archived content contenu archivé - public safety canadadiskette/large print/audio-cassette/braille)...

ARCHIVED - Archiving Content ARCHIVÉE - Contenu archivé

Archived Content

Information identified as archived is provided for reference, research or recordkeeping purposes. It is not subject to the Government of Canada Web Standards and has not been altered or updated since it was archived. Please contact us to request a format other than those available.

Contenu archivé

L’information dont il est indiqué qu’elle est archivée est fournie à des fins de référence, de recherche ou de tenue de documents. Elle n’est pas assujettie aux normes Web du gouvernement du Canada et elle n’a pas été modifiée ou mise à jour depuis son archivage. Pour obtenir cette information dans un autre format, veuillez communiquer avec nous.

This document is archival in nature and is intended for those who wish to consult archival documents made available from the collection of Public Safety Canada. Some of these documents are available in only one official language. Translation, to be provided by Public Safety Canada, is available upon request.

Le présent document a une valeur archivistique et fait partie des documents d’archives rendus disponibles par Sécurité publique Canada à ceux qui souhaitent consulter ces documents issus de sa collection. Certains de ces documents ne sont disponibles que dans une langue officielle. Sécurité publique Canada fournira une traduction sur demande.

BEST PRACTICESTreatment and Rehabilitationfor Driving While ImpairedOffenders

Our mission is to help the people of Canadamaintain and improve their health.

Health Canada

Published by authority of the Minister of Health

Également disponible en français sous le titreMeilleures pratiques – Traitement et réadaptation des contrevenantsdans les cas de conduite avec facultés affaiblies

This publication can be made available (in/on computerdiskette/large print/audio-cassette/braille) upon request.

For additional copies, please contact:

PublicationsHealth CanadaOttawa, OntarioK1A 0K9

Tel.: (613) 954-5995Fax: (613) 941-5366

This publication is also available on the internet at the following address:www.healthcanada.ca

© Her Majesty the Queen in Right of Canada, 2004Cat. H46-2/04-321EISBN 0-662-37448-7

Acknowledgements | iii

Health Canada would like to thank the technical team for this project that was led by Alan C.Ogborne, Canadian Centre on Substance Abuse (CCSA) and comprised of: Virginia Carver, private consultant; Robert Mann, Centre for Addiction and Mental Health; and Douglas J.Beirness, Traffic Injury Research Foundation. Various other CCSA staff supported this project:Gilles Strasbourg conducted the French interviews; Nina Frey and Manon Blouin conducteddocument search and acquisition respectively; Gilles Strasbourg and Richard Garlick edited theFrench and English reports respectively; Susan Rosidi oversaw the development of the inventory of driving while impaired (DWI) programs; and Gary Roberts managed the overall project.Appreciation is expressed to the Federal/Provincial/Territorial Working Group on Accountabilityand Evaluation Framework and Research Agenda (ADTR Working Group) for their support andguidance in developing this project, and the key informants for generously giving their time.

Acknowledgements

Table of Contents | v

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.2 Study parameters and definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.3 Structure of the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.4 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.4.1 Literature review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.4.2 Key informant interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.4.3 Inventory of Canadian DWI programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2. Overview of Impaired Driving in Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.1 Extent of impaired driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.2 Prevention of impaired driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2.3 Regulatory and legal context of impaired driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3. Current Treatment Practice Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.1 Effectiveness of educational or therapeutic interventions for DWI offenders . . . . . . . . 17

3.1.1 Indications from the literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.1.2 Key informant interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

3.1.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

3.2 Effectiveness of different types of treatment interventions for different types of impaired drivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32



3.2.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Table of Contents

vi | Best Practices – Treatment and Rehabilitation for Driving While Impaired Offenders

3.3 Identifying impaired drivers who may benefit from particular levels of substance abuse education or treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39



3.3.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

3.4 Effectiveness of programs that combine treatment and rehabilitation with licence suspension or other methods for limiting driving opportunities . . . . . . . . . . . 45



3.4.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

3.5 Interventions that target impaired drivers who are apprehended but not processed through the courts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47



3.5.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

3.6 Governance and training issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48



3.6.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

3.7 Relationships between DWI programs and licensing authorities . . . . . . . . . . . . . . . . . 50



3.7.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

3.8 Offender payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53



3.8.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Table of Contents | vii

3.9 Program evaluation and research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55



3.9.3 Best practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

4. Concluding Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

5. Best Practice Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

6. Inventory of Canadian DWI Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Appendix A: Rating Scale for Recent Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

List of Figures and Tables

Figure 1: Number and Rate of Persons Charged with an Impaired Driving Offence . . . . . . 12

Figure 2: Percent of Fatally Injured Drivers Tested Positive for Alcohol . . . . . . . . . . . . . . . 13

Table 1: Recent Control or Comparison Group Studies of the Effectiveness of Education and Treatment for DWI Offenders . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Table 2: Selected Characteristics of Commonly Used Questionnaires and Inventories for Identifying or Assessing DWI Offenders with Alcohol or Drug Use Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Executive Summary | 1

The aim of this report is to bring together current knowledge on the planning and delivery ofdriving while impaired (DWI) remedial programs (i.e. education programs and treatment andrehabilitation programs).

Although the magnitude of the drinking and driving problem in Canada has declined over the past two decades, it remains a significant cause of mortality and morbidity in this country. Less isknown about the impact of driving impairment due to other drug use, alone or in combinationwith alcohol, but there are indications that this is also an issue.

It is widely acknowledged that successes in reducing drinking and driving in this country have been the result of a broad and sustained mix of measures by governments and non-governmentgroups. DWI remedial programs include both educational and treatment interventions, and are an important part of this mix, as are effective public awareness and prevention programs,comprehensive roadside detection and meaningful sanctions.

There is now a reasonably extensive literature concerning remedial programs for impaired drivingoffenders and good scientific evidence for their general effectiveness. The research reviewed and theexperts consulted in the preparation of this report point to a number of practices that contribute toeffectiveness; where the evidence warrants, these practices have been identified as best practices, andare as follows:

Remedial education and treatment programs:

1. Remedial programs should occupy an integral place in a comprehensive impaired drivingcountermeasure program. Participation in such programs should be a condition of licencereinstatement for all persons convicted of an impaired driving offence.

2. Remedial programs should also be an integral part of comprehensive efforts to reducedriving while impaired by drugs other than alcohol. Participation in such programsshould be a condition of licence reinstatement for all persons convicted of a drug-relateddriving offence.

Different types of remedial interventions for different types of DWI offenders:

3. Comprehensive remedial programs for convicted impaired drivers should incorporate atleast two levels of intervention for individuals with differing levels of substance use andrelated problems.

Executive Summary

2 | Best Practices – Treatment and Rehabilitation for Driving While Impaired Offenders

4. All programs for convicted DWI offenders should incorporate both educational andtherapeutic activities, regardless of program length.

5. Mandatory clinical follow-up after licence reinstatement should be required for all DWI offenders sent to remedial programs.

Identification issues:

6. All convicted DWI offenders should complete a screening/assessment process to informdecisions about the most appropriate level or type of intervention.

7. Instruments that have been shown to be of value in assessing alcohol and drug useproblems and recidivism risk should form part of the screening procedure. Theperformance of these instruments should be monitored on an ongoing basis.

Programs that combine treatment with other measures:

8. Remedial programs should supplement, not replace, licensing actions.

When DWI offenders are not processed through the courts:

9. Individuals who receive pre-conviction roadside suspensions for impaired driving shouldbe considered for referral to assessment and participation in remedial programs.

Governance and training issues:

10. Remedial programs should be located in an environment in which a behavioural healthperspective and treatment orientation are well established and can be maintained.

11. Those providing remedial services to DWI offenders should be trained in substance useissues, and in adult education (particularly those delivering educational interventions)and group facilitation (particularly those delivering more therapeutic interventions).

12. Those providing remedial measures programs to convicted impaired drivers should besupported in accessing provincial or national training opportunities on an annual orbiennial basis.

Relationships between DWI programs and licensing authorities:

13. Remedial programs should be operated using an administrative model, where programcompletion is a requirement for relicensing.

Executive Summary | 3

14. Remedial programs should be operated by an agency other than the licensing authorities.

15. There is a need for formal and clear mechanisms for coordination and collaborationbetween licensing authorities and remedial programs to ensure reciprocal exchange of information to serve the best interests of clients and the public.

Payment structures:

16. Measures should be taken to reduce the financial burden for offenders, particularlythose who are assigned to more expensive program options. This could include applyinga single blended fee for all clients, or providing some form of financial assistance forlow-income clients.

Program evaluation and research:

17. Evaluation should be an integral part of any remedial measures program.

18. Program evaluation and research costs should be built into program budgets.

19. More emphasis should be placed on quality assurance, and studies of the cost-effectiveness of programs and their component parts.

This study has also pointed to gaps in current processes, knowledge and research that need to be explored, including but not limited to: 1) whether programs should be gender specific or agespecific; 2) how best to serve Canada’s ethnoculturally diverse populations; 3) which screening toolsmay be superior in identifying levels of substance use problems; 4) how to respond to the needs of those convicted of drug-impaired driving; 5) how to promote high standards of effective andefficient programming and program evaluation across Canada.

In most industrialized countries, impaireddriving is one of the most common crimes anda significant cause of alcohol- and drug-relatedmortality and morbidity. Most countries,including Canada, have therefore introducedmeasures to prevent impaired driving and topunish offenders. Many countries have alsodeveloped programs to educate, treat and/orrehabilitate people charged or convicted fordriving while impaired (DWI) by alcoholand/or other drugs.

There is now a reasonably extensive literatureconcerning education, and treatment andrehabilitation programs for impaired drivingoffenders and also good scientific evidence fortheir effectiveness. The aim of this report is to bring together current knowledge on theplanning and delivery of DWI education, and treatment and rehabilitation programs,particularly pertaining to the following issues:

• overall effectiveness of education andtreatment programs for impaired drivers;

• effectiveness of different types of suchremedial interventions for different types of impaired drivers;

• identifying impaired drivers who may benefitfrom substance abuse education or treatment;

• effectiveness of programs that combinetreatment and rehabilitation with licencesuspension or other methods for limitingdriving opportunities;

• need for interventions that target impaireddrivers who are apprehended but notprocessed through the courts;

• DWI program governance and providertraining issues;

• relationships between remedial programs and licensing authorities;

Introduction | 5

11.1 Purpose

KEY POINTS

• This study focusses on both educational andtherapeutic remedial programs for peoplecharged with or convicted of alcohol- and/ordrug-related driving offences.

• Specific interventions of interest include 1) education typical of specialized DWIprograms, and 2) interventions similar tothose found in general addiction treatmentprograms. Both emphasize the importance of separating drinking/substance use fromdriving.

Introduction


• offender payments for services; and

• program evaluation and research.

Beyond these main questions, the research team was also asked to give attention to currentknowledge on remedial programs for driversimpaired by drugs other than alcohol, and to be alert to issues of gender, ethnicity, place of residence (rural vs. urban), and clinicianliability during the research.

The project was initiated by Health Canada aspart of a research agenda developed by theFederal/Provincial/Territorial Working Group onAccountability and Evaluation Framework andResearch Agenda (ADTR Working Group). Partof the mandate of the working group is to over-see the development and implementation ofresearch studies that contribute to innovativesubstance abuse treatment and rehabilitationprograms by identifying best practices, evaluatingmodel treatment and rehabilitation programs,and identifying emerging issues. The knowledgeis then disseminated across the country.

This project builds on a series of best practicespublications including: Best Practices –Substance Abuse Treatment and Rehabilitation(Health Canada, 1999); Best Practices – FetalAlcohol Syndrome/Fetal Alcohol Effects and theEffects of Other Substance Use During Pregnancy(Health Canada, 2001a); Best Practices –Treatment and Rehabilitation for Women withSubstance Use Problems (Health Canada,2001b); Best Practices – Treatment andRehabilitation for Youth with Substance UseProblems (Health Canada, 2001c); Best Practices– Concurrent Mental Health and Substance UseDisorders (Health Canada, 2001d); Best Practices– Methadone Maintenance Treatment (HealthCanada, 2002a); and Best Practices – Treatmentand Rehabilitation for Seniors with Substance UseProblems (Health Canada, 2002b)

Following initial discussions with members ofthe ADTR Working Group, it was determinedthat the study would focus on educational andtherapeutic remedial programs1 for peoplecharged with or convicted of alcohol- and/ordrug-related driving offences. Efforts were also

made to identify knowledge on the identifica-tion and treatment of substance use problems2

among those charged with other traffic offences(e.g. dangerous driving, leaving the scene of anaccident), and impaired drivers who are appre-hended by the police, but not processed

1 The term “remedial programs” in the context of this report, refers to education and therapeutic programs for DWIoffenders.

2 The term “substance use problems ” is used to cover both substance abuse and substance dependence, as defined bythe American Psychiatric Association in the Diagnostic and Statistical Manual (DSM)-IV (1994)

1.2 Study parameters and definitions

Introduction | 7

through the justice system. These latter types ofoffenders are given roadside or administrativelicence suspensions, but are not subsequentlyprosecuted.

Interventions of concern were those typicallyused in specialized remedial programs for DWIoffenders and those used in programs indicatedin the 1998 Canada’s Drug Strategy planningdocument, namely:

…detoxification services, early identificationand intervention, assessment and referral,basic counselling and case management,therapeutic intervention, and aftercare andclinical follow-up. … offered on an out-patient, day-patient or in-patient basisincluding short-term and long-term residen-tial care.

(Health Canada, 1998, p. 9)

Specific interventions of interest includededucation typical of specialized DWI programsthat focus on substance use and driving, andthe importance of separating the two, as well asinterventions similar to those found in generaladdiction treatment programs in Canada (e.g.counselling, self-help, cognitive-behaviourtherapy, family therapy, guided self-change),but also have a focus on separating drinkingand driving.

Some reports of interventions that specificallytarget impaired drivers in emergency rooms or other medical settings were found (e.g.Gentilello et al., 1999; Monti et al., 1999).However, these were considered to be beyondthe scope of this project, because they areinterventions with impaired drivers who havenot been apprehended by the police. Victim

impact panels are a common, yet largelyineffective, form of remediation that wereconsidered beyond the scope of this report(C’de Baca et al., 2001; Polacsek et al., 2001;Shinar and Compton, 1995).

Other interventions, such as mandatory use ofignition interlock devices, fines and electronicallymonitored home confinement, were consideredbeyond the present scope of this report. However,as will be seen, there is evidence that educationand treatment programs are most effective whencombined with licence suspension and othermeasures, such as impounding offenders’ vehiclesor licence plates, installing ignition interlocks, orrequiring electronic home monitoring or housearrest.

The definition of best practice as it relates toprogram delivery in the health field has beenapproached with varying degrees of rigour. Forthe purposes of this project, best practices areemerging guidelines, gleaned from key expertperspectives and supported by the literature, onthe approaches and elements of treatment thatappear to result in successful treatment out-comes. Given this definition, best practices arerecommendations that may evolve, based onongoing key expert experience, judgment,perspective and continued research.


The report first provides a general overview ofthe impaired driving situation in Canada. Themain body of the report is structured around thenine main issues identified in the introduction;current knowledge drawn from the literature andkey informants is summarized in each section,

and when the level of knowledge warrants, bestpractice statements are presented. Gender,ethnicity, place of residence (rural vs. urban) andother issues are variously addressed under themain topic headings. Concluding the report isan inventory of Canadian DWI programs.

For the best practices, two sources of informa-tion were drawn upon:

• a review of published and unpublishedresearch reports on DWI treatment andrehabilitation; and

• interviews with experts in the field of DWIprogram development and delivery.

For the Inventory of Canadian DWI Programs(see Section 6), information was gatheredthrough the administration of a written surveycompleted by persons responsible for provincial/territorial impaired driving programs in Canada.

The primary sources used to identify researchreports were:

• Alcohol and Alcohol Problems ScienceDatabase (ETOH) of the US NationalInstitute on Drug Abuse (NIDA);

• the web site of the US National CommissionAgainst Drunk Driving (www.ncadd.com);

• a recent review of DWI literature (Beirness, Mayhew and Simpson, 1997);

• MEDLINE (Database of the NationalLibrary of Medicine, National Institutes of Health, U.S.);

• CANBASE (the database of Canadianaddiction library holdings);

• CCSADOCS (the database of holdings ofthe Canadian Centre on Substance Abuse);and

• reports identified by members of the steeringcommittee.

Priority for review was given to reports ofcontrolled studies pertaining to the issues ofconcern. A number of reports or publicationsby expert panels or internationally respectedauthorities were examined for knowledge

1.3 Structure of the report

1.4 Methodology

1.4.1 Literature review

Introduction | 9

pertaining to the aims of this report. These arereferenced in various sections that follow. Ascale (see Appendix A) was developed to rate

each study on the quality of the research andstrength of outcomes. The ratings are presentedin Table 2.

Program inventories from Bierness, Simpsonand Desmond (1994) and Stoduto et al. (1998)were used to identify respondents for a surveyof Canadian DWI programs. Key personnelwere contacted in the fall of 2002 and asked

to provide a profile of their program bycompleting a survey questionnaire. In manycases, follow-up phone calls were made toclarify or elaborate on information given.

The project steering committee nominated 12 key experts (e.g. directors, managers andmedical consultants for DWI programs) on the basis of their expertise in various aspects ofDWI remedial programming, and on the basisof regional representation. The key experts were contacted by the project team to solicittheir participation in a telephone interview ofapproximately 90 minutes. A standard inter-view guide was used during the interview, but with particular emphasis given to the keyinformant’s specific area of expertise.

In the interviews, key informants were asked for their advice on the following issues drawnfrom the main research questions: screening for

substance use problems; assessment and treat-ment assignment; effectiveness of educationaland therapeutic interventions; administrative orjudicial compliance mechanisms; effectiveness ofprograms that combine treatment with licencesuspension or some other method of limitingdriving opportunities; case monitoring, evalua-tion and research; provider training; recovery ofcosts for education/treatment programs; relation-ships between education or treatment servicesand motor vehicle registration departments; andprogramming for youth DWI offenders. Keyinformants were also asked about any recentdevelopments in DWI remedial measuresprogramming in their jurisdiction.

1.4.2 Key informant interviews

1.4.3 Inventory of Canadian DWI programs

Driving while impaired by alcohol and/or other substances continues to be a major cause of vehicle crashes, injuries and deaths inCanada. One indicator of the magnitude of theimpaired driving problem in Canada that is ofparticular relevance to the present project is thenumber of persons charged by the police with a Criminal Code impaired driving offence.Figure 1 presents the number and rate (per10,000 licensed drivers) of impaired drivingcharges in Canada from 1974 through 2001.The total number of persons charged withimpaired driving reached a peak of 162,048 in 1981. The number of impaired drivingcharges laid in a given year is, of course, partlya reflection of the level of enforcement activity.

However, it is generally agreed that theunprecedented reductions in impaired drivingduring the 1980s reflected the many new pre-vention and awareness programs, policies andactivities that were developed during this peri-od. The absolute number of charges decreaseddramatically, falling to a low of 69,192 in2000—a decrease of 57%; in the most recentyear for which data are available, the number of persons charged with an impaired drivingoffence increased slightly to 71,087 (CanadianCentre for Justice Statistics, 2002).

Overview of Impaired Driving in Canada | 11

22.1 Extent of impaired driving

KEY POINTS

• Driving while impaired by alcohol and/or othersubstances continues to be a major cause ofvehicle crashes, injuries and deaths in Canada.

• The unprecedented reductions in impaireddriving during the 1980s reflected the manynew prevention and awareness programs,policies and activities that were developedduring this period.

• In the decade between 1981 and 1990, thepercent of fatally injured drinking driversdecreased from 62% to 45%.

• In 2000, 35.6% of drivers killed in crashestested positive for alcohol.

• Less is known about the prevalence of drivingwhile impaired by drugs, however researchprovides evidence of increases in collision risk.

• Laws making it an offence to drive whileimpaired by alcohol have been in Canada’sCriminal Code for many years. In 1969, theimpaired driving law was supplemented by a perse law, which made it an offence to drive with aBlood Alcohol Content (BAC) over 80 mg%.

• Canada’s Criminal Code makes it an offence,with penalties equivalent to those for drivingwith a BAC over 80 mg%, to refuse to providea breath test.

• As well, most provinces have administrativesanctions that apply to drivers with BAC levelslower than 80 mg% – usually at 50 mg%.

Overview of Impaired Driving in Canada


A commonly used indicator of the magnitudeof the DWI problem is the percent of fatallyinjured drivers who test positive for the pres-ence of alcohol. Figure 2 presents this indicatorfor Canada from 1973 through 2000. It isevident in this figure that during the 1970s,there was very little change in the magnitude ofthe problem. In fact, this index of the problemreached a peak in 1981 when 62% of fatallyinjured drivers were found to have consumedalcohol. However, in the decade between 1981and 1990, the percent of fatally injured drink-ing drivers decreased from 62% to 45%. Theprogress of the 1980s suffered a setback in theearly part of the 1990s, but the downwardtrend has recently been re-established, albeit ata slower rate. In 2000, 35.6% of drivers killedin crashes tested positive for alcohol. In this,the most recent year for which data are avail-

able, it is estimated that 864 persons were killed in motor vehicle collisions involving adriver who had been drinking (Mayhew, Brownand Simpson, 2002).

