nadcp annual training conference dwi courts june 2nd€¦ · – self-administered vs. interviewer...

1

NADCP Annual Training ConferenceDWI Courts

June 2nd, 2016

Screening for Mental Health Issues among DUI Offenders

Sarah E. Nelson, Ph.D.Harvard Medical School;Division on Addiction, The Cambridge Health Alliance

• The Foundation for Advancing Alcohol Responsibility (FAAR) is providing five years of support for the development and testing of CARS.

• The National Institute of Alcohol Abuse and Alcoholism provided support for the study of repeat DUI offenders through the grants: – Toward Evidence Based Treatments to Reduce DUI

Relapse (R01 AA014710-01A1), and – DUI Offending: The Intersection of Criminality and

Psychopathology (R03 AA017516).

Sources of Support

2

Most Important Disclosure• Researcher, NOT Clinician, Counselor,

Doctor• This means:

– I can tell you what systematic research tells us about addiction and DUI

– I can suggest how this research might apply to practice

– I DO NOT claim that this research should be substituted for your clinical judgment and experiences

– I might bore you with numbers, but I will be really really excited about them

Outline• Why we need treatment for DUI

– Mental health and DUI– Addiction and Comorbidity

• Importance of and barriers to screening• Computerized Assessment and Referral System

(CARS) Research– Screening results– First-Offender vs. Second-Offender– Self-Administered vs. Interviewer Administered– Comorbidity and Outcomes 4

WHY WE NEED DUI TREATMENT

5

On Driving

1885: First combustion engine auto1904: Quarterly Journal of Inebriety

“Twenty-five fatal accidents occurring to automobile wagons…in nineteen of these accidents the

drivers had used spirits within an hour…of the disaster.”

– 76% rate of alcohol-related fatalities

Sources: Evans, 1991, Traffic Safety and the Driver 6

DUI-related Costs

• DUI is the second most common type of crime in the US (FBI, 2014)

• In 2013, 10,076 people died in alcohol-related motor-vehicle accidents in which the driver had a BAC of.08 or higher (NHTSA, 2014)– 31% of total motor vehicle fatalities in the US

• Annual economic cost of $49.8 billion (NHTSA, 2014)

7

Repeat DUI Offenders

During 2008, the NHTSA reported that re-offenders represent 33% of those who are arrested for DUI (NHTSA, 2008).

8

Legal Initiatives to Reduce DUI

• Licensing Sanctions– Up to 75% continue to drive (Ross & Gonzales, 1988)

• Vehicle Sanctions • Mandatory Sentencing • Ignition Interlock

– Recidivism returns to pre-interlock levels after removal (Elder, Voas, et al., 2011)

9

Percent of Total Traffic Fatalities that are Alcohol-Related

Adapted from NHTSA, 1993-2015

20%

25%

30%

35%

40%

45%

50%

55%

60%

% of motor vehicle fatalities that involved an alcohol-impaired driver (BAC of .08 and up for 2001 on; .10 and up for 2000 and earlier)

% of motor vehicle fatalities that involved a driver who had been drinking (BAC over .01)

10

Repeat DUI Offenders

11

MENTAL HEALTH AND DUITreatment Target:

12

Alcohol & Other Problems

“Treatment programs focusing exclusively on changing alcohol consumption behavior are not likely to reduce accident risk for

some of the offender groups” (p. 443).

Wells-Parker, E., Cosby, P., & Landrum, J. (1986). A Typology for Drinking Driving Offenders: Methods for Classification and Policy Implications.

Accident Analysis and Prevention, 18(6), 443-453.

13

Addiction Syndrome Model

• Expressions of addiction are opportunistic and associate with vulnerable hosts

• Behavioral (e.g., gambling disorder) & chemical (e.g., alcoholism) expressions primarily have common bio-psycho-social etiology and shared consequences

• Psychiatric disorder usually precedes addiction, but sometimes emerges after addiction

14

Shaffer, H. J., LaPlante, D. A., & Nelson, S. E. (2012). The APA Addiction Syndrome Handbook (Vol. 1 & 2). Washington, D.C.: American Psychological Association Press.

Addiction Syndrome Model• Variety of related signs & symptoms reflect

an underlying disorder– Craving, Tolerance, Withdrawal

• Not all signs & symptoms are present at all times

• Unique & shared components co-occur• Distinctive temporal progressionShaffer, H. J., LaPlante, D. A., & Nelson, S. E. (2012). The APA Addiction Syndrome Handbook (Vol. 1 & 2). Washington, D.C.: American Psychological Association Press.

