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Court-Mandated Treatment for Convicted Drinking Drivers

Patricia L. Dill, Ph.D., and Elisabeth Wells-Parker, Ph.D.

Court-mandated treatment, which requires offenders convicted of alcohol or other drug-related crimes to participate in treatment for their substance abuse problems or face legal consequences, has long been a component of sanctioning for driving under the influence (DUI) and is a primary path of entry into alcoholism treatment for many people with problem drinking. Several issues are relevant to mandated treatment: screening, assessment and referral, effectiveness, DUI events as opportunities for intervention, brief interventions for offenders outside of mandated treatment, and cost-effectiveness of mandated treatment. Treatment effectiveness depends to some extent on offenders’ motivation to participate, and offenders may resist treatment when their participation is coerced. Types of treatment such as motivational enhancement therapy may prove cost-effective with these involuntary participants. More research is needed into the changing DUI population, impaired driving and multidrug use, and new technologies for monitoring DUI offenders.

Offenders in the criminal justice system who are charged with crimes related to alcohol use (e.g., public drunkenness, driving under the influence [DUI], and underage drinking) can be sentenced to participate in some form of treatment for alcohol problems. This may consist of formal treatment as well as other rehabilitative interventions designed to address problem drinking and its harmful consequences. Court-mandated treatment remains a primary route by which many people enter alcoholism treatment (Weisner et al. 2002)

The terms mandated treatment and coercion often are used interchangeably (Farabee et al. 1998). Mandated treatment is accompanied by "threats of legal consequences if individuals refuse to comply with a referral to treatment" (Polcin and Greenfield 2003, p. 650). Offender perceptions of the likelihood and severity of these sanctions (e.g., jail time or house arrest) are critical determinants of whether these offenders comply with the treatment mandate (Cavaiola and Wuth 2002).

Court-mandated treatment to reduce drinking and driving and treat alcohol problems has been a common element of the sanctioning process, especially for DUI offenders, for several decades. This article focuses on mandated treatment for DUI offenders, who account for a large proportion of those legally required to attend treatment for problems arising specifically from alcohol use (Cavaiola and Wuth 2002; Weisner 1990). The following sections examine forms of mandated treatment; screening, assessment, and referral; the effectiveness of mandated treatment, including treatment matching; DUI events as opportunities for intervention; and brief interventions for offenders outside of mandated treatment. In addition, this article discusses treatment cost-effectiveness and access as well as future research needs and challenges. An exhaustive discussion of research needs for improving alcohol interventions, including treatment, with impaired drivers mandated to treatment in the legal system is beyond the scope of this article.

FORMS OF MANDATED TREATMENT

Mandated interventions for DUI offenders vary in intensity, frequency, and duration, ranging from relatively brief one- or two-session interventions, to multicomponent programs implemented over the course of weeks or months, to inpatient care with lengthy aftercare (Wells-Parker et al. 1995). Treatment referrals may involve several components because DUI offenders are diverse, both in terms of level of alcohol abuse and other characteristics, such as comorbid conditions, that may increase their risk of repeating their offense or becoming involved in a crash (Wells-Parker and Popkin 1994).

DUI offenders who have been mandated to treatment by the courts participate in a wide variety of alcoholism treatment programs (Cavaiola and Wuth 2002; Wells-Parker et al. 1995). Mandated interventions for DUI offenders can include generic alcoholism treatment programs offered in local communities, referral to groups such as Alcoholics Anonymous (AA), and strategies that specifically aim to reduce drinking and driving, such as education programs, supervised probation, and presentations by injured survivors or families of victims killed in alcohol-related crashes (i.e., victim impact panels). Mandated interventions often include supervised probation and other forms of supervision and monitoring as well. In addition to monitoring, these programs can provide supportive contact and assistance with problems that could contribute to the risk of driving while impaired (Wells-Parker et al. 1995).

