Treatment of chronic drunk drivers: the turning point project

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TREATMENT OF CHRONIC DRUNK DRIVERS: THE TURNING POINT PROJECT

ROBERT LANGWORTHY

AND EDWARD J.

LATESSA

Department of Criminal Justice University of Cincinnati Cincinnati, Ohio 45221

ABSTRACT

One current area ofconcern in the United States is how to deal with drunk drivers. This article presents results of an evaluation of Turning Point, a program designed to treut und educate chronic drunk drivers. The evaluation sought to determine whether Turning Point subjects performed better than other chronic drunk drivers after they were released from custodv. The analysis concludes that Turning Point subjects were less likely to be urrested,for new alcohol-related offenses or for any other offense upon their release from custody.

Drunk driving persists as one of the most vexing problems confronting contemporary U.S. society. Each year drunk drivers kill and injure many thousands of people and damage billions of dollars worth of property. In addition to impacts on individuals directly involved in drunk driving incidents, there are a host of collateral consequences that affect the entire society (damage to families, increased insurance costs, lost productivity, etc.). The enormity of the drinking-driving problem is indicated also by the array of programs designed to lessen it. There are positive programs focused on getting drinking people home without their having tq drive (designated drivers, arrangements with cab companies, etc.). There are largely negative programs that seek to deprive drunk drivers of the use of their autos (denial of driving privilege, devices to prevent the use of autos

if the operator is drunk, etc.) or seek to inflict increasingly severe punishments. There are also educational programs that seek to change the drinking-driving culture so that fewer people will drive drunk and programs that focus on changing the attitudes of drunk driving offenders. Finally, there are treatment programs that seek to “cure” pathological drinking. This article reports the results of an evaluation of a community treatment program designed to treat and educate chronic drunk drivers. Chronic drunk drivers not only pose a public safety problem for the community but also contribute to jail overcrowding problems. Programs that promise both to limit the period of incarceration and improve the behavior of chronic drunk drivers would ease the strain on jails and make public streets safer. The Turning Point Program of Talbert 26.5

266 House Inc., the such a program.

TREATMENT

ROBERT

subject

LANGWORTHY

of this

OF DRUNK

article,

and EDWARD

is

DRIVERS

There are many exhaustive reviews of the literature on educational and rehabilitative programs for the drunk driver (e.g., Klitzner, Blasinsky, Marshall, and Paquet, 1985; Mann, and De Genova, 1983; Leigh, Vingilis, McKnight, 1986; Peck, Sadler, and Perrine, 1985). While it is not the purpose of this article to reexamine this literature, it is important to point out that most drunk driver research has failed to distinguish first-time drunk drivers and chronic drunk drivers (exceptions include Nardone and Forcier, 1989; Vingilis, Adlaf, and Chung, 1982; and Nichols, Weinstein, Ellingstad, Struckman-Johnson, and Reis, 1980). The literature isolates three principal types of programs designed to treat drunk drivers: 1) long-term treatment programs designed to cure pathological drinking, 2) educational programs designed to correct poor judgment (Jacobs, 1989: 18 l-82), and 3) programs that prevent the drunk driver from driving. ’ The most common type of program is the shortterm drunk driving school that tries to educate offenders. Generally, research on drunk driving school interventions has not produced encouraging results (Brown, Zelhart, and Schurr, 1975; Jacobs, 1989). One plausible explanation was given by Jacobs (1989), who cited the inability of most drunk driving schools to weed out the habitual alcohol abusing, antisocial group from social drinkers. The implication is that educational programs might achieve higher rates of success if they focused on social drinkers. Though limited research has been done, it appears that individualized treatment over an extended period of time produces promising results with chronic drunk drivers. According to Mann, Vingilis, and Steward (1988: 265), “For high alcohol problem ofindividually oriented fenders, long-term, treatment programs appear to have traffic safety benefits. ” The Turning Point program appears to fall

J. LATESSA

somewhere between the short-term drunk driving school and the long-term individually oriented rehabilitation program. A combination of education and individual and group treatment sessions is provided, and offenders are placed in residential care for 28 days, with a six-month aftercare component and one year of probation supervision. Treatment combines the educational focus of the drunk driving school with the more alcohol-treatment aspects of individual therapy. TURNING

