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 Among Convicted Alcohol Impaired Drivers
Sandra Lapham, MD MPH
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Introduction
•Study Purpose
•Background
•Study Design
•Measures <= /div>
•Where we are as of July 31, 2006 =
•Summary of Current Findings
•Discussion
•Questions?
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Study Purpose
&#= 8226;To measure the long-term progression of alcohol use and other psychiatric disorders in a cohort of convicted impaired drivers
= –Lifetime alcohol use patterns
= –Driving after drinking
&#= 8226;To examine the natural history of alcohol and drug use disorders &= #13;
= –Qualitative substudy
• =
•
Th= is study advances earlier work by expanding the follow-up period to 15 years and = by integrating the findings from the current study into a broader explanato= ry framework that accounts for drunk-driving behavior.

Su= bjects will be located and re-interviewed to determine long-term outcomes of substance abuse/dependence and drinking/driving.&= nbsp; We will determine what aspects of recovery can be attributed to natural processes or treatment, and determine the applied utility of a social-control model in elucidating the role of risk and protective fact= ors for drinking/driving.

Sp= ecific Aims:
   Measure the long-term prog= ression of alcohol use and other psychiatric disorders among convicted drunk-dri= ving offenders, and the main effects of  = ;  gender and ethnicity on these conditions;

   Establish the extent to wh= ich natural recovery (no treatment), formal, and informal treatment are significantly associated with remission from    alcohol and drug use disorders;

   Determine long-term rates = of driving outcomes, including violations, crashes, and DWI arrests, through self-reports; and the rates of traffic &= nbsp;  outcomes validated with archival traffic records for those subjects residing in-s= tate during the follow-up period;

   Corroborate the Cognitive-Behavioral theoretical model obtained from the current study R= 03 secondary analyses with longitudinal data from the 15-   year follow-up study;

   Contrast the performance o= f an alternative theoretical model (i.e., the Social-Control model) wi= th those of the Cognitive-Behavioral model in    predicting long-term, self-reported drinking/driving and traffic outcomes of previo= usly convicted offenders;

   Assess the extent to which= the subjects’ self-report information explains variability in long-term maintenance of sobriety, non-problematic drinking,    or continued problematic drinking, and drinking/driving, using qualitative interview techniques in a smaller ra= ndom sample of subjects.

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Background
•= Subjects were initially contacted between April <= /span>1989 and March 1992 following a conviction of first DWI and referral to the LCSP.
•= The second contact was five years later with a cohort of all female offenders within the initial= timeframe, and a random cohort of males = matched to the females on date of screening referral and ethnicity.
–= 2559 subjects were selected
–= 81% were located
•58 were deceased&#= 13;
•1396 were interviewed
–
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Long-Term Change (LTC)
Study Design
&#= 8226;15-year follow-up to observe LTC in a cohort of individuals = first interviewed 1989-1992
&= #8226;Interview cohort (N=3D1396)
= –Anticipate 994 subjects will be contacted
= –Anticipate 835 will be interviewed
•
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HN5C5PMw5TrYEM0YJkMIVlwNu7J6jPHGP0pLuHWYrt57ZjICAoyfZcnbnHXd0Ga3aKXN5D5PM583 HiMFv3AIH3cKvJ3f5H+c1PB/bJu4jMzbVI3jYoUg7cjrnjn8vetminzeQcnmc/JJ4geGU7GQElVC qu4Dnkc9eg+lTOupx3ly8COxZ127vu7dozjLYzn2FbVFLm8g5PM54T+IFgf9wzSPyDheO3+Hb1pU bxAAygMCSSGZVPH5/QD2zXQUU+byFyeYgzgZ645opaKg0P/Z ------=_NextPart_01C6F84A.FC11C850 content-location: file:///C:/DE49AC8D/Lapham_files/slide0005.htm content-transfer-encoding: quoted-printable content-type: text/html; charset="us-ascii" Long-Term Change Among Convicted Alcohol Impaired Drivers
Measures
•Interviews
•Demographic/crimin= al history
•Alcohol treatment =
•Health and Life Events
•Composite Internat= ional Diagnostic Interview (CIDI).
•Lifetime Drinking History =
•Partner history
•Driving Behaviors = and Attitudes
•Family history = 3;
•
•
Th= e interview was designed to characterize offenders' long-term outcomes  (Specific Aim 1) and assess the effects of treatment on long-term outcomes (Specific Aim 2). Instruments developed for the 5-year follow-up study were modified to query events t= hat have ensued in the past 10 years.

