Treatment versus deterrence - drunk driving

Alcohol Health & Research World, Wntr, 1990 by James L. Nichols

Treatment Versus Deterrence

History of Treatment Approaches

The use of education and treatment programs for persons convicted of driving while intoxicated (DWI) began in the mid-to-late 1960s. The programs evolved from both therapy and counseling programs for alcohol abusers and from driver improvement programs for problem drivers.

The DWI Phoenix School, initiated in 1966, appears to have been the first documented DWI education program; it has served as a prototype for many of today's drinking drivers' schools.

Between 1970 and 1976, the DWI Phoenix School concept was employed nationally in 35 Alcohol Safety Action Projects (ASAPs) funded by the National Highway Traffic Safety Administration (NHTSA). Although the ASAPs included such components as law enforcement, prosecution, adjudication, legal sanctions, and public information, they emphasized efforts to diagnose DWI offenders and to refer them to education and treatment programs.

During this same period, the enactment of The Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616) established the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This Federal agency was instrumental in expanding the use of treatment programs for all persons with drinking problems, including those with DWI offenses. Approximately one-half of the ASAP sites referred DWI offenders to NIAAA-funded programs. With the growth of education and treatment programs during the 1970s, many State and local jurisdictions developed elaborate DWI referral systems.

Several States enacted legislation that required diagnosis of persons convicted of a DWI offense and mandated that these individuals participate in a DWI education or therapy program. Unfortunately, many locations offered education or treatment in lieu of traditional penalties, such as license suspensions. In some cases, persons who participated in an education or treatment program thereby avoided conviction on an alcohol-related offense. Because DWI offenses were not entered on drivers' records in these situations, many repeat offenders remained "first offenders" on official records. Some of the most extreme versions of these "diversionary" programs began to decline in the 1980s when the Presidential Commission on Drunk Driving (1983) recommended that such diversionary programs be eliminated. Many States and localities, however, continue to divert DWI offenders away from traditional sanctions and into education and treatment programs.

DWI Treatment Approaches Defined

"Treatment" for drinking drivers may refer to a variety of therapeutic interventions, approaches, and programs. Education often is considered to be one form of treatment. This article, however, distinguishes between education and other forms of treatment and evaluates the efficacy of education apart from other treatment options.

Most referrals of DWI offenders are to therapeutic programs that range from education to outpatient counseling or therapy. Inpatient counseling is less frequently available and less often recommended. Programs vary significantly in their length, format, content, and structure. Whereas most educational programs are 2 to 6 weeks in length, some therapy programs continue for a year or longer. Often, education programs are didactic in format and emphasize an increased awareness of both the effects of alcohol on the body and the legal penalties for alcohol-impaired driving. In contrast, therapy programs are more process oriented and interactive in nature. They require substantially more participation from the offender. Some DWI therapy approaches include individual counseling; however, most use small-group formats that frequently employ the use of films and videotapes.

First-time offenders and individuals diagnosed as nonproblem drinkers usually are referred to education programs or to DWI schools (Weinstein 1978). Unfortunately, repeat offenders and problem drinkers also are recommended to these programs, sometimes despite legislation that prohibits such referrals and despite evidence that these programs are ineffective for problem drinkers. In most locations, however, both repeat offenders and persons diagnosed as problem drinkers are directed to longer term (12-month) counseling programs or to Alcoholics Anonymous (AA). Counseling programs may be combined with other programs, such as disulfiram therapy, to provide additional incentives for avoiding alcohol consumption.

Treatment and Deterrence Compared

In this article, deterrence refers to measures that seek to reduce drinking and driving by instilling in existing and potential DWI offenders a fear of arrest and punishment as a consequence of DWI behavior. Deterrence seeks to change the drinking and driving behavior of both offenders who are arrested and punished (specific reform) and of the population as a whole (general deterrence). In general, deterrence focuses more on drinking and driving behavior than on drinking behavior, itself, and it relies on fear of legal consequences to modify such behavior.