CR 184: Drink Driving Rehabilitation: The Present Context (1999)
Alcohol abuse and alcohol-related problems remain a major public health issue. Drink driving is one alcohol-related problem that has gained much attention over recent years. The magnitude of the drink driving problem is often shown using crash data. Approximately one-third of all fatal road crashes, where the driver had been tested for alcohol, were associated with blood alcohol concentrations above the legal limit.
Road trauma, unlicensed driving and recidivist offending place additional financial and legal burdens on communities and reinforce the need to establish effective drink driving interventions.
Defining the Drink Driver
Drink driving has consistently been shown to be associated with a range of risk factors.
- Male, young age, low socio-economic background
- Problems with alcohol consumption and high levels of alcohol use
- Poor knowledge and deviant attitudes toward drink driving
- Extensive histories of criminal and traffic convictions
Drink Driving and the Social Context
The essential social determinant of drink driving is alcohol consumption. Drinking behaviours are often learned through family influences and therefore become ingrained lifestyle behaviours.
The social network of offenders can often influence drink driving behaviours through the affective nature of these relationships. Drink driving offenders are likely to be involved with peers who hold similar values toward drinking and drink driving and these relationships are likely to have a negative influence on drink driving behaviours. On the other hand, more supportive relationships in the offenders social network may help to reduce the incidence of drink driving through the possibility of disapproval from family and friends.
Differences between urban and rural areas can impact on the prevention and enforcement of drink driving. Enforcement in rural regions is more costly and harder to implement due to a lack of resources. Consequently, the probability of detection is much lower in these regions.
Licensing and liquor outlet legislation has also been shown to impact on drink driving. Three alcohol-related policies that are seen to be important in reducing drink driving are: raising the drinking age, increasing alcohol taxes and increasing enforcement of drink driving laws.
Countermeasures for Drink Driving
Intervention strategies designed to control the drink driving problem have been numerous. These strategies are generally divided into two groups depending on the primary target: general interventions and specific interventions.
General intervention strategies target the community in which the socially unacceptable behaviour is occurring. These strategies aim to deter or educate the general community as a way of reducing drink driving. Strategies of this kind include random breath testing and media campaigns and evaluations of these strategies as drink driving countermeasures have generally been positive.
Specific intervention strategies target the convicted offender with the aim of reducing their potential to re-offend. Strategies of this kind include licence sanctions and alcohol ignition interlock devices. Evaluations of these measures have shown significant reductions in traffic-related outcomes, at least for the period the intervention was administered.
Research into the effectiveness of drink driving interventions has mainly been carried out in US jurisdictions. However, differences in drink driving laws and enforcement procedures between the US and Australia can result in problems when applying the research findings to the Australian case.
Drink Driving Rehabilitation/Treatment Programs
Drink driving rehabilitation programs are specific intervention strategies that arose out of the need for alternatives to expensive and counterproductive jail terms. The importance of these programs in controlling the drink driving problem needs to be established to settle the debate over whether drink driving should be treated as a health problem (e.g. through rehabilitation programs) or as a crime to be punished (e.g. through licence sanctions).
Due to the nature of the drink driving offence (ie an offence that involves both a traffic and health-related outcome), an intersectoral approach to the treatment of the drink driving problem should be used. Drink driving has particular relevance to Transport Department policies, however Health Department initiatives may be better able to influence problem drinking. Health Department policies for the treatment of alcohol-related problems are grounded in the harm minimisation approach.
Drink driving rehabilitation programs in Australia are often implemented within the Australian judicial system. While coerced attendance of offenders onto rehabilitation programs through the court system ensures that all offenders are exposed to the program, there is more ethical support for some voluntary interest on the part of the offender.
There are many different types of rehabilitation programs. Education-based programs assume that it is a lack of knowledge that led to the drink driving offence and these programs attempt to assist the drink driver in separating future episodes of drinking from driving. Psychotherapy/counselling-based programs aim to assist the drink
driver in reducing their harmful alcohol consumption to a more reasonable level. However, there is more support for combination programs that include both educational and counselling components.
Screening and assessment techniques are often used in conjunction with drink driving rehabilitation programs to assist in better matching strategies to the needs of the individual offender. Two essential criteria for the effective use of screening techniques are firstly, that the techniques can predict potential risk (e.g. risk of recidivism) and secondly, that the techniques can identify appropriate cut points to define risk groups.
Evaluations of drink driving rehabilitation programs have been plagued with methodological problems. These include: selection biases such as the self-selection of offenders onto programs; lack of randomised case-controlled studies; and limitations in the evaluation measures used.
Evaluations of drink driving rehabilitation programs have generally been positive.
- Meta-analytic evidence suggests that rehabilitation programs can have a 7-9% reduction in recidivism in addition to the benefits shown by licence sanctions.
- Rehabilitation programs can impact on alcohol-related crashes and drink driving recidivism, but unlike licence sanctions do not appear to impact on non alcohol-related crashes. However, the benefits shown by rehabilitation programs appear to be longer lasting than those shown by licence suspensions.
- Drink driving rehabilitation programs can impact on knowledge and attitudes toward drink driving, lifestyle characteristics and psychosocial functioning.
- Multi-modal rehabilitation programs (ie programs which include counselling, education, probation, licence suspension, or a combination of these elements) are more likely to result in a positive outcome than single or 2-mode interventions.
Rehabilitation programs are more likely to be successful if they target high-risk offenders, target the needs and attitudes that are associated with drink driving behaviours, are based within the community and have a directive approach to treatment.
Summary of Literature Findings
Drink driving rehabilitation programs are important countermeasures in the control of drink driving. The most effective use of these measures, however, is by combining them with punitive sanctions (e.g. licence suspension) to provide a more holistic approach to treatment.
Under the Limit in the Current Research Context
Under the Limit (UTL) is a drink driving rehabilitation program that has been implemented in the Central Queensland region since 1993.
Initial design of the UTL program recognised the growing belief that drink driving was an indicator of alcohol dependency and incorporated elements of best practice models of treatment for alcohol dependency in its design.
Initial development of the program was also guided by the research findings described above.
- Development and implementation of the program was based on an intersectoral approach to treatment.
- The UTL program is a community based program involving many key stakeholders in drink driving rehabilitation.
- The program takes into consideration individual differences between offenders, including differences in learning styles and literacy levels.
- The program focuses on educating offenders about alcohol and drink driving issues. It also covers issues relating to alcohol use during times of stress and coping strategies to deal with negative emotions that result in alcohol use.
- The program forms part of a more complete intervention strategy that involves probation and licence suspension.
Download Complete Document: Alc_Rehab_2 [PDF: 341 KB]
Type: Research and Analysis Report
Sub Type: Consultant Report
Author(s): Ferguson, M, Sheehan, M, Davey, J, Watson, B
ISBN: 0 642 25567 9
Topics: Alcohol, Education
Publication Date: 01/11/99