1. A Study of DUI Offenders: Preliminary Results of an Alcohol Problem Computerized Screening Carrie Petrucci, Ph.D., Senior Research Associate, EMT, cpetrucci@emt.org Tim Ho, Data Manager, EMT, tho@emt.org October 11 th, 2007 Project funded by a grant from the California Office of Traffic Safety to Superior Court of Orange County. The evaluation is subcontracted through CSULB, Connie Ireland, Ph.D., and Libby Deshenes, Ph.D., Principal Investigators

2. 2 Today’s Presentation Brief overview of Orange County DUI courts Description of computerized screening process Preliminary findings from first 143 screenings

3. 3 Goals of the Orange County DUI Court To reduce recidivism among nonviolent adult and underage DUI offenders To reduce alcohol abuse among nonviolent adult and underage DUI offenders To increase the likelihood of successful rehabilitation through early, continuous and intensive judicially supervised treatment, periodic alcohol/drug testing and the use of graduated incentives and sanctions (Orange County DUI Court Manual, p. 4).

4. 4 The Orange County DUI Court Model Based on successful drug court model Includes: Treatment services (group and one-on-one) Intensive probation services Judicial monitoring Alcohol testing Case management by DUI court team Manualized program / sanctions, incentives A problem-solving court approach

5. 5 Summary of Findings from 2-Year Evaluation of Harbor Court Harbor Court began in October 2004 North Court began in January 2007 2-year Harbor findings are preliminary due to small sample sizes First 2-year Harbor preliminary results show: high retention and graduation rates compared to other published studies low overall recidivism as well as low DUI recidivism Further analyses with larger sample sizes needed to examine the change theory more thoroughly

6. Computerized Screening Introduction

7. 7 Computerized Screening Tool Practice purpose To identify low and high risk groups for future resource allocation Using standardized alcohol screenings Evaluation purpose To determine if differences occur across low and high risk groups on sanctions, program completion, and recidivism

8. 8 Computer Set-up in North Court

9. 9 Computer Set-up in Harbor Court

10. 10 How Screenings Are Implemented On laptops In the court room or in a room close by Self-administered by clients Also includes voice-over for clients with low- literacy In English and Spanish (can be in any language) Takes 20-30 minutes

11. 11 When Screenings are Implemented Post-arraignment During DUI court evaluation process Preferably before potential participants have declined the program All participants are legally eligible, but perhaps not SUITABLE Scoring sheets immediately passed on to treatment staff for evaluation of suitability

12. 12 Screenings to Identify Alcohol Problems Includes standardized alcohol screenings plus depression: RIASI (Research Institute on Addictions Self-Inventory) CAGE (Cut-down, Annoyed, Guilt, Eye-Opener) AUDIT (Alcohol Use Disorders Identification Test) RTC (Readiness to Change) AASE (Alcohol Abstinence Self-Efficacy) CES-D (Depression) All are public domain except RIASI which is used with permission of author

13. 13 Low / High Risk Groups based on Screenings Cut-off scores are used by clinicians to determine low or high risk groups for each instrument A one page “cheat sheet” for cut-off score interpretation provided to clinicians AASE does not have cut-offs All others do

14. Preliminary Findings Based on the first 143 screenings 77 from Harbor Court 66 from North Court

15. 15 Screening Reliabilities Scale Cronbach’s αNumber of Items RIASI Total Score.72749 AASE Negative Affect.8955 AASE Social Positive.8305 AASE Physical.8185 AASE Withdrawal Urges.8175 CES-D Depression.74210 CAGE Total.4494 AUDIT Total.82810 AUDIT Drinking.6573 AUDIT Problems.8077

16. 16 Readiness-to-change group differences in alcohol problems scores ScaleContemplation Avg. score Avg. (SD) Action Avg. score Avg. (SD) 45 cases97 cases RIASI Total*22.6(7.6)17.9(8.4) Recidivism*7.5(2.5)6.0(2.6) CAGE3.0(.87)2.8(.94) AUDIT Total*20.3(7.5)15.3(8.0) Drinking*7.3 (2.6)5.0(3.1) Problems*13.0(6.0)10.3(5.9) CES-D10.8(6.4)9.6(6.1) AASE Negative*14.6(5.2)16.5(4.9) Social Positive*13.7(4.6)16.7(4.4) Physical*17.5(4.5)19.2(4.3) Withdrawal*15.3(4.4)17.0(4.5) * Significant differences found

17. 17 Risk GroupContemplation 45 cases Action 97 cases Total 142 cases %N%N%N RIASI Total Low risk2% (1)14%(14)11% (15) High risk 9+98%(44)86%(83)89%(127) RIASI Recidivism Low risk2% (1)9% (9)7% (10) High risk 3+98%(44)91%(88)93%(132) CAGE Low risk4% (2)6% (6)6% (8) High risk 2+96%(43)94%(91)94%(134) AUDIT No risk (7 or lower)4% (2)18%(17)13% (19) Low risk (8 – 15)27%(12)39%(38)35% (50) Medium risk (16 – 19)7% (3)12%(12)11% (15) Alcohol dependence (20+)62%(28)31%(30)41% (58) CES-D Low risk51%(23)56%(54)54%(77) High risk 10+49%(22)44%(43)46%(65) Readiness-to-change group differences in risk groups

18. 18 AUDIT risk group differences in AASE self efficacy scores No risk (7 or lower) (n=20) Low risk (8-15) (n=50) Moderate risk (16-19) (n=15) Alcohol Dependence (20+) (n=58) Mean(SD)Mean(SD)Mean(SD)Mean(SD) AASE Negative Affect* 19.84.718.04.612.53.613.94.6 AASE Social Positive* 18.34.916.64.215.04.414.44.7 AASE Physical* 21.32.820.04.017.743917.04.6 AASE Withdrawal urges* 19.34.317.64.215.34.815.04.3

19. 19 Conclusions Vast majority of DUI participants fall into the broad “high risk” category of alcohol problems About 10% scored in the “no alcohol problem” area 40% of DUI participants have “alcohol dependence” (considered high risk) (per AUDIT) 68% of participants are at highest risk for continued alcohol use or DUI recidivism (per RIASI). This information needs to be confirmed with subsequent clinical diagnoses

20. 20 Conclusions Information from two or more of the instruments will likely be needed to determine low/high risk groups Continued analyses and validity discussions with the therapists/DUI court team are needed to define low/high risk groups Half of the participants are scoring within the clinically suggested cut-off for depressive symptoms This is similar to other study findings and suggests a need for treatment, as well as a high prevalence of risk for psychological distress among people with DUI’s Collecting assessments until next year