Drink Driving Rehabilitation Programs and Alcohol Ignition...
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This is the author-version of article published as: Freeman, James and Liossis, Poppy (2002) Drink driving rehabilitation programs and alcohol ignition interlocks: Is there a need for more research?. Road and Transport Research 4:pp. 3-13. Accessed from http://eprints.qut.edu.au © 2002 ARRB Group
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Freeman, J., & Liossis, P. (2002). Drink driving rehabilitation programs and alcohol ignition interlocks: Is there a need for more research? Road and Transport Research, 4, 3-13.
Drink driving rehabilitation programs and alcohol ignition
interlocks: Is there a need for more research?
<Author Name> James Freeman and Poppy Liossis
<Subhead 2> Abstract
<Abstract> Drink driving continues to be a serious problem on Australian roads, as alcohol-
related crashes result in substantial injuries, fatalities and property damage. While
legal sanctions such as fines and licence disqualification periods have been effective
in preventing a large proportion of the population from drink driving, sanctions have
been relatively ineffective in reducing alcohol-impaired driving among ‘hard-core’
repeat offenders (Marques, Voas and Hodgins 1998). As a result, drink driving
rehabilitation programs and alcohol ignition interlocks are being employed as
additional countermeasures to reduce the prevalence of alcohol-related injuries and
fatalities on public roads. This report aims to review the current evidence regarding
the effectiveness of rehabilitation and interlock programs, and to provide support for
the expansion of upcoming Australian interlock trials to include (a) screening and
matching procedures, (b) intervention and/or support programs and (c) formative
evaluations that focus on a number of measurement outcomes.
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Research has repeatedly demonstrated that between 20% and 30% of convicted drink
drivers re-offend (Buchanan 1995; Henderson 1996; Langford, 1998; Popkin 1994;
Ryan et al. 1996) and that this sub-group of drivers is disproportionately represented
in crash statistics (Hedlund and Fell 1995; Marques et al. 1998). The most common
strategy to deter convicted drink drivers has traditionally been to increase law-
enforcement activities such as arrests, convictions, fines and licence disqualification
periods (Longest 1999). This approach has proven extremely successful for the
majority of people who fear authority or perceive the probability of apprehension as
relatively high and sanctions as severe (Homel 1988; Ross 1992). However punitive
sanctions have not proven to be as effective for recidivist, habitual drink drivers who
have previously experienced punitive sanctions such as fines and licence
disqualification periods but continue to drink and drive.
There has been continued debate within the literature regarding the effectiveness of
legal sanctions to reduce recidivist drink driving compared with that of alternative
countermeasures such as rehabilitation programs (Nichols and Ross 1990). While
research has demonstrated that first-time offenders benefit most from licence
sanctions (e.g. disqualification periods), rehabilitation programs (often in combination
with legal sanctions) produce the greatest and longest reduction in repeat offending
for recidivist drink drivers (DeYoung 1997; McKnight and Voas 1991; Sadler,
Perrine and Peck 1991).
<Subhead 1> REHABILITATION PROGRAMS
<Body> Drink driving rehabilitation programs constitute a secondary form of prevention that
attempts to directly change offenders’ drink driving behaviour through education
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and/or treatment. The primary aim of drink driving programs has generally been
accepted to be the process of separating drinking from driving by providing
participants with the knowledge, skills and strategies to avoid further offending
behaviour (Popkin 1994; Wells-Parker 1994). A secondary aim has often been to
reduce drinking levels by increasing participants’ awareness of the seriousness of
excessive alcohol consumption (Wells-Parker 1994).
Rehabilitation programs are not new, as drink driving interventions have been
implemented in the US, Canada and Great Britain since the 1960s (Mann, Vingilis
and Stewart 1988). The majority of research and work into drink driving has been
conducted in the US, with the first Australian program not being developed until 1973
at St Vincent Hospital, Melbourne (Homel, Carseldine and Kearns 1988). Since then,
rehabilitation programs have expanded and evolved to incorporate a range of
interventions and techniques designed to accommodate the changing characteristics
and circumstances of the drinking population.