Although these and other indicators ofimpaired driving are substantially lower thantheir equivalents in previous decades, impaireddriving is still a major concern. Motor vehiclecollisions (MVCs), many of which are causedby drinking drivers, are a serious health andsafety issue in Canada. MVCs were the seventhleading cause of Potential Years of Life Lost(PYLLs) in 1997, and among children aged 0to19 they were the third leading cause of PYLLs(National Cancer Institute of Canada, 2001).About one third of all deaths resulting fromMVCs involve a drinking driver (Mayhew,Brown and Simpson, 2002). Alcohol-related

Figure 1: Number and Rate* of Persons Charged with an Impaired DrivingOffence (Canada 1974–2001)

01974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

0

20

40

60

80

100

120

140

Persons Charged

Rate

Persons Charged

* Per 10,000 Licensed Drivers

Source: Uniform Crime Reporting (UCR) Survey, Canadian Centre for Justice Statistics (CCJS)


motor vehicle crashes account for 13% of allalcohol-related hospitalizations and 12% of allalcohol-related days in hospital (Single et al.,1996). They also account for 22% of allalcohol-related deaths and 33% of all alcohol-related years of life lost (Single et al., 1996).Single et al. (1996) estimated that in 1992alcohol-related collisions in Canada resulted in direct costs for damage of $482,800,000.

Much less is known about the prevalence ofdriving while impaired by drugs other than alco-hol, and the risks associated with this behaviour.Canadian and international research does pro-vide evidence that cannabis, cocaine, possiblyother illicit drugs such as hallucinogens, andsome drugs used for therapeutic purposes, suchas benzodiazepines, impair the skills necessaryfor safe driving and are associated with signifi-cant increases in collision risk (Dussault et al.,

2002; Macdonald et al., 2002). After alcohol,the drugs most often detected in seriously andfatally injured drivers are cannabis, benzodi-azepines and stimulants (including cocaine)(Cimbura et al., 1990; Stoduto et al., 1993).Walsh and Mann (1999) reported that, in arepresentative sample of Ontario adult drivers,1.9% said they had driven within an hour ofsmoking cannabis at least once in the previous12 months and the proportion reporting drivingafter using cannabis was highest among youngerrespondents.

More recently, Adlaf, Mann and Paglia (2003)reported that, among Ontario high schoolstudents with a driver’s licence, 19.3% reporteddriving after using cannabis at least once in theprevious year. Research from Canada and else-where indicates that some psychoactive drugsnormally used for therapeutic purposes have

Figure 2: Percent of Fatally Injured Drivers Tested Positive for Alcohol:1973–2000

0

10

20

30

40

50

60

70

Percent

1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Source: Strategy to Reduce Impaired Driving (STRID) database – Traffic Injury Research Foundation (TIRF)


also been shown to be associated with increasedcollision risk (e.g. Hemmelgarn et al., 1997).Neutel (1995), in a Saskatchewan study,reported that the likelihood of a traffic injuryincreased significantly during the period afterprescriptions for benzodiazepines were filled, in comparison with controls who did notreceive a prescription for benzodiazepines. In arecent report of a random sample of Canadian

drivers, 17.7% indicated that, during the past12 months, they had driven within two hoursof taking some type of drug that could affectone’s ability to drive safely. The drugs mostcommonly used in this context were over-the-counter medications (15.9%), prescriptionmedications (2.3%), cannabis (1.5%) and otherillegal drugs (.9%) (Beirness et al., 2003).

Clearly, successes in reducing drinking anddriving in this country have not been the resultof any single initiative; instead, they are theresult of a broad and sustained mix of measuresby governments and non-government groupsover this period. Three main types of activitieshave been prominent among efforts to preventimpaired driving during the past 15 to 20 years:(1) primary prevention, which aims to educatethe general public about the dangers ofimpaired driving; (2) secondary prevention,which increases the efficiency of law enforce-ment; and (3) tertiary prevention, which aimsto reduce the risk of re-offending among thoseguilty of impaired driving, including educatingoffenders or treating them for a substance useproblem. A major thrust in tertiary preventionhas been to increase penalties for all types ofimpaired offenders and especially for repeatoffenders.

Canada has a national Strategy to ReduceImpaired Driving (STRID). The STRID TaskForce is under the auspices of the CanadianCouncil of Motor Transport Administrators(CCMTA). The CCMTA has adopted the

Road Safety Vision 2010 (Transport Canada,2002), which is an enhanced plan to makeCanada’s roads the safest in the world. Onetarget is to reduce morbidity and mortalityfrom driving while impaired by 40% by theyear 2010. The plan is supported by all levels of government, as well as by public and privatesector stakeholders.

DWI offender education programs were initiallydeveloped in the 1960s when it first becameapparent that many such offenders knew littleabout the effects of alcohol on driving perform-ance and related issues, and had inappropriateattitudes to driving after drinking. These pro-grams had mixed and often poor results whenused as alternatives to legal sanctions and licencesuspensions, without regard to individual differ-ences in alcohol-related and other problemsamong those involved (Mann, 1992). However,further research and analysis indicated that,when combined with licence suspensions,education programs did reduce the risk ofsubsequent DWI offences among offenders whodid not have significant alcohol use problems.These programs are thus supported by many

2.2 Prevention of impaired driving


jurisdictions and DWI offenders are oftenrequired to attend such programs in order toregain their drivers’ licences.

In Canada, interest in the potential value of remedial programs for drinking-drivingoffenders dates back many years (e.g. Smart andSchmidt, 1961). The first specialized programsfor impaired driving offenders were probablydeveloped and implemented on a limited basisin the 1960s (Mann, 1992). Since then, pro-grams have been developed and implemented inmany parts of the country. The comprehensiveprovince-wide program in Manitoba has servedas a model for programs in other provinces.

Mandatory screening/assessment and educa-tional or treatment intervention programs arein place in many provinces/territories and arerecommended by the STRID 2010. Theserequire the offender to go through a screening/assessment process and/or to complete aneducational or treatment intervention prior

to licence reinstatement. In those jurisdictionswith such programs, there are typically two orthree levels of intervention. The first level—forfirst offenders or those considered to be lowrisk—is usually a brief educational session. The second level of intervention is for offendersat an early stage of a substance use problem orat higher risk because of their attitudes andbehaviours regarding drinking and driving. Itusually takes place over a more extended periodof time and may involve a more comprehensiveassessment, as well as an opportunity to workon strategies to address identified problemareas. The third level of intervention is foroffenders assessed as having a serious substanceuse problem or dependency and usuallyinvolves a referral to a substance abuse treat-ment program. In those jurisdictions that havemandatory DWI programs, there is typicallysome cost-recovery for either the assessmentalone or for the assessment and treatment.

2.3 Regulatory and legal context of impaired driving

Laws making it an offence to drive whileimpaired by alcohol have been in Canada’sCriminal Code for many years. In 1969, theimpaired driving law was supplemented by aper se law, which made it an offence to drivewith a Blood Alcohol Content (BAC) over 80 mg%. Per se laws had been introduced inScandinavian countries and in Great Britain,where it was found that they greatly facilitatedthe processing of drinking-driving cases andresulted in significant reductions in collisions,injuries and fatalities (Mann et al., 2001; Ross,

1984). In addition, Canada’s Criminal Codemakes it an offence, with penalties equivalentto those for driving with a BAC over 80 mg%,to refuse to provide a breath test. The CriminalCode was revised in 1985, creating newoffences for impaired driving causing bodilyharm and impaired driving causing death. Morerecently, the Government of Canada increasedthe penalties in the Criminal Code for impaireddriving, including a maximum penalty of life inprison for impaired driving causing death.


All provinces and territories also use theirauthority under their respective highway trafficlaws to impose administrative sanctions andmeasures that apply to drivers convicted ofCriminal Code drinking-driving offences.These sanctions are independent of theCriminal Code and may include for examplelicence suspensions that exceed the prohibitiontime mandatory under the Criminal Code.These provincial and territorial sanctions andmeasures are invoked on conviction of aCriminal Code DWI offence.

As well, most provinces have the roadsidelicence suspension, an administrative sanctionthat applies to drivers with BAC levels lowerthan 80 mg%—usually at 50 mg%. Theseroadside licence suspensions take effectimmediately, rather than upon conviction of aCriminal Code DWI offence. Roadside licencesuspensions are ordered at the roadside at thediscretion of police officers and licences aresuspended for 12 or 24 hours. Some provinceskeep official records of these roadside licencesuspensions.

Current Treatment Practice Issues | 17

3Current Treatment Practice Issues

3.1.1 Indications from theliterature

To determine the effectiveness of any kind ofeducation, treatment or rehabilitation programfor DWI offenders, it is necessary to use aresearch design that controls for the influenceof other, non-treatment factors such as motiva-tion, problem severity and social resources. Theoptimal research design is one that involvessubjects who are randomly assigned to theintervention of interest or to some alternative.Alternatives could include punishment, noeducation or treatment and/or different kindsof education or treatment. Most studies ofeducation and treatment for impaired drivershave not used this kind of experimental design.This is because it is difficult to persuade thecourts to randomly select convicted DWIoffenders for punishment with or without some kind of treatment. However, there aresome notable exceptions (see below).

A more common study design is the quasi-experiment where outcomes for those who receive the intervention of interest arecompared with those for similar groups or

3.1 Effectiveness of Educational or TherapeuticInterventions for DWI Offenders

KEY POINTS

• Remedial programs for convicted DWIoffenders have become increasingly used over the past decades.

• There is good empirical evidence that remedialprograms can positively influence knowledge,beliefs, attitudes, alcohol use, recidivism,collisions and the health status of convictedDWI offenders.

• Based on a meta-analysis by Wells-Parker et al.(1995), treatment and rehabilitation had onaverage a small but positive influence (7-9%reduction) on the incidence of recidivism and crashes, when compared with standardpunitive sanctions without treatment.

• The Wells-Parker et al. (1995) meta-analysisalso suggested that combined strategies weremost effective for multiple, as well as firstoffenders.

• The literature search conducted for thisproject identified 11 reports of control orcomparison group studies written since 1990that aimed to assess the effects of education or treatment on DWI recidivism.

• No studies of the impact of a remedialprogram for individuals convicted of drivingwhile impaired by drugs other than alcoholwere located.

Key Points continues on page 18


individuals who did not. The challenge for theresearcher in these cases is to match individualsor groups on variables other than treatmentthat could influence their respective fates.Matching variables typically include age,gender, problem severity, and DWI arrest andconviction history. Sometimes this is done byfinding control cases for each individual in theintervention group or by finding comparisongroups whose overall characteristics are similarto those in the intervention group. Statisticalmethods can also be used to adjust for meas-ured differences between those in the treatmentand the comparison group(s). However, theresults of quasi-experimental studies will becompromised if the groups studied differ onfactors that are not measured or controlled (e.g. on levels of motivation for treatment, orexposure to criminal sanctions).

Other critical issues for the evaluation ofinterventions for DWI offenders include theselection of outcome measures and the follow-up interval. The most commonly used outcomemeasure is recidivism, as indicated by subse-quent DWI arrests and convictions. This hasthe advantage of objectivity, but may be a poorindication of actual DWI behaviours becausethe risk of arrest for driving while impaired by alcohol or drugs is small even for repeatoffenders. There is also an ethical concern fortreatment providers in the use of post-treatmentarrests as indicators of treatment outcomebecause the absence of an arrest does notnecessarily reflect attainment of treatment goals.Thus, convicted DWI offenders who are notsubsequently re-arrested for the same offencemight have modified their driving behavioursbut still have serious drinking or drug-useproblems. These would be considered failures

from a clinical perspective, but successes from a harm reduction or public safety perspective.This may not be important if treatments areprincipally intended to have harm reductiongoals (i.e. no drinking and driving), but this has not generally been the case. DWI offendersare given treatment not only to prevent themfrom further driving when impaired by alcoholor drugs but also because they are believed toneed help with their drinking or drug use.

The length of follow-up is also critical to the evaluation of education and treatmentprograms for DWI offenders because theseprograms are expected to have a lasting impact.The DWI research literature includes examplesof follow-up studies over 10 years or more, butthere are also studies with much shorter follow-up intervals and their results may not be validover a longer term.

Many published and unpublished reports ofstudies use quasi-experimental or experimentaldesigns to determine if specific kinds of educa-tion or treatment affect the subsequent behav-iours of people who drink or take drugs, anddrive. In most cases, these studies have comparedthose who received some type of education ortreatment with those who did not. However, afew studies have compared different types ofeducation or treatment. Generally, the main

KEY POINTS (cont’d)

• Studies that evaluate the effects of treatmentfor drug use problems on driving measureshave begun to appear, and have found thatsignificant post-treatment reductions in, for example, DWI convictions and totalcollisions, have been obtained.


outcome of interest has been DWI recidivism as indicated by post-intervention arrests.

A large number of studies (194) publishedduring or before 1990 were the subject of ameta-analysis by Wells-Parker et al. (1995).These studies all involved DWI offenders andhad compared “remediation” (active probation,education, psychological treatments, victimimpact panels and ignition interlocks3) to noremediation, or two or more forms of remedia-tion. Many of those given education or treat-ment also received licensing penalties and some-times these were more severe than those imposedon non-remediation groups. Eighteen of thestudies compared two or more independentsamples, thus providing a total of 212 discretestudies for analysis.

The studies varied greatly with respect to theirmethodological rigour and thus the degree ofconfidence that could be placed in the reportedresults and conclusions. Common problemsincluded poor reporting of results, and inade-quate description of the interventions andsanctions applied to the remediation and non-remediation groups. These problems were takeninto account in the meta-analysis and, in general,studies that were methodologically strongshowed remediations to have less effect thanthose that were methodologically weak.

The analysis did, however, indicate that, onaverage, treatment and rehabilitation had asmall but positive influence (7–9% reduction)on the incidence of alcohol-related drivingrecidivism and crashes, when compared withstandard punitive sanctions without treatment.

The average in this case took account of alltypes of offenders and all types of rehabilitationand treatment for which data were available.This was consistent with the conclusions drawnfor some earlier reviews of the published litera-ture (Mann et al., 1983; McKnight and Voas,1991), but at variance with reviews by Foon(1988) and the Institute of Medicine (1990),which concluded that remediation for DWIoffenders had no measurable effects.

The Wells-Parker et al. (1995) meta-analysisalso suggested that combined strategies (i.e.education plus psychotherapy, plus follow-upsuch as contact monitoring and aftercare) weremost effective for multiple, as well as firstoffenders. However, “severe” or “high-problem”offenders (the definition of which varied acrossstudies) showed smaller post-treatment reduc-tions in drinking and driving than offenderswith more moderate risk levels. It should benoted that some of these high-risk groups alsotended to receive less effective interventions(e.g. mandatory Alcoholics Anonymous (AA)alone). Wells-Parker and colleagues have arguedthat these results demonstrate the need forfurther research, particularly on the benefits of matching different types of DWI offendersto different types of treatment.

The literature search conducted for this projectidentified 11 reports of control or comparisongroup studies written since 1990 (the cut-offyear for studies in the Wells-Parker review) that aimed to assess the effects of education ortreatment on DWI recidivism. These studies aresummarized in Table 1 and further details aregiven below. Table 1 also includes scores

3 As noted earlier, ignition interlocks are not otherwise considered in this report.


assigned for methodological rigour using ascheme (Appendix A) based on a scale used byWells-Parker et al. (1995). However, given ourmore modest objectives, studies are not discrim-inated to the same degree. The maximum scorewas 12 (most rigorous). Scores below 6 indicateserious limitations and the need for extremecaution in interpreting results. The main reasonsfor low ratings were: (1) lack of information onthe interventions studied, and (2) uncontrolledbiases associated with the selection of cases foreducation or treatment. Typically, the selectionprocess for these studies involved self-selectionand judgment calls by magistrates. Another lim-itation in some cases was the compounding ofeducation or treatment with other benefits suchas the avoidance of criminal conviction or jail.

Peck, Arstein-Kerslake and Helander (1994)reported an assessment of factors affectingrecidivism in a group of convicted drinkingdrivers in California. The data for this analysiswere obtained from data from two previouslydescribed randomized evaluations of the effectsof remedial programs (Reis, 1982a,b), both of which found that assignment to remedialprograms resulted in significant reductions inrecidivism. Peck, Arstein-Kerslake and Helander(1994) combined the data from the two studiesreported by Reis and used multivariate statisticalmethods to attempt to control for previousdriving record, criminal record, age, maritalstatus, occupation and attitudes at intake.Because the two studies involved substantial dif-ferences in offender groups, remedial interven-tions used, and locations in which the programswere offered (among other differences), theanalyses reported by Peck Arnstein-Kerslake andHelander (1994) are most appropriately viewed

as a comparison group design in which groupequivalence on key variables is not always clear.

Offenders in this study (N=7,316) had beenassigned to one of several first or repeat offenderprograms or to no-treatment control groups.The treatment options for first offenders were:(1) in-class education (four 2.5 hour sessions) or(2) home study. For repeat offenders, the treat-ment options were: (1) therapeutic counselling;(2) counselling plus anti-alcohol drug therapy;or (3) bi-weekly contacts without counselling oranti-alcohol drug therapy. The outcome measurewas a composite measure unique to this study,which included reckless driving, accidents wherethe index case had been drinking and driving,late night accidents and DWI charges. Whileseveral demographic and driving-related meas-ures were significant predictors of this compositemeasure of problem driving, participation in aremedial program was not.

Taxman and Piquere (1998) reported on athree-year follow-up of 3,671 convicted DWIoffenders in Maryland who had received variousdispositions from the courts. These are listed inTable 1 but the authors provide few details.However, they indicated that the educationcomponent was a state-certified program, andthat treatment was mainly on an outpatientbasis. Assignment to particular forms of punish-ment and/or treatment was at the discretion ofthe court and based on multiple factors.

A Cox proportional hazard model was used toidentify variables that predicted recidivism over athree-year period. Offender variables used in thisanalysis were age, gender, first-time offender(yes/no), and number of prior traffic convictions.


Tab

le 1

: R

ecen

t C

on

tro

l o

r C

om

par

iso

n G

rou

p S

tud

ies

of

the

Eff

ecti

ven

ess

of

Ed

uca

tio

n o

r Tr

eatm

ent

for

DW

I O

ffen

der

s

Au

tho

r(d

ate)

Rat

ing

Des

ign

Sam

ple

an

d s

ize

Fo

llow

-up

per

iod

Ou

tco

me

mea

sure

sR

esu

lts

Inte

rven

tio

ns

com

par

ed

Taxm

an a

ndP

ique

re(1

998)

7C

ompa

rison

grou

p st

udy

with

stat

istic

al c

ontr

olfo

r ag

e, g

ende

ran

d of

fenc

ehi

stor

y

3,67

1 fir

st

or r

epea

tof

fend

ers

3 ye

ars

Any

DW

Ire

cidi

vism

Reh

abili

tatio

n,bu

t no

tpu

nish

men

t, w

asas

soci

ated

with

a lo

wer

rec

idi-

vism

rat

e

Pu

nis

hm

ent:

(1)

prob

atio

n be

fore

judg

emen

t(2

) lic

ence

res

tric

tion

(3)

jail

(4)

unsu

perv

ised

pro

batio

n(5

) su

perv

ised

pro

batio

n(6

) in

tens

ive

supe

rvis

ion

(7)

fines

Reh

abili

tati

on

:(1

) co

urt

orde

red

to r

emai

nab

stin

ent

(2)

AA

(3)

educ

atio

n(4

) tr

eatm

ent

prog

ram

(n

ot s

peci

fied)

De

You

ng(1

997)

7C

ompa

rison

grou

p st

udy

with

stat

istic

al c

ontr

olfo

r ca

se a

ndco

mm

unity

char

acte

ristic

s(s

ee t

ext)

88,5

52 f

irst

offe

nder

s

27,2

92 s

econ

dof

fend

ers

32,7

87 t

hird

offe

nder

s

The

re w

ere

ala

rge

num

ber

of c

ases

(>2,

000)

inea

ch c

ondi

tion

18 m

onth

sT

ime

to n

ext

conv

ictio

n

Any

DW

Ico

nvic

tion

Tre

atm

ent

with

eith

er d

river

licen

ce r

estr

ictio

nor

sus

pens

ion

was

ass

ocia

ted

with

the

low

est

re-c

onvi

ctio

nra

tes

Fir

st o

ffen

der

s:(1

) ja

il (2

) ja

il an

d lic

ence

res

tric

tions

(3

) ja

il an

d lic

ence

sus

pens

ion

(4)

jail

and

trea

tmen

t (5

) tr

eatm

ent

only

(6

) tr

eatm

ent

and

licen

cere

stric

tions

Sec

on

d-t

ime

off

end

ers:

(1

) tr

eatm

ent

and

licen

cere

stric

tions

(2

) tr

eatm

ent

and

licen

cesu

spen

sion

(3

) lic

ence

sus

pens

ion

only

Th

ird

-tim

e o

ffen

der

s:(1

) 18

-mon

th t

reat

men

t an

dlic

ence

rev

ocat

ion

(2)

30-m

onth

tre

atm

ent

and

licen

ce r

evoc

atio

n (3

) lic

ence

rev

ocat

ion

only


Au

tho

r(d

ate)

Rat

ing

Des

ign

Sam

ple

an

d s

ize

Fo

llow

-up

per

iod

Ou

tco

me

mea

sure

sR

esu

lts

Inte

rven

tio

ns

com

par

ed

Tab

le 1

: R

ecen

t C

on

tro

l o

r C

om

par

iso

n G

rou

p S

tud

ies

of

the

Eff

ecti

ven

ess

of

Ed

uca

tio

n o

r Tr

eatm

ent

for

DW

I O

ffen

der

s (c

ont’d

)

Nic

kel

(199

0a,b

)7

Com

paris

ongr

oup

stud

y w

ith s

econ

dary

anal

yses

com

parin

g ou

tcom

es f

orre

gion

s w

ithdi

ffere

nt D

WI

conv

ictio

n ra

tes

and

diffe

rent

age

grou

ps

2,88

8 se

cond

offe

nder

s of

who

m 1

,544

wer

e as

sign

edto

the

edu

ca-

tion

cour

se

3 ye

ars

and

5 ye

ars

Any

DW

Ico

nvic

tion

Re-

conv

ictio

nra

tes

for

thos

ew

ho a

ttend

edth

e co

urse

wer

elo

wer

tha

n fo

rth

e co

ntro

l gro

updr

iver

s (1

3.4%

vs.