POINT

PROGRAM

The Turning Point Program is part of Talbert House Inc., a nonprofit, multiservice agency consisting of thirteen programs in four areas: criminal corrections, mental health, victim assistance, and chemical dependency. The Turning Point Program was developed in response to the demand for housing and treatment for multiple-DUI offenders in Hamilton County (Cincinnati), Ohio. Begun in May 1988, Turning Point is a 40bed, 28-day chemical dependency treatment program for men and women serving sentences for multiple-DUI offenses. Selection for the program is based on six admission criteria: 1) multiple DUI offenses, 2) a minimum sentence of 45 days, 3) security classification of “minimum,” 4) inmate motivation to seek help, 5) inmate willingness to sign the treatment agreement and participate in all programs, and 6) Hamilton County residency. Inmates with severe psychological disorders, a history of violent behavior, an indication of a criminal lifestyle, work-release or weekend sentences, or serious medical problems are excluded from the program. After serving jail sentences of at least 30 days, offenders that are screened and selected for the program are relocated to the program site, where they reside for 28 days. During that time they are not permitted to leave the facility; however, contact with visitors is permitted. The program is designed as a comprehensive treatment regimen focused on alcohol addiction, and it includes individualized alcohol treatment, family counseling, and educational services. The in-patient program consists of six major services and activities:

Treatment of Chronic Drunk Drivers: The Turning

1. Assessment and Diagnosis: Each client undergoes a thorough chemical dependency assessment to determine the severity of his or her problem and to establish an initial treatment plan. 2. Treatment Planning: A primary counselor is assigned to each client to help develop and implement a personalized treatment plan. 3. Education: Educational presentations are conducted daily to assist the client in learn-

ing more about the impact of chemical dependency and how to establish a recovery program. 4. Counseling: Individual and group counseling sessions are provided to help the client work through personal treatment issues and to promote personal change. 5. Family Treatment: Education and counseling services are provided to family members at a separate location while the client is in treatment.

6. AA/NA Participation: Clients are expected to participate in AA/NA meetings during treatment. After completing the in-patient treatment, offenders are taken back to court for modified sentences, which include an average of two years of probation. Inmates who successfully complete the program receive significant reductions in their sentences, resulting in early release to the community. In addition to the in-patient program, each of its graduates is required to complete an after-care program consisting of 26 group meetings and attendance at a minimum of three Alcoholics Anonymous and/or Narcotics Anonymous meetings per week. To summarize: the program treatment strategy includes educational presentations conducted daily to assist each client in learning more about the impact of chemical dependency; individual and group counseling sessions designed to help the client work through personal treatment issues and to institute personal lifestyle changes; a strong family orientation and family participation, with counseling services provided to family members; and participation in the 12 steps of Alcoholics Anonymous and/or Narcotics Anonymous. After-care treatment consists of continuing supervision for a six-month period, which consists of a minimum of one

267

Point Project

recovery support group session per week, regular attendance at AA/NA meetings, and regular contact with an assigned probation officer. RESEARCH

DESIGN

Initially, evaluation of the Turning Point Program was to be accomplished by means of a quasi-experimental design with nonrandom assignment to experimental and control groups. The experimental group consisted of the population of offenders (531) that participated in the Turning Point program from its inception in February 1988 until December 1989. The control group consisted of 200 multiple-DUI offenders who were adjudicated during the same period as the experimental group but did not participate in the Turning Point program. Data describing Turning Point subjects’ demographic characteristics, personal histories, program performance, and postrelease performance were collected by Turning Point staff. Data describing comparison group demographic characteristics and postrelease (from jail) performance were collected by Hamilton County Probation Department employees from Department records. Conceptually, the initial research design was quite simple: comparison of the performance (in this case rearrests) of two groups, experimental and control, to determine if one group performed differently than the other. If a difference was detected and certain other conditions were met, a case could be made that the difference was attributable to the treatment. The principal other condition was that the experimental and control groups be comparable in all respects except receipt of treatment. If the groups were to differ in ways other than receipt of treatment, explanation of any observed posttreatment differences would become problematic. The present analysis encountered a number of problems that render interpretation of the study results problematic. First, as will be discussed further when the findings are presented, it appears that a substantial proportion of the Turning Point Program participants did not meet program admission criteria.