Addiction Syndrome• Variety of related signs & symptoms

reflect an underlying disorder• Not all signs & symptoms are present at

all times• Diagnostic criteria for substance use disorders

require that patients meet a certain number of criteria, not all of them

• Unique & shared components co-occur• Distinctive temporal progression



all times• Unique & shared components co-occur

– Non-specific neurobiological system risks; shared psychosocial risk factors; shared experiences

– Chasing behavior in gambling; Sepsis in intravenous drug use

• Distinctive temporal progression



all times• Unique & shared components co-occur• Distinctive temporal progression

• Similar etiology; similar relapse rates across addictions

Addiction Syndrome

Illustrating the Addiction Syndrome

An Animated Etiologic Model of How Different Expressions of Addiction Emerge

Element Domains

Biogenetic Elements

NeurophysicalReward Systems

NeurochemicalAction

Genetics

Psychological Elements

Symptom Clusters& Sequences

Sign Clusters& Sequences

Experiential Elements

Lifestyle Similarities

Exposure/Setting(e.g., macro tomicro)

Risky Behaviors

Natural History

PsychologicalConditions(e.g., cognitivedeficiencies)

Element Domains

Biogenetic Elements

NeurophysicalReward Systems

NeurochemicalAction

Genetics

Psychological Elements

Symptom Clusters& Sequences

Sign Clusters& Sequences

Experiential Elements

Lifestyle Similarities

Exposure/Setting

Risky Behaviors

Natural History

PsychologicalConditions

DisorderedGamblingUnique

ConsequencesAlcohol Use

DisorderUnique

Consequences

No ObjectOpportunity

Und

erly

ing

Pre

disp

ositi

ons

Expr

essio

n

SubjectiveShift

Threshold

No Addiction No Addiction

Common Adverse

Consequences

Exp

osur

e

Und

erly

ing

Pre

disp

ositi

ons

Exp

osur

eEx

pres

sion

Alcohol UseDisorder

DisorderedGambling

Alcohol UseDisorder &

Cocaine Use Disorder

Disordered Gambling &

Substance UseDisorder

Exercising and

Eating

TreatmentSelf or Other

Directed

DisorderedGambling

Und

erly

ing

Pre

disp

ositi

ons

Trig

ger

Exp

osur

eEx

pres

sion

Relapse

DisorderedGambling

Exercising and

Eating

Und

erly

ing

Pre

disp

ositi

ons

Exp

osur

eE

xpre

ssio

n

DisorderedGambling

Disordered Gambling & Alcohol Use

Disorder

Und

erly

ing

Pre

disp

ositi

ons

Exp

osur

eEx

pres

sion

Disordered Gambling & Alcohol Use

Disorder

TreatmentSelf Directed or Other Directed

Remission

Syndrome Model Implications for Recovery

• Addiction is recursive– Treating underlying vulnerabilities can alter people’s

risk for continued and new addictions– However, the consequences of addiction are often risk

factors for new or different expressions of addiction

• Some people can and do recover from addiction without treatment.

• Some risk factors for addiction are static (they can’t be changed) but others are dynamic. People can change some of their risks for addiction.

• Treating addiction as a syndrome suggests that it is multidimensional– Addiction will not respond favorably to a single

treatment modality– Addiction will not respond favorably to

treatments that ignore underlying problems -just say “no”

Implications for Treatment

Addiction Syndrome

Caveat: Association Does Not Equal CausationCorrelate Does Not Equal Determinant

Other UnknownDisorders

ManicEpisodes

DepressionPersonality

Disorder

Addiction(e.g., alcohol dependence; gambling

disorder)

When is Addiction Addiction?

Syndrome Disorder?

WHEN IS DUI, DUI?

35

14%

3%4%

2%

7%

AA/AD, DA/DD, ND, &/or PG (98%)CD &/or ADD &/or IED (27%)PTSD &/or GAD (20%)MDD &/or DYS (12%)Bipolar (8%)

54%

5%

2%

2%

2% 1%

3%

AA/AD = Alcohol abuse or dependence; DA/DD=Drug abuse or dependence; ND=Nicotine dependence; PG=Pathological gambling; CD=Conduct disorder; ADD=Attention deficit disorder; IED=Intermittent explosive disorder; PTSD=Post-traumatic stress disorder; GAD=Generalized anxiety disorder; MDD=Major depression; DYS=Dysthymia; Bipolar=Bipolar I or II.

