Flexibility Matters for DUI Population

The profile of many individuals who arrive at treatment because of an offense for driving under the influence does not exactly spell “ideal candidate” for treatment. Many DUI offenders are not inclined to agree that they need to change their substance-using behavior. Also, most do not meet diagnostic criteria for a current alcohol use disorder, making formal abstinence-based treatment a questionable fit.

“Treatment programs are at a disadvantage with this population,” says Thomas H. Nochajski, PhD, associate research scientist at the University at Buffalo's Research Institute on Addictions, who has studied the DUI offender for about 20 years. “Offenders come into the situation feeling that they have been done an injustice. They're not prepared to be treated; they're just angry because they got caught.”

Yet with some studies indicating that the number of DUI incidents for the average individual prior to the outcome of an actual arrest can amount in the hundreds, compelling health and public safety reasons exist for addressing problems in this population. Nochajski and colleague Paul R. Stasiewicz, PhD, director of the Research Institute's Clinical Research Center, set out to summarize current research knowledge about DUI recidivism and the impact of both justice- and treatment-focused approaches to the problem.

Their findings, published in the March 2006 issue of Clinical Psychology Review, indicate that the term “DUI population” is something of a misnomer, as this is a heterogeneous group of individuals requiring tailored approaches by treatment professionals.

Sorting out the data

Although the overall number of DUI incidents in the United States has declined substantially since the 1980s, signs point to having reached a plateau in overall progress. Nochajski and Stasiewicz's review indicates that the percentage of the driving population reporting driving after drinking, the number of DUI arrests, and the number of alcohol-related fatal accidents on U.S. roads all have remained relatively stable over the past ten years.

Moreover, the problem of driving under the influence of drugs has actually worsened during the period when some gains against drunk driving were being made. The researchers cite a 1994 study published in the New England Journal of Medicine finding that more than half of individuals stopped for reckless driving tested positive for cocaine or marijuana.

Men are consistently shown to be more likely to become repeat DUI offenders than women, with recidivism generally defined in most studies as having received a subsequent DUI arrest. Repeat offenders also are less likely to have a college education and are more likely to be unemployed or have a low income than first-time offenders, and have greater levels of substance abuse severity and psychiatric distress. In addition, there is evidence that DUI offenders are generally poorer drivers overall, already making them a target of law enforcement regardless of drinking behavior.

Past treatment for substance use problems has been found to be a good indicator of current repeat DUI offender status. However, Nochajski and Sta-siewicz's research review states that for those who have had three or more alcohol treatment episodes, treatment may serve as a protective factor for DUI recidivism. “It may be that these individuals finally recognize that there is a problem and take steps to change their behavior,” the journal article text states.

Sanctions or treatment?

Legal sanctions and rehabilitation programs represent the two main intervention approaches used with the DUI population. Legal sanctions generally stem from deterrence theory, stating that an individual will be less likely to engage in a behavior if there is a perception of certain, swift, and severe punishment for that behavior. Rehabilitation efforts involve both education and treatment, and recently have expanded to include a harm reduction approach for offenders with less severe alcohol problems, Nochajski and Stasiewicz's study states.

The study's findings lend credence to the view that harm reduction has a place in addressing the DUI problem—in fact, an integrated approach that takes advantage of all available interventions seems to make the most sense when considering this diverse population.

Regarding sanctions imposed on DUI offenders, what emerges as a prevalent theme from the research is the importance of a short time span between arrest and disposition of a case. Studies have shown that DUI recidivism increases as the time between arrest and disposition increases, according to the research review. This explains in part why most states have imposed administrative license suspensions that are ordered at the time of arrest as opposed to after a conviction.

Much research finds sanction-based approaches incomplete because relapse rates tend to increase after sanctions are removed. For example, an ignition interlock device for DUI offenders' vehicles may control drinking and driving incidents in the short term, but recidivism tends to return to typical levels for offenders once the device is removed.

“Despite the apparent deterrent effect of legal sanctions, there is a consensus that sanctions alone cannot address certain characteristics of the DUI population that may play a role in determining DUI relapse,” the study states.

Rehabilitation-focused programs for the DUI population have run the gamut from education to cognitive-behavioral therapy to treatment that focuses on individuals' readiness for change. Some interventions, such as victim impact panels in which an offender listens to presentations from people who have suffered harm from the actions of a DUI offender, generally have been shown to have little impact on recidivism.

But Nochajski and Stasiewicz's analysis indicates that an understanding of a DUI offender's characteristics can help professionals match treatment to client needs in order to maximize effectiveness. Studies of cognitive-behavioral models' applicability to the DUI population have found that skills training emphasizing alternative coping strategies for situations that could trigger drinking and driving can be effective—particularly for more socially stable individuals with fewer episodes of heavy drinking.

Because many DUI offenders do not meet diagnostic criteria for a current alcohol use disorder and therefore may express skepticism over the need for formal treatment, approaches that emphasize reducing the risk of future negative consequences of drinking are worth exploring, according to the research review. The study text states that “brief interventions that focus on risk reduction, rather than alcohol use per se, may be more successful in reducing recidivism for individuals with less severe alcohol and drug problems who also may be ambivalent about changing their behavior.”

Implications for professionals

Nochajski considers it critical when looking at the DUI population to distinguish between the subgroup with a substance dependence and the subgroup with an abuse problem. “When you put people with an abuse problem together with those who are dependent, they're going to say, ‘What am I doing here?’” he says.

Other personal characteristics of DUI offenders also should be taken into account, including attitudes toward drinking and driving, depression, motivation to change, and coping skills, the research suggests. Matching offenders to different types of treatment based on these characteristics appears to be a sound strategy. And professionals who come into contact with DUI offenders should remain mindful that in general, “You need both sanctions and treatment,” Nochajski says.

This is a complex population that definitely can tax the patience of a clinical professional, but one for whom good results can happen, Nochajski says. “You can't give up on these guys,” he says. “It may take two or three tries at treatment.”