In the early years of DUI programs, traditional educational programs that focused on teaching offenders about how alcohol impairs driving were based on the premise that most DUI offenders were social drinkers who had too much to drink on one occasion. However, a large body of evidence (Cavaiola and Wuth 2002; Wells-Parker et al. 1995) shows that convicted offenders have a range of drinking problems, as well as other problems that contribute to crash risk, and frequently are at high risk of crashes even when not impaired (Cavaiola and Wuth 2002). As a result of this research, most educational and specialized programs have moved from a primarily didactic approach to interventions with specific protocols (Hon 2003). Specialized interventions are being developed to reduce alcohol-impaired driving and address alcohol problems and other comorbid conditions that frequently occur among DUI offenders (Cavaiola and Wuth 2002; Hon 2003; Wells-Parker and Williams 2002).

SCREENING, ASSESSMENT, AND REFERRAL

DUI offenders mandated by the courts to receive intervention and treatment often are evaluated in terms of their future risk for impaired driving and crash involvement and for any personal problems or circumstances that may need to be addressed during intervention and treatment. The term screening typically is used to describe a less extensive evaluation performed early in the process, possibly before a referral is made or shortly thereafter, and tends to focus on determining the offender’s risk level for impaired driving and the extent of alcohol problems. Screening results often are used to make decisions about what type of intervention is mandated. The term assessment typically is used to refer to a more extensive evaluation that is conducted later, often just before or upon entry into intervention and treatment. Assessment results frequently are used to guide decisions about how to intervene and treat the offender and how long or intense the treatment will be. The ultimate goal of extensive assessment is to match the offender to the most appropriate intervention and treatment according to his or her specific circumstances. Often assessment is integrated into the intervention in order to guide the process and to assure that the offender’s problems are being addressed. The quality of information provided by either a screening or an assessment is an important part of the intervention and treatment process. One concern about court-referred assessment of alcohol and other substance use problems is that offenders may minimize their involvement with alcohol if they believe their answers could result in harsher sentencing or more intensive treatment (Lapham et al. 2002). In addition, a conflict of interest may arise when the same entity that will provide treatment conducts the assessment, which determines treatment length and cost. To address these concerns, valid and reliable screening and assessment processes that are not dependent on subjective and unvalidated judgments of assessors ultimately need to be developed. Standards for validating the screening and assessment procedures that inform referral and treatment decisions are critical to ensuring successful outcomes for clients. (For a review of the technical issues surrounding the development of valid and reliable screening and assessment tools and processes for use with mandated populations, and for standards for validating these tools, see Anderson and colleagues [2000].)

EFFECTIVENESS OF MANDATED TREATMENT

Systematic research on mandated treatment for DUI offenders since the early 1980s (Mann et al. 1994; Wells-Parker and Williams 2004) has provided a relatively clear picture of the effectiveness of this treatment as well as its limitations. In general, research has consistently shown that treatment has a modest effect on reducing drinking-driving and alcohol-impaired crashes among offenders who are mandated to attend and who actually receive the intervention (Wells-Parker and Williams 2002).

A meta-analysis of studies of the effectiveness of treatment and intervention with DUI offenders revealed several reliable patterns (Wells-Parker et al. 1995). An examination of crashes and DUI events over several years showed that alcohol-specific interventions and alcoholism treatment were better at reducing alcohol-related driving and crashes than interventions which were not alcohol specific. However, nonspecific interventions-such as revoking drivers’ licenses-were better at reducing all types of crashes (including crashes that did not involve alcohol), probably because they reduce overall driving exposure. Thus, the best strategy is to combine alcohol-related interventions and treatment with licensing actions to reduce impaired driving and crashes in general among DUI offenders who, as a group, are known to be high-risk drivers even when not impaired (Donovan et al. 1988; Donovan et al. 1985). Although the meta-analysis was conducted in 1992, more recent studies generally have confirmed the results (Hon 2003). Combining treatment with nontreatment sanctions that prevent offenders from drinking and driving (e.g., license revocation and alcohol ignition interlocks, which require the driver to pass an alcohol breath test before starting a car) also reduces the public’s risk while offenders are receiving treatment.

Findings from the meta-analysis did not reveal a consistent pattern of results for outcome measures related to drinking problem severity or other non-traffic-related outcomes because most studies focused on recidivism and crashes (Wells-Parker 1994; Wells-Parker et al. 1995). Results of one long-term study in which offenders were randomly assigned to receive treatment suggested that mandated interventions may have benefits beyond the traffic safety arena. In this study (Mann et al. 1994), offenders who received treatment had lower mortality rates after several years than did members of a comparable group who did not receive treatment.

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