The types and format of programs vary considerably from simple provisions of
reading materials to long-term treatment of alcohol problems (Ferguson et al. 1999;
Mann et al. 1988; Taxman and Piquero 1998). Specifically, interventions can consist
of either educative or health programs, skills-based programs, short-term and long-
term treatment programs, social skills and assertion training, other forms of
counselling or a combination of a number of treatments. More recently, technological
advances in alcohol assessment have lead to the inclusion in some programs of
biological measurements (e.g. gamma-glutamyl transpeptidase [GGT] and
carbohydrate-deficient transferrin [CDT] tests) to examine the alcohol consumption
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levels of participants, with successful program completion being contingent upon low
biological readings (Glitsch et al. 2000; Popkin 1994).
Despite the diversity of programs, the overarching aims and goals of such
interventions have usually been accepted to be (a) education involving strategies that
highlight the risks and consequences of drink driving, and/or (b) psychotherapy or
treatment that aims to target and treat drinking problems, and/or (c) skills-based
interventions that teach behaviours that might prevent further offences (Ferguson et
al. 1999; Sanson-Fisher, Redman and Osmond 1986). Within Australia the majority of
rehabilitation programs have focused on health and education (Homel et al. 1988;
Sanson-Fisher et al. 1990; Social Development Committee 1988), with the aim of
producing attitudinal and behavioural change through education and increasing
awareness of the serious consequences of the offence.
<Subhead 2> Effectiveness of rehabilitation programs
<Body> The large variation in both the structure and content of programs has led to a number
of different outcome measures being used to evaluate the effectiveness of the
rehabilitation programs. These outcome measures have included reductions in
recidivism, accident and fatality rates; improved knowledge and attitudes towards
drink driving; recognition of alcohol-related problems; impact on lifestyle (e.g.
number of drinking days, and general driving behaviours) as well as cost-
effectiveness (Sanson-Fisher et al. 1986).
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This variation in rehabilitation programs and outcome measures has often been
combined with numerous methodological weaknesses, and has resulted in conflicting
findings regarding the efficacy of programs to reduce recidivism. The range of
methodological limitations has included (a) a lack of random assignment of
participants to control and experimental groups (including judicial and self-selection
biases) (Ferguson et al. 2000; Wells-Parker et al. 1995), (b) follow-up periods that
have usually been short and reliant on recidivism rates, which has been suggested to
be an inaccurate measurement of treatment success (Mann et al. 1983), (c) assessment
difficulties such as the use of questionable psychometric assessment and diagnostic
screening procedures prior to the commencement of treatment (Mann et al. 1983;
Sanson-Fisher et al. 1986), and (d) lack of post-program participant assessment.
In relation to the Australian context, a comprehensive review of drink driving
programs in both Australia and New Zealand (Sanson-Fisher et al. 1986) reported that
the two major difficulties in evaluating programs are the large amount of variation
between interventions (including content, goals and implementation) and that few
evaluations have met the minimal methodological criteria needed for scientific
evaluations. For a complete summary of the difficulties experienced in reviewing
rehabilitation programs, the reader is directed to Mann et al. (1983), Wells-Parker et
al. (1995) and for Australian studies Sanson-Fisher et al. (1986) and Ferguson et al.
(1999).
Historically, there has been a tremendous amount of conflicting research regarding
the effectiveness of drink driving rehabilitation programs to reduce further offending.
A number of early evaluations in both America and Australia reported that such
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programs did not reduce the prevalence of repeat offending (Foon 1988; Holden 1983;
Peck 1994; Sanson-Fisher et al. 1986) and that licensing sanctions were a more
effective countermeasure in combating drink driving (Popkin 1994). These studies
have suggested that few changes in drinking patterns or re-offending behaviour result
from rehabilitation programs (Beirness, Simpson and Mayhew, 1998). In relation to
the Australian context, a comprehensive review by Sanson-Fisher, et al. (1986)
indicated that, aside from the difficulties in assessing interventions, it is unlikely that
such programs would reduce the prevalence of repeat offending, as most programs do
not incorporate the ingredients that produce long-lasting behavioural change such as
screening and matching practices and the inclusion of maintenance procedures.
Despite these negative results and the previous methodological difficulties that have
plagued evaluations, more recent studies have begun to demonstrate that drink driving
rehabilitation programs can reduce drink driving recidivism and alcohol-related
crashes (DeYoung 1997; McKnight and Voas 1991; Pratt, Holsinger and Latessa
2000; Sadler, et al. 1991; Siegal 1990). Promising results have been demonstrated by
large-scale meta-analytic studies that have included a number of aspects in the
statistical analyses such as first time and multiple offenders, effect size, intervention
characteristics and the quality of research designs for each study (Wells-Parker et al.