18.8

% a

t 36

mon

ths,

21%

vs

. 26

.9%

at

60m

onth

s)

(1)

Use

r pa

y 8-

wee

k co

urse

invo

lvin

g ed

ucat

ion,

sel

f-m

onito

ring,

dyn

amic

gro

upw

ork,

hom

ewor

k w

ith 1

-yea

rfo

llow

-up

(2)

Con

vict

ed D

WIs

judg

ed f

it to

driv

e w

ithou

t an

edu

catio

npr

ogra

m

Man

n,A

nglin

,W

ilkin

s et

al.

(199

4)

7R

ando

miz

edex

perim

ent

and

com

paris

ongr

oup

stud

y w

ith n

o co

ntro

lsfo

r gr

oup

diffe

renc

es

(1)

347

mal

ere

peat

offe

nder

s of

who

m 2

20w

ere

rand

omly

assi

gned

to

educ

atio

n

(2)

276

mal

ere

peat

offe

nder

sas

sign

ed t

oed

ucat

ion

(non

-ran

dom

)

8–13

yea

rsM

orta

lity

from

all c

ause

s an

dde

aths

fro

mci

rrho

sis,

alco

hol

depe

nden

ce,

acci

dent

s or

viol

ence

In b

oth

expe

rimen

tal

and

non-

expe

rimen

tal

stud

ies,

dea

thra

tes

from

acci

dent

s or

viol

ence

(bu

t no

t ci

rrho

sis

oral

coho

l dep

end-

ence

) w

ere

sign

ifica

ntly

low

er a

mon

gth

ose

expo

sed

to e

duca

tion

(1)

Brie

f ed

ucat

ion

(2)

No

trea

tmen

t


Au

tho

r(d

ate)

Rat

ing

Des

ign

Sam

ple

an

d s

ize

Fo

llow

-up

per

iod

Ou

tco

me

mea

sure

sR

esu

lts

Inte

rven

tio

ns

com

par

ed

Jone

s,W

ilisz

owsk

ian

d La

cey

(199

6)

6C

ompa

rison

grou

p w

ith s

ta-

tistic

al c

ontr

ol f

orag

e, g

ende

r,et

hnic

ity,

mar

ital

stat

us a

nd p

rior

DW

I co

nvic

tions

1,95

8 re

peat

offe

nder

s, o

fw

hom

506

wer

e in

the

trea

tmen

tco

nditi

on

20 m

onth

sA

ny D

WI

reci

divi

smR

ecid

ivis

m w

as10

.7%

for

com

-pa

rison

gro

upan

d 5.

6% f

ortr

eatm

ent

grou

p(p

<.0

02)

(1)

Inte

nsiv

e co

mm

unity

supe

rvis

ion

(2)

Tra

ditio

nal j

ail s

ente

nces

Jone

s an

dLa

cey

(199

9)

6C

ompa

rison

grou

p st

udy

with

stat

istic

al c

ontr

olfo

r ag

e, g

ende

r,et

hnic

ity,

educ

atio

n,al

coho

l abu

sean

d pr

evio

usco

nvic

tions

2,84

1 re

peat

offe

nder

s, o

fw

hom

176

wer

e in

the

trea

tmen

tgr

oup

80 m

onth

sA

ny D

WI

reci

divi

smN

o di

ffere

nces

betw

een

grou

psbu

t da

y re

port

ing

was

mor

e co

st-e

ffect

ive

beca

use

case

ssp

ent

less

tim

ein

pris

on

(1)

Day

rep

ortin

g ce

ntre

with

voca

tiona

l and

tre

atm

ent

need

s as

sess

men

t an

dpl

acem

ent

(2)

Sta

ndar

d pr

obat

ion

and

inca

rcer

atio

n w

ith le

ssin

tens

ive

and

less

foc

used

coun

selli

ng

Tab

le 1

: R

ecen

t C

on

tro

l o

r C

om

par

iso

n G

rou

p S

tud

ies

of

the

Eff

ecti

ven

ess

of

Ed

uca

tio

n o

r Tr

eatm

ent

for

DW

I O

ffen

der

s (c

ont’d

)

Pec

k,A

rste

in-

Ker

slak

ean

dH

elan

der

(199

4)

6R

ando

miz

edex

perim

ent

4,63

1 fir

stof

fend

ers

2,68

5 m

ultip

leof

fend

ers

4 ye

ars

Com

posi

tem

easu

re o

fre

cidi

vism

,w

hich

incl

uded

reck

less

driv

-in

g, a

ccid

ents

whe

re t

hein

dex

case

had

been

drin

king

and

driv

ing,

late

nig

htac

cide

nts

and

DW

I ch

arge

s

Tre

atm

ent

varia

bles

did

not

influ

ence

rec

idi-

vism

whe

n ca

sech

arac

teris

tics

wer

e co

ntro

lled

usin

g re

gres

sion

anal

ysis

Fir

st-t

ime

off

end

ers:

(1)

In-c

lass

edu

catio

n(2

) H

ome

stud

y(3

) C

ontr

ol g

roup

Mu

ltip

le o

ffen

der

s:(1

) C

ouns

ellin

g(2

) C

ouns

ellin

g +

dru

gtr

eatm

ents

(3)

Bi-w

eekl

y co

ntac

ts o

nly

(4)

Con

trol

gro

up


Au

tho

r(d

ate)

Rat

ing

Des

ign

Sam

ple

an

d s

ize

Fo

llow

-up

per

iod

Ou

tco

me

mea

sure

sR

esu

lts

Inte

rven

tio

ns

com

par

ed

Tab

le 1

: R

ecen

t C

on

tro

l o

r C

om

par

iso

n G

rou

p S

tud

ies

of

the

Eff

ecti

ven

ess

of

Ed

uca

tio

n o

r Tr

eatm

ent

for

DW

I O

ffen

der

s (c

ont’d

)

Dav

ies

et a

l. (n

o da

te)

3C

ompa

rison

grou

p st

udy

with

no c

ontr

ol f

orpo

tent

ially

sig

nif-

ican

t gr

oup

dif-

fere

nces

20,0

00 f

irst-

time

or m

ultip

leof

fend

ers,

of

who

m 9

,000

had

acce

pted

are

ferr

al t

o th

em

anda

tory

educ

atio

nco

urse

4 ye

ars

Any

DW

Ico

nvic

tion

Atte

ndan

ce a

tth

e co

urse

s w

asas

soci

ated

with

50%

red

uctio

n in

rat

es o

f re

-con

vict

ion

(1)

Man

dato

ry e

duca

tion

(use

rpa

ys)

and

redu

ced

leng

th o

flic

ence

sus

pens

ion

(2)

Fin

e an

d lic

ence

sus

pens

ion

Luck

er a

ndO

sti (

1997

)2

Com

paris

ongr

oup

stud

y w

ithno

con

trol

s fo

rob

viou

s gr

oup

diffe

renc

es

3,99

4 fir

st-t

ime

offe

nder

s10

yea

rsA

ny D

WI

reci

divi

smO

ffend

ers

who

wer

e co

nvic

ted

of D

WI

and

put

on p

roba

tion

had

a 47

% g

reat

erch

ance

of

re-

conv

ictio

n th

anth

ose

who

com

-pl

eted

the

pre

-tr

ial i

nter

vent

ion

(1)

Pre

-tria

l int

erve

ntio

nin

volv

ing

shor

t-te

rmco

mm

unity

-bas

ed p

rogr

ams

with

sup

ervi

sion

and

sup

port

and

no c

rimin

al c

onvi

ctio

n(2

) C

onvi

ctio

n w

ith s

ente

nces

to

educ

atio

n an

d pr

obat

ion

Koo

ler

and

Bru

vold

(199

2)

Not

rat

edC

ompa

rison

grou

p w

ithst

atis

tical

con

trol

for

race

, ag

e,ge

nder

and

serio

usne

ss

of o

ffenc

e

Ove

r 70

0ju

veni

le D

WI

offe

nder

s, o

fw

hom

100

rece

ived

in-

clas

s ed

ucat

ion

Var

iabl

e an

don

ly t

o 18

thbi

rthd

ay

Any

juve

nile

DW

I of

fenc

eC

lass

room

part

icip

ants

ha

d fe

wer

rep

eat

offe

nces

(1)

In-c

lass

edu

catio

n fo

rju

veni

les

on p

roba

tion

(2)

Pro

batio

n on

ly

Torn

os(1

994)

6C

ompa

rison

grou

p st

udy

with

indi

vidu

al m

atch

-in

g on

age

, ge

n-de

r, cr

imin

ality

, m

ain

offe

nce

1,22

2 im

pris

-on

ed D

WI

offe

nder

s, o

fw

hom

611

volu

ntar

ilyat

tend

ed t

heed

ucat

ion

prog

ram

4 ye

ars

Any

DW

Ico

nvic

tion

Re-

conv

ictio

nra

tes

for

first

-tim

e of

fend

ers

wer

e lo

wer

amon

g pr

ogra

mpa

rtic

ipan

ts(1

2.5%

vs.

19.5

%).

No

diffe

renc

es f

orre

peat

offe

nder

s(4

3% in

eac

hca

se)

(1)

Vol

unta

ry 4

-wee

ked

ucat

iona

l pro

gram

(2)

No

prog

ram


The results indicated that for all offenders,remedial interventions (education and treat-ment), but not punishment, were associatedwith a lower relapse rate. However, the analysisdid not consider the combined effects of theremedial programs and punishment. Those who had been given a probation order prior to sentence were less likely to re-offend thanothers and among first-time offenders therewere no significant effects for treatment. For all cases, recidivism was associated with beingolder and having prior DWI convictions.

DeYoung (1997) examined the effectiveness ofalcohol treatment, driver’s licence actions andjail terms in reducing impaired-driving recidi-vism. He used a quasi-experimental design tocompare re-conviction rates and time to first re-conviction over an 18-month period forconvicted first-time, second-time and multipleDWI offenders receiving various dispositionsfrom the courts. Few details of these dispositions,except for those indicated in Table 1, are providedin DeYoung’s report. The sample sizes were verylarge: 88,552 first-time offenders, 27,292 second-time offenders and 32,787 third-plus offenders.

All analyses controlled for age and gender, classof licence, convictions, total crashes and fatal or injury crashes over the previous three years,and various characteristics of the community ofresidence (average injury crash rates, movingtraffic violations, average time to travel to work,ethnic composition, unemployment rates andincome levels).

Results of the analyses showed that for all levelsof prior DWI conviction, combining alcoholtreatment with either driver’s licence restrictionor suspension was associated with the lowestDWI re-conviction rates.

Mann et al. (1994) examined mortality rates for convicted second-offence drinking drivers(N=347) who had been randomly assignedeither to a brief educational program or to ano-treatment control condition. The reportindicates that the goals, structure and contentsof the program resembled those for other NorthAmerican programs operating at that time. Foreight weeks offenders met weekly in groups fortwo hours. They were presented with informa-tion on the biological and psychological effectsof alcohol, legal aspects of drinking and driving,the nature of alcohol abuse and alcohol depend-ence, identification of personal problems withalcohol and additional resources for dealingwith these problems.

Over a follow-up period ranging from 8 to13years, 14 (11%) of the controls and 17 (7.7%)of the rehabilitation group died from variouscauses. Although the difference was not statisti-cally significant using conventional criteria(p=0.08), deaths from accidental and violentcauses (but not cirrhosis or alcohol dependence)were significantly lower in the group assignedto education. Additional comparisons involvingcases not randomly assigned to the education orcontrol condition generated similar results. Theauthors speculated that education programsmay reduce driving risk behaviours amongearly-stage or episodic problem drinkers, but


may be of limited value for reducing the risk of death from cirrhosis or alcohol dependenceamong those who have patterns of chronicalcohol use problems.

Nickel (1990a,b) reported on an evaluation of awell-established educational user-pay programfor first-time DWI offenders in Germany. The program was based on a group-dynamicapproach. DWI offenders were assigned to the program if they were judged unfit to drivewithout it. Participants signed a contract indi-cating that they would attend all sessions, bepunctual, abstain from alcohol on the day of asession and complete all homework assignments.

The program began with a two-week series ofactivities in which participants were asked tomonitor drinking patterns and complete a seriesof homework assignments. The main courseactivities involved six weekly small-group sessionsin which the participants discussed drinking pat-terns, identified drinking and driving habits andlearned self-observation and self-control as waysto induce behavioural change. During the subse-quent 18 months, participants received informa-tion letters and were asked to complete furtherhomework assignments. This continued contactwas intended to reinforce the lessons and providesupport and encouragement to continue theprocess of behavioural change. After attendingsix small-group sessions, participants received acertificate that was to be used to reinstate thedriver’s licence. The group reconvened after 24months to discuss any difficulties and problemsand to check on progress.

Nickel found that re-conviction rates for 1,544program participants after 36 months werelower than those for 1,344 convicted DWIoffenders who were judged fit to drive withoutattending the program (13.4% vs.18.8%). After60 months, the re-conviction rates were alsolower for the program participants (21% vs.26.9%). Although these differences may seemsmall, they are remarkable because the controlgroups were assessed as being fit to drive with-out an education program and would thus beexpected to have a lower re-conviction rate.

Nickel found that regional differences in theintensity of law enforcement and drinking habitsdid not influence differences in re-convictionrates between program participants and others.However, differences were greater for older sub-jects while the re-conviction rates for those aged18 to 24 were the same for program participantsand others. Among participants, re-convictionrates were also influenced by marital status (higher if not married) and period of licencesuspension (higher if period shorter). Amongboth program participants and others, multiplere-convictions were more common amongyounger cases, those with a previous hit and runoffence, those who had driven without a licence,those who recidivated in a shorter time period,those who reported no impairment with a BACof 80 mg%, those who were drinking at age 14,and those who reported having problems withtheir spouses or friends.

Jones, Wiliszowski and Lacey (1996) compared:(1) pre-trial intensive community supervisionand attempts to enhance treatment engagementwith (2) traditional jail sanctions. Their report


also compares in-home confinement and elec-tronic monitoring with traditional jail sanctions(beyond the scope of this report).

The treatment group (N=506) were repeatoffenders who, after arrest, were offered (butnot guaranteed) a reduced jail sentence if theyparticipated in the program. The programaimed to reduce impaired driving by addressingdrinking habits and drinking problems amongthose involved. It featured at least bi-weeklycontact with probation officers for four to fivemonths. These officers monitored their clients’progress and needs and, where indicated, madereferrals to appropriate treatment agencies.

The comparison group (N=1,452) were repeatoffenders who were not offered or who did notaccept assignment to intensive probation andtreatment. Instead, they went to jail followed byprobation. Assignment to the new program wasbased on multiple considerations, includingmotivation.

Survival analysis was used to compare recidi-vism rates over a maximum of 20 months forthe two groups. The analysis controlled for age,sex, ethnicity, marital status and number ofprior convictions. After adjusting for thesevariable, the one-year recidivism rate for theexperimental group was 5.6%, and 10.7% forthe control group. This difference was highlysignificant statistically and would occur bychance less than two times in 10,000 if theintervention studied had no effect. There werealso cost savings associated with the new pro-gram, principally associated with reduced timein jail for those given intensive communitysupervision.

Jones and Lacey (1999) reported a comparisongroup study involving DWI offenders assignedto a Day Reporting Centre (DC) or to a stan-dard probation program. Both groups involvedoffenders who had been charged and convictedof serious DWI offences and had initially beensentenced to at least four months in prison.Both groups received some form of treatmentor counselling (not specified) and visits with aprobation officer four times a year for fouryears. However, the treatment for those in theDC group was based to a greater extent onassessment and appropriate placement inprograms.

Those in the DC group were also assessed forjob skills and educational needs and thenplaced into specific programs as appropriate.While in the program, the offenders had at leasttwo contacts per week with probation officersand had to seek employment. Participation last-ed for one to two months in lieu of a similarperiod of incarceration and was followed bystandard probation. Assignment to the DCprogram was not random but based on multipleconsiderations, including motivation.

Post-assignment data on DWI convictions werereported for 176 cases in the DC program and2,765 given standard probation. Survival analysiswas used to compare recidivism over a maximumof 80 months for the two groups. Covariatesinclude age, sex, ethnicity, education, alcoholabuses (yes/no) and variables concerning previ-ous convictions. The results showed that the DCprogram was no more effective than standardprobation in reducing recidivism. However, itwas more cost-effective because it reduced timein prison.


Tornos (1994) reported on an evaluation of aneducational program for incarcerated impaireddrivers in Sweden. The program was voluntaryand generally involved daily lectures for fivedays each week, over a four-week period. Theaim was to educate participants about the risksof drinking by providing information on topicssuch as the physiological and psychologicaleffects of alcohol, effects on driving and trafficsafety and impaired driving legislation. Lectureswere given by prison staff, AA members,psychologists, doctors and lawyers.

For first offenders, the recidivism rate withinfour years was 12.5% for participants and19.5% for a control sample whose memberswere individually matched on age, gender,criminality, main offences, and months ofimprisonment. For similarly matched repeatoffenders, the recidivism rates were very similar(about 43%).

Davies et al. (no date) examined re-convictionrates over three years for more than 20,000drinking-driving offenders in the UnitedKingdom, of whom 9,000 (45%) had attendedmandatory education courses. However, offendersdid not have to accept a referral to the educationcourse. Those who completed the course couldearn a reduced period of licence suspension.There was considerable variation in the propor-tion of offenders assigned to education in differ-ent jurisdictions and this was used as a control forthe effects of subject selection bias. The authorsinterpreted their results as showing that thedrinking-driver rehabilitation courses reduced re-conviction rates by slightly more than 50%.Some further analysis suggested offenders aged 30to 39 may have benefited from the courses more

than others and that men may have benefitedmore than women. However, the differences weresmall and no analyses that controlled for otheroffender characteristics were undertaken.

Lucker and Osti (1997) reported on an evalua-tion of pre-trial intervention (PTI) for DWIoffenders, which was available for some DWIoffenders at the time of their arrest. Thisinvolved 3 to12 months of supervision andsupportive counselling from a probation officerand was an option for offenders who were legalUS residents with no criminal records who had not previously received a PTI and whosecurrent offence did not involve violence, drugsor serious property damage. Those choosing the PTI option could avoid the usual criminalcourt procedures and have all charges dismissedif they completed the program. However, theywere also required to attend a 12-hour state-certified DWI course where they were givenfactual information about the effects of alcoholand encouraged to become aware of their ownsubstance use and driving habits, and to devel-op plans to reduce future DWI occurrences.Those who did not choose the pre-trial inter-vention or who were ineligible for it were alsorequired to attend this course.

Survival analysis was used to compare the riskof re-arrest for up to10 years for 3,994 first-time DWI offenders who either: (1) chose aPTI program, or (2) were convicted of DWIand sentenced to DWI education classes andprobation. The results indicated that thoseconvicted of DWI and put on probation had a47% greater risk of a re-arrest for DWI thanthose who completed the PTI program.


The authors concluded that the PTI reducedrecidivism and costs to the publicly financedcriminal justice system. This conclusion maynot, however, be warranted because no attemptswere made to show that those who completedthe PTI program had the same base-line charac-teristics as those who either failed to choose thisoption or were ineligible to receive it. The selec-tion process suggests that these differences mayhave been quite significant and likely to lead to different outcomes independent of theinfluence of the PTI.

Kooler and Bruvold (1992) evaluated an educa-tional intervention for juveniles found guilty ofDWI. Over 700 juveniles convicted of DWIformed the study group and, of these, 100 hadbeen referred to an 18-hour educational pro-gram by their probation officers. About 60% of non-referrals were from a time before theeducation program was available; however, thereport does not indicate why some were or werenot referred once the program started.

Pre-post measures of those participating in theprogram indicated increased knowledge, strongerattitudes against driving while impaired and lessself-reported alcohol use and risky automobile-related behaviours. County juvenile records ofoffences committed prior to age 18 were alsoexamined and class participants were found tohave significantly fewer repeat offences comparedwith non-participants. According to the authors,this could not be explained by race, offenceseverity, age or gender.

This study does, however, have significant limi-tations. Forty-two percent of those involved inthe study were within six months of their 18thbirthday on referral to the education programand thus had only a short time to re-offend.

DiscussionAs with the earlier studies reviewed by Wells-Parker et al. (1995), these more recent studiesvary in methodological rigour. As with earlierstudies, most of those that are methodologicallyweak (Davies et al., undated; Jones, Wiliszowskiand Lacey, 1996; Kooler and Bruvold, 1992;Lucker and Osti, 1997; Tornos, 1994) supportthe remediations evaluated. However, with the exception of the study by Peck, Arnstein-Kerslake and Helander, (1994), the method-ologically more robust studies also indicate that remediation (but not victim impact panels)can reduce the risk of DWI recidivism, especiallyin combination with legal sanctions (DeYoung,1997).

Overall then, the literature supports educationand treatment for DWI offenders. Several well-designed studies with large samples and long-term follow-up intervals have produced positiveresults and, on balance, the degree of supportfor DWI remediation is as strong as that forremediations that target other populations withalcohol use problems.

As previously noted, the Wells-Parker et al.(1995) meta-analysis indicated that treatmentstrategies that combined education, psychother-apy with follow-up and aftercare were mosteffective for multiple and first offenders.However, some reports provided few details ofthe kinds of treatments considered. This is alsothe case for many of the new reports reviewedabove. Exceptions are the reports by Nickel(1990a,b). These include fairly detailed descrip-tions of the program studied and involved avariety of components, including education,self-monitoring, dynamic group work andfollow-up.