26X

ROBERT

LANGWORTHY

It appears that more than 7 percent had fewer than two prior DUI convictions and that nearly 30 percent were not incarcerated at all (an additional 5 percent were incarcerated for less than 30 days). Examination of comparison group characteristics also highlighted departures from program eligibility criteria. While members of the comparison group were substantially more likely to have served a jail sentence (only 3 percent were not incarcerated), in excess of 50 percent of the comparison group was incarcerated for less than 30 days. However, just 3 percent of the comparison group had fewer than two prior DUI convictions. These findings suggest that the population originally targeted was not the population ultimately included in the program. Second, as will be discussed further. the treatment and comparison groups differed on a number of theoretically important demographic and experiential dimensions. Because the research design failed to yield conparable groups, the evaluation was altered from experimental control of extraneous variation to statistical control for extraneous variation. Thus, the resulting analysis is presented in three sections. followed by consideration of the substantive significance. First, the clientele of the Turning Point Program is described in terms of demographic and expercharacteristics. This description iential highlights differences with the expected treatment population and compares the Turning Point clientele to profiles developed in other studies of drunk drivers. Second, Turning Point Program participants are compared to members of the control group, and differences in demographic and experiential characteristics are identified. which arc statistically accounted for in the last section. Chi square was used to detect differences between the treatment and control group distributions. Each variable on which the treatand control groups differed was ment designated for inclusion in the third stage of the analysis-programmatic effect on the likelihood of rearrest. Programmatic effects were addressed in the third and final stage of the analysis. Because it was demonstrated that the two groups were

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not similar to one another, the comparisons were made with the observed differences statistically controlled. The multivariate statistical procedure employed was logistic regression, which is appropriate when the dependent variable is dichotomous, as was the case in this study-subjects either failed or succeeded. Two sets of equations were estimated with logistic regression. The first set focused on the inlluence of Turning Point participation. with group differences statistically controlled, on the likelihood of failure rather than success for the pooled sample (including Turning Point subjects and subjects in the comparison group). The second set of equations examined subsets of the pooled sample that more closely represented the population initially targeted for treatment by the Turning Point Program.

FINDINGS

This section describes the Turning Point participants in terms of demographic characteristics. prior DUI convictions, length of incarceration for treatment offense, and postrelease performance. Table I shows that the overwhelming majority of Turning Point cases were male, 90 percent. and white, 77 percent. The average age was 32.6. while the average level of education was I I. I years. Sixty-nine percent of the experimental group made less than $15.000 per year; this group had an average income of $12,625. Slightly over 7.5 percent were employed prior to incarceration, and over 50 percent held skilled or professional positions. Regarding marital status there was a fairly even distribution among the three categories. Over 63 percent were married or had been married, and 61 percent reported having children. Table 1 also shows that eight percent of the Turning Point subjects had fewer than two prior DUI convictions but that as group they averaged nearly four prior DUI convictions. Twenty-eight percent were not incarcerated for the present offense, but 67 percent served mom than 30 days in jail. As a group the

TABLE 1 CHARACTERISTICS OF TURNING POINTAND COMPARISONGROUP CLIENTS Number Characteristic Sex Male Female Total Race White Black/Other Total Age ~21 years 21-25 years 26-30 years 31-35 Years 36-40 years >40 years Total Mean age Education < 12 years 12 years > 12 years Total Mean education Income <$5,000 $5-10,000 $1 o-1 5,000 $15-20.000 >$20,060 Total Mean income Employed prior to incarceration Yes No Total Skill Unskilled Skilled Professional Total Marital status Single Divorced/separated/widowed Married Total Children Yes No Total Prior DUls <2 convictions 2-5 convictions 6-l 0 convictions > 10 convictions Total Mean priors Time incarcerated 0 days l-30 days 31-90 days 91-180 davs > 180 daysTotal Mean days incarcerated