1995). For example, an early review of rehabilitation programs in the 1970s and early
1980s by Mann et al. (1983) demonstrated that both education and treatment
programs may have reduced recidivism among convicted drink drivers. Furthermore,
Mann et al. reported that drink driving programs also have beneficial effects on traffic
safety measures (e.g. knowledge and attitudes) as well as driving behaviours. More
recently, Wells-Parker et al. (1995) conducted a now-famous comprehensive meta-
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analysis of 215 drink driving rehabilitation programs and concluded that treatment has
a small but consistent effect (7–9% reduction in drink driving) compared to no
treatment, punishment or licence sanctions. The largest improvements in traffic safety
have been reported for rehabilitation programs that incorporate three intervention
aspects such as psychotherapy or counselling, education, and probation (Wells-Parker
et al. 1995) rather than single-mode or two-mode interventions (DeYoung 1997).
Wells-Parker et al. also confirmed that, despite the large number of methodological
difficulties that have limited previous intervention evaluations, such programs provide
positive effects on both recidivism rates and general traffic safety (e.g. alcohol-related
crashes). It has been suggested that the relatively small positive effect resulting from
rehabilitation programs is dramatically increased when evaluated against subsequent
reductions in drink driving related crashes and injuries (Beirness et al. 1998).
<Subhead 2> Recidivist offenders
The most promising indications regarding the effectiveness of rehabilitation programs
have been for those interventions that have focused primarily on recidivist drink
drivers (DeYoung 1997; Ferguson et al. 2000; Mann et al. 1994; Nickel 1991;
Taxman and Piquero 1998; Siskind et al. 2001, pers. comm.). Research has
demonstrated that such programs are most effective for serious repeat offenders who
are apprehended with blood alcohol content levels of 0.15 g/100 mL or greater
(Siskind et al. in press). These studies have demonstrated that rehabilitation programs
are most effective in reducing further offences when they are combined with licence
disqualification periods. First, the continued application of fines and licence
disqualification periods ensures offenders realise the punitive costs associated with re-
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offending. Second, rehabilitation programs provide recidivist drink drivers with a
range of skills and strategies to avoid the drink driving sequence, which include
information regarding the effects of alcohol, drink driving laws, safe driving practices
and possible indicators of drinking problems.
Despite these reported reductions in drink driving behaviour resulting from
rehabilitation programs, some ‘hard core’ offenders continue to drink and drive after
completing such programs, while others fail to complete the programs. Alcohol
ignition interlocks have been proposed as a further intervention to reduce the
prevalence of recidivist drink driving (Morse and Elliott 1992; Popkin et al. 1992).
<Subhead 1> ALCOHOL IGNITION INTERLOCKS
<Body> An alcohol ignition interlock is a device that measures an individual’s blood alcohol
content (BAC). It is connected to the ignition and power system of a vehicle and is
designed to prevent the vehicle from being started if the driver’s BAC exceeds the
legal limit.
It has been suggested that, in contrast to other countermeasures that focus primarily
on traditional deterrence-based strategies (e.g. random breath testing, fines and
licence disqualification), interlocks provide drivers with the opportunity to develop
and practice strategies to avoid drink driving (Weinrath 1997). In addition, the device
allows drivers to re-enter the licensing system legally, with insurance rather than
permitting offenders to continue to drive unlicensed without supervision (Beirness
and Simpson 1991). Further benefits of interlocks include the prevention of the
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vehicle being started if the driver exceeds the previously specified BAC level, and the
instrument serves as a constant reminder to the driver of possible alcohol problems
and the difficulties that have arisen from drink driving. Interlocks also offer many
offenders the opportunity to maintain employment (Beirness and Simpson 1991).
<Subhead 2> Effectiveness of Interlocks
<Body> Since the 1980s there have been a number of interlock trials in the US and Canada
(Beck, Rauch and Baker 1997; Jones 1992; Popkin et al. 1992; Weinrath 1997) and
two preliminary trials in Australia (Coxon and Earl 1998; Spencer 2000). Early
evaluations of interlocks suggest that the devices have the potential to significantly
reduce recidivism rates among convicted drink drivers (Baker 1987; Beck et al. 1997;
Collier, Comeau and Marples 1995; Morse and Elliot 1992; Weinrath 1997). For
example, Morse and Elliot (1992) in Ohio reported that when interlocks were
installed, recidivism rates were lower (65% reduction) than for offenders given only
licence suspension sentences during the same period of time, while unlicensed driving
was reduced by 91%. Furthermore, Popkin et al. (1992) in North Carolina and Jones
(1992) in Oregon performed quasi-experimental interlock trials and reported
significant reductions in re-arrest rates for interlock participants while the interlock
was installed. Beck et al. (1997) in Maryland conducted the only complete
randomised interlock trial and also reported a 65% reduction in recidivism rates while
the interlock was installed. Finally, Weinrath (1997) examined the combination of
interlocks with a support program, which produced the most promising results
including significant reductions in drink driving recidivism and in the number of other
dangerous driving practices (e.g. those resulting in collisions and injuries).