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Measures
•Self Report
•= Lovelace Comprehensive Screening Instrument, measuring driving behaviors and attitudes
•= Leigh Expectancy Scale <= /div>
•= Internal-External Scale (IE)
•= Rosenberg Self-Esteem Inventory
•= Beck Depression Inventory
•Record Da= ta (Third Party)
•= DWI Citation Traffic File
•= Vehicle level accident file
•= Driver history file
Th= e interview was designed to characterize offenders' long-term outcomes  (Specific Aim 1) and assess the effects of treatment on long-term outcomes (Specific Aim 2). Instruments developed for the 5-year follow-up study were modified to query events t= hat have ensued in the past 10 years.

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Where we are: July 31, 2006
•= 1135 subjects reached their 15-year anniversary
•= 358 have completed F/U interviews
•= 6 unable to complete
•= 66 deceased
•= 78 refused interview
•= 627 in the locating/scheduling process
•<= /span>We are interviewing more women and = Hispanics compared with target population<= /span>
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Subject Characteristics*
29.63
44.67
2= 8.85
4= 3.89
36= .94
51= .99
3= 1.56
4= 6.59
2= 9.44
4= 4.46
4= 5.05
Av= g. Age
  screening
   15-yr anv <= /div>
    Interview=
40.5%
45.9%
11.8%
1.8%
4= 0.7%
4= 5.5%
1= 2.1&
1= .7%
36= .3%
51= .5%
6.= 1%
6.= 1%
5= 3.8%
3= 7.2%
9= .0%
0= .0%
3= 8.0%
4= 7.5%
1= 3.1%
1= .4%
Ra= ce
    White
    Hispanic
    Am Ind
    Other
44.4%
4= 7.2%
47= .0%
4= 7.4%
3= 8.3%
Ma= le
Total
N=3D1133
N= ot Int
n= =3D631
D= eceased
n= =3D66
R= efused
n= =3D78
In= terviewed
n= =3D358
•*Reached anniversary as of 7/31/06<= /div>
Bo= ttom Line:
GENDER
•No significant differences Interviewed versus R= efused or Deceased Status

RACE/ETHNICITY
•Significant differences (p<.04) by interview= ed, refused, deceased and not interviewed
•Significant differences (p<.03) between Whit= e, not Hispanic and Hispanic by Refused. White likely to refuse more often.
•No significant differences
•By interviewed, deceased, not interviewed
•Between Hispanic and native American by refused=
•Between white and native American by refused

AVERAGE AGE & Age Groups
•Slightly older age at interview may be accounte= d for by time to locate, schedule and complete interview.
•No differences between interviewed, refused, an= d not interviewed
•As expected significant difference (p<.001) = between age groups by interviewed versus deceased with the 55-90 group accountin= g for the difference
•Although a higher death rate is noted in the ol= der groups, the average age interviewed remains less than 1-year different f= rom target.

SUMMARY
Interviewees are more heavily weighted towards females suggesting easier to located.<= /b>
White, not Hispanic, appear to refuse interview more often.



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Demographics
•= Marital Status
–No significant differences between gender or Race/Ethnicity by marital status.
•= Income
–Females more likely to be in the lower two income levels (<12,000 and 12,000-23,999 in the past 12 months)
BY= ALCOHOL DIAGNOSTIC GROUP
Pa= st year group more likely than >5 to be separated, widowed, or divorced verus legal= ly married or living together
Pa= st year group less likely than >5 to be in the $24,000 or above income categoty
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Summary of Current Findings