Percent

Turning Point

Comparison

478 53 531

191 9 200

405 119 524

Turning Point

Comparison

X2 = 5.6’ P < ,025

90 10

96 4

139 58 197

x2 = 3.7 P > .05

77 23

71 29

17 100 142 116 64 90 529 32.6

0 5 27 46 34 83 195 40.7

X2 = 84.9’ P < ,005

3 19 27 22 12 17

0 3 14 24 17 43

214 166 71 451 11.1

83 71 22 176 11 .o

x2 = 1.3 P = .25

47 37 16

47 40 12

115 124 114 69 85 507 $12,625

16 30 22 22 23 113 $14,245

x2 = 6.6 P > .lO

23 24 22 14 17

14 27 19 19 20

395 128 523

142 23 165

X2 = 4.8’ P < .05

76 24

86 14

245 227 24 496

-

49 46 5

-

199 175 157 531

61 67 60 188

x2 = 1.5 P 1 .25

37 33 30

32 36 32

324 207 531

125 68 193

X’ = 5.1* P < .025

61 39

65 35

42 416 69 4 531 3.8

6 179 10 1 196 3.5

X2 = 16.3’ P < ,005

8 78 13 1

3 91 5 1

147 25 284 63 12 531 50.7

6 105 27 31 17 186 77.1

X’ = 308.8’ P < .005

28 5 53 12 2

3 56 15 17 9

‘Statistically significant distributions at alpha = .05

ROBERT

270

LANGWORTHY

Turning Point subjects were incarcerated for an average of slightly more than 50 days, versus slightly more than 77 days for the comparison group. However, when the 28 days spent in the Turning Point program were included, there was virtually no difference between the two groups. Table 2 illustrates the time at risk and the postrelease performance of the two groups. The Turning Point group was at risk for an average of approximately 13 months. Twothirds of the Turning Point participants had no new charges filed against them following their release from the program. Fifteen percent had one or more new alcohol-related charges, while slightly less than 20 percent were arrested for nonalcohol-related charges. Of those arrested on new alcohol-related charges, slightly more than half were arrested for DUI. Although there have been few studies of persons with numerous prior DUI convictions, review of those that have been done permits comparison of rearrest behavior. Holden (1983), in an evaluation of a treatment program, reported that 28.1 percent of subjects classified as problem drinkers were rearrested for any new offense within two years of their release. Holden also noted that nearly 19 percent of the problem drinkers were

and EDWARD

J. LATESSA

rearrested for DWI. An examination by Wheeler and Hissong (1988) of the relative effects of alternative sanctions revealed that 20.6 percent of those with two or more prior convictions for DWI would be arrested again for DWI within three years. Similarly, Nardone and Forcier ( 1989) examined the recidivism of multiple-DUI offenders released from a Massachusetts minimum correctional institution designed exclusively to treat multipleDUI offenders. The rearrest rate after 12 months was 24.9 percent (all offenses). Of those rearrested, 3 1.6 percent were arrested for drunk driving (or 7.7 percent overall). At the end of 24 months the rate for drunk driving rearrests was 12.3 percent. Finally, a recent evaluation of the effectiveness of ignition interlock devices conducted in Hamilton County by Morse and Elliot (1992) provides additional information regarding DUI survival rates. Morse and Elliot indicated that between 3 and 4 percent of persons using the interlock devices were rearrested within the 30-month follow-up period. They also noted that after two years at risk nearly 10 percent of the comparison group had been rearrested for DUI. It appears that between 10 and 20 percent of persons classified as problem drinkers (Holden), those with prior DWI convictions (Wheeler and Hissong;

TABLE 2 POSTRELEASEPERFORMANCE OF TURNING POINT AND COMPARISONGROUP CLIENTS Number

Variable Time at risk ~6 months 6-9 months 9-l 2 months 12-l 5 months 15-l 8 months > 18 months Total Mean days at risk Postrelease performance No new charges New incidents Alcohol, not DUI DUI Not alcohol-related Total ‘Distributions

statistically

Percent

Turning Point

Comparison

19 97 137 91 90 97 531 392

14 29 19 38 29 65 194 432

355 176 35 43 97 531

119 81 16 21 44 200

different at alpha = .05

Turning Point

Comparison

X’ = 37.5* P < ,005

4 18 26 17 17 18

15 10 20 15 34

x2 P X’ P

67 33

= > = >

3.4 .05 ,l .9

7

8 18

60 40 a 10 22

Treatment

of Chronic

Drunk Drivers: The Turning Point Project

Nardone and Forcier), and those who were examined in the interlock test (Morse and Elliot) were rearrested for DUI during a 2-to3-year follow-up. While all of the studies cited above provided for longer periods of follow-up and generally were concerned with persons whose prior DUI records were not as serious as those of the Turning Point subjects, the failure rates for Turning Point subjects were similar. Eight percent of Turning Point subjects who were at risk for an average of 13 months were charged with new DUI offenses. Turning Point and Control Comparison

Group

Table 1 shows differences between the Turning Point and control groups on a number of characteristics. The groups differed in the distribution of such characteristics as sex, age, employment, having children, term of incarceration, and time at risk. More of the treatment group participants were female, and they tended to be younger, less likely to be employed prior to being incarcerated, and slightly less likely to have children. They also averaged a greater number of prior DUI convictions and tended to be at risk (ie, released from detention) for a shorter period of time. The groups did not differ significantly in terms of race, level of education, income, marital or in terms of their postrelease status, performance. Because the treatment and comparison groups were not comparable on a number of criteria, many of which are theoretically related to the likelihood of success, a different analysis had to be performed than the one originally planned. Rather than the straightforward univariate comparison of those who received the Turning Point treatment with those who did not, a multivariate comparison of groups in which detected differences could be controlled statistically was indicated. The question addressed in the multivariate analysis was, Did Turning Point subjects do better than others if the effects of other apparent differences are taken into account‘?-rather than the simpler question, Did Turning Point subjects do better than others?