No studies of the impact of a remedial programfor individuals convicted of driving whileimpaired by drugs other than alcohol werelocated. However, studies that evaluate theeffects of treatment for drug use problems ondriving measures have begun to appear. Mannet al. (1995) examined driver records of 137males between the ages of 21 and 40 before andafter treatment. About one third of the samplehad a problem with alcohol use only, one thirdhad a problem with alcohol plus one othersubstance, and one third had a problem withthe use of one or two substances other thanalcohol. Overall, significant post-treatmentreductions were found in moving violations,DWI convictions and total collisions, and nodifferences in outcome between drugs wereobserved, suggesting that treatment for drugsother than alcohol can positively affect drivingbehaviours.

Macdonald et al. (2002) examined the drivingrecords of patients admitted to substance abusetreatment in 1994 for a primary problem ofalcohol (N=128), cannabis (N=80) or cocaine(N=150). A comparison group of 507 licenseddrivers matched by age, sex and place of resi-dence was randomly selected for comparisonpurposes. All three drug groups had significantlyhigher collision rates in the five years prior totreatment. In the five years after treatment, thecollision rates for the alcohol and cocaine groupdid not differ from controls, while the collisionrates of the cannabis group remained elevated. In a subsequent study, Macdonald et al. (2003)conducted telephone interviews with 110 clientstreated in 1995 for a problem with alcohol(N=44), cannabis (N=37) or cocaine (N=29),

and a randomly selected sample of 104 driversfrom the general population, matched by age, sex and place of residence. Prior to treatment,the drug groups reported significantly higher col-lision rates, while after treatment no differencesbetween the treatment and control groups wereobserved. As well, treatment subjects reportedsignificant reductions in driving after the use ofalcohol, cannabis and cocaine following treat-ment. Thus, there are indications in the literaturethat treatment for at least some forms of druguse problems are associated with decreases inDWI by drugs and associated collisions.

Some research on treatments for the generalpopulation of people with substance use prob-lems suggests that those with low to moderatealcohol dependence may benefit more fromprograms where they are allowed to chooseabstinence or reduced drinking as a goal thanfrom programs that only have abstinence goals(Institute of Medicine, 1990). However, theimpact of goal choice on drinking and drivinghas not been studied. Such a choice is, ofcourse, often denied to DWI offenders by thecourts and many treatment programs alsorequire all clients to have a goal of completeabstinence. It is not known if programs thatallow a choice of goals permit such a choiceamong DWI offenders who are ordered by thecourt to refrain from the use of alcohol ordrugs.



Most, but not all, key informants recommendedthat both first and repeat offenders should havesome type of remedial intervention and that thisshould occur as rapidly as possible following aDWI conviction. Offenders, whether in educa-tion or treatment, should be provided withinformation on the effects of alcohol and otherdrugs on driving, and the laws on drinking anddriving in Canada.

Issues related to drug-impaired drivers wereraised by a number of key informants. Issuesidentified included driving while impaired bypsychoactive medication, the need to developrisk levels for drug-impaired drivers, and theneed for police to have tools/methods to detectpeople driving while impaired by drugs otherthan alcohol. Key informants also endorsedscreening/assessment for all substances.

There was no consensus regarding the involve-ment of family members in educational or treat-ment interventions. Some felt that successfultreatment required family involvement, particu-larly for youth, while others were concerned thatrequiring family involvement could be seen ascoercive or could possibly pose a risk to familymembers in situations of domestic violence.

The issue of effective ways to provide ongoingmonitoring and support for DWI offenders was raised by a number of key informants,particularly for repeat offenders. Several keyinformants mentioned the restorative justicemodel (an approach to criminal justice thatgives a balanced focus to the offender, victimand community) and the need to involve awide range of people and systems in providingmonitoring and support.

3.1.3 Best practices

Remedial programs for convicted drinking driv-ers have become increasingly used over the pastdecades. There is good empirical evidence thatthey can positively influence knowledge, beliefs,attitudes, alcohol use, recidivism, collisions andthe health status of convicted DWI offenders.

Less is known about other drugs and drivingthan about alcohol and driving. However, thereare clear indications that the use of certaindrugs (including medications) can impair theability to operate a vehicle safely and increasethe risk of fatal crash involvement. There is alsopreliminary evidence that treatment for drugabuse is associated with post-treatment reduc-tion in motor vehicle collision rates.

Best Practice 1

Remedial programs should occupy an integralplace in a comprehensive impaired drivingcountermeasure program. Participation in suchprograms should be a condition of licencereinstatement for all persons convicted of animpaired driving offence.

Best Practice 2

Remedial programs should also be an integral part of comprehensive efforts to reduce drivingwhile impaired by drugs other than alcohol.Participation in such programs should be acondition of licence reinstatement for all personsconvicted of a drug-related driving offence.



Many jurisdictions with remedial programs forDWI offenders have two or more levels ofinterventions for those judged to have more orless serious substance use problems. Thosejudged to have less serious problems oftenreceive education, while others may receiveboth education and some type of therapydesigned, for example, to increase motivationfor reducing excessive alcohol or drug use, tohelp offenders to identify and plan for high-risksituations, and to promote lifestyle changes.

Some of the studies noted in the first sectionconsidered the relative effectiveness of differenttypes of interventions and outcomes for differ-ent types of offenders, particularly first-time orrepeat offenders. In general, first-time offendersseem to benefit more from education and treat-ment than multiple offenders, but it is also pos-sible that other sub-types of offenders may ben-efit more from particular types of education ortreatment.

Manitoba has had a province-wide program forpersons convicted of a first or subsequent DWIoffence since 1986 (Health Canada, 1997). In1986, the current Impaired Drivers Programwas established. The program is mandatory forfirst and subsequent impaired driving offendersprior to reinstatement of their driving privi-leges. Offenders are placed into one of thefollowing four interventions on the basis of anassessment involving the Substance Abuse/Life

Circumstances Evaluation (SALCE) (see Table 2) and a structured interview by a trained addictions counsellor:

1. No interventionNo intervention occurs when cases areassessed as having no apparent substance useproblem requiring further services and aredeemed not to be at risk of re-offending.They are judged to be taking responsibilityfor the offence committed and have viablealternative plans to prevent further offences.They may have already made lifestylechanges prior to accessing the program. Nofurther action is taken to provide educationor treatment to this group.

2. Presumptive problemThese offenders are judged to be using alco-hol or other drugs in a high-risk manner.There are two possible referral options:

3.2 Effectiveness of different types of treatmentinterventions for different types of impaired drivers

KEY POINTS

• The literature supports the need for allremedial interventions to include, at a mini-mum, education regarding alcohol and trafficsafety, an examination of one’s substance useand driving behaviour, and strategies to avoiddriving while impaired.

• For offenders at higher risk, additionalcomponents with greater emphasis ontherapeutic interventions are required.


(i) Educational workshopThis is a one-day workshop that aims tohelp participants to develop alternative plansto drinking and driving. The workshop pro-vides accurate information on alcohol anddrugs, and their effects on driving. It empha-sizes the need to keep drinking behavioursseparate from driving. The workshop is alsodesigned to be interaction-oriented, withgroups of 10 to 12.

Those referred to the workshop are consid-ered to be at risk of re-offending, due mainlyto a combination of not taking responsibilityfor the offence; not having viable options toprevent further incidents of impaired driv-ing; engaging in high-risk behaviours asidentified through their driving abstract orlifestyle (e.g. not considering the potentialconsequences to their employment when it isdependent on a driver’s licence); and/or notbeing able to gain insights easily into theneed to make lifestyle changes.

(ii) High-risk programThe program spans an average of three to sixmonths, including an average of nine hoursof contact with program staff. It is deliveredthrough a series of individual and groupsessions, involving a minimum of threeindividual sessions and a maximum of sixgroup sessions. During the initial phase ofinvolvement, the agreement calls for totalabstinence. In the latter half of the program,the participant and counsellor negotiatewhether abstinence or moderate drinkingwill be the behaviour adopted.

Throughout the program, participants areencouraged to discuss any problems theyhave with abstinence or moderate drinking.If the problems are great, then it may beviewed as indicative of a possible substancedependence, and a referral to a treatmentprogram is considered.

Criteria used to select offenders for thisprogram include some combination of (a) periods of over-using substances, whichmay also include episodic reduction in con-sumption or abstinence; (b) inability to linkhis/her behaviour with subsequent conse-quences; (c) no obvious signs of substancedependence; (d) previous involvement withthe impaired drivers program; (e) demon-strable risks in lifestyle as evidenced by sub-stance use that compromises personal health;(f ) lifestyle centred around heavy consump-tion; (g) family/work concerns related toalcohol/drug use, or (h) the need for a morein-depth program to gain insights into theneed to make lifestyle changes.

3. Specialized abstinence-based residentialor non-residential addictions treatmentprogramOffenders referred to these programs are cur-rently experiencing the signs and symptomsof a substance dependence. They are referredto a particular program depending on theirneeds.


4. Referral to resources previously found tobe helpfulThose who have a substance dependence andare in recovery with a lifestyle that supportsabstinence are required to maintain absti-nence and are referred to the resources thatthey have found helpful in the past. Anassociated person is contacted periodicallyover a two-year period to verify self-reportedabstinence.

A report prepared for Health Canada (1997)indicates that the Manitoba program is wellregarded across the country and appears to havea positive impact on some offenders. However,it has not been evaluated using an experimentalor quasi-experimental design due to ethical con-siderations involved in mandatory programs.

One of the few studies to empirically examine“offender by intervention” interactions in aDWI offender population found interactionsinvolving several demographic characteristicsand supportive counselling (Wells-Parker et al.,1988). For this study, DWI offenders wererandomly assigned to a variety of interventions,including supportive monthly counselling in a year-long probation context and licence sus-pension only. The probation-based supportivecounselling was found to be especially effectivefor younger (under 30) minority group offend-ers (primarily African American). Programscombining traditional short-term DWI inter-ventions with supportive counselling andprobation were most effective for this group.The study also suggested that women might bemore responsive to all interventions than men,but the numbers were too small to draw firmconclusions.

Another more recent study (Wells-Parker andWilliams, 2002) considered possible interac-tions between different types of treatment andselected characteristics (age, gender, minoritygroup membership and depression). In thisstudy, first-time DWI offenders (N=4,074)were randomly assigned to a standard first-offender program or an enhanced standardprogram that included two short individualsessions and a brief follow-up session. Over a28 to 55 month follow-up interval, offendersclassified as suffering from depression who wereassigned to the enhanced program were 35%less likely to recidivate than those assigned tothe standard program. However, no significantinteraction effects were found between programtype and age, minority status or gender. Theauthors concluded that a combination of astandard first-offender program with briefindividual counselling can be effective for DWIoffenders who report depressed moods and whoare at high risk for recidivism.

Only one other study (Ball et al., 2000) hasconsidered the benefits of matching differenttypes of DWI offenders to different treatments.However, this study did not use post-treatmentDWI offences as an outcome measure.

Despite the limited evidence in favour ofmatching, some researchers believe that there is still much to be learned and many attemptshave been made to develop typologies of DWIoffenders to guide research and to inform clini-cal practice. Attempts to identify sub-types ofDWI offenders using cluster analysis or otherstatistical methods have found a substantialminority (40% or more) with few risk factors forrecidivism, and others with various types of risks,


including alcohol use problems, bad drivinghabits, psychiatric problems, social instability,impulsiveness, sensation seeking, hostility,depression and anti-social attitudes (Donovanand Marlatt, 1992; Donovan, Umlauf andSlazberg, 1988; Macdonald and Mann, 1996;Wieczorek and Miller, 1992; and Wilson, 1991).

McMillen et al. (1992) found first-time andmultiple DWI offenders differed significantlywith respect to personality traits, drinkingbehaviour and problems, and driving behav-iours. More specifically, multiple offenders hadhigher scores on measures of hostility, sensationseeking, psychopathic deviance, mania anddepression than first offenders. Multiple offend-ers were also significantly lower in emotionaladjustment and assertiveness and had morenon-traffic arrests, accidents and traffic ticketsthan first offenders. They also consumed signif-icantly more alcohol, evidenced more alcoholuse problems and had higher BACs at the timeof arrest than first offenders.

Wells-Parker, Cosby and Landrum (1986) alsofound that DWI offenders could be grouped onthe basis of their previous traffic and criminalrecords. Five groups were identified usingcluster analysis. The largest group encompassedoffenders with few previous offences. Othergroups comprised offenders who mainly hadtraffic offences, licence and equipment offences,public drunkenness offences or a mixture ofoffences.

One recent study (Chang, Lapham andWanberg, 2001) used scores from the AlcoholUse Inventory (AUI) (Horn, Wanberg andFoster, 1987) to develop a typology of first-timeDWI offenders and to determine if some typeswere more likely to re-offend than others. Six

types were identified using cluster analysis. Thelargest encompassed 50% of all cases and mem-bers had low scores on all AUI scales. Othertypes were variously distinguished with respect to scores on measures of alcohol preoccupation,anxiety and the enhancing or disruptive effects ofdrinking. Predictors of recidivism included malegender, young age, less education, high arrestBAC and presenting high scores on disruptiveand/or enhancing effects of alcohol scales.

Another multi-dimensional classificationscheme with implications for treatment plan-ning has been proposed by Cavaiola and Wuth(2002). This was used at one of the largestDWI programs in the United States (in CookCounty, Illinois). This scheme is based on theresults of self-administered questionnaires, face-to-face interviews with offenders andsignificant others, and objective data such asprevious convictions. Offenders are assigned to one of six “level of risk” categories:

• Minimal: No prior convictions or court-ordered supervision for DUI; no prior statu-tory summary suspension; no prior recklessdriving invocations reduced from DUI; aBAC of less than .15g/dl at the time of thearrest for DUI; and no symptoms of sub-stance abuse or dependence.

• Moderate: No prior conviction or court-ordered supervision for DUI; no prior statu-tory summary suspension; no prior recklessdriving conviction reduced from DUI; aBAC of .15 to .19 or a refusal of chemicaltesting at the time of the current DUI arrest;and no other symptoms of substance abuseor dependence.


• Significant: One prior conviction or court-ordered supervision for DUI, one prior statu-tory summary suspension, or one prior reck-less driving conviction reduced from DUI;and/or a BAC of .20g/dl or higher at thetime of the most current arrest for DUIand/or other symptoms of substance abuse.

• High: Symptoms of substance dependence,no prior arrest.

• High +: Two prior convictions or court-ordered supervisions for DUI, two priorstatutory summary suspensions, or two priorreckless driving convictions reduced fromDUI within a ten-year period from the dateof the most current (third) arrest.

• High ++: Symptoms of substance depend-ence and two prior convictions or court-ordered supervisions for DUI, or two priorstatutory summary suspensions, or two priorreckless driving convictions reduced fromDUI within a ten-year period from the dateof the most current (third) arrest. (Cavaiolaand Wuth, 2002, pgs. 165 – 166)

To return to the issue of matching, it is of notethat the broader literature on substance abusetreatment includes some studies indicating thebenefits of matching clients to treatment, but it cannot be assumed that the results can begeneralized to DWI populations. There is,however, a consensus among service providersthat a variety of flexible and individualizedservices are needed to address the variety of

problems presented by clients of specializedsubstance abuse services. As stated in a HealthCanada report:

Some clients need services for mental healthproblems, others require help with employ-ment and other social problems, and somewill need temporary or longer-term shelter.Attention to these problems is essential if thoseinvolved are to achieve and maintainimprovements in substance use behaviours.

(Health Canada, 1999, p. 24)

These points have been further elaborated withrespect to treatment for alcohol-impaired driv-ers by a committee of experts convened by theUS Century Council (1997), and there are nogood reasons to believe that the issues differ fordrivers impaired by other drugs. The CenturyCouncil recommends that treatment for DWIoffenders should be:

• based on a personalized assessment processthat is needed to evaluate an individual’s useof, or dependence on, alcohol;

• individualized to meet the needs of eachoffender;

• based on a combination of strategies, such aseducation with therapy, plus follow-up; and

• provided over a sufficient period of time formeaningful behaviour changes to occur, andbe monitored.


The Century Council’s expert committee alsoindicated that treatment should not be a substi-tute for other sanctions, especially licence sus-pensions. It noted that treatment has its largestimpact on recidivism when it is combined with sanctions such as licence suspensions andinterlock requirements.

Mann et al. (1997) reviewed the DWI treat-ment literature, the broader literature on sub-stance abuse treatment and the literature on the treatment of offenders to identify the mostimportant elements for comprehensive remedialprograms for DWI offenders. They proposedthe following components for programs intend-ing to address a diversity of needs:

• alcohol and traffic safety education;

• motivational enhancement to cut downexcessive drinking;

• consciousness raising concerning theindividual’s quantity, frequency and patternof drinking;

• identification of high-risk situations, andplanning;

• rehearsal of alternative coping skills;

• promotion of lifestyle changes;

• social support for reduced drinking orabstinence;

• information on further treatment options;and

• the opportunity to choose abstinence ormoderate drinking as a program goal.

Mann et al. (1997) also noted that the litera-ture shows the importance of dealing withclients in a non-judgmental manner.

The literature supports the need for all remedialinterventions (including those for offenders atno or low risk of recidivism) to include, at aminimum, education regarding alcohol andtraffic safety, and an opportunity to examinetheir substance use and driving behaviour andto develop strategies to avoid driving whileimpaired in the future. These objectives are bestmet through participatory instructional strate-gies, based on sound adult education practice.For offenders at higher risk, additional compo-nents with greater emphasis on therapeuticinterventions are required (Century Council,1997; Mann et al., 1997).


Key informants supported the need for multiplelevels of intervention to ensure that offenderswere not over-treated or under-treated, and for interventions that were client-centred andtailored to each client’s strengths and problemareas as identified in the screening/assessmentprocess. “One size does not fit all” wasexpressed by a number of key informants.Based on current practice across the country,these different levels of intervention wouldaddress the needs of those who require educa-tion regarding the effects of alcohol (BAC) and DWI legislation; are considered higher risk because of their attitudes and behavioursregarding drinking and driving and/or are at an early stage of a substance use problem; andhave a serious substance use problem. A groupformat was considered the most cost-effective


intervention modality for DWI offenders.Though it was generally felt that educationalinterventions were appropriate for many firstoffenders, key informants also cautioned thatassignment should be in the context of theresults from screening/assessment.

Several key informants recommended thatoffenders, particularly repeat offenders, beregularly monitored for periods that would bedetermined by relapse pattern and rating ofrisk. Key informants were particularly con-cerned about offenders who they felt continuedto pose a risk for drinking and driving and thatthey should continue to be monitored follow-ing licence reinstatement.


It is widely assumed that two or three levels of intervention are needed: (1) education forthose at a lower risk for relapse, (2) outpatienttreatment and (3) more intensive treatment for those at higher risk due to the severity oftheir substance use problem. This assumption isreflected in the practices of many jurisdictions.Although the empirical support for sucharrangements is limited, clinical experiencesupports the value of having two or three levelsof intervention.

Available research identifies effective compo-nents that can be incorporated into all pro-grams, regardless of length. Programs that relysolely on a didactic approach, or on an attemptto confront clients with the consequences oftheir actions, appear to be less effective thanprograms that incorporate both educational and therapeutic activities, regardless of thelength or intensity of the program.

Follow-up is widely considered to be a centralaspect of effective substance use treatment andprograms for convicted impaired drivers. Withconvicted impaired drivers, follow-up can serveseveral important purposes: it can be as anadditional therapeutic contact; it extends theperiod during which clients are under therapeu-tic supervision; it aids in the consolidation ofthe positive behavioural and attitudinal changesmade in remedial programs; and it is also acheck on the success of the client in maintain-ing those gains.

Best Practice 3

Comprehensive remedial programs for convictedimpaired drivers should incorporate at least twolevels of intervention for individuals with differinglevels of substance use and related problems.

Best Practice 4

All programs for convicted DWI offenders shouldincorporate both educational and therapeuticactivities, regardless of program length.

Best Practice 5

Mandatory clinical follow-up after licencereinstatement should be required for all DWIoffenders sent to remedial programs.



As evidenced by the previous section, thepopulation of impaired drivers includes peoplewho differ with respect to many factors thatmight indicate their need for substance abuseeducation, treatment or rehabilitation (e.g.frequency of drinking and drug use, severity of substance use problem, impaired drivingcharges, criminality, personality, motivation tochange and psychopathology). They also differwith respect to age, gender, social circumstancesand other factors that could influence the out-comes of remedial interventions (Applegate,Langworth and Latessa, 1997; C’de Baca,Miller and Lapham, 2001; Health Canada,1999; Van Whitloc and Lubin, 1998; Wells-Parker et al., 2000). There is, however, nosimple or consistently reliable method foridentifying those most in need of any particulartype or level of education or treatment.

A major challenge in the identification of DWIoffenders who may benefit from a particulartype of remedial program is their tendency todeny or otherwise misrepresent their drinkingand drug use behaviours and problems(Lapham et al., 2001). For this reason, somescreening and assessment instruments andprocedures use objective and/or “disguised”indicators of substance use problems. The mostcommonly used objective indicators include

DWI arrest history and BAC level at the timeof arrest. However, in neither case do theseprovide reliable indications of problem severity.Many first-time offenders have significantsubstance use problems, and BAC at the timeof arrest is a poor indicator of alcohol useproblems as indicated by other measures(Wieczorek, Miller and Nochajski, 1992).However, BAC level at the time of arrest has been shown to be highly correlated withrecidivism (Gjerde and Morland, 1988). Someexperts therefore recommend that both arresthistory and BAC level at the time of arrest beconsidered in the context of comprehensivescreening and assessment programs.

