Drunk Driving: A Strategy for Reducing Recidivism

12th Annual Michigan Traffic Safety Summit

Tuesday March 13, 2006

Bradley Finegood, MA, LLPC

A Problem Snapshot• From 2002 and 2003, persons between the ages of 16 to

20 (Age group of which the leading cause of death is traffic fatalities)– 21 % reported driving under the influence of alcohol and drugs– 17% reported driving under the influence of alcohol– 14% reported driving under the influence of illicit drugs– 8% reported driving under the influence of both a the same

time.– Of those who reported driving under the influence 4% reported

being arrested / cited with a DUI offense.

– National Survey on Drug Use and Health, 12-31-04

Drinking and Drugged Driving

• In 12 states including Michigan it is illegal to drive with any detectable level of illicit drug or it’s metabolite.

• As a person get older, the less likely they are to drive under the influence of alcohol or drugs in the past year.– 21 to 25 years old (33.8%)– 26 to 34 years old (24.3%)– Over 35 continues to go down.

– NHTSA

More Drinking and Drugged Driving

• In a Maryland Trauma Center, driver’s admitted from automobile accident:– 34% tested positive for drugs only.

– 18% tested positive for alcohol only

– 50% under 18 tested positive for alcohol and / or drugs.

• Studies in a number of localities point to 4 to 14 percent of traffic accidents causing injury or death, a driver tests positive for marijuana.

• NIDA

How is Recidivism Reduced

• Stop Alcohol and Other Drug Use, i.e. increase abstinence, sobriety and recovery– Poly and cross addicted persons

• Change cognitive / emotional / behavioral patterns that leads to breaking the law and endangering other’s lives.

Changing Paradigm

• Public Safety vs. Rehabilitation – – With DUI these are dependent systems– 95-98% of incarcerated people will be released

• Does Hierarchical Systems (State / DOC) see these concepts as integrated?

Issues for Consideration

• Type / Intensity of Supervision• Coordination of Services from Incarceration

/ Probation / Parole / Community • Traditional Schisms in the System• Availability of Services• Harm Reduction Models • Pharmacotherapies in conjunction with

treatment.

NIDA Principles of Drug Abuse Treatment for Criminal

Populations: An Evidenced- Based Approach

July, 2006

13 Principles

1. Drug Addiction is a Brain Disease• Chronic / No Acute• Long Lasting• Relapse Potential

13 Principles – cont.

2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time.• Not necessarily fixed length treatment.• Case Management and Contingency Management

• Following through and monitoring with client’s treatment and case management regimen.

• Effective Incentives and Sanctions for appropriate and specific behaviors.

13 Principles – cont.

3. Treatment must last long enough to produce stable behavioral changes.

• Cognitive and Behavioral Patterns and Cycles

• Substance Abuse is often a Ritualistic Process

• Stability in Recovery– Changing paradigm in modalities.

13 Principles – cont.

4. Assessment is the first step in treatment.• Co-occurring issues

– Mental Health, Other Bio-Psycho-Social Issues

• Effective Treatment Planning• Assessment is also:

– Second step, Third Step……Last Step; meaning assessment must be an ongoing process.

13 Principles – cont.

5. Tailoring services to fit the needs of the individual is an important part of effective substance abuse treatment for the criminal justice populations.

• Appropriate, age, gender, ethnic / cultural factors

• Problem severity level• Motivational level of change

13 Principles – cont.

6. Drug and alcohol use during treatment should be carefully monitored.

• Addiction is “cunning, baffling and powerful”, but also manipulative.

• Identify Relapse.– Encourage Honesty– Relapse as a part of Recovery Addiction

13 Principles – cont.

7. Treatment should target factors that are associated with criminal behavior.

• Criminal Thinking, Lifestyle, Behavior Patterns

• DUI Specific.– Social Interest / Empathy Building Skills– MADD Victim Impact Panel

13 Principles- cont.

8. Criminal justice supervision should incorporate treatment planning for substance abusing offenders, and treatment providers should be aware of correctional supervision requirements.

• Triangulation• Coordination of needs, resources.• Community Transitioning.• Continuum of Care Transition.

13 Principles- cont.

9. Continuity of care is essential for drug abusers re-entering the community.

• Re-entry Programs• MPRI• Sober / Recovering Communities• ¾ way houses / Transitional Living

Environments.

13 Principles- cont.

10. A balance of rewards and sanctions encourages pro-social behavior and treatment participation.

• Carrot or Stick.• Remember the context of the population.

– Often Abused, Demeaned, Low Sense of Self-Worth.

13 Principles- cont.

11. Offenders with co-occurring alcohol / drug abuse and mental health problems often require an integrated treatment approach.

• High degree of mental health issues.• Schism in the community.• Severe and Persistent vs. Moderate.

13 Principles- cont.

12. Medications are an important part of treatment for many drug abusing offenders.

• Need for Addictionologist• Cross-Pharmaco issues w/ high degree of

abuse.• Cross-Coordination with physicians

13 Principles – cont.

13. Treatment planning for drug abusing offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, Hep. B and C, and TB.

Brad’s 14th Principle

• Effective treatment must be based on “What Works” or evidenced based practices.– Cognitive-Behavioral Treatment– Motivation Enhancement Therapy– Support Groups.

• Drug Courts