271

Turning Point Effect: Statisticul Significance In the multivariate analysis Turning Point and comparison group subjects were combined to form a single data set. The pooled data set contained 647 subjects for whom all requisite data were available. The pooled data set was subjected to logistic regression analysis in which subject failure was regressed on several control variables and the dummy-coded treatment variable. Subject failure, the dependent variable, was defined in two ways for this analysis. First, failure was defined as any new offense. In the pooled data set 227, or 3.5 percent, of the subjects were charged with at least one new offense following their release from physical custody. The second definition focused on alcohol-related failures by defining failure as any new alcohol-related offense. In the pooled data set 10 1, or 16 percent, of the subjects were charged with at least one new alcohol-related offense after release from physical custody. Turning Point treatment, the explanatory independent variable, was coded as a dummy variable to indicate whether an individual received Turning Point treatment or was part of the comparison group. In the pooled sample 5 10, or 79 percent, of the subjects received Turning Point treatment while 137, or 21 percent, did not.’ The extraneous control variables were those isolated in the second stage of the analysis, which contrasted Turning Point and comparison group subjects. The control variables were: sex, age, job (employment at the time of incarceration), children, prior DUIs, time at risk, and time jailed. While several of these variables are theoretically linked to posttreatment performance. the concern with them in this analysis was to control for their effects while examining the Turning Point effect. Table 3 is the first of two reporting the regression results. This part of the analysis addressed the question, Was the likelihood of failure for someone who received Turning Point treatment less, with other differences controlled, than the likelihood for someone who did not receive that treatment? For both definitions of failure the answer

272

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and EDWARD

J. LATESSA

TABLE 3 LOGISTICREGRESSIONOF THE LIKELIHOOD OF FAILUREOF TURNING POINT AND OTHER MULTIPLE-DUI OFFENDERS WITH DEMOGRAPHIC AND EXPERIENTIALDIFFERENCESCONTROLLED (Logit coefficients) Any new incident Variable Sex (1 = male, 2 = female) Age (years) Job (1 = employed, 2 = not employed) Children (number) Prior DUls (number of convictions) Time at risk (days) Time jailed (days) Turning Point (1 = no, 2 = yes) Constant 2’log likelihood (8 df) N = 647, missing information on 84 cases

Alcohol-related

Estimate

t-value

Estimate

t-value

- ,227 - ,026 ,498 ,093 -.008 ,002 ,002 - .407 - .409 33.72

-.72 -2.63”’ 2.39”’ 1.88 -.21 3.39”’ 1.67 - 1.79” -.52

-.760 -.022 .793 ,039 .034 ,002 ,003 - ,399 -1.621 30.63

-1.52 -1.71 3.12”’ .63 .80 2.66”’ 2.23”’ - 1.38’ -1.54

NOTE: Failures are those involvedin incidentsresultingin new charges. Two forms of failure are addressed in the table: failure when any new charge is brought and failure when the new charge is alcohol-related. JOB refers to whether the offender was employed at the time he/she was incarcerated. Time at risk is the elapsed time between 1 March 1990, the study reference period, and the date when the subject was released from physical custody. “‘Statistically different than zero at alpha = .05. “Statistically different than zero at alpha = .05 in one-tailed test as predicted. ‘Statistically different than zero at alpha = .lO in one-tailed test as predicted.

to the question was yes. The negative logit coefficient associated with Turning Point treatment and being charged with any new offense (- .407) was statistically less than zero at alpha less than .05 in a one-tailed test. This indicates that Turning Point subjects were less likely to be charged with any new offense than comparison group other differences were when subjects taken into consideration statistically. When failure was defined as a new alcohol-related charge, the conclusion was somewhat more tenuous. The negative logit coefficient associated with Turning Point treatment and being charged with a new alcohol-related offense (- .399) was statistically less than zero at alpha less than 10 in a one-tailed test. As above, this indicates that the Turning Point subjects did better than the comparison group when other differences were taken into consideration. However, this difference can be considered statistically significant only if the criterion is relaxed to alpha < . 10 rather than the more conventional alpha < .05. Table 4 focuses on alcohol-related offense failures among subjects initially targeted by the Turning Point Program. Three equations are presented. The first estimates the effect