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However, like rehabilitation programs, interlock evaluations have also been plagued
by methodological difficulties including small sample sizes, self-selection and judicial
biases, non-random assignment of groups, unmatched intervention and control groups,
and short follow-up evaluation periods. Coben and Larkin (1999) reviewed 31
interlock studies in North America and found that only 6 studies could be
comprehensively reviewed, due to methodological weaknesses with research designs
such as non-random sampling procedures, sole reliance on recidivism rates and the
failure to control for exposure (e.g. number of kilometres driven).
In addition, the majority of interlock studies have reported that once the interlock was
removed from the vehicle many drivers returned to re-offending (Beck et al. 1997;
Jones 1992; Morse and Elliot 1992; Popkin et al. 1992; Voas et al. 1999). For
example, the majority of interlock trials report significant reductions in the prevalence
of re-offending while the device was installed to the vehicle (50% to nearly 100%
reduction), but there have been no reported significant reductions in re-offending
compared to control groups once the device is removed (Voas et al. 1999). Overall,
the research suggests that interlocks may merely incapacitate or restrict individuals
from drink driving while installed in the vehicle, but the device loses any beneficial
effect upon removal (Weinrath 1997). At present it remains unclear why offenders
continue to drink and drive once the device is removed from the vehicle, nor what (if
any) beneficial effects are derived from interlock usage.
There have only been two prior interlock trials in Australia to determine the feasibility
of such programs. Both trials consisted of volunteer participants. The first study was
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conducted in Riverland, South Australia, over a 6 month period in 1998 and consisted
of 24 volunteers who were employees or were affiliated to one of a number of road
safety departments in South Australia (Coxon and Earl 1998). The second trial was
conducted in New South Wales between January 1999 and March 2000 and consisted
of 23 repeat offenders who volunteered to install an interlock to their vehicle and
were interviewed both during interlock installation and when the device was removed
from their vehicles (Spencer 2000).
Both studies demonstrated that interlocks were a viable countermeasure in Australia
(e.g. reliability and servicing of the device) with participants reporting positive
experiences regarding the use of interlocks. For example, participants reported that
using the device increased their knowledge regarding appropriate drinking levels to
remain under the blood alcohol limit and most believed that the device was a viable
sentencing option to traditional legal sanctions (Coxon and Earl 1998; Spencer 2000).
Despite these positive reviews of interlock trials of volunteer participants, a major
limitation of interlock research (involving court-ordered installation of the device),
has been that evaluations have failed to examine the impact that interlocks have on
offenders’ lifestyles, motivations, attitudes, driving and drink driving behaviours. It is
unclear what psychological and behavioural changes occur while the device is
installed (e.g. attitudes and driving habits), or why the majority of participants
continue to drink and drive after the interlock is removed from their vehicles.
Interestingly, at present it is not clear what the offenders believe is the purpose or aim
of the interlocks. Program facilitators and researchers have suggested that interlocks
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have two main aims: (a) behavioural control and/or incapacitation, which is attained
through technological advances designed to minimise the risk of harm and re-
offending (Henderson, 1999), and (b) rehabilitation/education, which aims to provide
users with knowledge and skills/strategies to avoid driving after exceeding the legal
blood alcohol limit (Ferguson et al. 2000; Weinrath 1997). It is important is to
determine whether users have the same beliefs as interlock administrators regarding
the purpose of the device (e.g. rehabilitation and incapacitation), and what
consequences arise if perceptual disparities exists between the groups. Examination of
these factors may provide valuable insight into the effect that perceptions of and
attitudes to interlocks have on frequent usage of the device as well as on successful
program outcomes e.g. the avoidance of further offending.
