Evelyn Vingilis

A CRITICAL REVIEW ON THE EFFECTIVENESS OF DRINKING-DRIVING REHABILITATION PROGRAMMES

Research designs, assessment instruments, and follow-up procedures for the evaluation of D.W.I. rehabilitation programmes are considered and the results of these programmes are reviewed. While evaluations of the rehabilitation programmes have been hindered by methodological difficulties, the information presently available indicates that certain of these programmes may reduce recidivism in D.W.I. offenders. These results need to be replicated in future well-controlled studies; methods for assessing which individuals would benefit most from specific programmes are also required.

Sentence severity and the drinking driver: relationships with traffic safety outcome.

While a major response to the drinking-driving problem has been to increase penalties for drinking-driving offences, the impact of sentence severity on the driving behaviour of offenders (specific deterrence) remains unclear. In this research, relationships between aspects of sentence severity (license suspension, fine, jail term, assignment to probation, or temporary absence programmes) and postconviction accidents and drinking-driving convictions were examined, while controlling statistically for demographic and previous driving record factors. License suspensions were consistently associated with traffic safety benefits. However, increasing severity of other aspects of punishment seemed unrelated to outcome or was associated with increased traffic safety problems. As well, important differences between first, second, and multiple offenders were observed, which may be related to the impact of different aspects of sentence severity on driving behaviour.

Alcohol and driving factors in collision risk.

In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n=8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR=0.989), region overall, Central East region (OR=0.71), West region (OR=0.67), and North region (OR=0.67), income overall and those who did not state income (OR=0.64), marital status overall and those married or living common law (OR=0.60), and number of kilometers driven in a typical week (OR=1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR=1.51) and each of the Step 3 models (ORs=1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs=1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.

School-based programmes for the prevention of drinking and driving: Issues and results☆

In an effort to decrease alcohol-related driving accidents and fatalities among youth, many school-based programmes to prevent drinking and driving have been developed. These programmes would seem to have many important advantages, including being able to foster appropriate attitudes and behaviours at critical times before and during the formation of driving behaviours and drinking behaviours. The didactic assumptions of these programmes are examined in this paper, and evaluations are reviewed. Programmes based on accurate provision of information and non-threatening attempts to change attitudes, and on behavioural peer intervention techniques, consistently demonstrate knowledge gains, and in some cases appropriate changes in attitudes and self-reported behaviours, immediately following programme exposure. These effects often tend to dissipate with time. Since the impact of these programmes on traffic safety measures has not been examined, their development should be carefully monitored and evaluated until traffic safety benefits can be documented.

COMPARISON OF AGE AND SEX CHARACTERISTICS OF POLICE-SUSPECTED IMPAIRED DRIVERS AND ROADSIDE-SURVEYED IMPAIRED DRIVERS

Abstract The age and sex characteristics of drivers randomly stopped by police-conducted spot-checks and suspected of drinking were compared to drivers stopped and breath-tested during an independent roadside survey. Discrepancies were evident. A significantly higher proportion of younger drivers were requested to submit to a roadside screening device, yet a greater proportion of older drivers, particularly females, registered a “fail” (over 80 mg 100 ml ) . The results of the independent roadside survey of the same geographical region found no differences in the proportion of younger and older drivers with B.A.C.s over 80 mg. Although the nature of the study precludes firm conclusions being drawn, hypotheses are offered as interpretations of these findings.

REVIEW: DRUGS AND TRAFFIC COLLISIONS

Three categories of drugs, and specific commonly used drug subcategories are examined in this paper: depressants (benzodiazepines, methadone), stimulants (cocaine), and hallucinogens (cannabis). Descriptive, epidemiological studies on the incidence of drugs in driving populations show that cannabis or benzodiazepines are the most common drugs detected in most industrialized countries. The large number of experimental studies on the impact of various drugs on psychomotor performance show that the effects of the three categories of drugs and specific drugs with each category vary considerably. Some psychoactive drugs within these three categories have the potential to alter the skills required for driving. Analytic epidemiological studies, where comparison groups are utilized, provide the best information on the role of drugs in traffic crashes. The most rigorous epidemiological studies have been conducted on benzodiazepines and traffic crashes. Generally, benzodiazepine users are up to 6 times more likely to be in crashes than non-users, depending on the study; however, the effects can be mitigated by altering the mode and type of prescriptions. In terms of the other types of drugs, the research is less rigorous and has not clearly shown they are associated with increased rates of traffic crashes.