of the Turning Point program on subjects with three or more prior DUI convictions with other differences controlled. The negative logit coefficient associated with Turning Point treatment and being charged with a new alcohol-related offense (- ,629) was statistically less than zero at alpha less than ,025 in a one-tailed test. This equation indicates that persons with three or more prior DUI convictions who were treated in the Turning Point program did better than their counterparts in the comparison group. The second equation estimates the effect of the Turning Point Program on subjects who had served 30 or more days in jail with other differences controlled. The negative logit coefficient associated with Turning Point treatment and being charged with a new alcohol-related offense (- ,499) was statistically less than zero at alpha less than .10 in a one-tailed test. As noted above, differences at this level are not statistically significant; nevertheless, these differences were in the predicted direction. The third equation presented in Table 4 estimates the effect of the Turning Point Program on persons with three or more prior DUI convictions who served 30

Treatment of

Chronic

Drunk Drivers: The Turning Point Project

273

TABLE 4 LOGISTICREGRESSIONOF THE LIKELIHOOD OF AN ALCOHOL-RELATED FAILUREOF TURNINGPOINT AND OTHER MULTIPLE-DUIOFFENDERSWITH SELECTEDDEMOGRAPHIC AND EXPERIENTIALDIFFERENCESCONTROLLED (Logit coefficients)

Variables Sex (1 = male, 2 = female) Age (years) Job (1 = employed, 2 = not) Children (number) Prior DUls (number of convictions) Time at risk (days) Time jailed (days) Turning Point (1 = no, 2 = yes) Constant 2’log likelihood

3 or More Prior DlJls (N = 511)

30 or More Days in Jail (N = 434)

3 + DUls and 30 + Days (N = 352)

-.648 - .038*’ ,612” ,024 ,042 ,002” ,004” - ,629” -.579 28.50

-.250 -.017 ,869” ,017 ,049 ,001 ,004 - ,499’ -1.895 19.80

- ,387 - ,033 .799** ,009 ,053 ,001 ,003 -.819*’ -.515 20.44

NOTE: Alcohol-related failures are those incidents resulting in new charges in which at least one of the new charges was alcohol-related. “Statistically different than zero at alpha < .05 ‘Statistically different than zero at alpha < .lO in one-tailed test as predicted.

or more days in jail. The negative logit coefficient associated with Turning Point treatment and being charged with a new alcoholrelated offense (- .819) was statistically less than zero at alpha less than .025 in a onetailed test. Consistent with the results of the preceding analyses, persons who were treated in the Turning Point Program performed better (less likely to be charged with a new alcohol-related offense) after their release from custody than did those in the comparison group. Turning Point Effect: Substantive Significance It is evident from the foregoing analyses that the Turning Point project had its intended effect. That is, Turning Point subjects failed at a “statistically significant” lower rate than other multiple-DUI subjects when group differences were statistically controlled. Since the statistical difference is fairly clear, it is necessary to address substantive differences. The data presented in the remainder of the article comprise information that will facilitate somewhat more straightforward decisionmaking. To this end, the results of two additional statistical tests are presented. First, the models in Tables 3 and 4 are translated from log-odds ratios to simple odds that

TABLE 5 ODDS OF FAILURERATHERTHAN SUCCESSFOR COMPARISONGROUP AND TURNINGPOINT SWJECTS BY ALTERNATIVEFAILURECRITERIA (Odds Ratios) Failure Criterion Any new offense New alcohol offense 3 or more prior DUls 30 or more days in jail 3+ DUls and 30+ days

Comparison Group

Turning Point

,664 ,198 .560 ,150 ,598

.442 ,133 ,299 .091 ,263

someone will fail rather than succeed. Odds are presented that permit isolation of the magnitude of the Turning Point effect. Second, failure rates for Turning Point and comparison group subjects are estimated from the odds. The data permit those involved in guiding the project to assess whether the program’s performance was satisfactory. Table 5 presents the odds that comparison group and Turning Point subjects would fail rather than succeed.3 It is evident that Tuming Point subjects consistently had lower odds of failing upon release from custody than did subjects in the comparison group when group differences were taken into consideration. For example, the odds of comparison group subjects being involved in any new offense rather