1%

No Disorders (1%)

Lifetime Prevalence

% represents given combination of disorders

(Shaffer, Nelson, LaPlante, LaBrie, Albanese, & Caro, 2007)

Lifetime Prevalence of Psychiatric Disorder among MDUIL Sample & NCS-R (Kessler et al., 2005)

9%

14%

12%

3%

8%

19%

6%

7%

17%

3%

4%

10%

0% 5% 10% 15% 20%

Generalized AnxietyDisorder

Post Traumatic StressDisorder

Major Depressive Disorder

Dysthymia

Bipolar Disorder

Conduct Disorder

Lifetime Disorder Prevalence

NCS-RMDUIL

37(Kessler et al., 2005; Shaffer, Nelson, LaPlante, LaBrie, Albanese, & Caro, 2007)

Chart1

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Post Traumatic Stress DisorderPost Traumatic Stress Disorder

Major Depressive DisorderMajor Depressive Disorder

DysthymiaDysthymia

Bipolar DisorderBipolar Disorder

Conduct DisorderConduct Disorder

MDUIL

NCS-R

Lifetime Disorder Prevalence

3%

0.09

0.06

0.14

0.07

0.12

0.17

0.03

0.03

0.08

0.04

0.19

0.1

Sheet1

Generalized Anxiety DisorderPost Traumatic Stress DisorderMajor Depressive DisorderDysthymiaBipolar DisorderConduct Disorder

MDUIL0.090.140.120.030.080.19

NCS-R0.060.070.170.030.040.1

IMPORTANCE OF AND BARRIERS TO SCREENING

38

Comorbidity & DUI Recidivism

39(Nelson, Belkin, LaPlante, Bosworth, & Shaffer, 2015)

Comorbidity & DUI Recidivism

40(Nelson, Belkin, LaPlante, Bosworth, & Shaffer, 2015)

Barriers to Mental Health Screening

• Awareness• Training• Time / Resources• Lack of Immediate Output

DUI treatment providers don’t always have the training or resources to identify and address mental health issues in their clients.

41

A Comparison of Alcohol Treatment Program Diagnoses and CIDI Mental Health Diagnoses

• Bipolar Disorder– Provider Estimate: 0.9%– CIDI: 6.0%

• Depression– Provider Estimate: 10.3%– CIDI: 24.5%

Diagnoses obtained through CIDI (composite international diagnostic interview) compared to diagnoses obtained at any time during mandatory alcohol treatment among 233 repeat DUI offenders.

(McMillan, Timken, Lapidus, C’de Baca, Lapham, & McNeal 2008)

• OCD• Provider Estimate: 0.0%• CIDI: 2.6%

• Drug Use Disorder• Provider Estimate: 27.0%• CIDI: 10.7%

42

The Need for Screening in DUI Populations

• Psychiatric comorbidity in DUI populations• Mental health issues linked to recidivism• Screening for mental health issues beyond

alcohol-use disorders is rare within DUI treatment programs

• DUI treatment providers rarely have the training or experience to identify mental health issues among their clients

43(Lapham et al., 2006; Lapham et al., 2001; Nelson et al., 2015; Shaffer et al., 2007)

Generalized Anxiety Disorder Major Depressive Disorder Dysthymia Bipolar I Disorder Bipolar II Disorder Panic Disorder Alcohol Abuse Alcohol

Dependence Post Traumatic Stress Disorder Substance Abuse Substance Dependence

Personality Eating DisordersTobacco Use DUI Behavior

Oppositional Defiant DisorderIntermittent Explosive

Disorder DUI Behavior Conduct Disorder Criminal History

Personality Disorder Psychosocial Risks Peer Networks Psychosis Gambling Disorder Obsessive Compulsive Disorder Attention Deficit Hyperactivity

Disorder… and more44

CARS: The Computerized Assessment and Referral System

• Standardized mental health assessment adapted from the Composite International Diagnostic Interview (CIDI: Kessler et al., 2004)

• Diagnostic report generator that gives providers and clients:

• Immediate diagnostic information for DSM-IV Axis I disorders

• Geographically and individually targeted referrals

46

What Is the purpose of CARS?• Identify mental health issues that influence DUI.• Identification of these issues is a first step toward

intervening to reduce their impact on DUI and improve offenders’ chance of rehabilitation.

