Drunk Driving: A Strategy for Reducing Recidivism 12th Annual Michigan Traffic Safety Summit Tuesday March 13, 2006

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Drunk Driving A Strategy for Reducing
Recidivism12th Annual Michigan Traffic Safety
SummitTuesday March 13, 2006

• Bradley Finegood, MA, LLPC

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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

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Drinking and Drugged Driving

• In 12 states including Michigan it is illegal to
  drive with any detectable level of illicit drug
  or its 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

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More Drinking and Drugged Driving

• In a Maryland Trauma Center, drivers 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

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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 others lives.

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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?

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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.

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NIDA Principles of Drug Abuse Treatment for
Criminal Populations An Evidenced- Based Approach

• July, 2006

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13 Principles

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

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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 clients
  treatment and case management regimen.
• Effective Incentives and Sanctions for
  appropriate and specific behaviors.

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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.

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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 StepLast Step
  meaning assessment must be an ongoing
  process.

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13 Principles cont.

• 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

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13 Principles cont.

• 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

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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

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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.

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13 Principles- cont.

• 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.

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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.

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13 Principles- cont.

• 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.

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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

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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.

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Brads 14th Principle

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