274

ROBERT

LANGWORTHY

and EDWARD

than not being involved in a new offense were ,664 (1 failure for every 1.S I successes), while the odds of a Turning Point subject failing were only ,442 (I failure for every 2.26 successes). It is also apparent that the difference between Turning Point and comparison group subjects was more pronounced for those involved in a new alcohol offense who had three or more prior DUls. The odds of such Turning Point subjects failing were ,299 (I Failure for every 3.34 successes), while similar comparison group subjects’ odds of failure were ,560 ( 1 failure for every I .78 successes). Table 6 presents estimated failure rates (percent who fail) for comparison group and Turning Point subjects derived from the odds’ presented in Table 5. These estimated failure rates permit a somewhat more direct assessment of the magnitude of the effect of the program on subjects. As shown above, the Turning Point sub.jects were estimated to fail at a lower rate than comparison group subjects. The rate of failure for Turning Point subjects was estimated to be a little more than 9 percent lower than that for comparison group sub_jects when failure was defined as any new offense. Again, as above, the differences were most pronounced when the analysis focused on success rates of persons with three or more prior DUIs and when failure was defined as a new alcohol-related offense. It was estimated that. all else equal, nearly 13 percent more comparison group subjects with three or more prior DUls would be involved in a new alcohol-related offense than similarly situated Turning Point subjects. CONCLUSIONS This article has presented the results of an evaluation of an in-patient treatment program

J. LATESSA

designed for chronic drunk drivers who have served a term of incarceration. Though the original quasi-experimental research design became untenable, it was still possible to evaluate Turning Point in ways that might give guidance to program administrators and to future researchers. Several conclusions have been reached. First. it is apparent that the Turning Point Program had its intended effect. When the two groups were compared statistically. Turning Point subjects were more likely to succeed than comparison group subjects. That noted, it is important to recall that the observed statistical relations were weak. This indicates that Turning Point subjects did just marginally better than comparison group subjects. However, it is necessary to recall that when the analyses focused on the population originally targeted (those with three or more DUIs and 30 days served in jail), the beneficial effects of the Turning Point intervention were more pronounced.5 Second, it is important to note that the time at risk was relatively short (slightly more than a year), given the low probability of detection. Some researchers have suggested that the reason deterrence does not seem to be effective in curbing drunk driving is that the likelihood of detection is very low. Estimates of detection rates vary from 1 in 200 to 1 in 2,000 (Ross, 1982; Vingilis. Adlaf. and Chung. 1982; Lonsdale and Stacey. 1981; Persson, 197X). A low probability of detection coupled with a relatively short time at risk and weak statistical significance suggests that the findings in support of the Turning Point program are tenuous. With a longer follow-up these statistically weak findings may evaporate. increase. or prove to be robust.

TABLE 6 ESTIMATED FAILURE RATES FOR COMPARISON GROUP AND TURNING POINT SUBJECTS BY ALTERNATIVE CRITERIA

(Percent Failure Criterion Any new offense New alcohol offense 3 or more prior DUls 30 or more days in jail 3+ DUls and 30+ days

Who Fail)

Comparison Group

Turning Point

Percentage Difference

39.9 16.5 35.9

30.7 11.7 23.0

-9.2 ~-4.6 - 12.9

13.0 37.4

8.3 20.8

m-4.7 -16.6

Treatment

of Chronic

Drunk

Drivers:

Third, data were presented in a metric that permits a wider audience to address the substantive question, Is the success of the Tuming Point project of such a magnitude that there are practical implications? While we are fully aware that answers to substantive questions are normative, we suggest that the success rate differences of the magnitude observed for this project are promising. This article began with the observation that drunk driving persists as a particularly pernicious social problem in the United States. The persistence of this problem suggests that existing programs are not sufficiently effective and that further improvements are needed. The positive findings in this review of the Turning Point program are encouraging. Our hope is that these findings will encourage and promote additional, more rigorous research into the effects of programs designed to reduce drunk driving. NOTES I. Examples of strategies to prevent the drunk driver from driving include suspension of the driver’s license, impounding vehicles, electronic monitoring, and devices that prevent an intoxicated driver from starting a vehicle. See, for example, Morse and Elliot (1990) and Voas (1988). 2. Review of the treatment histories of subjects in the comparison group make it apparent that they did not go without treatment. Treatment for persons in this group included hospitalization, intensive supervision, Alcoholics Anonymous, and other court-ordered intervention programs. 3. The estimated odds presented in Table 5 were derived from the equations presented in Tables 3 and 4. The estimates for the comparison group are the antilogs of the constants. This has the effect of using parameter estimates that control for the differences isolated in Tables 1 and 2 to estimate the odds of failure. Using only the constant to derive the “base failure expectancy” has the effect of setting all the other values to 0. The estimate thus was derived from the following formula: log odds of failure = constant + b,, (0) + b.,, (0) + b,ob (0) +

&

(0)