47

Additional Treatment or Self-

Help

Repeated DUI Behavior

Mental Health Issues

CARS

+

-+

Develop Test usabilityImplement

and Test Follow-Up

48

CARS Research

49

Implementation Trial

50

Implement and Test

Implementation Trial

• First offender and repeat offender programs• Randomization w/in program• CARS Screener vs. Comprehensive CARS• Self-administered CARS Screener vs.

Interviewer-Administered CARS Screener• Follow-up Outcomes (6 months+)

51

Implementation Trial Findings• 375 repeat DUI offenders enrolled (51.6% of all)• 163 first-time DUI offenders enrolled (71.2% of all)

• CARS data available for 255 repeat offenders and 122 first-time offenders

0102030405060708090

100

Full CARS CARSScreener

S-A CARSScreener

Intake asUsual

Discharged/Incomplete

#

RepeatFirst-time

Implementation Trial: Screener Findings

• Positive screen indicates that further assessment is required, NOT that the respondent qualifies for the disorder.

• Full CARS provides diagnostic information

53

Implementation Trial: Repeat Offender Screener & Full CARS Findings

0% 20% 40% 60% 80% 100%

Alcohol Use Disorder

Drug Use Disorder

Tobacco Dependence

Gambling Disorder

Past Year Met Criteria (Full CARS) Past Year Screen Lifetime Screen 54

Implementation Trial: First-Time & Repeat Offender Lifetime Screener Findings

0% 20% 40% 60% 80% 100%


Drug Use Disorder

Tobacco Dependence

Gambling Disorder

First-Time Offender: Lifetime Screen Repeat Offender: Lifetime Screen 55*p

Implementation Trial: First-Time & Repeat Offender Past Year Screener Findings

0% 20% 40% 60% 80% 100%


Drug Use Disorder

Tobacco Dependence

Gambling Disorder

First-Time Offender: Past Year Screen Repeat Offender: Past Year Screen 56*p

Implementation Trial:Repeat Offender Screener & Full CARS Findings

0% 20% 40% 60% 80% 100%

Panic Disorder

Generalized Anxiety

PTSD

Social Phobia


Implementation Trial:First-Time & Repeat Offender Lifetime Screener Findings

0% 20% 40% 60% 80% 100%

Panic Disorder

Generalized Anxiety

PTSD

Social Phobia

First-Time Offender Lifetime Screen Repeat Offender Lifetime Screen 58*p

Implementation Trial:First-Time & Repeat Offender Past Year Screener Findings

0% 20% 40% 60% 80% 100%

Panic Disorder

Generalized Anxiety

PTSD

Social Phobia

First-Time Offender Past Year Screen Repeat Offender Past Year Screen 59*p

Implementation Trial:Repeat Offender Screener & Full CARS Findings

0% 20% 40% 60% 80% 100%

Depression (incl. mania)

Depression (excl. mania)

Suicidal Ideation

Mania


Implementation Trial:First-Time & Repeat Offender Lifetime Screener Findings

0% 20% 40% 60% 80% 100%



Suicidal Ideation

Mania

First-Time Offender Lifetime Screen Repeat Offender Lifetime Screen 61*p

Implementation Trial:First-Time & Repeat Offender Past Year Screener Findings

0% 20% 40% 60% 80% 100%



Suicidal Ideation

Mania

First-Time Offender Past Year Screen Repeat Offender Past Year Screen 62*p


0% 20% 40% 60% 80% 100%

Intermittent Explosive Disorder

Obsessive Compulsive Disorder

Eating Disorder

Psychosis

First-Time Offender Lifetime Screen Repeat Offender Lifetime Screen63

*p

Implementation Trial: First-Time & Repeat Offender Past Year Screener Findings

0% 20% 40% 60% 80% 100%

Intermittent Explosive Disorder

Obsessive Compulsive Disorder

Eating Disorder

Psychosis

First-Time Offender Past Year Screen Repeat Offender Past Year Screen64

*p


0% 20% 40% 60% 80% 100%

Conduct Disorder

Oppositional Defiant Disorder

Attention Deficit Hyperactivity Disorder

First-Time Offender Lifetime Screen Repeat Offender Lifetime Screen65

*p

Implementation Trial: Repeat Offender Personality Screener Findings

0% 20% 40% 60% 80% 100%

Cluster A (schizotypal, schizoid, paranoid)

Borderline

Cluster C (avoidant, dependent,obsessive-compulsive)

Antisocial

Probable Case Possible Case66

Implementation Trial: Self-Administered vs. Interviewer-Administered

• Past year screening results for interviewer-administered (IA) and self-administered (SA) CARS did not differ significantly.