<Subhead 3> The combination of rehabilitation programs and interlocks
<Body> In the past, the majority of drink driving interventions implemented to reduce the
prevalence of repeat offending have incorporated uni-module characteristics. That is,
previous studies have not combined interlock installation with some form of drink
driving rehabilitation or support program and thus drivers are not provided with either
(a) the appropriate knowledge, skills and strategies to avoid the drink driving
sequence or (b) treatment for alcohol-dependency problems before interlock
installation and removal. Whether this occurrence has contributed to the substantial
proportion of offenders continuing to drink and drive once the device is removed
remains unproven, but what is evident is that interlock installation alone may not be
an adequate tool to stop recidivism.
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The exceptions to this pattern are a small number of current interlock trials in North
America (Maryland, Alberta) and in Europe (Sweden) which include treatment,
rehabilitation and/or intensive supervision programs with interlock installation (Beck
et al. 1997; Marques et al. 2001). Although most of these programs are currently
being implemented and have not been comprehensively evaluated, early indications
suggest that the inclusion of such support initiatives with interlock programs provides
positive results, e.g. lower rate of failed start-up attempts (Marques et al. 2001). For
example, the Alberta trial has combined interlocks with a harm-reducing and
motivational intervention technique which includes (a) education and support to
offenders regarding interlock usage, (b) case management support (e.g. family
counselling), (c) motivational enhancement therapy (e.g. raising awareness regarding
the seriousness of drink driving), and (d) protective planning (e.g. assistance in
planning for driving without the interlock) (Marques et al. 1999). At present it appears
that while the device is installed participants who receive the combined intervention
are less likely to record failed BAC start-up attempts than individuals who do not
receive the intervention. However, follow-up research has yet to be completed to
determine whether the combination of interlocks with support or intervention
programs provides long-term benefits once the device is removed. Preliminary results
indicate that combining interlock usage with compatible rehabilitation and/or support
programs may produce beneficial results. Such practices may ensure that offenders
address their drinking and/or drink driving problems by developing new skills and
strategies to avoid re-offending before applying these strategies to driving with the
assistance of interlocks. Conversely, it may be unrealistic to enforce interlock
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installation without addressing the individual factors that ultimately affect successful
program outcomes such as the ability to control alcohol consumption.
<Subhead 3> Formative evaluations and process outcomes
<Body> Previous evaluations of drink driving rehabilitation programs have predominantly
focused on summative outcomes such as recidivism rates and alcohol-related crashes
(Popkin 1994). Archival data such as recidivism rates are perhaps the simplest and
most accessible outcome measure (Buchanan 1995) and have continually been used as
the major indicator of program effectiveness (Ferguson et al. 2000; Sanson-Fisher et
al. 1986). However, a number of researchers have highlighted difficulties associated
with using recidivism rates, and have questioned the accuracy and validity of the
measure as a reflection of the prevalence of drink driving on public roads (Fitzpatrick
1992; Marques et al 2001; Popkin 1994; Ross 1984; Sanson-Fisher et al. 1986).
For example, in America it has been estimated that the chances of a driver with a
BAC of .10% or greater being arrested are 1 in 500 (Fitzpatrick 1992). A similar
estimation for the Australian context offered by Homel et al. (1988) suggests that only
0.5–1.5% of intoxicated drivers are detected by the police at any one time.
Considering that many drink drivers report that they continually offend without
apprehension, and often employ techniques to avoid detection (Ross 1992; Voas,
Tippetts and Lange 1997), it may be argued that the probability of repeat offenders
being caught also remains relatively low. Therefore the accuracy of measures such as
recidivism rates (which are continually used as the dominant outcome measurement
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of programs) may be heavily dependent on the level and effectiveness of law-
enforcement activities in jurisdictions.
As a result, accurate indications of the effectiveness of rehabilitative interventions
have not yet been attained. For the above reasons, there is a need for research that
incorporates formative and process outcomes that measure change from multiple
perspectives, as the possibility of drawing misleading conclusions increases when one
simple index is used to measure change (Lambert and Hill 1994). A possible initiative
to improve the accuracy of current knowledge regarding the impact of drink driving
rehabilitation and interlock programs is to conduct formative evaluations and thus
include several measures of program effectiveness such as self-reported changes in
lifestyles, attitudes, motivations, self-efficacy and drinking and drink driving
behaviour. A broadening of measurement outcomes would result in improved
detection of both behavioural and psychological changes resulting from completing
either drink driving programs or interlock trials. Fitzpatrick (1992) has highlighted
that this lack of multiple measures of program effectiveness incorporating clear goals
and objectives has contributed to the uncertainty regarding the effectiveness of
rehabilitation programs.