The log of the odds that a Turning Point subject would fail were estimated from the same equation except that the TP value was changed from 0 to 1. The odds ratios presented in Table 5 were converted from the log odds by taking the antilog of the estimates described above. 4. The estimated percentages presented in Table 6 were derived from the odds ratios presented in Table 5. For example, an odds ratio of ,644 was translated to a percentage by taking its reciprocal (l/.644 = I .51) to derive the odds (1 : 1.51). This otlds ratio means that the

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sample was composed of 1 failure and 1.5 1 successes. The total sample then was the sum of failures and successes (1 + 1.51 = 2.51), and the percent who failed was (l/2.51) * 100 = 39.9. 5. This conclusion is consistent with that recently reached by Andrews et al. (1990) in their meta-analysis of the correctional treatment effectiveness studies. They noted that the appropriate linking of designed programs to intended clients results in improved programmatic success rates. REFERENCES Andrews, D.; Zinger, I.; Hoge. R.; Bonta, J.; Gendreau, P.; and Cullen, F. (1990). Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Crim 28(3): 369-404. Brown, P.; Zelhart, P.; and Schurr, B. (1975). Evaluating the effectiveness of reduction programs for convicting impaired drivers. In Alcohol, drugs and rrafic safety, ed. S. Israelstam and S. Lambert, 749-63. Toronto: Alcoholism and Drug Addiction Research Foundation of Ontario. Holden, R. (1983). Rehabilitative sanctions for drunk driving: An experimental evaluation. J Res Crime 20: 55-72. Jacobs, J. (1989). Drunk driving. Chicago: University of Chicago Press. Klitzner, M.: Blasinsky, M.; Marshall, K.; and Paquet, U. (1985). Determinants of youth attitudes and skills towards which drunk driving prevention programs should be directed. Vol I: The state of the art in youth DWI prevention programs. Washington, DC: U.S. Department of Transportation. Lonsdale, C., and Stacey, B. (1981). An analysis of drink-driving research in New Zealand. Christ Church: Department of Psychology, University of Canterbury, New Zealand. McKnight, A. (1986). Intervention in teenage drunk driving. Alcohol, Drugs and Driving: Abstracts and Reviews 2: 17-28. Mann, R.; Leigh, G.; Vingilis, E.; and De Genova. Y. (1983). A critical review on the effectiveness of drinking-driving rehabilitation programmes. AccidAnal Prev 15: 441-61. Mann, R.; Vingilis, E.; and Steward, K. (1988). Programs to change individual behavior: Education and rehabilitation in the prevention of drinking and driving. In Social control of the drinking driver, ed. M. D. Laurence, J. R. Snortum, and F. E. Zimring, 321-370. Chicago: University of Chicago Press. Morse, B. J., and Elliot, D. (1992). Effects of ignition interlock devices on DUI recidivism: Findings from a longitudinal study in Hamilton County, Ohio. Crime Delin 38(2): 131-57. Nardone, J., and Forcier, M. (1989). Correctional alcohol treatment centers: An impact evaluation. BOSton: Massachusetts Department of Corrections. Nichols, J.; Weinstein, E.; Ellingstad, V.; StruckmanJohnson, D.; and Reis, R. (1980). The effectiveness of education and treatment programs for drinking drivers: A decade of evaluation. In Alcohol, drugs, and traffic safety, ed. L. Goldberg, 1298-1395. Stockholm: Almqvist and Wiksell. Peck, R.; Sadler, D.; and Perrine, M. (1985). The comparative effectiveness of alcohol rehabilitation and licensing control actions for drunk driving offenders:

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A review of the literature. Alcohol, Drugs, and Drivingc Abstracts and Reviews I(4): 15-40. Persson, L. (1978). Actual drunken driving in Sweden. Scandinavian Studies in Criminology 6: IO 1 - 12. Ross, H. L. (1982). Deterring the drinking driver. Lexington, MA: Lexington Books. Vingilis, E.; Adlaf, E.; and Chung, L. (1982). Comparison of age and sex characteristics of police-suspetted impaired drivers and roadside-surveyed impaired drivers. Accid Anal Prev 14: 425-30.

and EDWARD

-

J. LATESSA

(198 1). The Oshuwa Impaired Drivers Programme: An evaluation of a rehabilitation program. Toronto: Addiction Research Foundation. Voas, R. (1988). Emerging technologies for controlling the drunk driver. In Social control of the drinking driver, ed. M. D. Laurence, J. R. Snorturn, and F. E. Zimring, 321-70. Chicago: University of Chicago Press. Wheeler, G.. and Hissone._. R. (1988). . , Effects of criminal sanctions on drunk drivers: Beyond incarceration. Crime Delin 34: 29-42.