• Lifetime screening results for IA and SA CARS did not differ significantly, with 3 exceptions (out of 40 tests).– Repeat DUI offenders were more likely to screen

positive for bipolar and conduct disorder in the SA condition than in the IA conditions.

– First-time DUI offenders were more likely to screen positive for alcohol use disorder in the IA conditions than in the SA conditions

67

Implementation Trial: Conclusions To Date

• Continued evidence of comorbidity in the repeat DUI population– Particularly anxiety-related disorders

68

Implementation Trial: Conclusions To Date

• Results from self-administered screener do not differ fundamentally from those for the interviewer-administered screener– SA screener might be more sensitive for some

disorders• Both counselors and clients are able to use

CARS in a DUI program setting.

69

Caveat: Self Report vs. Behavior

71

CARS: Follow-Up• Currently conducting follow-up interviews with

first-time and repeat offenders• Key measures:

– Alcohol and drug use– Treatment– Lapses and relapses– Probation violations– Behavioral changes– Mental health check-in

72

CARS: Follow-Up Interviews

0%

10%

20%

30%

40%

50%

60%

70%

First-time Offenders (N=161) Repeat Offenders (N=345)

% initially refused followup % refused when contacted % still incomplete % completed

• 198 complete repeat offender follow-up interviews (65% of those who agreed to follow-up)• 93 complete first-time offender follow-up interviews (58% of those who agreed to follow-up)

73

CARS: Follow-Up Outcomes• Positive PY anxiety screen at baseline predicts:

– Probation violation• Positive PY mood disorder screen at baseline

predicts:– Drug use– Absence of self-reported DUI behavior– Probation violation

• Positive LT childhood disorder screen at baseline predicts:– Drug use– Probation violation

CARSPilot Sites and Distribution

74

National Pilot Sites

• Move beyond Massachusetts– 5 pilot sites throughout US

• Move beyond 1st offender and 2nd offender programs– Pre-sentencing– Initial sentencing– Probation– Aftercare – DWI Courts

75

Expand

76

National Pilot Sites

• Pilot site implementation (Summer/Fall 2016)• CARS public distribution

(2017)

The time between sentencing and DUI treatment represents an assessment

opportunity for at-risk clients77

Moving Beyond Post-Conviction DUI Programs

78

Time to Treatment

• In our study, 48% of repeat offenders entered the mandatory inpatient treatment program more than 12 months after their offense

• 33% entered 6-12 months after their offense

• Only 12% entered within 2-6 months of their offense

Diagnosis and TreatmentKarl Menninger

“Treatment depends upon diagnosis, and even the matter of timing is often

misunderstood. One does not complete a diagnosis and then begin treatment; the

diagnostic process is also the start of treatment. Diagnostic assessment is treatment; it also enables further and

more specific treatment.”79

Special Thanks• Dr. Howard Shaffer• Katerina Belkin• Scarvel Harris• Emily Shoov• Jed Jeng• Daniel Tao• Melanie Mitchell• Layne Keating• Alec Conte• Dr. Debi LaPlante• Dr. Heather Gray• John Kleschinsky

• Dr. Tauheed Zaman• Dr. Ron Kessler• Nancy Sampson• Mark McKnight• CARS Advisory Panel• Staff and clients of:

– Massachusetts Driving Under the Influence of Liquor Treatment Program

– Advocates, Inc.– High Point– Lowell House– Behavioral Health Network

80

Additional Resources• www.divisiononaddiction.org

– Division on Addiction’s main website– Current projects and publications

• www.basisonline.org– Brief science reviews and editorials on current issues in the

field of addictions– Addiction resources available, including self-help tools

• https://www.facebook.com/divisiononaddiction– The Division’s facebook page

• @Div_Addiction– The Division’s twitter account

• [email protected]– Email me with any additional questions 81

http://www.divisiononaddiction.org/http://www.basisonline.org/https://www.facebook.com/divisiononaddictionhttps://twitter.com/Div_Addictionmailto:[email protected]

The Computerized Assessment & Referral System:

Implementation Q & A

82

Do I need to use full CARS or just the CARSscreener?

