4.1 Alcohol Problem Assessment and Treatment
It is widely recognized that many DWI first offenders and most repeat offenders are dependent on alcohol or have alcohol abuse problems (White & Gasperin, 2007). They likely will continue to drink and drive unless their alcohol abuse problems are addressed. DWI arrests provide opportunity to identify offenders with alcohol abuse problems and to refer them to treatment as appropriate. However, treatment should not be provided in lieu of other sanctions or as part of plea bargain or diversion programs that eliminates records of DWI offenses (see the Alcohol- and Drug-Impaired Driving chapter, Section 3.2).
Alcohol problem assessment can take many forms, from a brief paper-and-pencil questionnaire to a detailed interview with a treatment professional. Alcohol treatment can be even more varied, ranging from classroom alcohol education programs to long-term inpatient facilities. For brief overviews of alcohol assessment and treatment programs and further references see Century Council (2008), Dill and Wells-Parker (2006), Voas and Lacey (2011), NCHRP (Goodwin et al., 2005, Strategy C4), and Robertson et al. (2008).
Part of the assessment process is determining the likelihood that an offender will continue to drive impaired. Under a cooperative agreement with NHTSA, the American Probation and Parole Association developed a screening tool – the Impaired Driving Assessment – to determine an offender’s risk of recidivism and to help determine the most appropriate and effective community supervision program to reduce that risk (Lowe, 2014). Pilot testing of the IDA revealed that probation failure is commonly associated with extensive prior legal histories, mental health problems, and higher levels of alcohol/drug use.
Use: All States have laws for alcohol treatment for DWI offenders (NHTSA, 2017). However, the nature of the treatment – and to whom it applies – varies greatly. Some States mandate treatment, especially for repeat offenders, but usually treatment requirements are at the court’s discretion.
Effectiveness: Even the best of the many assessment instruments currently in use are subject to error. Chang et al. (2002) found that none of the assessment instruments studied correctly identified more than 70% of offenders who were likely to recidivate. However, the assessment process itself can have therapeutic benefits. See the Alcohol- and Drug-Impaired Driving chapter, Section 5.1 on alcohol screening and brief interventions.
Wells-Parker et al. (1995) reviewed the studies evaluating treatment effectiveness. They found that, on average, treatment reduced DWI recidivism and alcohol-related crashes by 7 to 9%. Treatment appears to be most effective when combined with other sanctions and when offenders are monitored closely to assure that both treatment and sanction requirements are met (Century Council, 2008; Dill & Wells-Parker, 2006).
Costs: Treatment expenses vary widely depending on program type. However, several studies suggest alcohol abuse treatment can be cost effective (NIDA, 2020; UKATT Research Team, 2005). For example, a study from California found every dollar spent on treatment potentially saved taxpayers up to $7 (Gerstein et al., 1994). Offenders can bear some of the costs of both assessment and treatment, though provisions must be made for indigent offenders.
Time to implement: Implementation time also varies depending on program type. The simplest can be implemented in several months, while others may take years.
- Treatment options: There are many effective treatment options for alcohol abuse problems including cognitive-behavioral therapy, group counseling, pharmacological interventions (e.g., naltrexone, acamprosate), and brief interventions (see the Alcohol- and Drug-Impaired Driving chapter, Section 5.1). It is important that treatment be tailored to the individual. Also, combining therapies can result in better outcomes because DWI offenders usually have a range of diverse and complex problems (Dill & Wells-Parker, 2006).
- DWI Courts: Alcohol problem assessment and treatment are integral parts of DWI courts. In addition, DWI courts can sanction offenders who fail to complete assigned treatment programs. For more information, see the Alcohol- and Drug-Impaired Driving chapter, Section 3.1.
- Other mental health issues: Alcohol assessment and treatment provide opportunity to address other problems that may underlie or contribute to problems with alcohol. One study found that more than 60% of DWI repeat offenders have other psychiatric disorders in addition to alcohol-related problems, such as post-traumatic stress disorder, anxiety disorders, and bipolar disorder (Shaffer et al., 2007). This is substantially higher than the rate of about 30% for the general population.
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