Effectiveness of a Cognitive Therapy for Repeat Drinking and Driving Offenders

1. Effectiveness of a Cognitive Therapy for Repeat Drinking and Driving Offenders Kathleen A. Moore, PhD Melissa L. Harrison, MS M. Scott Young, PhD Department of Mental Health Law and Policy Florida Mental Health Institute

2. Individuals who choose to drive under the influence are one of the most dangerous criminal offenders we have in our society Impaired driving is one of the most frequently committed crimes, killing someone in America every 30 minutes Alcohol-related crashes accounted for 38% of Florida’s total number of traffic fatalities Overview

3. In 2004, Hillsborough County was a state leader in DUI crashes, injuries, and fatalities There were 7,134 arrests in Hilllsborough County this past year; 5.6% increase from 2004 In response to the high DUI-related crashes, injuries, and fatalities, an initiative has been funded by a Justice Assistance grant in order to combat drinking and driving Hillsborough County Facts

4. Law Enforcement (Hillsborough County Sheriff’s Office) – heighten awareness of community (DUI checkpoints, saturation patrols) Prosecution(State Attorney’s office) – felonization of repeat offenders (updating criminal records, integrating records from others) Treatment(Tampa Crossroads) – focus on patterns of criminal thinking and behavior Collaborators of DUI Initiative

5. Number of DUI Arrests:HCSO Central Breath Testing Data Note. Data are from the HCSO Central Breath Testing.

6. Alcohol-Related Crashes Note. Data obtained from Florida DHSMV.

7. Alcohol-Related Injuries Note. Data obtained from Florida DHSMV.

8. Alcohol-Related Fatalities Note. Data obtained from Florida DHSMV.

9. Treatment for DUI offenders has been found to reduce alcohol-related crashes and recidivism (Wells-Parker et al., 1995) Reductions in recidivism of 20% or higher have been reported when treatment is combined with other sanctions (e.g., fines, license revocation) (Mann et al., 1994) Treatment of DUI Offenders

10. In order to assess the overall effectiveness of the treatment program, the following factors will be examined: Treatment factors (length of stay, treatment compliance, and urinanalysis results) Criminal justice factors (arrest history and recidivism rates) Risk factors (alcohol use and criminal thinking) Protective factors (motivation to change, self-esteem and self-efficacy) Goals of Treatment Initiative

11. Participants were convicted of at least 2 DUI-related charges and court-mandated to Tampa Crossroads for treatment: Enrolled in weekly group and individual therapy Treatment focused on criminal thinking patterns Other treatment models employed in counseling sessions include cognitive behavioral therapy (CBT), motivational enhancement treatment (MET), substance abuse, and relapse prevention Treatment Design and Procedure

12. Demographic Information - age, gender, and race Treatment Information - number of days in treatment - successful graduation - urinalysis results Criminal Justice Information - number of times client was arrested - charges for each arrest - BAC level Measures

13. Satisfaction Measure - quality of the program, counseling, and open- ended questions CAGE - assesses the attempt to cut down on drinking - having been annoyed by others’ criticisms of one’s drinking behavior - the feeling of guilt associated with drinking - drinking in the morning as an eye opener Michigan Alcoholism Screening Test (MAST) - 24-items assessing consequences of drinking Readiness to Change Questionnaire - 12 items assessing readiness to change Measures (cont.)

14. Demographic Information (N=118)

15. Length of Treatment - The mean length of stay was 102 days with a range from 30 to 278 days Successful Graduation – 81% of clients (N = 96) successfully graduated from the TRIAD treatment program Urinalysis Results – 89% of clients (N = 105) had no positive urinalysis throughout the program. The clients that did test positive had used a variety of drugs (e.g., alcohol, crack cocaine, marijuana) Treatment Factors

16. Arrest History - average number of pre-treatment arrests was 2.5 with a maximum of 8 arrests with the majority DUI-related charges (past 5 years in Hillsborough County) Rearrest Data - Only 16 clients were arrested during and after treatment with the majority being arrested for a violation of their probation Arrest Differences - There were a higher number of arrests for those that did not graduate vs. those that did graduate from the program Blood Alcohol Level - The average is .18 with a range from .08 to .40 Criminal Justice Factors

17. Number of Arrests for Graduates and Non-graduates

18. Participant Satisfaction with the Quality of the Program

19. “I am more effective in dealing with my drinking since taking this program”

20. Because the items on the CAGE are worded “have you ever” we are assessing life-time problems with alcohol. These should not be expected to change in the six month duration of treatment. However, there are two findings of importance here: The high rate of alcohol dependence in this sample. Our sample ranged from 56% at baseline to 65% at posttest meeting or exceeding the cut-off of 2 on the CAGE. In contrast, Mischke & Venneri (1987) found 22% of their sample met or exceeded the same cut-off, when assessing a sample of “significant problem drinkers” in the DUI population (not necessarily repeat offenders). Increased scores at posttest, although not significantly different from baseline, may indicate treatment effectiveness as denial may be decreasing. Clearly, anyone with two DUI convictions should be answering “yes” to at least two questions on the CAGE! Changes in CAGE Scores Across Time

21. The MAST is composed of 24 items assessing consequences of drinking (Selzer, 1971) Using Selzer’s cut-off of 5 or more – 80% of the sample (N = 32) would be classified as alcoholic at baseline Caviola et al. (2003) found 31% of a sample of repeat DUI offenders scored 6 or more on the MAST while 78% of the current sample scored 6 or more at baseline. Using Jacobson’s more stringent cut-off of 10 or more – 58% of the sample (N = 23) would be classified as “positive alcoholics” at baseline. Michigan Alcoholism Screening Test (MAST)

22. Brief “readiness to change” questionnaire examines three stages: precontemplation, contemplation, and action (Rollnick et al., 1992) The majority (80%) of the sample reported taking action to change their drinking behavior at baseline and again (82%) at posttest Readiness to Change

23. The results of this evaluation clearly indicate that treatment is effective in reducing recidivism and alcohol and/or drug use. Some of the highlights include: High graduation rate: 81% of clients successfully completed the TRIAD treatment program High treatment compliance: 86% of clients were treatment compliant with both individual and group counseling Few positive urinalysis results: 89% of clients remained alcohol and/or drug free during the course of treatment Low recidivism rate: Only 4 clients were rearrested for DUI-related offenses during or after treatment. The majority of clients were rearrested for violation of probation charges either during treatment (N = 12) or after treatment (N = 15) Conclusions

24. High satisfaction rates with the TRIAD treatment program: 91% of evaluation participants were very satisfied with the counseling and 78% with the quality of the TRIAD treatment program Problem Drinking Behavior: Over 50% were classified as alcoholic using two well-validated measures of alcohol use Readiness to Change: 81% of evaluation participants were classified as in the “action” stage, maintaining their readiness to change their drinking behavior Conclusions