• CARS is adapted from the Composite International Diagnostic Interview (CIDI).

• To generate full DSM-IV diagnostic level information consistent with the diagnoses generated by the CIDI, full CARS is necessary.

• The CARS screener identifies mental health risk areas and takes less time than full CARS.– The screener takes between 15-50 minutes to

complete.83

Do I need to use full CARS or just the CARSscreener?

• Which version you use depends on your resources and goals

• We are currently testing how well the screener identifies mental health risk areas compared to full CARS.

• Possible to use the screener and then follow-up at a later time or with select clients with further CARS modules.

84

Is CARS a risk/needs assessment?

• Not in the traditional sense.• However, CARS identifies specific mental

health disorders for which an offender is at-risk

• These identified mental health issues and the generated report in turn inform the user about the offender’s treatment needs.

85

Can CARS predict DUI recidivism?• The primary purpose of CARS is to

– identify mental health issues that might influence DUI behavior, and

– facilitate additional treatment for those issues. • Currently, CARS identifies DUI risk based on

known predictors from the research literature• As we collect data from CARS, we will be able to

modify this risk scale using empirical data to linking specific mental health profiles to recidivism risk.

How does CARS compare to the APPA Impaired Driving Assessment?

• The primary purpose of the APPA’s tool is to predict DUI recidivism and match this to level of supervision. A secondary use is to identify possible service needs, one of which is mental health.

• The primary purpose of CARS is to identify mental health issues among DUI offenders and facilitate treatment referral for those issues. A secondary use will be to predict DUI recidivism risk from those mental health profiles.

• If resources are available, the two could be used in a complementary fashion. 87

References• Elder, R.W., Voas, R., Beirness, D., Shults, R.A., Sleet, D.A., Nichols, J.L, & Compton, R.

(2011). Effectiveness of ignition interlocks for prevention alcohol-impaired driving and alcohol-related crashes: A Community Guide systematic review. American Journal of Preventive Medicine, 40(3), 362-376.

• Evans, L. (1991). Traffic safety and the driver. Van Nostrand Reindel: New York, NY. • Federal Bureau of Investigation. (2014). Crime in the United States: 2013. Crime in the

United States.• Kessler, R.C., Berglund, P.A., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. (2005).

Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 593-602.

• Kessler, R.C., & Ustun, T.B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). The International Journal of Methods in Psychiatric Research, 13(2), 93-121

• Lapham, S. C., C'De Baca, J., McMillan, G. P., & Lapidus, J. (2006). Psychiatric disorders in a sample of repeat impaired-driving offenders. Journal of Studies on Alcohol, 67(5), 707-713.

• Lapham, S. C., Smith, E., C'De Baca, J., Chang, I., Skipper, B. J., Baum, G., et al. (2001). Prevalence of psychiatric disorders among persons convicted of driving while impaired. Archives of General Psychiatry, 58(10), 943-949.

• McMillan, G. P., Timken, D. S., Lapidus, J., C’de Baca, J. Lapham, S. C., & McNeal, M. (2008). Underdiagnosis of comorbid mental illness in repeat DUI offenders mandated to treatment. Journal of Substance Abuse Treatment, 34, 320-325.

88

References• National Highway Traffic Safety Administration. (2008). Traffic safety facts 2008: Laws:

Repeat intoxicated driver laws. • National Highway Traffic Safety Administration. (2007-2015). Traffic safety facts: Alcohol-

impaired driving. • National Highway Traffic Safety Administration. (1993-2006). Traffic safety facts: Alcohol. • Nelson, S. E., Belkin, K., LaPlante, D. A., Bosworth, L., & Shaffer, H. J. (2015). A prospective

study of psychiatric comorbidity and recidivism among repeat DUI offenders. Archives of Scientific Psychology,3(1), 8-17.

• Nelson, S. E., & Tao, D. (2012). Driving under the influence: Epidemiology, etiology, prevention, policy, and treatment. In H. J. Shaffer, D. A. LaPlante & S. E. Nelson (Eds.), The APA Addiction Syndrome Handbook (Vol. 2. Recovery, Prevention, and Other Issues, pp. 365-407). Washington, DC: American Psychological Association Press.

