March 21, 2013

Linda Clark ADSAC Field Services Coordinator Post Office Box Oklahoma City, OK

NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION PROVIDED TECHNICAL ASSISTANCE TO THE OKLAHOMA HIGHWAY SAFETY OFFICE WHICH RESULTED IN A LIST OF PRIORITY RECOMMENDATIONS

 Some of the recommendations refer to ◦ SCREENING ◦ ASSESSMENT ◦ TREATEMENT ◦ REHABILITATION

A Standardized Intervention for Driver’s License Reinstatement

ADSAC is an acronym for ALCOHOL AND DRUG, SUBSTANCE ABUSE COURSES This phrase is found in Title 47 Motor Vehicle Code and originally referred to the entire process of assessment, education and treatment. Authority for the ADSAC process comes from Title 43A Mental Health Law Title 47 Motor Vehicle Code Title 22 Criminal Code

 The ADSAC mission is to promote public safety by reducing the occurrence of substance abuse and related high-risk behavior.

ODMHSAS has responsibility for; ASSESSMENTDefining type, duration and intensity of intervention. FACILITATION10 & 24 hour course standards and curricula CERTIFICATION Assessors Assessment Agencies Facilitators Course Organizations TRAINING Assessors Instruments, Interview Techniques & Code Facilitators Adult Education, Interactive Journaling & Code

 25% to 40% of the population never drink alcohol  20% of the drinking population consume 90% of the alcohol  30% of this group are physically dependent on alcohol NATIONAL INSTITUTE OF HEALTH

HISTORY OF ADSAC IN OKLAHOMA

ADSAC BEGAN AS AN OFFENSE DRIVEN PROCESS

 November 1, hour DUI school Testing suspensions  July 1, hour DUI school All alcohol related suspensions  May 26, hour DUI school Drug convictions  September 1, 1993Assessment required  November 1, hour DUI school  July 1, 2003Assessment driven – Evidence based  July 1, 2008Recommendations in code  November 1, 2008Change in assessment fee collection

ADSAC IS AN EVIDENCE BASED PROCESS

LICENSE REVOCATION AFTER JULY 1, 2003

ASSESSMENT DRIVEN PROCESS

ASSESSMENT NEEDS TO BE DONE FIRST

MUST FOLLOW ADSAC ASSESSMENT RECOMMENDATIONS FOR LICENSE REINSTATEMENT

 Alcohol or other drug related driving offenses (upon arrest) ◦ DUI ◦ DUI D ◦ DWI ◦ APC  Drug offenses (upon conviction) ◦ Possession ◦ Transportation ◦ Distribution ◦ Paraphernalia

PRIMARY PURPOSE

REDUCE RECIDIVISM

ASSESSMENT PROCESS

TITLE 450 Chapter 22 Certification of Alcohol and Drug Assessment and Evaluations Related to Driver’s License Revocation Effective July 1, 2009

ASSESS NEED – Use approved tools – Comprehensive evaluation Interview participant Search arrest history Clarify areas of concern or where inconsistency exists RECOMMEND INTERVENTIONS – Participants required to complete as condition of license reinstatement (depends on revocation date)

ADSAC ASSESSMENT PROCESS ◦ Face to face interview ◦ Bio-psych-social Addiction Severity Index (ASI) ◦ Drivers Risk Inventory revised (DRI II) ◦ Defendant Questionnaire (DQ) ◦ Additional supporting assessment instrument

Drivers Risk Inventory revised DRI II Defendant Questionnaire DQ

Drivers Risk Inventory revised DRI II # QUESTIONS…140 TIME TO ADMINISTER 30 MINUTES

Defendant Questionnaire DQ # QUESTIONS…162 TIME TO ADMINISTER 35MIN

BASED ON SCORES From the DRI-II or DQ

SECOND SUPPORTIVE INSTRUMENT CLINICAL INTERVIEW

SCORES HELP DETERMINE THE INTERVENTION CATEGORY INTERVENTION CATEGORIES BASED ON ASAM CRITERIA

TOOLS USED TO ASSESS ARE, IN PART BASED ON ASAM CRITERIA

 DR. MEE LEE  Consulted with ADSAC to help implement ASAM criteria  a board-certified psychiatrist, and certified by the American Board of Addiction Medicine (ABAM).

