CRICOS No 00213J

The First National Conference on Alcohol Consumption and Related Problems in Thailand

“Alcohol Situation, Trend, Threat and Policy”

Bangkok

13th to 15th July 2005

Alcohol interventions: development of Alcohol interventions: development of a rehabilitation program for drink a rehabilitation program for drink

driving offendersdriving offenders

Prof Mary SheehanCentre for Accident Research and Road Safety –

QueenslandQueensland University of Technology

Content of PresentationContent of Presentation

Background Defining the drink driving offender Defining the problem Targeting successful drink driving programs Psychosocial Treatment models for Alcohol

Dependency “Under the Limit 1”: a prototype “Under the Limit 2” Overview

The context of drink drivingThe context of drink drivingTheoretical Model of Tiers of Influence on Drink Driving Behaviour

Alcohol levels & Drink Driving AssociationAlcohol levels & Drink Driving Association

Percentage of fatally injured drivers and motorcycle riders with a BAC of 0.05gms/100ml or greater in Australia, 1981 to 1998, and total litres of pure alcohol consumed by Australians per capita

0

10

20

30

40

50

0

2

4

6

8

10

12

Fatally injured drivers with BAC 0.05 or greater Alcohol consumption

Total litres of alcohol consumed

%

Defining the drink driving offender (1Defining the drink driving offender (1))

Methods for determining alcohol impairment

a) ‘Per Se’ → BAC → Impaired driving

OR

b) Impaired Driving → BAC

Defining the drink driving offender (2)Defining the drink driving offender (2)

Offence severity index combines BAC and number of offences

BAC

Offences

1 2 3+

.02 - .04

.05

.06 - .14

.15(+)

25-30%Alternative is ‘hard core’ offender and ‘others’

Drink Driver CharacteristicsDrink Driver Characteristics

More likely to belong to a heavy drinking subculture that accepts drink driving

Majority male

Aged between 20 – 39 years

Have a history of convictions

Have poor employment and literacy histories

Targeting successful drink driving Targeting successful drink driving rehabilitation programsrehabilitation programs

Program Goals

Challenge and educate regarding unsafe driving associated with alcohol consumption

Challenge and change alcohol use

Program Approaches

Education or information based Psychotherapy / counselling based Combination of above

Success defined as reducing drink driving recidivism usually measured by time to re-offence

Characteristics of successful programsCharacteristics of successful programs

Content

Education and information on effect of alcohol on driving skills Estimating personal alcohol consumption and associated BAC (as

measure of impairment) Targeting reducing alcohol consumption Use cognitive, social and behavioural focus on both alcohol use and

drink driving

Process Target high-risk offenders Target the offence behaviour Are community based Structural with clear objectives and content Use directive approach or style Intervention integrity – is delivered as designed

Combination rehabilitation programs in association with licence restrictions and probationary supervision

Psychosocial treatments for alcohol Psychosocial treatments for alcohol dependencydependency

Address motivation and self-efficacy skills

Teach coping and other social and behavioural skills

Modify reinforcement contingencies

Foster management of negative emotions

Improve interpersonal functioning

Foster adherence to pharmacotherapyMATCH, 2002 & UKATT, 2004

Under the Limit 1: a prototypeUnder the Limit 1: a prototype Process 11 weekly sessions A contract signed to:

come on timeall homework completednot to drive to or from the sessioncome to session free of alcoholattend all sessions

A diary and other homework activities must be completed weekly A support person enlisted to help with change All sessions have focus, objectives, key activities and expected outcomes explicitly presented and discussed Directed interactive learning experience

Under the Limit 1: a prototypeUnder the Limit 1: a prototypeContentContent

Core Elements

Controlled drinking strategies and skills Information on hazards related to drinking

and driving Training in skills and strategies to avoid

future drink driving Developing social and behavioural skills

and change strategies around ‘who, where, when and how much?’

drinking occurs

Under the Limit 1 – a prototypeUnder the Limit 1 – a prototypeFacilitatorsFacilitators

Aim to maximise social context change using community leaders as facilitators

Community Health Nurse

TAFE Teacher

Principal Secondary School

Retired Police Officer

Taxi Driver

Family Services Officer

Proprietor – Small Business

Driving School Proprietor

Director – Day Care Centre

Secondary School Teacher

Primary School Teacher

University Lecturer

Youth Worker

Tax Officer

Defensive Driver Trainer

Physical Education Teacher

Physical Therapist

Community Development Officer

Computer Programmer

Drug and Alcohol Counsellor

Under the Limit 2Under the Limit 2

Under the Limit 1 and Alcohol Ignition Interlock

Training in how it works What it does How it can help avoid future drink driving

OverviewOverview

Distal/ situational influences

Manage Alcohol Access / RBT

Proximal Influences

Rehabilitation / Social Skills

Personal Characteristics

Rehabilitation / Behaviour Change

Behaviour Interlocks/ RBT

Drink driving

At Risk

Acquaintances, Family, Peers

Social Context