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

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

Drinking and Drugged Driving

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

More Drinking and Drugged Driving

• In a Maryland Trauma Center, driver’s 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

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 other’s lives.

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?

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.

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

July, 2006

13 Principles

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

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 client’s treatment and case management regimen.

• Effective Incentives and Sanctions for appropriate and specific behaviors.

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.

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 Step……Last Step; meaning assessment must be an ongoing process.

13 Principles – cont.

5.

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

13 Principles – cont.

6.

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

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

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.

13 Principles- cont.

9. 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.

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.

13 Principles- cont.

11. 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.

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

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.

Brad’s 14

th

Principle

• Effective treatment must be based on “What Works” or evidenced based practices.

– Cognitive-Behavioral Treatment – Motivation Enhancement Therapy – Support Groups.

• Drug Courts