 In the 1980's, Dr. Mee-Lee was one of 3 main authors doing initial work on what was known as the Cleveland Criteria.  This work developed into the ASAM Criteria with the first edition published in 1991.

 the chief Editor of the revised second edition of the ASAM Patient Placement Criteria, ASAM PPC-2R, published in April 2001.

WHY DO PEOPLE CHANGE?

Discovered insights into change while treating alcohol and other drug problems.

They conducted research to study “change”

Motivation is fundamental to change The greater the motivation to change, the higher the likelihood that change will occur

WHICH RESULTED IN THE DEVELOPMENT OF MOTIVATIONAL INTERVIEWING

MOTIVATIONAL INTERVIEWING IS NOW A KEY COMPONENT OF THE ADSAC PROCESS

ADSAC COURSES

TITLE 450 Chapter 21 Certification of Alcohol and Drug Substance Abuse Courses (ADSAC), Organizations and Facilitators Effective July 1, 2009

 The course encourages responsible decision- making by providing participants with accurate information, use of Interactive Journaling® and the application of the Stages of Change and Motivational Interviewing principles.

 All participants who complete the courses also complete a standardized pre/post-test, which measures knowledge and attitude/behavior change as well as a course evaluation.

 Question 1: Gender  Male 69%  Female 31%

 Question 2: Age  %  %  %  %  %  60+ 4%

 Question 3: Ethnicity  African American 5%  American Indian 14%  Asian/Pacific Islander 1%  Hispanic/Latino 8%  White/Caucasian 68%  Other 4%

 Overall, how would you rate this course?  Good  25%  Average  4%  Poor  0%  Excellent  71%

 Questions 5-9  How useful were the following activities in helping you meet your goals for the course?  Very UsefulUsefulNot Useful  Participant Workbook69%31%0%  Homework47%45%8%  Personal Change Plan65%35%0%  Class Discussions79%20%1%  Small Group Activities59%39%2%

 How much did you learn from the course?  79% responded with the highest rating of Learned a Lot

Gender Male80% Female20%

Age of participant in years 15 to 195% 20 to 2931% 30 to 3921% 40 to 4924% 50 to 5917% 60+ 2%

Course activity rating very usefulusefulnot useful Workbook64%34%2% Homework53%41%6% Change plan61%37%2% Class discussion74%25%1% Small grp exer60%37%3%

Rating of course Excellent72% Good26% Average2%

Composite facilitator ratings Excellent88.8% Good10.8% Average.4% Poor0%

Changes measured by Pre-test/Post-test Improved knowledge82% Positive attitude change68%

POST TEST RESULTS (24 hour ADSAC ) KNOWLEDGE RETENTION  Reading10%  Lecture20%  Observation30%  Observation and lecture50%  Verbal restatement of learning70%  Learning through doing90%

LICENSE REINSTATEMENT REQUIREMENTS VS COURT REQUIREMENTS

 PROVIDE RESULTS OF THE ALCOHOL AND DRUG, SUBSTANCE ABUSE COURSE (ADSAC) ASSESSMENT TO COURTS FOR USE IN SENTENCING ADSAC ASSESSORS PROVIDE THIS INFORMATION WITHIN 72 HOURS OF THE ASSESSMENT WHEN REQUESTED BY THE PARTICIPANT, THEIR ATTORNEY OR THE COURT

THE ADSAC PROCESS IS BASED ON RESEARCH

COLORADO 7.9% recidivism with an “at risk time average” of 45 months or 3.7 years Randall Deyle, EDUCATION/TREATMENT INTERVENTION AMONG DRINKING DRIVERS AND RECIDIVISM, Colorado Department of Human Services, June 2008 Vol. 4

