Citation

Brown TG, Moxley-Kelly N, Ouimet MC. J. Subst. Abuse Treat. 2022; 142: e108855.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.jsat.2022.108855

PMID

35988514

Abstract

INTRODUCTION: Driving while impaired by alcohol (DWI) is a persistent problem. Tailoring intervention modality to client risk and needs (i.e., risk/needs) is posited to both reduce recidivism more efficiently than uniform approaches and circumvent overtreatment or undertreatment. DWI drivers in Quebec must participate in a severity-based intervention assignment program to be relicensed, but like most tailoring programs it has yet to undergo systematic scrutiny. The current longitudinal cohort study tests two main hypotheses underpinning this approach: 1) drivers classified at higher recidivism risk based on their arrest characteristics (DWI(R)) show poorer outcomes over up to 5-years postassessment compared to drivers classified at lower risk (DWI(F)); and 2) for both DWI(R) and DWI(F) groups, assignment of drivers with greater risk/needs to intensive intervention (II) will be advantageous for reducing recidivism risk compared to assignment into brief intervention (BI) for those with lower risk/needs.

METHODS: Drivers who entered the program from 2012 to 2016 were followed to the end of 2018 (N = 37,612). Survival analysis examined the predictive validity of the initial classification into DWI(R) or DWI(F) groups for documented recidivism over a follow-up of up to 5 years. Logistic regression discontinuity evaluated the relative outcomes of drivers who were assigned to either BI or II. The study explored interaction effects between classification and intervention assignment with age and sex.

RESULTS: In line with the hypothesis, the average hazard of recidivism was 58 % greater in DWI(R) drivers compared to DWI(F) drivers. In both DWI(F) and DWI(R) drivers, assignment of drivers with greater risk/needs to II was associated with reduced recidivism compared to assignment of drivers with lower risk/needs to BI, with 57 % and 35 % decreased probability of recidivism, respectively. Younger age was more strongly associated with recidivism risk in DWI(F) drivers than in DWI(R) drivers.

CONCLUSIONS: The current study found that Quebec's severity-based intervention assignment approach accurately identifies DWI drivers who: i) by their arrest characteristics pose a greater risk for recidivism, which may require expeditious exposure to preventative countermeasures; and ii) as a function of their greater risk/needs, benefit from assignment to more intensive intervention to mitigate their recidivism risk.

Keywords: Ethanol impaired driving

Language: en

Keywords

Risk assessment; Driving under the influence; Driving while impaired; Intervention assignment; Longitudinal outcomes; Recidivism prevention