3.3 Identifying impaired drivers who may benefit fromparticular levels of substance abuse education ortreatment

KEY POINTS

• There is a need for different levels of interven-tions for different DWI offenders as researchindicates that they differ in the extent of theirsubstance use and other ways that can influ-ence DWI recidivism.

• There is no simple or reliable method foridentifying those most in need of any particu-lar type or level of education or treatment.

• A clearly delineated screening/assessmentprocess is important to support the decisionsaround matching.

• Several screening instruments, validated usingDWI populations and programs, have beenidentified, and their use is consistent with best practice.


Screening and assessment4 instruments thatfeature at least some disguised or indirectindicators of substance use and related prob-lems are the Mortimer-Filkins questionnaire(Mortimer, Filkins and Lower, 1971), theMacAndrew Alcoholism Scale (Revised)(MacAndrew, 1965), the Research Institute onAddictions Self-Inventory (RIASI) (Nochajskiand Miller, 1995; Nochajski et al., 1993), and the Substance Abuse Subtle ScreeningInventory-ll (SASSI) (Miller, 1994). Briefdescriptions are given in Table 2.

Table 2 also includes selected information oncommonly used screening questionnaires andinventories that use only “non-disguised” itemsconcerning alcohol or drug use. Thus, theintent of the items is obvious to the respondentand the responses can be influenced by a strongdesire to minimize the extent of the problem.In all cases, the choice of cut-off scores influ-ences the percentage of cases correctly identified(true positives) and percentage of cases wronglyidentified as having substance use problems(false positives).

Structured interviews can also be used toidentify DWI offenders with substance useproblems. The gold standard is the StructuredClinical Interview (SCID) for the Diagnosticand Statistical Manual III-R (DSM-III-R)(Spitzer et al., 1990). This requires an experi-enced interviewer who is required to makeclinical judgments regarding the meaning andinterpretation of client responses. Each sectionof the SCID corresponds with one of the major

diagnostic categories of the DSM-III-R and,when used to screen cases for alcohol or druguse problems, only those sections that concernsubstance abuse or dependence are used. Thedisadvantages of the SCID are that it is timeconsuming and requires skilled interviewers.

An alternative to the SCID is the DiagnosticInterview Schedule or DIS (Robins et al.,1982). This is simpler to administer andrequires very little decision making by theinterviewer. The results indicate if the clientqualifies for a diagnosis of alcohol or drug abuseor dependence. The DIS has mainly been usedin research, but it can also be used clinically. Adisadvantage is that, as with other direct screen-ing and assessment instruments, offenders mayintentionally minimize the severity of theirproblem. The same limitation pertains to otherstructured interviews such as the AddictionSeverity Index or ASI (McLellan et al., 1992),the Comprehensive Drinker Profile or CDP(Marlatt and Miller, 1984) and the TimelineFollow Back (Sobell and Sobell, 1992).

Although quite widely used, the SASSI has notbeen validated with DWI samples, nor has itbeen shown to be superior to other instrumentsfor detecting people with alcohol or drug useproblems in other settings. Gray (2001) foundthat reliability was generally good for the directscales but poor for the indirect scales. Neitherthe Driver Risk Inventory nor the SALCE hasbeen widely validated (Chang, Gregory andLapham, 2002).

4 Screening generally refers to a relatively brief process designed to identify probable cases (in this instance, cases withsubstance use problems) and assessment to a more detailed and extended process designed to confirm the results ofscreening and to generate more detailed information for treatment planning.


5 A number of other instruments with limited research support are used in some US states (Chang, Gregory andLapham, 2002)

Table 2: Selected Characteristics of Commonly Used Questionnaires andInventories for Identifying or Assessing DWI Offenders with Alcohol or Drug Use Problems5

Instrument Description

Mortimer-Filkins Test (Mortimer, Filkinsand Lower, 1971)

58 yes/no and short answer items plus structured interview. Items concerndrinking patterns, problems and attitudes, personal/social problems andlifestyle issues.

MacAndrew Alcoholism Scale –Revised (MAC-R) (MacAndrew, 1965)

49 true/false items derived from the Minnesota Multiphasic PersonalityInventory (MMPI), a widely used clinical assessment instrument; has noquestions about drinking or drug use.

Substance Abuse Subtle ScreeningInventory-ll (SASSI) (Miller, 1994)

62 true/false items with low face validity for chemical abuse, and 26questions that help clients identify negative consequences of their use of alcohol and other drugs.

Research Institute on Addictions Self-Inventory (RIASI) (Nochajski andMiller, 1995)

52 yes/no items directly or indirectly related to, or indicative of, drinkingproblems.

Michigan Alcoholism Screening Test(MAST) (Selzer, 1971)

25 weighted yes/no items concerning drinking habits, alcohol dependencesymptoms and drinking-related problems.

Driver Risk Inventory-ll (DRI)(Lindeman and Scrimgemour, 1999)

140 items directly or indirectly related to, or indicative of, drinkingproblems.

Substance Abuse Life/CircumstancesEvaluation (SALCE) (ADE Inc., 1986)

85 true/false or Likert items designed to identify behavioural, attitudinaland clinical indicators of an individual’s need to alter alcohol or drug use.

Drug Use Screening Inventory (DUSI)(Tarter and Hegedus, 1991)

149 yes/no items concerning substance use, behaviour patterns, healthstatus, psychiatric disorders, social competence, family systems, schoolperformance, work, peer relationships and leisure activity.

Drug Abuse Screening Test (DAST)(Skinner, 1982)

28 yes/no items concerning drug taking, drug dependence symptoms anddrug-related problems—similar to items on the MAST.

Alcohol Use Inventory (AUI) (Horn,Wanberg and Foster, 1987)

228 items concerning benefits of alcohol use, styles of use, negativeconsequences of use, concerns about use and acknowledgement that use causes problems.

Alcohol Use Disorders IdentificationTest (AUDIT) (Bohn, Babor & Kranzler(1995)

10 items concerning amount and frequency of drinking, alcoholdependence, and problems caused by alcohol.


The RIASI has been shown to be superior tothe MAST and the Mortimer-Filkins for identi-fying cases that qualify for DSM-II-R diagnosesof alcohol abuse or dependence (Nochajski,Miller and Parks, 1994). In one study, theRIASI identified 69% of cases known to havehad a lifetime diagnosis of alcohol abuse ordependence, while the MAST identified only49% of these cases. The RIASI also identified79% of cases with drug-related problems and80% of cases that reported driving after usingdrugs. The corresponding percentages for theMAST were both 38%. These findings have ledto the use of the RIASI in place of the MASTand the Mortimer-Filkins instruments in someDWI programs in the United States. However,a recent review of commonly used assessmentinstruments found that the evidence forpredictive validity was strongest for theMacAndrew Alcoholism Scale and the AlcoholUse Inventory (Chang, Gregory and Lapham,2002). These instruments have been shown todetect about 70% of DWI recidivists.

There are, however, no clear indications of thesuperiority of any one screening instrument orset of instruments and procedures, and expertsagree that the selection of specific instrumentsand procedures should be guided by the needsand resources in particular jurisdictions(Beirness, Mayhew and Simpson, 1997).Further information on screening instrumentsand various issues in the screening of impaireddrivers can be found in two recent publications:Cavaiola and Wuth, 2002, pp. 75–111; andChang, Gregory and Lapham, 2002.

All of these instruments and procedures can, of course, be used to identify people with sub-stance use problems in other clinical or criminal

justice populations or in the general population.This includes drivers charged with trafficoffences that are not specifically related toalcohol or drugs. No studies providing advicefor substance abuse screening of these driverswere identified in this review. It is of note thatDonovan et al. (1985) found that men withmultiple non-alcohol-related traffic convictionsor accidents had higher levels of drinking thanthose in the general population of drivers, butnot as high as repeat DWI offenders. However,they were similar to repeat DWI offenders onmeasures of personality, depression and hostility.These results suggest the need for more researchconcerning substance abuse in the generalpopulation of repeat traffic offenders.


There was agreement among key informantsthat anyone convicted of a DWI offence,whether a first offence or a repeat offence,should be screened and assessed in order toassign the offender to an appropriate level of intervention. Though not all jurisdictionscurrently assess first offenders, there was recog-nition that many first offenders have drivenafter drinking on many previous occasions, anddoing a comprehensive work-up provides anopportunity for earlier intervention.

Most (but not all) key informants also agreedthat all offenders should receive some type ofintervention, regardless of the results of thescreening/assessment, though one jurisdictionprovides for a “no further action” option.

There was no agreement among key informantsas to whether screening or assessment shouldoccur only after a conviction or after an


administrative suspension or charge. Some feltthat waiting until a conviction would undulydelay the start of education or treatment, whileothers felt that proceeding with assessment priorto conviction might infringe on civil liberties.

Most key informants felt that screening/assess-ment procedures should also be applied todrivers of vehicles other than cars, particularlysnowmobiles, since alcohol is frequently afactor in snowmobile deaths. Impaired driversof these other vehicles could be charged underthe Criminal Code, but Motor VehiclesDepartments would not necessarily be notified.

Several concerns were raised about individualsdriving while impaired by psychoactive medica-tion (prescribed or over-the-counter), particularlysince people may not recognize the impairingeffects of medication. In this context, several keyinformants commented on the need for tools/methods to help police in detecting peopledriving while impaired by substances other than alcohol.

Several key informants noted the importance ofhaving information on arrest BAC, driver history(lifetime) and previous history of education/treatment as part of the assessment information.It should be noted that for youth, informationon arrest BAC and driver history is not availablebecause of provisions under the Youth CriminalJustice Act. The need for BAC information wasnot, however, supported by all key informants.One noted that a high BAC may or may notindicate a general pattern of heavy consumption.

In addition to the instruments identified inTable 2, one or more key informants men-tioned the CAGE (King, 1986), Alcohol Risk

Assessment and Intervention (ARAI) Guidelines(by the College of Family Physicians of Canada, 1994), the 20 questions of AlcoholicsAnonymous (Alcoholics Anonymous n.d.), andthe Personal Experience Screening Questionnaire(PESQ) for youth (Winters, 1991). One keyinformant emphasized the need to use standard-ized instruments administered by a qualifiedprofessional so that results could be defended ina court of law.

A number of key informants raised the issue ofthe validity of self-report information and con-cerns that DWI clients “fake good” or minimizethe extent of problem substance use. In this con-text, several key informants noted the impor-tance of using psychometric instruments thatinclude some type of “lie scale”; several men-tioned other sources of information, such asinformation from family, friends or employer.One key informant identified the need for atraffic safety risk assessment, based on suchinformation as history of traffic violations andcrashes. This key informant was particularly con-cerned about the validity of self-report informa-tion. Generally, it was felt, and reported as beingthe practice, that screening/assessment should bedone by substance abuse counsellors.

There were mixed responses to the issue ofgathering collateral information from familymembers or others such as friends, physiciansand employers, as part of the assessmentprocess. In terms of family members, some keyinformants indicated that their involvement wascritical, particularly for youth, or where therewas contradictory information; others raisedsome concerns about putting family membersat risk in situations of domestic violence, theethical problem in requiring family member


involvement, and what information providedby the family could be appropriately sharedwith the client in the assessment feedbackprocess.

There was no consensus regarding the assess-ment of client readiness to change and use ofmotivational interviewing approaches withDWI offenders. Some key informants indicatedthat offender stage of readiness for change wascritical in terms of matching the offender to theappropriate type and level of intervention andengaging them in the intervention process,while others indicated that either they had no experience applying this model to a DWIpopulation and/or that it was not appropriate,given that offenders were mandated to treat-ment thereby limiting the options available tothe counsellor.

Most key informants indicated that the majorityof offenders were male. Other populationgroups for which some special provisions needto be made were noted as follows:

1. Women: Ideally, there should be gender-specific screening/assessment (if done as agroup process) and intervention, but in most(but not all) jurisdictions this is not practicalbecause of low numbers. In some jurisdic-tions, particularly large urban areas, womencan be referred to gender-specific treatmentprograms.

2. Aboriginals: For this group, there are issuesof language, cultural appropriateness ofscreening/assessment tools, and process andintervention (in one jurisdiction, they dotheir own DWI programming).

3. Rural residents: These residents may experi-ence difficulty accessing DWI programsbecause of distance and lack of public trans-portation, thus sanctions may be more severefor them; one key informant mentionedrural women in particular because of suchbarriers as child care and having only onefamily car.

4. Youth: Some key informants indicated thereshould, ideally, be specialized programming,while others felt that youth could be part ofan adult intervention. Several key informantsmentioned the importance of graduatedlicences and having lower thresholds totrigger sanctions.

5. Older adults: Key informants identified thefollowing issues: stigma; being reluctant toattend an intervention program; and difficultyunderstanding some of the instruments.

6. Deaf clients and those with low literacyskills: These offenders were also mentionedas needing specialized approaches.


In principle, it may be possible to identify indi-viduals for whom a remedial program wouldserve no benefit. Previous practices in manyCanadian jurisdictions, where courts assignedsome people but not others to remedial pro-grams, were based on this assumption. Thispractice is still followed in some jurisdictions in the United States and elsewhere. However,there is no support in the research literature forthis practice. No methods are currently avail-able that can reliably identify those individualswho will and those who will not benefit from


remedial programs. In the face of compellingevidence that these programs do have benefitsto participants in the aggregate, the best prac-tice is (as identified in best practice statements1 and 2) to require that all DWI offendersattend some type of remedial program.

The fact that research indicates that DWIoffenders differ in the extent of their substanceuse problems and other ways that can influencethe risk of DWI recidivism suggests the needfor different levels or types of interventions fordifferent individuals. Although the best ways tomatch offenders with level or types of treatmenthave not been determined, in general moreintensive interventions may be appropriate forthose with more serious problems, and a clearlydelineated screening/assessment process isimportant to support these decisions.

Several screening instruments that have beenvalidated using DWI populations and programshave been identified, and the use of theseinstruments by those familiar with theirstrengths and limitations should be consideredconsistent with best practice.


When rehabilitation programs were first beingintroduced, one strategy that was frequentlyused to encourage offenders to attend a remedialprogram was for courts or licensing authoritiesto offer to reduce or waive the period of licencesuspension, which typically is a consequence ofa conviction for impaired driving (Mann et al.,1983). However, this substitution strategyproved to be a serious mistake, at least from atraffic safety perspective. Several evaluationscomparing offenders sent to rehabilitative

programs (who had a licence returned) to con-trol groups not sent to such a program (whowere subject to a licence suspension) revealedthat those sent to rehabilitation usually had asmany or more collisions and convictions atfollow-up (e.g. Preusser, Ulmer and Adams,

Best Practice 6

All convicted DWI offenders should complete a

screening/assessment process to inform decisions

about the most appropriate level or type of inter-

vention.

Best Practice 7

Instruments that have been shown to be of valuein assessing alcohol and drug use problems andrecidivism risk should form part of the screeningprocedure. The performance of these instrumentsshould be monitored on an ongoing basis.

3.4 Effectiveness of programs that combine treatmentand rehabilitation with licence suspension or othermethods for limiting driving opportunities

KEY POINTS

• Greater reductions in impaired drivingrecidivism and collisions are obtained with acombination of remedial programming andlicensing actions such as suspensions andinterlock requirements.


1978). This occurred because licence suspen-sions have important traffic safety benefits(Mann et al., 1991) that are forgone when they are substituted for another measure likerehabilitation.

A subset of the studies included in the Wells-Parker et al. (1995) analysis involved cases with varying levels or types of education ortreatment and/or licensing penalties. It was thus possible to explore the relative influence of education/treatment and legal sanctions orcombinations of both. The results indicatedthat the greatest positive impact on alcohol-related traffic events and more general trafficsafety occurs when offenders receive botheducation or treatment and licence suspensions.

This conclusion is reinforced by the previouslynoted study by DeYoung (1997). Also, as previ-ously noted, this was the conclusion reached bythe panel of experts convened by the CenturyCouncil (1997). Other experts have reachedsimilar conclusions (e.g. National CommissionAgainst Drunk Driving, 2002; Nichols, 1990;Voas and Fisher, 2001;).


Key informants supported the need for legalsanctions to be combined with educational ortreatment interventions. Several emphasized theimportance of a balance between education/treatment and legal sanctions, and raised con-cerns that making legal sanctions too severe can reduce offenders’ motivation to change andencourage driving without a licence. Some keyinformants raised the importance of offenders

taking responsibility for their offence, and therole of the administrative model (see below) inputting the onus on the offender to followthrough on requirements for licence reinstate-ment.

In addition, several key informants indicatedthat the current system can be confusing forclients because highway traffic acts in differentprovincial/territorial jurisdictions can increasepenalties beyond those imposed under theCriminal Code. Almost all key informantsemphasized the need for standardization acrossprovinces/territories in terms of legal sanctionsand education/treatment interventions.


The evidence indicates that greater reductionsin impaired driving recidivism and collisions are obtained with a combination of remedialprogramming and licensing actions such assuspensions and interlock requirements.Previous efforts to use reductions in licensingactions as an incentive to enter remedialprograms have found that this policy discardsany traffic safety benefits that accrue as a resultof remedial programs.

Best Practice 8

Remedial programs should supplement, notreplace, licensing actions.



There is some evidence that individuals whoreceive a roadside suspension are similar tothose who receive a Criminal Code impaireddriving conviction. For example, Quaye andBoase (2002) reported that as the number ofroadside suspensions increased in a jurisdiction,so did the number of Criminal Code convic-tions on driving records. In an unpublishedstudy, Vingilis (1983) examined the characteris-tics of a sample of 3,337 drivers who received aroadside suspension in Ontario in 1982. Thissample excluded drivers who were involved in acollision or were charged with a Criminal Codeimpaired driving offence. They found that overone third of the sample already had a licencesuspension—most often for a DWI convic-tion—on their driver’s record. Over a 2.5-yearfollow-up period, about 19% of the totalsample were convicted of an impaired drivingoffence—a figure that is similar to recidivismrates observed in drivers convicted of aCriminal Code impaired driving offence (Mann et al., 1991).


Some, but not all, key informants felt thatthose who have received an administrative roadside licence suspension (particularly thosewith multiple administrative offences) shouldbe screened or assessed for substance useproblems as well.


The evidence suggested that individuals whoare given pre-conviction roadside suspensionsresulting from an impaired driving occasion are similar to those who are convicted of animpaired driving offence. Thus, it is likely thatboth they and society will experience the sametypes of benefits that remedial programs confer.

Best Practice 9

Individuals who receive pre-conviction roadsidesuspensions for impaired driving should be con-sidered for referral to assessment and participationin remedial programs.

3.5 Interventions that target impaired drivers who areapprehended but not processed through the courts

KEY POINTS

• Individuals who are given roadside suspen-sions are similar to those who are convicted of an impaired driving offence in terms ofdrinking and driving patterns.

• It is likely that both those who receive a road-side suspension and society will experience thesame types of benefits that remedial programsconfer.



DWI offenders share many characteristics withpersons with substance use problems (Macdonaldand Mann, 1996; Miller and Windle, 1990)which suggests that programs that aim to addresstheir substance use problems should be placed inthe hands of trained addictions professionalsoperating from a behavioural health perspective.This means an emphasis on individual responsi-bility and the use of science-based knowledge andtechniques to bring about behavioural changethrough self-initiated individual activities thatresult in abstinence or less harmful substance usebehaviours. A variety of alternative governancemodels have, however, been developed (Mann etal., 1997). Thus, in Canada, responsibility forvarious portions of programs rests with provincialaddictions agencies, health ministries, transporta-tion ministries or private sector service providers.In the United States, programs are often regulatedand managed by an agency with a state mandateto provide impaired driver programs and toensure that programs meet state-determinedstandards (e.g. Mississippi, New Jersey). Theseagencies often contract with other agencies toprovide programs in specific areas. In some USjurisdictions, where only education programs areprovided to some DWI offenders, there is littleregulation of programs and the situation approxi-mates that of a free market, with providerscompeting on the basis of such factors as priceand length of program.


Generally, key informants recommended thatthe level of programmer training differ betweenthose delivering education programs and thosedelivering treatment/rehabilitation programs. It was felt that those delivering education pro-grams should have adult education and groupfacilitation skills, while those involved intreatment and rehabilitation should be trainedaddictions counsellors/clinicians with particulartraining in DWI-related issues. Personal credi-bility, being a resource to the community and having role models from the recoveringcommunity were also mentioned.

Several key informants identified the need forongoing, annual training to address issues suchas updated information on program applica-tions and quality assurance. Several key inform-ants indicated that Motor Vehicle Registrationstaff could benefit from training on remedialprograms so they would understand thatperspective.

3.6 Governance and training issues

KEY POINTS

• Effective remedial programs for convictedDWI offenders require a behavioural healthperspective and an orientation consistent withaddictions treatment.

• Programs that address DWI substance useproblems should be placed in the hands oftrained addictions professionals operatingfrom a behavioural health perspective, who are given ongoing training to maintain theirskills and acquire effective new techniques.



The evidence suggests that effective remedialprograms for convicted impaired drivers requirea behavioural health perspective and an orienta-tion consistent with addictions treatment. Thismeans an emphasis on individual responsibilityand the use of science-based knowledge andtechniques to bring about behavioural changethrough self-initiated individual activities thatresult in abstinence or less harmful substanceuse behaviours.

Key informants indicated that individuals whoprovide remedial services to convicted impaireddrivers need to have skills in adult education,group facilitation and addictions counselling.These skills are typically found in individualswho have been trained in, or have acquiredskills in, the addictions field.

There are many remedial programs for convictedimpaired drivers in Canada and the number ofthese programs is likely to increase over time.

The key informants indicated that ongoingtraining is required for professionals to maintaintheir skills and acquire effective new techniques.

Best Practice 10

Remedial programs should be located in an envi-ronment in which a behavioural health perspectiveand treatment orientation are well established andcan be maintained.