• Ross, H.L., & Gonzales, P. (1988). Effects of license revocation on drunk-driving offenders. Accident Analysis & Prevention, 20(5), 379-391.

• Shaffer, H. J., LaPlante, D. A., & Nelson, S. E. (2012). The APA Addiction Syndrome Handbook (Vol. 1 & 2). Washington, D.C.: American Psychological Association Press.

• Shaffer, H. J., Nelson, S. E., LaPlante, D. A., LaBrie, R. A., Albanese, M. J., & Caro, G. (2007). The epidemiology of psychiatric disorders among repeat DUI offenders accepting a treatment sentencing option Journal of Consulting and Clinical Psychology, 75(5), 795-804.

• Wells-Parker, E., Cosby, P. J., & Landrum, J. W. (1986). A typology for drinking driving offenders: Methods for classification and policy implications. Accident Analysis and Prevention, 18(6), 443-453. 89

Screening for Mental Health Issues among DUI OffendersSources of SupportMost Important DisclosureOutlineWhy we need DUI treatmentOn DrivingDUI-related CostsRepeat DUI OffendersLegal Initiatives to Reduce DUIPercent of Total Traffic Fatalities that are Alcohol-RelatedRepeat DUI OffendersMental Health and DUIAlcohol & Other ProblemsAddiction Syndrome ModelAddiction Syndrome ModelAddiction SyndromeAddiction SyndromeAddiction SyndromeSlide Number 19Slide Number 20Slide Number 21Illustrating the Addiction SyndromeSlide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Syndrome Model Implications for RecoverySlide Number 31Slide Number 32Caveat: �Association Does Not Equal Causation�Correlate Does Not Equal DeterminantWhen is Addiction Addiction?When is DUI, DUI?Slide Number 36Slide Number 37Importance of and barriers to screeningComorbidity & DUI RecidivismComorbidity & DUI RecidivismBarriers to Mental Health ScreeningA Comparison of Alcohol Treatment Program Diagnoses and CIDI Mental Health DiagnosesThe Need for Screening in DUI PopulationsSlide Number 44Slide Number 45CARS: The Computerized Assessment and Referral SystemWhat Is the purpose of CARS?Slide Number 48��CARS ResearchImplementation TrialImplementation TrialImplementation Trial FindingsImplementation Trial: Screener FindingsImplementation Trial: Repeat Offender Screener & Full CARS FindingsImplementation Trial: �First-Time & Repeat Offender Lifetime Screener FindingsImplementation Trial: �First-Time & Repeat Offender Past Year Screener FindingsImplementation Trial:� Repeat Offender Screener & Full CARS FindingsImplementation Trial:� First-Time & Repeat Offender Lifetime Screener FindingsImplementation Trial:� First-Time & Repeat Offender Past Year Screener FindingsImplementation Trial:� Repeat Offender Screener & Full CARS FindingsImplementation Trial:�First-Time & Repeat Offender Lifetime Screener FindingsImplementation Trial:�First-Time & Repeat Offender Past Year Screener FindingsImplementation Trial: First-Time & Repeat Offender Lifetime Screener FindingsImplementation Trial: First-Time & Repeat Offender Past Year Screener FindingsImplementation Trial: �First-Time & Repeat Offender Lifetime Screener FindingsImplementation Trial: Repeat Offender Personality Screener FindingsImplementation Trial: �Self-Administered vs. Interviewer-AdministeredImplementation Trial: �Conclusions To DateImplementation Trial: �Conclusions To DateCaveat: Self Report vs. BehaviorCARS: Follow-UpCARS: Follow-Up InterviewsCARS: Follow-Up Outcomes��CARS �Pilot Sites and DistributionNational Pilot SitesNational Pilot SitesMoving Beyond Post-Conviction DUI ProgramsTime to TreatmentDiagnosis and Treatment�Karl MenningerSpecial ThanksAdditional ResourcesThe Computerized Assessment & Referral System: � �Implementation Q & ADo I need to use full CARS or just the CARS screener?Do I need to use full CARS or just the CARS screener?Is CARS a risk/needs assessment?Can CARS predict DUI recidivism?How does CARS compare to the APPA Impaired Driving Assessment?ReferencesReferences

nadcp annual training conference dwi courts june 2nd€¦ · – self-administered vs. interviewer...

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