COLORADO At ten years post assessment 10.4% recidivism for those completing all interventions 44% recidivism for those not completing all interventions Randall Deyle, EDUCATION/TREATMENT INTERVENTION AMONG DRINKING DRIVERS AND RECIDIVISM, Colorado Department of Human Services, June 2008 Vol. 4

VIRGINIA 1 year study of DUI offenders on probation and assigned to VASAP program. 9% recidivism during probation 5% recidivism after probation Recidivism Rate Comparison Study Rappahannock Area Alcohol Safety Action Program

VERMONT 1997 to % of offenders had a prior conviction with a median time between convictions of 4.5 years. HOW MANY COME BACK? DUI OFFENDER RECIDIVISM IN VERMONT, William Clements, Vermont Bar Journal, March 2002 pp 1-4

CALIFORNIA Each prior conviction increased recidivism risk by 26.9% Each 0.01% increase in BAC increased recidivism risk by 5.4% Being male increased recidivism risk by 57.5% 1995 California State Report

CALIFORNIA 44% of DUI offenders had a prior offense within the last ten years 1995 California State Report

CALIFORNIA Each year of age decreased recidivism risk by 2.1% Full time employment decreased recidivism risk by 37.6% Completion of Tx decreased recidivism risk but, multiple Tx completions increased recidivism risk 1995 California State Report

WASHINGTON Five year DUI recidivism rate 31.8% Deferred Prosecution of DUI Cases in Washington State: Evaluating the Impact of Recidivism, August 2007, Washington State Institute for Public Policy

MISSOURI At two years post intervention there was a 16% recidivism rate Missouri Department of Mental Health 1999

TENNESSEE Recidivism at one year8.7% Recidivism at two years10.4% Recidivism at three years18.3% Recidivism at six years52.3% Recidivism at ten years61.5% Little, Baker, McCarthy, Davison & Urbaniak, An MRT Based Cognitive Behavioral Treatment for fiirst-time DUI Offenders: Two and Three year Cohort of Davidson County, Tennessee Offenders With a Comparison to the Prime For Life Program March 2010

Currently, Oklahoma has a 4.2% recidivism rate at eighteen months post intervention completion

1200 NE 13 TH P.O Box OKC, OK FAX

 Berg-Smith S. (2004) Practical strategies for motivating diabetes-related behaviour change. International Journal of Clinical Practice, 58 (supplement 142),  Berg-Smith S, Stevens V, Brown K, Van Horn, L, Gernhofer N, Peters E, Greenberg R, Snetselaar L, Ahrens L (1999). A brief motivational intervention to improve dietary adherence in adolescents. Health Education Research; 14(3):  Dunn C & Rollnick S (2003). Lifestyle Change. London: Mosby.  Miller W (2000). Rediscovering fire: Small interventions, large effects. Psychology of Addictive Behavior, 14: 6-18  Miller W & Rollnick S (2002) Motivational Interviewing: Preparing People for Change (2nd Edition). New York: Guilford Press.  Miller W (2004). Motivational Interviewing in Service to Health Promotion. American Journal of Health Promotion, 18: 1-12  Resnicow K, DiIorio C, Soet J, Borrelli B, Hecht J, Ernst D (2002). Motivational Interviewing in health promotion: It sounds like something is change. Health Psychology; 21(5):  Rollnick S, Mason P, Butler C (1999). Health Behavior Change: A Guide for Practitioners. Edinburgh: Churchill Livingstone.  Rollnick S, Miller W, Butler C (2007). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press.  Rosengren D (2009) Building Motivational Interviewing Skills: A Practitioner Workbook. New York: Guilford Press  Motivating Offenders to Change: A Guide for Probation and Parole  Available for download at  The Motivational Interviewing Page: Resources on MI, including general information, links, discussion board, training resources, and information on reprints and latest research:.