Process outcomes may be defined as the changes that occur through the rehabilitation
process and include participants’ hopes, expectations, values, and intentions that can
be demonstrated through actions, behaviours, statements and non-verbal
communication (Robertson and Colborn 1998). Such measures have successfully been
incorporated in health, business, and education sectors to explain how change occurs
(Robertson and Colborn 1998). This information would not only provide more
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accurate indications of the effectiveness of drink driving rehabilitation programs but
also provide information regarding program strengths and deficiencies that would
benefit policy and program development.
<Subhead 2> Previous formative evaluations
<Body> At present, only a minority of research has incorporated formative aspects in program
evaluations such as participants’ self-report data regarding knowledge and attitudes
towards drink driving, alcohol consumption levels, etc. (Ferguson et al. 2000).
Despite this, initial studies have provided rich contextual information regarding the
impact that interventions have on a range of psychological and behavioural factors.
For example, Ferguson et al. (2000) demonstrated that although knowledge and
attitudes do not necessarily change through program completion, participants are
significantly more likely to adopt newly learned strategies to avoid further drink
driving. Furthermore, Wells-Parker et al. (1998, 2000) highlighted that program
participants are more likely to be motivated to change their drink driving rather than
their drinking behaviours. In addition, the researchers demonstrated the important
effect that perceived self-efficacy to avoid drink driving has on further offending
behaviour, as individuals who report low levels of control over both their drinking
and drink driving behaviours are at the greatest risk of re-offending (Wells-Parker et
al. 2000).
In relation to process evaluations of interlock programs, a small series of studies from
the Alberta interlock trial have incorporated vehicle-based measurement outcomes
such as the number of times participants start and use their vehicles, days of the week,
BAC readings, and distance travelled (Marques et al. 1999, 2000, 2001). These
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studies have demonstrated that participants use the device on approximately 80% of
days and usually record a steep decline in the number of failed start-up attempts
during the life of the trials, with the highest number of failed attempts being on
weekends (Marques et al. 1999). Furthermore, there have been indications that
participants are less likely to use the device on the weekend and that higher numbers
of failed start-up attempts during the trial proves to be a reliable indicator of further
offending once the interlocks are removed (Marques et al. 2001; Voas et al. 2000).
These studies have focused on interlock recordings and have provided valuable
insight into the driving and drink driving patterns of interlock participants, such as the
frequency of interlock usage, BAC readings, circumvention attempts etc. However,
such studies have once again relied on indirect measurements of drinking and drink
driving occurrences (e.g. interlock recordings) and do not provide an accurate
indication of the impact that interlocks have on participants’ lifestyles, the possible
changes that may result from intervention completion, or of participants’ perceptions
regarding the effectiveness or convenience of the device in comparison to traditional
legal sanctions.
The authors of this paper recognise that questions remain regarding the applicability
and reliability of formative measurements. The major limitations of formative
evaluations include (a) the cost of completing such tasks (both time and money), (b)
the sensitivity of self-reported data (confidentiality and accuracy) and (c) the
reliability of responses when they are dependant upon an outcome, e.g. licence
reinstatement (Sanson-Fisher et al. 1986). Popkin (1994) suggested that self-report
data is extremely subjective and may be influenced by the individual’s inability or
denial to recall events accurately. Therefore, issues have been raised regarding
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whether measures such as knowledge and attitudes towards alcohol and drink driving
accurately reflect changes in drink driving behaviour (Sanson-Fisher et al. 1986).
<Subhead 2> Combine summative and formative outcomes
<Body> A possible solution to these evaluation difficulties is to incorporate both summative
and formative measurement outcomes in research designs. Researchers are now
beginning to suggest that interviews with participants that involve questionnaires
concerning self-reported behaviour (i.e. actual recidivism rates) can provide realistic
and valuable indicators of offending behaviour in addition to official offending
statistics (Buchanan 1995; Siskind et al. in press). For example, the inclusion of
recidivism rates with intermediate outcomes such as changes in attitudes, knowledge
and motivation would provide a more complete description of attitudinal and
behavioural changes resulting from successful program completion. As Robertson and
Colborn (1998, pp.39) highlight, ‘summative evaluations describe an end product;
formative evaluations are performed at specified intervals to assure the end product is
obtained.’ The researchers go on to suggest that the real strength of a rehabilitation
program is found in the link between the program and the process outcomes, as it
demonstrates how and why, for whom and under what circumstances programs work.