Blood alcohol testing of motor vehicle crash admissions at a regional trauma unit.

Motor vehicle crashes remain a leading cause of death and injury in the industrialized world. Alcohol consumption is implicated as a major factor in fatal motor vehicle crashes (MVCs), but only poor estimates of blood alcohol concentrations among nonfatally injured crash victims are available. A 3-year study was undertaken at a Regional Trauma Unit to determine the demographics, injury severity, and alcohol positivity of motor vehicle crash victims. Between August 1, 1986 and July 31, 1989, 825 motor vehicle crash victims were available for study; 368 drivers were admitted to the unit within a period of 4 hours. Of 715 patients tested for alcohol, 31.0% were positive. A total of 333 drivers were tested for blood alcohol; 128 (38.4%) were positive. The mean blood alcohol concentration (BAC) at admission for the drivers was 145.6 mg/100 ml; the estimated mean BAC at crash was 180.9 mg/100 ml. The mean age of BAC positive drivers was 31.4 years, compared to a mean age in the BAC negative drivers of 35.2 years (p less than 0.02). Male patients represented 76.6% of the drivers, yet represented 83.6% of the BAC positive drivers (p less than 0.05). There was a marked seasonal variation in BAC positivity, with 46.1% of drivers positive during the summer months. Alcohol appears to be a significant factor in nonfatal MVCs.

Psychosocial sequelae of motor vehicle collisions: a follow-up study

One-hundred-and-forty-nine motor vehicle collision trauma victims were interviewed one year after discharge from a Regional Trauma Unit. Follow-up data indicated major post trauma problems such depression, anxiety, family stress, financial problems and driving fears. Almost 40% reported drinking driving after the crash with a greater proportion of alcohol (blood alcohol content) positive drivers engaging in drinking driving than blood alcohol content negative drivers. Notably, almost 16% of the blood alcohol content positive and 13% of the blood alcohol content negative reported involvement in another crash in the year since discharge.

Psychosocial characteristics of alcohol-involved and nonalcohol-involved seriously injured drivers☆

This study compared two groups of alcohol-positive and alcohol-negative, seriously injured, crash-involved drivers on demographics, personality characteristics, driving-related attitudes, prior driving history, lifestyle, substance use, and antecedent driver condition. The study sample was drawn from motor vehicle accident admissions to the Sunnybrook Health Science Centre Regional Trauma Unit. One hundred and six interviews were completed between August 1986 and November 1989, with blood alcohol concentration (BAC) data available for 96 drivers. These data suggest no driving-related attitude differences between the two groups. Self-reported driving histories indicated significantly fewer graduates of driving schools and more licence suspensions for the BAC-positive group. The only consistently significant differences were found for the drinking-related variables, with a greater percentage of the BAC-positive group reporting: lower age of first intoxication; a greater self-perceived drinking problem; a greater frequency of intoxication in the month before the accident; and greater self-reported drinking-driving in the month before the accident. Principal-components factor analysis revealed a four-factor solution labelled: Alcohol Use, Deviant/Illicit Drug Use, Aggression, and Neuroticism. Alcohol Use was the only factor found to contribute substantially to the discriminant function, together with the job-related stress item. These data suggest that seriously injured, alcohol-positive and alcohol-negative crashed drivers are similar except that the alcohol-positive drivers show more signs of an alcohol problem.

YOUTH AND THE FORBIDDEN FRUIT: EXPERIENCES WITH CHANGES IN LEGAL DRINKING AGE IN NORTH AMERICA

The effects of changes in the minimum drinking ages in various North American jurisdictions are reviewed. The research suggests that although most teenagers have experimented with alcohol, the rates of alcohol consumption and alcohol-related traffic collisions can be increased and decreased with the drinking age control legislation.