohol use by DDs.

CONCLUSIONS

Increasing awareness of the planning components of DD use could deter alcohol use by DDs among college students.

Drinking characteristics of drivers arrested for driving while intoxicated in two police jurisdictions

OBJECTIVE

Are drivers arrested for driving while intoxicated (DWI) most likely to be the drinking drivers who are involved in fatal and serious injury crashes? This study determined the drinking characteristics of drivers arrested for DWI or driving under the influence (DUI) and the proportion classified as problem drinkers and hardcore drinking drivers in two police jurisdictions. In addition to determining the drinking characteristics of DWI arrestees, the results were compared to the drinking characteristics of intoxicated drivers killed in traffic crashes.

METHOD

Police officers gathered data at the time of arrest from 1027 drivers apprehended for DWI or DUI in the two communities on their alcohol consumption, their drinking-and-driving frequency, their self-reported alcohol problems, their place of drinking and types of drinks before the arrest, and their perceptions of impaired-driving enforcement intensity.

RESULTS

Data analyses indicated that 52 percent of the arrested DWI offenders were considered problem drinkers, 46 percent were repeat offenders, 57 percent were classified as hardcore drinking drivers, 51 percent were drinking at a bar or restaurant before their arrest, and 72 percent were drinking beer before their arrest.

CONCLUSIONS

Compared to highly intoxicated (blood alcohol concentration [BAC] ≥.15) drivers killed in traffic crashes, the high-BAC arrestees were substantially more likely to be problem drinkers and to report drinking and driving more often. The limited resources available for combating impaired driving should not be solely allocated to problem drinkers, hardcore drinkers, or repeat offenders because, at most, they constitute only about half of the impaired-driving problem in the United States. General deterrent strategies have the best chance of impacting the total population of at-risk drinking drivers.

Posts to online news message boards and public discourse surrounding DUI enforcement

OBJECTIVE

This study analyzes posts to online news message boards covering driving under the influence (DUI) enforcement efforts to determine their usefulness for informing traffic safety program planning and public relations efforts aimed at mainstream drinking drivers.

METHODS

A series of Google searches were conducted using keywords designed to capture news stories regarding impaired driving enforcement efforts. For each search, the first 100 Web pages returned were reviewed and articles were included in analysis if they were from an independent news source and contained user comments. Coders captured data on 28 fields for each post, including tone in relation to enforcement, tone of interpersonal communication with other posters, and expressed feelings regarding drinking and driving.

RESULTS

Fifty-six news articles covering DUI enforcement efforts met study criteria, with 615 posts. The majority of posts (57%) were neutral on DUI enforcement; 24 percent (148) took a negative tone and 19 percent (115) positive. Posts that discussed checkpoints were 2.6 times more likely to take a negative tone toward enforcement than those that did not. Twenty-one percent of anti-enforcement posts challenged the idea that driving after drinking was necessarily dangerous. Of the 321 posts involving direct communication between posters, 67 percent involved disagreement with another post. Profanity or belittling comments appeared in 10 percent of posts.

CONCLUSION

Public responses to DUI enforcement news articles provide insight into the beliefs and thought processes of those who oppose enforcement efforts or view drinking and driving as no big deal. Primary objections to enforcement focused on civil and personal rights issues, skepticism regarding law enforcement's motives and objectivity, and the belief that drinking driving is not a "real" crime. Online news message boards could be useful in informing campaigns and helping program planners frame media events and press releases to best appeal to the most at-risk segments of the driving public.

Results from a national survey of Crown prosecutors and defense counsel on impaired driving in Canada: a "System Improvements" perspective

INTRODUCTION

This article summarizes the main findings from a study designed to examine the legal process in Canada as it applies to alcohol-impaired driving from the point of view of Crown prosecutors and defense counsel, and to identify evidentiary or procedural factors that may impact the legal process, the rights of the accused, and interactions of all parts in the legal process.

METHOD

The data in this study were collected by means of a survey that was mailed out to the population of Crown prosecutors and defense counsel in Canada. In total, 765 prosecutors and 270 defense lawyers or an estimated 33% of all Canadian prosecutors and 15% of defense lawyers completed and returned the questionnaire. The "systems improvement" paradigm was used to interpret the findings and draw conclusions. Such an approach acknowledges the importance of the context in which countermeasures are implemented and delivered and the structures or entities used to deliver countermeasures to a designated target group.

RESULTS

Results on type of charges and breath alcohol concentration, caseload, case outcomes, case preparation time, conviction rate at trial and overall conviction rate, reasons for acquittals and time to resolve cases are described.

DISCUSSION

The findings from this national survey suggest that there are important challenges within the criminal justice system that impede the effective and efficient processing of impaired driving cases. Some of these challenges occur as a function of practices and policies, while others occur as a function of legislation.

IMPACT ON INDUSTRY

This study illustrates that a "system improvements" approach that acknowledges the importance of all elements of the criminal justice system and the interaction between those elements, can be beneficial in overcoming the alcohol-impaired driving problem.

Identifying repeat DUI crash factors using state crash records

The objective of this study is to identify high risk factors that are closely related to repeat DUI crashes using readily available information from the state crash records. Survival analysis was used and a Cox proportional hazards model was developed using the police-reported crash records in the state of Louisiana. A variety of variables were found to be significant in predicting repeat DUI crashes. The factors included the characteristics of the drivers (gender, race, and age), the types of the vehicle (light truck/pick up truck or other), the characteristics of the crash (hit-and-run, driver violations, and whether the driver is arrested), the type of location (residential area or other), and the characteristics of the roadway (highway type and roadway type). This study provides a comprehensive picture of the repeat DUI crashes. The model can quantitatively predict the relative hazards of repeat DUI crashes. It can be used to identify the characteristics of the crash-involved DUI drivers who are at greatest risk of being involved in a subsequent DUI crash, allowing to apply appropriate remedial measures to reduce the risk.

Transportation and aging: a research agenda for advancing safe mobility

PURPOSE

We review what we currently know about older driver safety and mobility, and we highlight important research needs in a number of key areas that hold promise for achieving the safety and mobility goals for the aging baby boomers and future generations of older drivers.

DESIGN AND METHODS

Through the use of a framework for transportation and safe mobility, we describe key areas of screening and assessment, remediation and rehabilitation, vehicle design and modification, technological advancements, roadway design, transitioning to nondriving, and alternative transportation to meet the goals of crash prevention and mobility maintenance for older adults.

RESULTS

Four cross-cutting themes emerged from this review: safe transportation for older adults is important; older adults have a variety of needs, abilities, and resources; research to help meet the transportation needs of older adults may be of benefit to persons with disabilities; and transportation issues concerning older adults are multifaceted.

IMPLICATIONS

Safe mobility is essential to continued engagement in civic, social, and community life, and to the human interactions necessary for health, well-being, and quality of life. When safe driving is no longer possible for older adults, safe and practicable alternative transportation must be available. Furthermore, older adults are individuals; they have specific needs, abilities, and resources. Not all older adults will have difficulty meeting their transportation needs and no single transportation solution will work for all people. Research and countermeasures intended to help meet the transportation needs of older adults will likely also benefit younger users of the transportation system, particularly those with disabilities. The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if we are to make significant progress in the next decade as the baby boomers begin to reach age 70.