CRICOS No J The impact of completing a drink driving rehabilitation program on future drinking: the clients’ perspective Professor Mary Sheehan ICADTS Symposium, Potsdam September 8 th 2011

Context Consistent international (Europe, UK and Australia) replication of drink driving rehabilitation program effectiveness with high recidivist drink drivers (1,2,3) Similar findings in the USA where program was an alcohol treatment rather than drink driving intervention (4) Long term debate about responsibility for drink drivers –Health: it is an alcohol dependency problem –Transport: the alcohol problem is a secondary concern- people need to separate their driving and drinking

Study Questions Does a drink driving rehabilitation program reduce the participants’ level of alcohol use after program completion? Are there implications for decision making about appropriate program referrals for convicted drink drivers? Why is rehabilitation more effective for recidivist drink drivers?

Elements of effective drink driving programs Undertaken in addition to licence restriction and/or suspension Offenders perceive transparent and objective client selection *Group programs – 10 participants most common size reported in effective programs *Longer rather than shorter programs (approx. 10 sessions over 10 weeks) *Interactive discussion – active learning not didactic teaching *Use of drinking diaries and trackers to develop strategies for high potential drink driving situations *Information essential but not sufficient *A focus on personally relevant strategies and skills to avoid drink driving and group processing of problem solutions *Staff trained to handle class relationship problems professionally *A formally structured program defined by a written manual *These are also core process elements recommended for group alcohol treatment programs

Methodology Consent obtained from UTL drink driving rehabilitation course attendees to participate in further research Drinking and drink driving variables assessed at 3 months post course completion Questionnaires received from 30 of approximately 150 program participants CRICOS No J

Sample characteristics CharacteristicPercentage Gender Male Female 67.9% 32.1% Education Didn’t complete primary Primary school Junior high (year 10) Senior high (year 12) Certificate/diploma 3.6% 42.9% 25.0% Employment None Full time Part time Voluntary Other 32.1% 39.3% 17.9% 7.1% 3.6% Internet access (n = 23) Yes No 74.0% 26.0%

Age groups of participants

Comparison of participants and State completions

Post-UTL Knowledge What is a standard drink?Percentage correct Full strength beer67% Nip of spirits100% Glass of wine*33% Pot of beer79% Can of mixed drink82% While UTL participants could generally identify beer, mixed drinks and spirits, there remains a lack of knowledge about standard glasses of wine.

Post-UTL Knowledge (cont.) What will make you sober up?Percentage correct Drinking milk100% Drinking coffee100% Vomiting96% Time*86% Having a shower100% Exercising89% The majority of UTL participants could correctly identify the only way to be sober was with time, and dismissed other methods of becoming sober.

Alcohol use since UTL AUDIT-C scoring (6) 76% of participants scored hazardous drinking level 24% of sample reported no alcohol use at all after the UTL program..

Course component mean score usefulness 1 = useless 5 = useful

Strategies used following UTL program 1 = never 5 = regularly

Life improvements since the course 1 = strongly disagree 3 = somewhat 5 = strongly agree

Change in actions since the program (n=30) %

Action plans 93% of the sample reported a plan to avoid drink driving in the future –‘I plan to be wise about my drinking and feel free to say no...’ –‘Plan ahead, public transport/taxi, leave car at home, either drinking or driving; never both’ –‘Well when I get back my licence, I won't be taking it for granted, so if planning a night out have more money for taxi, leave car at home...’

Changing drinking 87% of the sample noted a reduction in alcohol use –‘The program has made me realise how dangerous drinking really is’ –‘I used to drink every day till I messed up my life and found it hard trying to get back to work or even getting around’ –‘I have cut back - I am more aware of how much I drink’

Research direction Participants currently being recruited to add to the sample numbers

Participant feedback Would your answer have been different before the program? “Yes my answer would have been different. I drunk more to hide pain I was going through.” “Yes I have had to stop drinking altogether because I attempted to drive while I was drunk.” “Yes, I used to drink a heap more now I value my licence more.” “Yes I have cut back on drinking when I have had to drive.” “Yes I have an alcohol problem and have given up completely. Total abstinence is the only choice.” Other comments “I’ve been sober for 6 months now.” “The program was ok, the program itself did not stop me from drink driving, the fines & no licence did.” “I don’t like many things. I am sinful. I like a help.” “Need more teaching on abstinence from drugs & alcohol. 12 step programs. Most people in the course had an alcohol problem.”

References 1.Davies, G.P., Broughton, J., Harland,D.G.,& Tunbridge, R.(1999) Drink/driver rehabilitation courses in England and Wales.TRL Research Report 426. Transport Research Laboratory, Crowthorne. 2. Mills, K., Hodge, W., Johansson, K.,& Conigrave, K.M.(2008) An outcome evaluation of the New South Wales Sober Driver Programme: a remedial programme for recidivist drink drivers. Drug and Alcohol Review, 27, 65 – Bartl, G. (2003) Analysis of driver rehabilitation programmes. Paper presented at the GOCA –Your safe Mobility Congress, Oct. Brussels. 4. Deyoung, D. J.(1997) An evaluation of the effectiveness of alcohol treatment, driver license actions and jail terms in reducing drunk driving recidivism in California. Addiction, 92, Babor, T.F., Biddle-Higgins, J.C., Saunders, J.B. & Monteiro, M.G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. Geneva, Switzerland: World Health Organization

Questions? & Mark your Diaries! International Council on Alcohol, Drugs and Traffic Safety Conference (T2013) August 2013, Brisbane