Best Practice 11

Those providing remedial services to DWIoffenders should be trained in substance useissues, and in adult education (particularly thosedelivering educational interventions) and groupfacilitation (particularly those delivering moretherapeutic interventions).

Best Practice 12

Those providing remedial measures programs toconvicted impaired drivers should be supported inaccessing provincial or national training opportu-nities on an annual or biennial basis.



There are two general models in which treat-ment and rehabilitation programs for convicteddrinking drivers have been implemented. Thefirst model can be termed the judicial model, inwhich attendance at a treatment or rehabilita-tion program is required by the courts. Underthis model, judges assign convicted offenders to programs at the time of sentencing and thecourts assume responsibility for ensuring thatprograms are completed. Often, programattendance is a condition of probation, andthose who do not attend or do not successfullycomplete the program may be considered inbreach of probation. Under this model, vehicleregistration departments have very little contactwith treatment and rehabilitation services. Thismodel was previously common in Canada, and is still very common in the United States(Century Council, 1997; Stoduto et al., 1998).

Secondly, there is an administrative model, inwhich a licensing agency requires an offender to complete an education or treatment programprior to reinstatement of the driver’s licence.This model is used in most jurisdictions inCanada. It is generally considered to be superi-or and more efficient than the judicial modelbecause it ensures that all offenders complete aneducation or treatment program prior to licencereinstatement. It also reduces the likelihoodthat courts will use a reduced licence suspen-sion as an incentive to encourage offenders to

attend programs. This model requires treatmentand rehabilitation services to communicate withdriver licensing authorities, particularly whenoffenders begin and complete programs. Insome provinces, programs are actually managedby driver licensing agencies (Stoduto et al.,1998).


In most jurisdictions, but not all, the adminis-trative model is in place; this means that thedecision regarding licence reinstatement ismade by the driver licensing authority and it isthe responsibility of the offender to meet anyrequirements for licence reinstatement. One keyinformant noted that prior to implementationof the administrative model, when legal andother sanctions were court-ordered, the onuswas often on the probation officer rather thanthe offender to find the appropriate educationor treatment service or other services.

3.7 Relationships between DWI programs and licensingauthorities

KEY POINTS

• The administrative model, in which a licens-ing agency requires an offender to complete aneducation or treatment program prior to rein-statement of the driver’s licence, is used inmost jurisdictions in Canada.

• The administrative model is generally consid-ered to be superior and more efficient than thejudicial model as it ensures that all offenderscomplete an education or treatment programprior to licence reinstatement.


All respondents recommended clarity regardingroles and responsibilities, and good communi-cation between the treatment/rehabilitationsector and driver licensing offices and/or thejustice system (e.g. regular meetings, provincialcoordinating body). Several raised concernsabout offenders being “caught in the middle”when communication is unclear. Key inform-ants also indicated that offenders need to beclear about their responsibilities and reportingrequirements. Manitoba was identified as ajurisdiction that had clear protocols (e.g. theAddictions Foundation of Manitoba [AFM]working for the client and the motor vehicleregistration office dealing with the enforcementaspect). The Manitoba respondent emphasizedthat the provincial justice department alwaysinvolves AFM and the motor vehicle licensingauthority in any discussion of proposed changesto DWI legislation and that AFM works veryclosely with the motor vehicle registrationoffice.

Several key informants raised the issue ofoffenders “shopping around” for a jurisdictionwith less onerous requirements in terms ofeducation/treatment and that it would behelpful to have mechanisms for informationexchange between jurisdictions on driver historyand remedial requirements. Many key inform-ants mentioned the need for national standardsor standardization between jurisdictions.

Most, but not all key informants indicated thatthey were not concerned with confidentialityabout the nature of the information beingtransmitted to licensing authorities. Mostintervention programs provide standardized and basic information to the motor vehicle

registration office regarding whether the clienthas met requirements. They will also identifyany concerns regarding future substance useissues. Some jurisdictions use risk levels andsome concerns were raised regarding their inter-pretation by motor vehicle registration officesand issues of confidentiality and liability intheir interpretation. One key informant raisedthe issue of risk levels for drugs other thanalcohol needing to be developed.

The issue of DWI programs being able toproactively contact those convicted of DWIoffences was not supported by most keyinformants. However, the issue was raised inthe context of offenders being unaware of therequirements for assessment and intervention orleaving it until the last moment in terms of thelicence suspension period. One key informantrecommended that programs have access toconviction information and driver history inorder to follow up with clients who are notcomplying with program attendance require-ments, while another suggested that all thosearrested for DWI should be required to gothrough a program whether or not they decideto get their licence back.

In this context, some key informants mentionedthe issue of enforcement and that there was littlelikelihood that offenders driving while undersuspension would be caught, particularly inrural areas. One key informant in particular feltthat much greater levels of enforcement in termsof detecting impaired drivers were required toreduce DWI offences. Several key informantsalso mentioned the need for increased publicawareness about the consequences of DWI interms of legal and other sanctions.



Preceding sections have made it clear that, toachieve the maximum impact on traffic safety,all impaired driving offenders should completea remedial measures program (instead of relyingon the discretion of the courts to refer to pro-grams those who they think would benefit).The research indicates that maximum safetybenefits, in terms of reduced collisions, areachieved when all offenders are required tocomplete a remedial requirement as a conditionof relicensing, as opposed to the situation wherethe court determines who is and who is notsuitable for a remedial program.

One possible model is for the licensing authorityto supervise or run remedial programs them-selves. However, the conflicts between the“administrative culture” of a licensing authorityand the “therapeutic culture” required in a reme-dial program are likely to be substantial. Thebalance of expert opinion is that there needs to

be a separation between the administration oflicence suspensions by the licensing authorityand the provision of remedial programming.

One issue that arose is that of communicationsbetween licensing authorities and remedial pro-gram providers. The key informants indicatedthat remedial programs require informationfrom licensing authorities to make importantdecisions about clients, and licensing authoritiesrequire information from remedial authoritiesto make decisions about licence status. Inaddition, clients need to be able to obtain clearinformation about program requirements andregulations.

Best Practice 13

Remedial programs should be operated using anadministrative model, where program completionis a requirement for relicensing.

Best Practice 14

Remedial programs should be operated by anagency other than the licensing authorities.

Best Practice 15

There is a need for formal and clear mechanismsfor coordination and collaboration between licens-ing authorities and remedial programs, to ensurereciprocal exchange of information to serve thebest interests of clients and the public.



A key issue in the provision of remedial pro-grams for convicted impaired drivers is thefunding of these services. A variety of modelsfor fee collection are used across Canada, withoffenders paying service providers directly insome cases, while in others, program chargesare included in relicensing fees. A similar situa-tion exists in the United States (Mann et al.,1997; Stoduto et al., 1998).

Some authors have proposed that there shouldbe some consideration of financial hardship.Mann et al. (1997) recommended against sucha policy in Canada, in part because costs werelower than in jurisdictions that had financialhardship provisions (mostly American jurisdic-tions), and because these costs themselves canserve as a deterrent to drinking and driving.


There was support from the majority (but notall) of the key informants that DWI screening/assessment and education/treatment programsshould be subject to some measure of costrecovery. Among key informants who supportedcost recovery, there was broad support for costrecovery for assessments, but less support foroffenders paying for DWI-specific educationand treatment interventions. Several key inform-ants raised the issue of clients with low incomesor living on social assistance being unable topay. Fee payments by instalments were suggested

by one key informant and several mentioned the need to keep payments at a reasonable level,otherwise it will deter participation. Key inform-ants were also clear that the principle of costrecovery applied specifically to those services thatfocus on substance use and driving, and did notextend to addictions treatment services.

Generally, key informants supported paymentof costs up front. However, the issue of whetherpaying up front might deter participation wasraised by several key informants. One keyinformant indicated that in his jurisdiction,payment is not made until the client applies for licence reinstatement; he endorsed this as a method that increases the “show-rate” forassessment and intervention.

As noted earlier for education/treatment inter-ventions, key informants recommended thatcost-recovery measures be standardized betweenjurisdictions. Information on program costs,including those borne by program participants,is available in Section 6 of this report,Inventory of Canadian DWI Programs.

3.8 Offender payments

KEY POINTS

• A variety of models for fee collection are usedacross Canada, with offenders paying serviceproviders directly in some cases, while inothers, program charges are included inrelicensing fees.



The issue of who should pay for remedialprograms has been addressed in several ways indifferent jurisdictions. However, over the yearsan emerging consensus has been that the clientsshould bear at least some of the costs for theseservices. This has occurred for several reasons,including constraints on public spending andan effort to reinforce the deterrent effect of animpaired driving conviction and associatedcosts. The key informants have indicated sup-port for cost recovery for these remedial pro-grams. It should be clarified, though, that costsrecovered are for the DWI remedial programsspecifically, and not for addictions treatmentcosts that may occur if individuals are referredto that system. Thus, it is recommended thatcosts for remedial programs for convictedimpaired drivers be financed at least in part by user fees.

Program costs, in particular for longer or moreintensive programs, can become expensive foroffenders. The key informants indicated that itis important to find means to reduce the finan-cial burden for offenders who may be assigned

to more expensive program alternatives, or wholacked the financial resources to pay programcosts. Several jurisdictions have introducedblended fees for offenders, where costs for allprograms are covered by one set fee. While thismay increase costs for clients who are in low-cost programs, it reduces the difficulties experi-enced in meeting fee requirements by thoseassigned to longer or more intensive programs,and it also allows more intensive programs tobe introduced for those who may need them.Because treatment program fees are likely to besmall in comparison with other costs associatedwith licence reinstatement (e.g. licence fees andincreased insurance costs), these are not likelyto be a major barrier to treatment engagement.

Best Practice 16

Measures should be taken to reduce the financialburden for offenders, particularly those who areassigned to more expensive program options. Thiscould include applying a single blended fee for allclients, or providing some form of financial assis-tance for low-income clients.



Program evaluation encompasses a variety ofactivities and processes designed to show theextent to which programs are needed, are con-ceptually sound, are adequately resourced, areimplemented as planned and are cost-effective.Evaluations provide information on the needfor a program or program component, and cansupport accountability, program developmentand resource allocation decisions. Althoughclosely related, when the primary aim of a pro-gram evaluation is to create new knowledge, itmay be more properly referred to as research.

Canadian researchers were among the first todocument the elevated crash risk associated withdriving while impaired by alcohol and amongindividuals with alcohol use problems (e.g.Schmidt, Smart and Popham, 1963). They werealso among the first to provide information onindividuals convicted of a drinking-drivingoffence that proved crucial to the development ofsuccessful remedial programs for drinking drivers(e.g. Vingilis, 1983). Several influential evalua-tions of Canadian programs, conducted in the1970s and 1980s, showed them to be effectiveand stimulated further program development(Health Canada, 1997; Mann et al., 1994;Vingilis, Adlam and Chung, 1981; Whitehead,Hulton and Markovsky, 1984; Zelhart, Schurrand Brown, 1975).

Evaluations of Canadian remedial measures pro-grams have provided important insights into theways these programs operate. In Manitoba andAlberta, evaluations have pointed to the effective-

ness of programs in meeting needs of participants(Health Canada, 1997; Parsons, Wnek andHuebert, 1993). In Ontario, evaluations havedemonstrated that the provincial program hasbeen implemented with a high level of consistencyand quality across 28 provider sites (e.g.Chipperfield and Mann, 2000; Shuggi et al.,2002) and that the assessment instrument used inthe province demonstrates adequate psychometricproperties (Flam-Zalcman, Chipperfield andMann, 2002). In Quebec, evaluation research hasdescribed important characteristics of individualswho complete a program assessment (Boudreault,Brassard and Gagnon, 2002) and characteristics ofindividuals who are non-adherents in mandatoryprograms (Brown et al., 2002).

However, it is clear that evaluation has not beenconsistently supported over the years in thiscountry. Frequently, programs have had fewresources for evaluation activities, except thosethat generate basic information needed for

3.9 Program evaluation and research

KEY POINTS

• Canadian researchers were among the first to document the risk associated with drivingwhile impaired by alcohol and to provideinformation crucial to the development ofsuccessful remedial programs.

• Several influential evaluations of Canadianprograms showed the remedial programs to be effective and stimulated further programdevelopment.

• There is a need for more extensive evaluationactivities that can contribute to qualityimprovements, innovations and decisionsabout resource allocation.


program management. Programs have thus hadto rely on external sources for funds to carryout other evaluation activities. This has notfacilitated the kind of sustained evaluationactivities necessary to ensure accountability,innovation and high quality programming.


In the context of describing programming in theirjurisdictions, several key informants identified theneed for evaluation, and the lack of resources todo this. There were several suggestions that thefederal government should develop evaluationcriteria that could be used across the country, andidentify model Canadian programs. The need for more Canadian research was also expressed.Research on effective client matching tools, differ-ent assessment and treatment approaches, theeffectiveness of education programs, research onprogramming for chronic repeat offenders andmandatory treatment were all mentioned.

Key informants generally agreed that DWIrecidivism (as measured by incidents that cometo the attention of the police, such as 24-hoursuspensions and youth violating zero tolerance),and broad client outcomes should both bemonitored. Several key informants identifiedthe need to follow up with offenders afterlicence reinstatement. Several key informantsalso identified the need for research on offend-ers who do not apply for licence reinstatementand on the proportion who drive without alicence, and for how long.

Though key informants did not identify specificbest practice mechanisms for quality enhance-ment, they did describe mechanisms in their ownjurisdictions, which included using standardized

assessment and interventions across a jurisdiction,monitoring program delivery in terms of waittimes for assessment and program entry, regularprogram management meetings, and annualtraining.


Program evaluation and research are necessaryfor program accountability, program develop-ment and rational resource allocation. Keyinformants have identified a strong need forprogram evaluation and research.

Funding for program evaluation and research hasbeen very inconsistent over the years in thiscountry. To maintain these activities, they shouldbe supported on an ongoing basis as part of coreprogram activities, and budgeted accordingly.

Basic program monitoring activities are generallycommon. However, key informants identified theneed for more extensive evaluation activities thatcan contribute to quality improvements, innova-tions and decisions about resource allocation.

Best Practice 17

Evaluation should be an integral part of anyremedial measures program.

Best Practice 18

Program evaluation and research costs should bebuilt into program budgets.

Best Practice 19

More emphasis should be placed on qualityassurance, and studies of the cost-effectiveness of programs and their component parts.

Concluding Comments | 57

4Concluding Comments

Many important steps have been taken toaddress the needless deaths and injuries causedby impaired driving in Canada, and the advance-ment of remedial programs for convicted offend-ers has been a very important development inthis process. The research evidence reviewed inthis report provides solid support for their con-tinued use. This research and expert opinion alsoprovide valuable insights and guidance on waysin which these programs can be most usefullyimplemented and organized. These best practiceshave a reasonably solid research and experientialbase.

However, the available evidence and experiencewere not able to address all of the issues of con-cern to this report. These issues includedwhether or not individuals charged or convictedof an offence not related to alcohol or drug useshould be required to complete a remedial pro-gram; whether or not programs should be gen-der specific; and the means by which Canada’sethnoculturally diverse population can be bestserved by remedial programs. While the evi-dence provides some guidance on screeningtools, there is a need for more research to iden-tify clearly superior instruments or procedures.

Beyond these issues, there are likely to be otherchallenges that these programs will face in thefuture. Due to greater public attention and

improved detection methods, it is probable that there will be a need to respond effectivelyto individuals referred to remedial programsbecause of drug-impaired driving (e.g. pre-scribed medications and cannabis), and due tooffences that do not explicitly involve alcoholor drugs (e.g. dangerous driving). In theabsence of clear direction on these issues, it may be most appropriate for program providersto respond to these situations based on localneeds, opportunities and resources. Theseunresolved issues and challenges also point toimportant areas for further investigation.

KEY POINTS

• This report demonstrates that there is solidsupport for the continued use of DWIoffender remedial programs.

• This study has also pointed to gaps in currentprocesses, knowledge and research that need to be explored: 1) whether programs should be gender specific or age specific; 2) how best to serve Canada’s ethnoculturally diversepopulations; 3) which screening tools may besuperior in identifying levels of substance useproblems; 4) how to respond to the needs of those convicted of drug-impaired driving;5) how to promote high standards of effectiveand efficient programming and programevaluation across Canada.


Nearly all key informants expressed a desire fora national perspective on remedial programs.Several identified the need for greater standardi-zation between provinces/territories with respectto remedial programming, client costs and addi-tional penalties under highway traffic acts. Thiswould assist in maintaining high standards ofprogramming nationally and would also be par-ticularly valuable in those cases where an indi-vidual residing in one province is required, byvirtue of an offence committed in anotherprovince, to meet the remedial program require-ments of that province. National training andworkshop opportunities for program providerswere also recommended. These would providevaluable opportunities for providers in differentregions to obtain the most recent informationon effective program initiatives. As well, recom-mendations for national standards for researchand program evaluation were also made. Thesecould include guidelines for quality assuranceand cost-effectiveness activities. They might alsoidentify the most pressing areas for research todevelop and evaluate new program initiatives.

It is widely acknowledged that successes inreducing drinking and driving in this countryhave been the result of a broad and sustainedmix of measures by governments and non-governmental groups. Remedial programs arean important element in these efforts to reducethe deaths and injuries caused by impaireddrivers in Canada. As reflected in this report,there is much information available to guidethe development, implementation and opera-tion of these programs. There is a need for stillmore insight into effective practices for deliver-ing DWI remedial programming, which will be best served by increased national linkagesand the same attention to quality that hascharacterized Canadian efforts over the pastfour decades.

Remedial education and treatment programs:1. Remedial programs should occupy an integral place in a comprehensive impaired

driving countermeasure program. Participation in such programs should be a conditionof licence reinstatement for all persons convicted of an impaired driving offence.

2. Remedial programs should also be an integral part of comprehensive efforts to reducedriving while impaired by drugs other than alcohol. Participation in such programsshould be a condition of licence reinstatement for all persons convicted of a drug-relateddriving offence.

Different types of remedial interventions for different types of DWI offenders:3. Comprehensive remedial programs for convicted impaired drivers should incorporate at

least two levels of intervention for individuals with differing levels of substance use andrelated problems.

4. All programs for convicted DWI offenders should incorporate both educational andtherapeutic activities, regardless of program length.

5. Mandatory clinical follow-up after licence reinstatement should be required for all DWIoffenders sent to remedial programs.

Identification issues:6. All convicted DWI offenders should complete a screening/assessment process to inform

decisions about the most appropriate level or type of intervention.

7. Instruments that have been shown to be of value in assessing alcohol and drug useproblems and recidivism risk should form part of the screening procedure. Theperformance of these instruments should be monitored on an ongoing basis.

Programs that combine treatment with other measures:8. Remedial programs should supplement, not replace, licensing actions.

5Best Practice Statements

Best Practice Statements | 59


When DWI offenders are not processed through the courts:9. Individuals who receive pre-conviction roadside suspensions for impaired driving should

be considered for referral to assessment and participation in remedial programs.

Governance and training issues:10. Remedial programs should be located in an environment in which a behavioural health

perspective and treatment orientation are well established and can be maintained.

11. Those providing remedial services to DWI offenders should be trained in substance useissues, and in adult education (particularly those delivering educational interventions)and group facilitation (particularly those delivering more therapeutic interventions).

12. Those providing remedial measures programs to convicted impaired drivers should besupported in accessing provincial or national training opportunities on an annual orbiennial basis.

Relationships between DWI programs and licensing authorities:13. Remedial programs should be operated using an administrative model, where program

completion is a requirement for relicensing.

14. Remedial programs should be operated by an agency other than the licensingauthorities.

15. There is a need for formal and clear mechanisms for coordination and collaborationbetween licensing authorities and remedial programs, to ensure reciprocal exchange of information to serve the best interests of clients and the public.

Payment Structures:16. Measures should be taken to reduce the financial burden for offenders, particularly

those who are assigned to more expensive program options. This could include apply-ing a single blended fee for all clients, or providing some form of financial assistancefor low-income clients.

Program evaluation and research:17. Evaluation should be an integral part of any remedial measures program.

18. Program evaluation and research costs should be built into program budgets.

19. More emphasis should be placed on quality assurance, and studies of the cost-effectiveness of programs and their component parts.

Inventory of Canadian DWI Programs | 61

6Inventory of Canadian DWI Programs

This is an inventory of educational and thera-peutic remedial programs in Canada, as of2002, for people charged with or convicted ofalcohol- or drug-related driving offences. Alljurisdictions have a DWI program in place withthe exception of the Northwest Territories,Nunavut and Yukon.

All programs are provincial in scope except forthe province of British Columbia. The QuesnelAddictions Services DWI Program is a regionalprogram serving the municipality of Quesnel

and surrounding areas. Saskatchewan has twoDWI programs. The Safe Driving Program isoffered in all 12 Regional Health Authorities. Itincludes an educational component, screeningand assessment, and referral to a recovery pro-gram through Clinical Services. The secondprogram, the St. Louis Impaired DriverTreatment Program, is a two-week residentialprogram for persons convicted of a repeat DWI offence. Most clients are mandated to this program by the Corrections Branch.

