Janet C'de Baca

A multiple risk factor approach for predicting DWI recidivism.

A sample of DWI (driving while impaired) offenders was studied to compare various approaches for predicting reoffenses over a 4-year period. Logistic regression yielded multivariate predictor equations that were significant statistically, but were not helpful to clinicians in assessing risk for reoffending. As a different approach, five predictor variables that were consistently correlated with reoffense status were examined to determine the cut score at which the repeat offense rate exceeded the base rate. These were combined to yield the number of risk factors (from 0 to 5) for each offender. This method, used for the original and a hold-out sample, yields results as accurate as those derived from a logistic regression model that includes all the risk variables, and allows clinicians to classify offenders into low and high risk categories in a straightforward manner. Nearly half of offenders with four or five risk factors (age, years of education, arrest blood alcohol concentration (BAC), score on the receptive area scale of AUI and raw score on the MacAndrews scale of MMPI-2) were rearrested compared to the base rate (25%). However, this method is not sufficiently precise to accurately predict which individuals will and will not be rearrested. Although generalizability of specific algorithms across populations needs to be examined, this method appears promising as a clinically accessible way to classify, in a given offender population, those who are most likely to repeat the offense.

What every mental health professional should know about alcohol

Mental health professionals are playing an increasing role in the treatment of alcohol problems. Yet many such professionals have had little specialized training in this area. This article presents a 50-item self-assessment quiz regarding basic knowledge that might be expected of professionals treating alcohol problems. Expanded answers are provided, along with normative data from samples of clinical psychology students and Ph.D. alumni. Students currently in training scored significantly higher on this quiz than did graduated clinical psychologists, reflecting in part a higher percentage of current psychology students receiving specific training in alcohol problems.

Cognitive predictors of alcohol involvement and alcohol consumption-related consequences in a sample of drunk-driving offenders.

Motivational theories of alcohol involvement emphasize a wide range of cognitive factors as precursors to “heavy” or high-risk drinking. Central to this consideration has been expectancies, drinking urges, triggers, and situational cues, all of which can synergistically or independently stimulate drinking. Unfortunately, empirical studies have scrutinized low-level or moderate drinkers drawn from the general population, and less is known about the role of cognitive factors as precursors to high-risk drinking. The present study examines the unique contribution of several measures of cognitive motivation to harmful alcohol use in a sample of convicted drunk drivers. Confirmatory factor analysis indicated the psychometric soundness of a model positing four latent predictor constructs assessing drinking urges/triggers, situational cues, positive and negative expectancies and outcome constructs assessing harmful alcohol use and perceived consequences of harmful drinking. A structural equation model indicated that each motivational construct was associated uniquely with both drinking and perceived consequences, with the largest overall effect in both cases associated with situational cues. Results are discussed in terms of identifying prominent cognitive factors that may foster harmful drinking among high-risk populations and their implications for treatment.

Reclassifying DIS-III-R Alcohol Use Disorders to DSM-IV Criteria in a Sample of Convicted Impaired Drivers

OBJECTIVE This study used data gathered from the Diagnostic Interview Schedule, Version Three, Revised (DIS-III-R), which calculated diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), criteria and rescored the data to be compatible with the criteria of the Fourth Edition of the DSM (DSM-IV) for lifetime alcohol abuse and dependence. METHOD A psychologist reassigned questions from the DIS-III-R according to DSM-IV criteria. Another clinician evaluated the rescoring criteria and discrepancies were discussed and resolved. Using these criteria, SAS code was written to automate the rescoring of responses to DIS-III-R questions to DSM-IV diagnoses from a population of DWI offenders. RESULTS There was a fair-to-good level of agreement between the DSM-III-R and rescored DSM-IV diagnoses (kappa = .65). Three hundred forty-eight subjects classified as alcohol dependent using DSMIII- R were reclassified as alcohol abuse in the DSM-IV rescore. Among subjects who were alcohol dependent based on DIS-III-R criteria, the distribution of DSM-IV diagnoses was similar across gender, age, and ethnic groups. There was no difference in agreement between DSMIII- R and the rescored DSM-IV diagnoses by age category. However, women and Hispanics had significantly higher weighted kappa statistics than men and non-Hispanic whites. CONCLUSIONS Our rescoring results were consistent with earlier studies that compared DSM-III-R and DSM-IV diagnoses. Here, we offer an approach that may be useful to investigators who used the DIS-III-R in earlier studies. The DIS-III-R questions corresponding to DSM-IV criteria for alcohol abuse and alcohol dependence are on our Web site at www.bhrcs.org, along with the scoring algorithm.

Perceptions of policy change: Hispanics speak out on the 1998 New Mexico drive-up liquor window closure

Public health policies are intended to influence behaviors, and should be in accordance with differing cultures and social, legal and economic environments (WHO, 2000). However, studies of whether policy changes differentially affect minority populations are rare. Hispanics are the fastest growing ethnic group in the USA, and are over-represented among those arrested for driving while impaired (DWI). The relationship between the availability of alcohol and alcohol-related problem behaviors has been established. Drive-up liquor window sales may facilitate drinking and driving, and may be disproportionately found in minority neighborhoods. In 1998 New Mexico (NM) became the twenty-seventh state to close drive-up liquor windows. This study examines how the closure was perceived by Hispanics versus people of other ethnicities. We conducted a telephone survey followed by a mailed questionnaire. The telephone survey was completed by 108 residents from four NM communities, and the mailed survey was responded to by 133 residents living within two blocks of a closed liquor window. Many Hispanic telephone-survey respondents felt the closures only effect on the community was reducing DWI crashes (44%). Respondents of other ethnicities were more likely to be unsure of its effects. Mailed-survey results of Hispanics indicate similar views, with 48% reporting that the closure reduced DWI crashes. Respondents of other ethnicities more often felt the closure had little effect on the neighborhood. The qualitative analysis revealed three themes: ‘zero tolerance;’ ‘ineffective;’ and ‘right track.’ Hispanics generally thought the closure was an ineffective means of addressing the DWI problem, while respondents of other ethnicities felt the closure was a step in the right direction. Respondents living closest to the former drive-up windows strongly felt the closure resulted in safer streets, less noise, fewer accidents, and less ‘wild driving.’