ADSAC PROCESS: CLINICAL INTERVENTIONS Maureen Guerrero

 Maureen Guerrero MS, LPC, LADC, NCGC  Clinical Director /ADSAC Assessor  The Center for Therapeutic Interventions  4845 S Sheridan Suite 510  Tulsa, OK  (918) 

ASSESSMENT DRIVEN PROCESS

The DRI II consistently places high in studies of DUI assessment instruments. When cost, ability to screen for drugs as well as alcohol, truthfulness scales, and research to determine reliability and validity are considered, then the DRI II places highest. Review of Screening Instruments and Procedures for Evaluating DUI Offenders AAA Foundation for Public Safety 2002 The Illinois DUI Assessment Instrument Project & National Highway Traffic Safety Administration

FIFTY-ONE STATES AND DISTRICTS 30Assessment driven process66% 7Modified assessment driven process15.5% 6Offense driven13.3% 2No statewide regulation4.5% 6UnknownNA

2009 DRIVER RISK INVENTORY-II DEFENDANT QUESTIONNAIRE SUMMARY REPORT Information for this report was gathered between April 2008 and March 2009

Average age of offender in years Overall33.9 First offenders, both sexes31.7 Multiple offenders both sexes37.1 Male33.8 Female34.2

Education levels Less than high school20.1% GED35.6% High school diploma30.5% Some college12.2% College graduate1.6%

Number of DUI arrests lifetime First offenders Male56.3% Female68.0% Multiple offenders Male43.7% Female32.0%

BAC at arrest All offenders.124 Male offenders.123 Female offenders.128 First time offenders.121 Multiple offenders.130 Offenders under 21 yrs.106

Refused breathalyzer First offenders12.4% Multiple offenders17.8%

Previous program attendance First offense5.7% Multiple offense50.4% two or more Tx Male24.8%6.2% Female19.1%3.1%

COURSES

COURSE EVALUATION AND PRE/POST-TEST RESULTS 2008

LEVEL I

Gender Male77% Female23%

Age of participant in years 15 to 198% 20 to 2937% 30 to 3925% 40 to 4917% 50 to 599% 60+ 4%

Course activity rating very usefulusefulnot useful Workbook66%32%2% Homework54%40%6% Change plan57%40%3% Class discussion77%22%1% Small grp exer62%35%3%

Rating of course Excellent70% Good28% Average2%

Composite facilitator ratings Excellent91.4% Good7.6% Average1% Poor0%

Changes measured by Pre-test/Post-test Improved knowledge80% Positive attitude change75%

LEVEL II

Gender Male80% Female20%

Age of participant in years 15 to 195% 20 to 2931% 30 to 3921% 40 to 4924% 50 to 5917% 60+ 2%

Course activity rating very usefulusefulnot useful Workbook64%34%2% Homework53%41%6% Change plan61%37%2% Class discussion74%25%1% Small grp exer60%37%3%

Rating of course Excellent72% Good26% Average2%

Composite facilitator ratings Excellent88.8% Good10.8% Average.4% Poor0%

Changes measured by Pre-test/Post-test Improved knowledge82% Positive attitude change68%

COURSES KNOWLEDGE RETENTION  Reading10%  Lecture20%  Observation30%  Observation and lecture50%  Verbal restatement of learning70%  Learning through doing90%

Knowledge alone will not modify behavior A course significantly changes knowledge and attitude using Interactive Journaling,

 designed specifically for DUI/DWI offender assessment.  The DRI-II was rated "The Best" by the National Highway Traffic Safety Administration (NHTSA),  This test has been standardized on over one million DUI/DWI offenders and incorporates DSM-IV classification criteria along with independent measures of alcohol and drug use (or abuse) severity.

 The Defendant Questionnaire (DQ) is designed for defendant misdemeanor or felony assessment in court settings.  The DQ is especially useful in substance abuse related cases (to include alcohol and other drugs).