From this it appears that the combination of both measurement outcomes (carefully
chosen to reflect goals and aims of programs) may prove valuable measures of
program strengths and weaknesses.
<Subhead 2> Matching
<Body>
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Finally, the implementation of formative evaluations may reinforce the need for
screening, tailoring and matching procedures, which would assist in directing
offenders to the appropriate forms of drink driving interventions, to ensure that
maximum rehabilitative effects are attained. Researchers have continually suggested
that the effectiveness of rehabilitation programs may be dependent upon recognising
specific individual characteristics of drink drivers and matching participants to the
appropriate interventions (Ferguson et al. 2000; Glitsch, et al. 2000; Nochajski,
Stasiewicz and Gonzalez, 2000; Sanson-Fisher et al. 1986). According to the
matching hypothesis, different types of drink driving offenders require different forms
of interventions such as skill-based, educational or treatment programs to ensure
successful outcomes (Wells-Parker 1994). Program participants are beginning to be
assessed for a range of psycho-biological factors (e.g. alcohol dependence and
psychological problems), as these factors have been recognised to affect successful
program completion and re-offending rates (Andren et al. 2000; Wells-Parker et al.
2000).
However, these procedures have yet to be transferred to interlock programs, and to
date there has been very little examination of the needs and requirements of interlock
users before installation. Pre-interlock assessment is vital to ensure that the device can
provide the maximum benefits to participants. Assessment may include an
examination of the participants’ driving requirements and family circumstances
before interlock installation to determine whether offenders are in fact going to use
the interlock-installed vehicle and to estimate what impact the interlock may have on
other family members. Previous research has demonstrated that many interlock
participants regularly use non-interlock installed vehicles and may be likely to not use
the device at ‘high-risk’ periods, e.g. weekends (Voas et al. 2000). Pre-and-post
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interlock assessment of participants’ attitudes and circumstances may lead to the
development of tailored programs that are compatible with offenders’ lifestyles and
thus ensure regular use of the device.
<Subhead 1> CONCLUSION
<Body> To answer the question posed in the title of this paper, the effectiveness of both drink
driving rehabilitation programs and the use of interlocks may be clarified by
conducting processes and evaluations that examine the impact of such interventions
on a range of outcomes. First, when considering the impending increase in the
prevalence of interlock trials in Australian, the inclusion of formative outcomes in the
research design may prove to be extremely valuable, considering the number of
factors that presently remain unclear. Second, combining interlocks with an
associated intervention and/or support program may produce an additive affect that
provides participants with the opportunity to practice and consolidate newly
developed skills and strategies to avoid the drink driving sequence. Finally, assessing
and matching participants’ needs to suitable programs may ensure that offenders
receive the appropriate treatment which would ultimately improve the effectiveness of
rehabilitative interventions. This might result in alcohol-dependent individuals being
directed towards therapeutic programs addressing alcohol-related issues before
interlock installation, while young offenders may need to confront issues relating to
drinking in the social context and the effects of peer group pressure. Although the
implementation of such research initiatives may well be governed by the practical
reality of allocating precious resources (time and money), such practices will provide
a means of monitoring referral patterns, and forming databases for the examination of
Rehabilitative Interventions 21
treatment effects and characteristics of clients (Sanson-Fisher et al. 1986), as well as
developing screening mechanisms that facilitate the development of programs that
accommodate specific individual needs.
<Subhead 1> REFERENCES
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<Bio/Contact> James Freeman is a PhD scholar at the Centre for Accident Research and Road Safety–Queensland and he is currently part of a research team that is implementing the first Australian court-ordered trial of alcohol ignition interlocks for recidivist drink drivers. James is a registered psychologist and his current research interests focus on producing behavioural change, including punishment and models of deterrence and the processes of change produced by rehabilitative interventions. Poppy Liossis completed her PhD at the University of Queensland and is currently a lecturer at the Queensland University of Technology (developmental psychology). Her current research interests focus on the nature of the changing family. Poppy is also a private practitioner.
Contact
James Freeman Centre for Accident Research and Road Safety–Queensland, (CARRS-Q) Queensland University of Technology Beams Rd, Carseldine, QLD 4034. Email: [email protected]
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