1. Newfoundland and Labrador:Think First – A Program About Drinkingand Driving

2. Prince Edward Island: Driver Rehabilitation Course

3. Nova Scotia: Addiction Services DWI Program

4. New Brunswick: Auto Control and Auto Control Plus

5. Québec: Programme sur l’évaluation de la compatibilitédu comportement des personnes relativement àla consommation d’alcool ou de drogue, avec laconduite sécuritaire d’un véhicule

6. Ontario: Back on Track: Ontario’s RemedialMeasures Program for Impaired Drivers

7. Manitoba: Addictions Foundation of Manitoba’sImpaired Drivers’ Program

8. Saskatchewan: Safe Driving Program; Impaired DriverTreatment Program

9. Alberta: Planning Ahead/Impact

10. British Columbia: Quesnel Addictions Services – DWIProgram

List of Programs from East to West


Program: Think First – A Program About Drinking & Driving

Address: Newfoundland and Labrador Safety CouncilDWI ProgramRegatta Plaza84 – 86 Elizabeth AvenueSt. John’s, NL A1A 1W7

Contact: Marliese Janes, President

Telephone: (709) 754-0210

Fax: (709) 754-0010

E-mail: [email protected]

Website: www.safetycouncil.net

Geographic areaserved:

Provincial

Program delivery sites: Bay Roberts, Clarenville, Corner Brook, Gander, Goose Bay, Grand Falls,Labrador City, Marystown, St. Anthony, St. John’s and Stephenville. Alsooffered by correspondence for remote sites.

Program access: Condition of re-licensing.

Target group: Those given one or more 12–24-hr. suspension; First offenders (convicted).

Assessment/screening tools:

Clients with two or more convictions since 1995 are required to have anAlcohol Assessment completed by Addictions Services, the Department ofHealth.

Newfoundland and Labrador

Treatment setting: Not specified

Individual session: No


Group session: One session – four hours. Offered once a month in St. John’s, once everytwo months outside St. John’s. The program is educational in focus. Thereare five components to the course:

Session 1 – Introductory section examines pre-course knowledge andbeliefs;

Session 2 – Takes a look at the Criminal Code, Highway Traffic Act andConditions for Reinstatement;

Session 3 – Impairment – the effects of alcohol on the body (BAC) andon driving skills;

Session 4 – Questions and Answers designed to help clients gain controland plan ahead;

Session 5 – Closure and distribution of certificates.

Follow up: Letters

Yearly programcapacity:

450 clients

Total DWI budget: Not specified

Client fee: Yes. $125.35 (tax included)

Funding sources: Client funded

Type of evaluation: Process evaluation; Quality assurance; Client satisfaction.

Evaluation report: No

Postprogram reporting: No

Suspension reduction: No

Resources used: Think First! Participant Handbook, A Program About Drinking andDriving, published by the Newfoundland and Labrador Safety Council.


Program: Driver Rehabilitation Course

Address: Driver Rehabilitation CourseHighway Safety OperationsP.O. Box 2000Charlottetown, PE C1A 7N8

Contact: Audrey Mayhew, Safety Officer

Telephone: (902) 368-5214

Fax: (902) 368-5236


Website: www.gov.pe.ca


Provincial

Program delivery sites: Program is offered in Charlottetown and Summerside three times per yearand in Montague twice per year.

Program access: Mandated

Target group: First offenders (convicted); Second offenders (convicted); If three or moreconvictions, clients are automatically referred to addiction services.


Any driver convicted of two lifetime DWI offences is referred to theDriver Rehabilitation Course for a Driver Risk Assessment—a computer-ized screening tool. Following the assessment, they may be referred backto the Driver Rehabilitation Course or require further assessment, possiblyleading to treatment at an addictions facility.

Prince Edward Island

Treatment setting: Outpatient. Course led by a safety officer from the Highway Safety Branch.

Individual session: No


Group session: Yes. Thirty clients maximum per group.

Two three-hour sessions.

Educational in focus, the sessions include films, discussions and guestspeakers from the police, RCMP, the Crown Attorney’s Office, andAddiction Services.

Follow up: Yes. Face-to-face interviews. Linked to probation terms—every second orthird month if necessary, up to 1 year minimum. Half an hour per session


Approximately 300 clients per year.

Total DWI budget: No separate budget.

Client fee: No

Funding sources: Government – 100%

Type of evaluation: Client satisfaction.


Postprogram reporting: Yes, to the Ministry of Transportation.


Resources used: Film: Victims of the Crime. This locally produced film features interviewswith victims and relatives. Other films include: What Everyone ShouldKnow About Alcohol; and Driving and the Law.


Program: Addiction Services/Drug Dependency DWI Program

Address: Cape Breton District Health Authority and Guysborough Antigonish Strait Health AuthorityNova Scotia Department of HealthP.O. Box 640115 Alexandra StreetSydney, NS B1P 6H7

Contact: Everett Harris, Director

Telephone: (902) 563-2060

Fax: (902) 563-2059


Website: www.addictionservices.ns.ca


Provincial

Program delivery sites: The DWI program is delivered by the District Health Authorities in the following communities: Antigonish, Dartmouth/Halifax, Kentville,Lunenburg, Pictou, Springhill, Strait Richmond, Sydney, Yarmouth.

Program access: Not specified

Target group: Those issued a 90-day administrative licence suspension; First offenders(convicted); Multiple offenders (convicted).


SASSI; clinical interview; collateral information; other measures atclinician’s request.

Nova Scotia

Treatment setting: Outpatient. Educational and therapeutic focus led by addictionscounsellors. Client’s session schedule is dependent upon the assessment.


Group session: Yes. Maximum size of group—20 clients.

Follow up: Discretionary. Booster sessions; letters; interviews; telephone follow-up.


Not specified

Total DWI budget: Not specified

Client fee: $350.00 for assessment only.

Funding sources: Government – 95%Clients – 5%

Type of evaluation: Client satisfaction

Evaluation report: Not specified

Postprogram reporting: Yes. Must report to the Registry of Motor Vehicles.


Resources used: Not specified

Individual session: Yes


Program: Auto Control and Auto Control Plus

Address: Centre for Education and Research in SafetyP.O. Box 5221Shediac, NB E4P 8T9

Contact: J.E. Louis Malenfant, President

Telephone: (506) 532-2501, 1-800-665-1107 (to register)

Fax: (506) 532-1453

E-mail: [email protected], [email protected]

Website: http://www.cers-safety.com


Provincial

Program delivery sites: Auto Control (for 1st offenders): Bathurst, Campbellton, Edmundston,Fredericton, Grand Falls, Miramichi, Moncton, Richibuctou, Sackville, St. Stephen, Saint John, Sussex, Tracadie, Woodstock.

Auto Control Plus (for repeat offenders): Bathurst, Fredericton, GrandFalls, Miramichi, Moncton, Saint John, Tracadie.


Target group: First offenders (convicted); Multiple offenders (convicted).


SASSI, Inventory of Drinking Situations (ARF), Alcohol and Major LifeAreas Inventory, Alcohol Control Knowledge Inventory, RelationshipsImprovement Checklist, MAST, Traffic Safety, Risk Taking Assessment(experimental) and others as needed.

New Brunswick

Treatment setting: Outpatient. Group and individual sessions led by masters and doctorallevel addictions counsellors, psychologists, social workers and guidancecounsellors.


Group session: Maximum size of group is 18 clients and six to eight in the subgroups forthe half-day session. Minimum three and one-half hours up to a fullweekend.

Auto Control: Same as for individual sessions. Also includes the presenta-tion of a 17-minute video which gives an overview of the program andcovers: a) the negative impact of DWI on society, on the victims and onthe offenders, and b) the means for convicted offenders to avoid impaireddriving.

Auto Control Plus: A victim’s panel and the presence of a significant otherto conclude the program is an important feature of the Auto Control PlusProgram. Audiovisual displays, modelling, and practice are employed toteach problem solving, stress management techniques and self-controltraining. Participants are removed from their daily routine for a weekend toexamine the consequences of their substance use on themselves and theirfamily. The program is designed to increase the likelihood that participantswill seek treatment through motivation, knowledge about mood-alteringsubstance, self-awareness of personal health status, knowledge about treat-ment efficiency and availability, and familiarity with the treatment process.

Follow up: Minimum of one scheduled within one month.

Letters and telephone follow-up. Results of the assessment will be mailedto each program participant. Telephone follow-up will be done for selectcases.


Approximately 1,200

Total DWI budget: Not specified.

Individual session: Individual sessions are offered upon exception.

Minimum three hours plus additional sessions if required.

Auto Control: A program for first-time DWI offenders. Offers both assess-ment and education. The program teaches participants about DWI and its cost to society, and about alcohol and its effects on behaviour. It alsoteaches self-management techniques and enlists the help of significantothers and professionals.

Auto Control Plus: A program for repeat DWI offenders.


Client fee: First offenders pay $195; repeat offenders pay $435.

Funding sources: Clients – 100%

Type of evaluation: Client satisfaction; quality assurance; process evaluation.

Evaluation report: Auto Control and Auto Control Plus programs now emphasize evaluationof DWI participants.

SASSI and a Traffic Safety Risk Assessment have been evaluated, as part ofthe programs, on an experimental basis.

Postprogram reporting: Yes. Must report to the Department of Public Safety.


Resources used: Auto Control: A Program to Address Lifestyle Issues Related to DrivingWhile Impaired (1992)

(First offender program, also available in French).

Auto Control Plus: A Program to Address Lifestyle Issues Related toDriving While Impaired (1992) (Repeat offender program, available inFrench).

Auto Control: A 17-minute video to complement the Auto ControlPrograms (available in French) (1994).

L’effet de matériel pédagogique portant sur l’acquisition de connaissances saines,d’habiletés efficaces et de comportements pro-actifs pour contrer l’usage d’alcoolpar les adolescents de 13 et 14 ans (1999), submitted to the CanadianBrewers Association.

Tiens-Toi Debout! Evaluation d’une trousse pédagogique pour prévenir l’usageabusif et illégal de l’alcool chez les adolescents de 13 et 14 ans (2000). This is a web-based educational program to sensitize and dissuade Canadianpre-teens from consuming alcohol.

You can visit the website at www.schoolnet.ca.


Program: Programme sur l’évaluation de la compatibilité ducomportement des personnes relativement à la consommationd’alcool ou de drogue, avec la conduite sécuritaire d’un véhicule

Address: Fédération Québécoise des centres de réadaptation pour personnes alcooliqueset autres toxicomanes (FQCRPAT)204 Notre-Dame ouest, Pièce 350Montréal, QC H2Y 1T3

Contact: Michel Proulx, Manager

Telephone: (514) 287-9625

Fax: (514) 287-9649

E-mail: [email protected]; [email protected]

Website: www.fqcrpat.org


Provincial

Program delivery sites: Amos, Baie-Comeau, Beauceville, Chandler, Drummondville, Hull, Îles de la Madeleine, Jonquière, Laval, Mont-Laurier, Montréal, Québec,Rimouski, Rivière-du-Loup, Robertville, Saint-Hubert, Saint-Jérome,Sept-Îles, Sherbrooke, Ste-Anne des Monts, St-Charles-Borromée, St-Philippe de Laprairie, St-Romuald, Trois-Rivières, Victoriaville.


Target group: First offenders (convicted); Multiple offenders (convicted); DWI offenceother than alcohol.


Standardized questionnaire.

Quebec


Group session: No

Follow up: Yes. One, one hour face-to-face interview in six months.


2,500 to 10,000

Total DWI budget: Not available

Treatment setting: Outpatient. Individual session only led by addictions counsellors,psychologists and nurses all accredited to do assessments by FQCRPAT.

Individual session: Yes. The number of sessions vary between one and three; each session isapproximately one and one half hours. A treatment plan is developed thatencourages the individual to reflect upon 1) driving while impaired, and2) his or her alcohol and drug use.

Client fee: Yes. Three different assessments. The price varies with each.

Funding sources: Clients pay 100% of costs.


Evaluation report: Yes

Postprogram reporting: Yes, to the Société de l’Assurance Automobile du Québec


Resources used: Not specified


Treatment setting: Outpatient. Sessions are led by addictions counsellors.

Individual session: Offered for those unable to function in a group setting—with specialaccommodation. Eight hours—usually one session.

The focus is therapeutic and the session content includes: alcoholeducation; goal setting; drinking and drug use diary; high-risk situations;formulating an action plan; coping skills training; readings and writtenassignments.

Program: Back on TrackOntario’s Remedial Measures Program for ImpairedDrivers

Address: Centre for Addiction and Mental Health33 Russell Street, Room 1062Toronto, ON M5S 2S1

Contact: Rania Shuggi, Manager, Remedial Measures Program

Telephone: 1 (888) 814-5831

Fax: (416) 595-6735


Website: www.remedial.net


Provincial

Program delivery sites: Aurora, Barrie, Belleville/Napanee, Bracebridge, Brampton, Brantford,Brockville/Smith’s Falls, Burlington, Cornwall, Guelph/Kitchener,Hamilton, Kenora, Kingston, London, North Bay, Oshawa, Ottawa,Owen Sound, Pembroke/Renfrew, Sarnia, Sault Ste. Marie, Stratford, St. Catharines, Sudbury, Thunder Bay, Timmins, Toronto, Windsor.



Research Institute on Addictions Self-Inventory (RIASI); AlcoholDependence Scale (ADS); Drug Abuse Screening Test (DAST).

Ontario


Group session: Group Treatment Program—16 clients per group; and the Educationprogram—25 clients per group. Sixteen hours, usually two eight-hoursessions. The group session is both therapeutic and educational in focus.The therapeutic content is similar to that presented in the individualsessions. The educational component (8 hours) includes: consequences ofimpaired driving; identifying pre-charge attitudes/beliefs; alcohol educa-tion; drinking/drug use diary; alcohol, other drugs and driving; choosing a goal; high-risk drinking and driving situations; activators of impaireddriving; ways to avoid impaired driving; victim impact; readings andassignments.

Follow up: Yes. Telephone follow-up; face-to-face interviews.

One follow-up interview, six months from completion of education ortreatment. Usually a 30 minute phone interview but can also be conductedin person.


Approximately 7,500 registrations/year.

Total DWI budget: Funding based on client fees.

Client fee: $475 plus GST = $508.25


Type of evaluation: Client satisfaction; content evaluation; assessment consistency.

Evaluation report: Back on Track, Report No.1, analysis of client satisfaction data, collectedto January 2000. Centre for Addiction and Mental Health.

Postprogram reporting: The Ministry of Transportation receives results on drivers within 24 hoursof their completion of each component (i.e. assessment, education/treatment, follow-up). Clients must complete all program components to have their licence reinstated.



Resources used: Back on Track Assessment and Follow-up Manual;

Education Program Facilitators Manual and Participants Workbook;

Treatment Program Counsellor’s Manual and Client Workbook;

Mother’s Against Drunk Driving (MADD) Video – Close to Home.

We also acknowledge our debt to the following sources and programs:

Alberta Alcohol and Drug Abuse Commission (1987). Impaired Drivers’Course: Planning Ahead.

Mississippi Alcohol Safety Education Program (1995), Mississippi StateUniversity.

Addiction Research Foundation (1996). Drinking, Drugs and Driving:Tips for Driver Educators.

Addiction Research Foundation (1994). Guided self-change for assessmentand referral centres.

Structured relapse prevention program (1996). Addiction ResearchFoundation.

Impaired driver’s educational workshop manual (1992), AddictionsFoundation of Manitoba.


Program: Addictions Foundation of Manitoba’s Impaired Drivers’Program

Address: Addictions Foundation of Manitoba (AFM)1031 Portage AvenueWinnipeg, MB R3G 0R8

Contact: Heather Mitchell, Supervisor

Telephone: (204) 944-6326

Fax: (204) 774-8091


Website: www.afm.mb.ca


Provincial

Program delivery sites: Brandon, Dauphin, Flin Flon, Gillam, Killarney, Neepawa/Minnedosa,Portage la Prairie, Rossburn, The Pas, Thompson, Winnipeg.

Program access: Condition of re-licensing; Mandated.

Target group: Those given two or more 24 hour suspensions in a three year period orone 24 hour suspension following an impaired charge in the previousthree years;

Those issued a 90-day administrative licence suspension;

First offenders (convicted);

Multiple offenders (convicted);

DWI offence other than alcohol;

DWI offence while using off-road vehicles.


SALCE (Substance Abuse/Life Circumstance Evaluation) and anindividual interview by a trained addictions counsellor to complete acounsellor-directed assessment.

Manitoba


Group session: Maximum size of group is 15.

Education Program for those assessed as having a presumptive substanceuse problem consists of a one day, eight-hour workshop. This educationalprogram includes awareness of laws and consequences, attitudes of owner-ship, effects of alcohol and other substances on BAC, separating drinkingfrom driving behaviour, alternative planning, styles and categories ofdrinking.

High Risk Program for those assessed as being at risk of re-offending dueto continued high-risk behaviours or being at risk of dependent involve-ment: six groups—12.5 hours over approximately six months. The HighRisk Program focuses on risk reduction through examining one’s use andmaking plans to implement change in use.

Rehabilitation Program Options is community-based, once a week for threehours for 10 weeks; or daily intensive with five days a week for three weeksplus self-help; or a residential program of 21 to 28 days plus self-help.

Follow up: Although there is no follow-up to the Education Program or the HighRisk Program, after-care is available for those clients who complete one ofthe rehabilitation programs.

Follow-up sessions vary from one to two hours, for rehabilitation four tosix sessions.

Treatment setting: Community-based and residential sessions led by addictions counsellors.

Individual session: Dependent upon program referral.

Educational Program has no individual session.

High Risk Program is educational in focus and geared to high-risk clients.The session content aims to initiate a contract for involvement, to monitorprogress in the program, to work toward awareness, to establish goals re:substance abuse, and to monitor abstinence or modified usage.


2,000

Total DWI budget: $445,000 for the assessment, educational workshop and high-riskprogram. The rehabilitation costs are covered through the agency’s regular program budget. Only 15% of those assessed are referred to therehabilitation program.


Funding sources: Clients and government funding.

Type of evaluation: Outcome

Evaluation report: 1997—Comprehensive evaluation conducted by Health Canada;1999—A comparative analysis by AFM.

Postprogram reporting: If the assessment is court ordered. For all clients, reporting is required to the Division of Driver and Vehicle Licensing of Manitoba and/oroccasionally to other provinces and states if the offence occurred outsidethe province.


Resources used: Administrative and program manuals.

Client fee: $300.00 per assessment. There is an assessment fee for each new charge.


Program: Impaired Driver Treatment Program

Address: St. Louis Alcoholism Rehabilitation CentreImpaired Driver Treatment ProgramSaskatchewan HealthP.O. Box 220545 – 1st StreetSt. Louis, SK S0J 2C0

Contact: Roger Zelinski, Director

Telephone: (306) 422-8533

Fax: (306) 422-8488


Website: None available


Provincial

Program delivery sites: St. Louis, Saskatchewan


Target group: Multiple offenders (convicted)


SASSI 3.

Saskatchewan

Treatment setting: Residential, led by addictions counsellors.

Individual session: Two or three one- to two- hour sessions as needed. History, education, behaviour patterns.


Group session: Maximum of eight clients per group.

Daily for two weeks, one to one and one-half hours per session.

The program is designed to screen clients for chemical dependency,provide education related to the transition stage of recovery and presentalternatives for a chemical-free lifestyle. Includes lectures, videos, work-shops, mandatory participation in A.A., Aboriginal cultural awareness, etc.

Follow up: Clients may be referred back to the Driving Without ImpairmentProgram after completing the program at St. Louis AlcoholismRehabilitation Centre. Almost all clients are referred for participation in asix-month follow-up program supervised by staff of Corrections, NationalNative Alcohol and Drug Abuse Program, or Health Services. At the endof the second week, all clients are either released from St. Louis to returnhome or transferred to a Correctional Centre. This is determined by thelength of the sentence.


Approximately 550 to 600

Total DWI budget: $750,000





Resources used: St. Louis Alcoholism Rehabilitation Centre Impaired Driver TreatmentProgram brochure.

Client fee: No


Program: Safe Driving Program

Address: SGI Driver Licensing2260, 11th Avenue, 3rd FloorRegina, SK S4P 0J9

Contact: Phyllis Glowatsky, Manager

Telephone: (306) 775-6180

Fax: (306) 569-9631


Website: www.sgi.sk.ca


Provincial

Program delivery sites: Screening is offered in all 12 Regional Health Authorities and the DWICourse is offered in 22 centres. Other than northern points, the programis set up so that no one has to travel more than 150 kilometres to accessservices.

Program access: Condition of re-licensing; Mandated

Target group: Those given one or more 12 to 24 hour suspension;

First offenders (convicted);


DWI offence other than alcohol;

DWI offence while snowmobiling;

Any driving-related Criminal Code conviction (e.g. leaving the scene of anaccident, dangerous driving).

Saskatchewan (cont’d)


Individual session: Approximately four hours over two to four sessions.

The focus of the program is both educational and therapeutic. All clientshave individual sessions for screening and are subsequently referred to oneof two options: Education through the Drive Without Impairment Course,or to Recovery. If recovery is indicated, a Clinical Services addictions coun-sellor will develop an individualized treatment plan. The screening processexamines the history of the client re: drinking, drugs, family, work, and thelegal circumstances regarding the charges. We also screen for substancedependency.

Group session: Schedule varies—depends on site location.

Maximum size of group varies but approximately 12 people.

DWI Course: The DWI education component is a group course designedto educate individuals about the serious problems related to drinking anddriving and to distinguish and separate the acts of drinking and driving.

Recovery Program: If a client is screened as chemically dependent, he orshe is referred to a recovery program often offered at the same addictionsservices site as the screening. The recovery program is an individualizedplan, recommended by the addictions counsellor, and may include weeklyindividual or group counselling, assignment to a treatment centre, partici-pation in AA, counselling from other agencies or other actions.

Follow up: One-hour voluntary face-to-face interviews.

Follow-up is always offered but rarely used and it is not mandated.


3,500 clients in total; 75% are screened to the DWI Course and 25% arescreened to Recovery.

Total DWI budget: The DWI budget for the year 2000 was approximately $1.2 millionprovincially for the screening. This allows for approximately three andone-half to four hours per client for screening and assessment and breaksdown into $344 per client. Recovery is through the Health System anddoes not have a separate budget.


SASSI; MAST; AUDIT; ICD#10; DAST; Bio-Psycho-Social Assessment.

Treatment setting: Outpatient. Sessions led by addictions counsellors.




Suspension reduction: Individuals who have completed the court order and the program may beeligible for a restricted licence for the first half of the suspension period.At this time, they must apply for a provisional licence until the end of theoriginal suspension period. The Ignition Interlock Program allows forearly reinstatement of a restricted driver’s licence under certain circum-stances and with certain requirements.

Resources used: Videos: Truth About Drinking, Disease Concept, Addiction—Getting In,Getting Out;

Educational material on addiction —disease concept, addiction cycle,valley chart;

AA referral as required;

DWI Manual, Safe Driving Program Administrative Manual; Additionalresources vary from site to site.

Client fee: Clients screened to the DWI education program must pay $150 each.


Program: Alberta Impaired Driving ProgramPlanning Ahead/Impact

Address: Alberta Motor AssociationAlberta Impaired Driving ProgramAdministration Centre10310 – 39A AvenueEdmonton, AB T6J 6R7

Contact: Walter Barta, Traffic Safety Coordinator

Telephone: (780) 430-5533

Fax: (780) 430-5676


Website: www.ama.ab.ca


Provincial

Program delivery sites: Planning Ahead (first offender course): Barrhead, Bonnyville, Brooks,Calgary, Camrose, Cold Lake, Drayton Valley, Edmonton, Edson, FortMcMurray, Grande Prairie, High Level, High Prairie, Hinton, Lac LaBiche, Lethbridge, Lloydminster, Medicine Hat, Peace River, PincherCreek, Red Deer, Rocky Mountain, St. Paul, Slave Lake, Stettler,Vegreville, Vermillion, Wainwright, Westlock, Wetaskiwin, Whitecourt.

IMPACT (repeat offender course): Calgary (3 sites), Claresholm,Edmonton, Grande Prairie.


Target group: Those issued a 90-day administrative licence suspension; first offenders(convicted);


DWI while boating or snowmobiling is a possible cause for referral but rare.

Alberta



IDS (Inventory of Drinking Situations); SASSI (Substance Abuse SubtleScreening Inventory); IMPACT Questionnaire (patterns-of-use question-naire developed for the program).

Treatment setting: Planning Ahead is outpatient; IMPACT is residential.

Sessions are led by addictions counsellors and professional educators withaddictions training.

Individual session: IMPACT: includes one individual interview.

Group session: Maximum size of group is 30.

Planning Ahead: One large group session with some break-out sessions,all educational in focus. This program includes a review of the CriminalCode; laws and regulations; myths about drinking and driving; estimatingblood alcohol content (BAC); education about drinking and driving; gain-ing control; group assignment; action plans.

IMPACT: Nine small group sessions (max. 6 clients) and six large groupsessions (max. 30 clients) all scheduled over one weekend. This programincludes an introduction; effects of mood-altering drug use; major lifeareas; individual interviews; Major Life Areas review; level of use; personalempowerment; personal strategies; Alcoholics Anonymous (AA) presenta-tion; video presentation; taking action.

Follow up: No


Planning Ahead: 6,000 IMPACT: 1,500

Total DWI budget: Program operates on a user pay scheme with no government funding.

Planning Ahead: $485,000 for 2002

IMPACT: $235,000 for 2002


Client fee: Planning Ahead: $115

IMPACT: $205


Type of evaluation: Process evaluation; outcome evaluation.

Postprogram reporting: Yes. For the IMPACT program only, a summary report with a diagnosisand recommendations is produced for all participants. Some clients arerequired to present this report to the Driver Control Board (DCB). TheBoard may insist on compliance with the report recommendations.


Resources used: Planning Ahead: Video—short version of Make Sure It Isn’t You;Planning Ahead Handbook; Program Guide.

IMPACT: Video—Make Sure It Isn’t You and I’ll Quit Tomorrow; infosheets from Alberta Alcohol and Drug Abuse Commossion—ABC’s ofDrugs and Alcohol Series; Program Guide.


Program: Quesnel Addictions Services—DWI Program

Address: Quesnel Alcohol and Drug Abuse AssociationDriving While Impaired ProgramP.O. Box 4043543 Front StreetQuesnel, BC V2J 3J2

Contact: Bea Randall, Executive Director

Telephone: (250) 992-5189

Fax: (250) 992-2657


Website: None available


Municipal area of Quesnel and surrounding areas.

Program delivery sites: Quesnel, BC

Program access: Referral by Probation Officers.

Target group: First offenders (convicted);

Multiple offenders (convicted).

British Columbia


MAST; DAST; SASSI

Treatment setting: Outpatient. Sessions led by addictions counsellors.

Individual session: One one-hour session; additional weekly session can be arranged if needed.Focus is both educational and therapeutic. The individual session includesassessment and consultation which is client-centered.


Group session: One weekend program (21 hours) offered once per year. We try toschedule participants during their probation period. Maximum size ofgroup is 15. Focus is educational. Group session content tends to focusmostly on alcohol and drug education; effects of alcohol and drugs; DWI and the law; examination of life areas; RCMP presenters, etc.

Follow up: One 15-minute telephone interview within three months.


Approximately 15 clients.

Total DWI budget: Approximately $1,500 for room rental, food costs, assessments andtreatment tools, wages.


Client fee: No.


Postprogram reporting: Yes. To the Probation Officer.

Resources used: Videos: Chalk Talk; Addictions—Getting in, Getting Out; Through aBlue Lens; Steer Clear.

Manuals: Most of the program has been adapted from the Impactprogram manual developed by the Alberta Alcohol and Drug AbuseCommission.

References | 89

References

ADE, Inc. (1986). Substance Abuse/Life Circumstances Evaluation Manual (SALCE). Clarkson, MI:ADE, Inc.

Adlaf, E.M., Mann, R.E. & Paglia, A. (2003). Drinking, cannabis use and driving among Ontariostudents. Canadian Medical Association Journal, 168, 565–566.

Alcoholics Anonymous 20 Questions (n.d.) http://www.recoveryresources.org/twenty.html.Accessed 9/3/03.

Applegate, B.K., Langworth, R.H. & Latessa, E.J. (1997). Factors associated with success intreating chronic drinking drivers: The turning point program. Journal of Offender Rehabilitation,24, 19–34.

Ball, S.A., Jaffe, A.J., Crouse-Artus, M.S., Rounsaville, B.J. & O’Malley, S.S. (2000).Multidimensional subtypes and treatment outcome in first-time DWI offenders. AddictiveBehaviours: An International Journal, 25, 167–181.

Beirness, D.J., Simpson, H.M. & Desmond, K. (2003). The Road Safety Monitor 2002: Drugs andDriving. Ottawa: Traffic Injury Research Foundation.

Bohn, M.J., Babor, T.F. & Kranzler, H.R. (1995). Alcohol Use Disorders Identification Test(AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies onAlcohol, 56, 423–432.

Boudreault, J., Brassard, A. & Gagnon, J.P. “Behavioural Assessment of Quebec Drivers Convictedof a Second or Subsequent Impaired Driving Offence Under the Criminal Code”. Paper presentedat the 14th International Conference on Alcohol, Drugs and Traffic Safety – T2002, Montreal,Aug. 4–9, 2002.

Brown, T., Nadeau, L., Lageix, P., Lepage, M., Tremblay, J. & Seraganian, P. “Non-Adherents inMandatory Substance Abuse Evaluation Following a DUI Offense: Their Characteristics andReasons for Non-Compliance”. Paper presented at the 14th International Conference on Alcohol,Drugs and Traffic Safety – T2002, Montreal, Aug. 4–9, 2002.

Canadian Centre for Justice Statistics. (2002). http://www.statcan.ca/english/IPS/Data/85F0033MIE.htm. Accessed 12/1/02.


Cavaiola, A. & Wuth, C. (2002). Assessment and Treatment of the DWI Offender. New York: TheHaworth Press.

C’de Baca, J., Lapham S.C., Liang, H.C. & Skipper B. J. (2001) Victim Impact Panels: Do TheyImpact Drunk Drivers? A Follow-Up of Female and Male, First-Time and Repeat Offenders.Journal of Studies on Alcohol, September 2001, 62 (5) 615–620.

C’de Baca, J., Miller, W.R. & Lapham, S.C. (2001). A multiple risk factor approach for predictingDWI recidivism. Journal of Substance Abuse Treatment, 21, 207–215.

Century Council. (1997). Combating Hardcore Drunk Driving: A Sourcebook of Promising Strategies,Laws and Programs. Washington, DC.

Chang, I., Gregory, C. & Lapham, S.C. (2002). Review of Screening Instruments and Procedures forEvaluating DWI Offenders. AAA Foundation for Traffic Safety. http://www.aaafoundation.org.Accessed 12/01/02.

Chang, I., Lapham, S.C. & Wanberg, K.W. (2001). Alcohol Use Inventory: Screening andassessment of first-time driving-while-impaired offenders. I. Reliability and profiles. Alcohol andAlcoholism, 36, 112–121.

Chipperfield, B. & Mann, R.E. (2000). Back on Track Reports: No. 1. Analysis of Client SatisfactionData: Data Collected to January 2000. Toronto: Centre for Addiction and Mental Health.

Cimbura, G., Lucas, D.M., Bennet, R.C. & Donelson, A.C. (1990). Incidence and toxicologicalaspects of cannabis and ethanol detected in 1,394 fatally injured drivers and pedestrians in Ontario.(1982–1984). Journal of Forensic Science, 35(5), 1035–1041.

Davies, G.P., Broughton, J., Harland, D.G. & Tunbridge, R. (undated). “Drink/DriverRehabilitation Courses in England and Wales”. http:||www.se/traf_sak/+2000/404.pdf

DeYoung, D.J. (1997). An evaluation of the effectiveness of alcohol treatment, driver licenceactions and jail terms in reducing drunk driving recidivism in California. Addiction, 92(8),989–997.

Donovan, D.M. & Marlatt, G.A. (1992). Personality subtypes among driving-while-intoxicatedoffenders: Relationship to drinking behaviours and driving risk. Journal of Consulting and ClinicalPsychology, 50, 241–249.

Donovan, D.M., Queisser, H.R., Salzberg, P.M. & Umlauf, R. (1985). Intoxicated and bad drivers:Subgroups within the same population of high-risk men drivers. Journal of Studies on Alcohol, 46,375–382.

References | 91

Donovan, D.M., Umlauf, R.L. & Salzberg, P.M. (1988). Derivation of personality subtypes amonghigh risk drivers. Alcohol, Drugs and Driving, 4, 233–243.

Dussault, C., Brault, M., Bouchard, J. & Lemire, A.M. (2002). The contribution of alcohol andother drugs among fatally injured drivers in Quebec: Some preliminary results. In D.R. Mayhewand C. Dussault (eds.) Proceedings of the 16th International Conference on Alcohol, Drugs and TrafficSafety, pp. 423–430. Quebec: Société de l’assurance automobile du Québec.

Flam-Zalcman, R., Chipperfield, B. & Mann, R.E. (2002). Back on Track Reports: No. 5.Evaluation of the Back on Track Assessment Instrument and Process: Data from 2001. Toronto: Centre for Addiction and Mental Health.

Foon, A.E. (1988). The effectiveness of drinking-driving treatment programs: A critical review.International Journal of the Addictions, 23, 151–174.

Gentiello, L.M., Rivara, F.P., Donovan, D.M., Jurovich, G.J. et al. (1999). Alcohol interventions in atrauma centre as a means of reducing the risk of injury recurrence. Annals of Surgery, 230, 473–480.

Gjerde, H. & Morland, J. (1988). A two-year prospective study of rearrests for drunken driving.Scandinavian Journal of Social Medicine, 16, 111–113.

Gray, B.T. (2001). A factor analytic study of the Substance Abuse Subtle Screening Inventory(SASSI). Educational and Psychological Measurement, 61, 102-118.

Health Canada (1997a). DWI Repeat Offenders: A Review and Synthesis of the Literature. Ottawa:Minister of Public Works and Government Services. Cat. No. H39–416/1997E.

— — — . (1997b). Evaluation of Addictions Foundation of Manitoba’s Impaired Driver’s Program.Ottawa. Minister of Public Works and Government Services. Cat. No. H39-415/1997E.

— — — .(1999). Best Practices – Substance Abuse Treatment and Rehabilitation. Ottawa: Minister ofPublic Works and Government Services. Cat. No. H39-438/1998E.

— — — .(1998). Canada’s Drug Strategy. Ottawa: Minister of Public Works and GovernmentServices. Cat. No. H39-440/1998E.

— — — .(2001a). Best Practices – Fetal Alcohol Syndrome/Fetal Alcohol Effects and the Effects ofOther Substance Use During Pregnancy. Ottawa: Minister of Public Works and GovernmentServices. Cat. No. H49-156/1-2001E.

— — — .(2001b). Best Practices – Treatment and Rehabilitation for Women with Substance AbuseProblems. Ottawa: Minister of Public Works and Government Services. Cat. No. H49-153/2001E.


— — — .(2001c). Best Practices – Treatment and Rehabilitation for Youth with Substance UseProblems. Ottawa: Minister of Public Works and Government Services. Cat. No. H49-154/2001E.

— — — .(2001d). Best Practices – Concurrent Mental Health and Substance Use Disorders. Ottawa:Minister of Public Works and Government Services. Cat. No. H39-599/2001-2E.

— — — .(2002). Best Practices – Methadone Maintenance Treatment. Ottawa: Minister of PublicWorks and Government Services Cat. No. H49-164/2002E.

Hemmelgarn, B., Suissa, S., Huang, A., Boivin J.F. & Pinard, G. (1997). Benzodiazepine use and therisk of motor vehicle crash in the elderly. Journal of the American Medical Association, 278, 27–31.

Horn, J.L., Wanberg, K.W. & Foster, F.M. (1987). Guide to the Alcohol Use Inventory. Minneapolis:National Computer Systems.

Institute of Medicine. (1990). Broadening the Base of Treatment for Alcohol Problems. Washington,DC: National Academy of Science.

Jones, R.K., Wiliszowski, C.H. & Lacey, J.H. (1996). Evaluation of Alternative Programs for RepeatDWI Offenders. Washington, DC: National Highway Traffic Safety Administration.

Jones, R.K. & Lacey, J.H. (1999). Final Report: Evaluation of a Day Reporting Center for RepeatDWI Offenders. Washington, DC: National Highway Traffic Safety Administration.

King, M. (1986). At risk drinking among general practice attenders: Validation of the CAGEquestionnaire. Psychological Medicine, 16: 213–217.

Kooler, J.M. & Bruvold, W.H. (1992). Evaluation of an educational intervention upon knowledgeattitudes and behaviour concerning drinking-drugged driving. Journal of Drug Education, 22: 87–100.

Lapham, S., C’de Baca, J., Chang, I., Hunt, W. & Berger, L. (2001). Are drunk-driving offendersreferred for screening accurately reporting their drug use? Drug and Alcohol Dependence, 66, 243–253.

Lindeman, H. & Scrimgemour, W.G. (1999). Driver Risk Inventory (DRI): An Inventory ofScientific Findings. Phoenix, AZ: Behavioral Data Systems, Ltd.

Lucker, G.W. & Osti, J.R. (1997). Reduced recidivism among first-time DWI offenders as acorrelate of pre-trial intervention. Journal of Offender Rehabilitation, 24, 1–17.

MacAndrew, C. (1965). The differentiation of male alcoholic outpatients from non-alcoholicpatients by means of the MMPI. Quarterly Journal of Studies on Alcohol, 42, 604–623.

References | 93

Macdonald, S. & Mann, R.E. (1996). Distinguishing causes and correlates of drinking and driving.Contemporary Drug Problems, 23, 259–290.

Macdonald, S., Mann, R.E., Chipman, M.L. & Anglin-Bodrug, K. “Collisions of Alcohol, Cannabisand Cocaine Clients Before and After Treatment”. Paper presented at the 16th InternationalConference on Alcohol, Drugs and Traffic Safety – T2002, Montreal, Aug. 4–9, 2002.

Macdonald, S., Mann, R.E., Chipman, M.L. & DeSouza. A. (2003). “Self-Reports of DrivingAfter Use of Alcohol, Cannabis and Cocaine for Substance Abuse Treatment Clients andPopulation Controls”. Unpublished manuscript.

Mann, R. (1992). Effectiveness of DUI treatment and the importance of screening and matchingclients to appropriate treatment. In: Drinking and Driving Prevention Symposium. Ontario, CA:Automobile Club of Southern California.

Mann, R.E., Anglin, L., Rahman, S., Blessing, L.A., Vingilis, E.R. & Larkin, E. “Does Treatment for Substance Abuse Improve Traffic Safety? A Preliminary Evaluation”. Paper presented at the 13th International Conference on Alcohol, Drugs and Traffic Safety. Adelaide, Australia, August 13–18,1995.

Mann, R.E., Anglin, L., Wilkins, K., Vingilis E.R., Macdonald, S. & Sheu, W.J. (1994).Rehabilitation for convicted drinking drivers (second offenders); effects on mortality. Journal ofStudies on Alcohol, 55, 372–74.

Mann, R., Koski-Jannes, A., Room, R., Mitchell, B., Harrison, S., Stoduto, G. & Rush, B. (1997).Remedial Programs for Convicted Drinking-Drivers. Part 2: Implementing a Systematic Program inOntario. Toronto: Addiction Research Foundation.

Mann, R.E., Leigh, G., Vingilis, E. & De Genova, K. (1983). A critical review on the effectivenessof drinking-driving rehabilitation programs. Accident, Analysis and Prevention, 15, 441–461.

Mann, R.E., Macdonald, S., Stoduto, G., Shaikh, A. & Bondy, S. (1998). Assessing the PotentialImpact of Lowering the Legal Blood Alcohol Limit to 50 mg% in Canada. Publication No. TR 13321E. Ottawa: Transport Canada.

Mann, R.E., Stoduto, G., Macdonald, S., Shaikh, A., Bondy, S. & Jonah, B. (2001). The effects of introducing or lowering legal per se blood alcohol limits for driving: An international review.Accident Analysis and Prevention, 33, 61–75.

Mann, R.E., Vingilis, E.R., Gavin, D., Adlaf, E. & Anglin, L. (1991). Sentence severity and thedrinking driver: Relationships with traffic safety outcome. Accident, Analysis and Prevention, 23,483–491.


Marlatt, G.A. & Miller, W.R. (1984). Comprehensive Drinker Profile. Odessa, FL: PsychologicalAssessment Resources.

Mayhew, D. R., Brown, S.W. & Simpson, H.M. (2002). The Alcohol-Crash Problem in Canada:1999. Ottawa: Transport Canada.

McKnight, A.J. & Voas, R.B. (1991). The effect of licence suspension upon DWI recidivism.Alcohol, Drugs and Driving, 7, 43–54.

McLellan, A.T., Kusher, H., Metzger, D., Peters, R., Smith, I., Grisson, G. & Pettinati, H. (1992).The fifth edition of the Addiction Severity Index: Historical critique and normative data. Journal ofSubstance Abuse Treatment, 9, 199–213.

McMillen, D.L., Adams, M.S., Wells-Parker, E., Pang, M.G. & Anderson, B.J. (1992). Personalitytraits and behaviors of alcohol-impaired drivers: A comparison of first and multiple offenders.Addictive Behaviors, 17, 407–414.

Miller, G.A. (1994). The Substance Abuse Subtle Screening Inventory Manual (SASSI). Bloomington,IN. The SASSI Institute.

Miller, B.A. & Windle, M. (1990). Alcoholism, problem drinking and driving while impaired. In R.J. Wilson and R.E. Mann (eds.), Drinking and Driving, Advances in Research and Prevention,pp. 68–98. New York, NY: The Guilford Press.

Monti, P.M., Colby, S.M., Barnett, N.P., Spirito, A., Rohsenow, D.J., Myers, M., Woolard, R. &Lewander, W. (1999). Brief intervention for harm reduction with alcohol-positive older adolescentsin a hospital emergency department. Journal of Consulting and Clinical Psychology, 67, 989–994.

Mortimer, R.G., Filkins, L.D. & Lower, J.S. (1971). Court Procedures for Identifying ProblemDrinkers: Final Report. Ann Arbor, MI: Highway Safety Research Institute, University of Michigan.DOT Contract FH-11-761.

National Cancer Institute of Canada. (2001). Canadian Cancer Statistics, 2001. Ottawa: NationalInstitute of Cancer.

National Commission Against Drunk Driving. 2002. http://www.ncadd.com/policies.cfm. Accessed9/10/03.

National Highway Traffic Safety Administration & the National Institute on Alcohol Abuse andAlcoholism. (1996). A Guide to Sentencing DUI Offenders. Washington, DC: DOT HS 808-365.

Neutel, C.I. (1995). Risk of traffic accident injury after a prescription for benzodiazepine. Annalsof Epidemiology, 5(3), 239–244.

References | 95

Nichols, J.L. (1990). Treatment versus deterrence. Alcohol Health and Research World, 14, 44–51.

Nickel, W.R. (1990a). A five-year follow-up of treatment for DWI recidivists in the FederalRepublic of Germany. Alcohol, Drugs and Driving, 6, 119–132.

— — — .(1990b). Programs for the rehabilitation and treatment of drinking-driving multipleoffenders in the Federal Republic of Germany. In R.J. Wilson and R.E. Mann (Eds), Drinking and Driving, Advances in Research and Prevention, pp. 250–266. New York: The Guilford Press.

Nochajski, T.H. & Miller, B.A. (1995). Training Manual for the Research Institute on Addictions Self-Inventory (RIASI). Buffalo, NY: Research Institute on Addictions.

Nochajski, T.H., Miller, B.A. & Parks, K.A. (1994). Effectiveness of the RIASI for Screening ofConvicted DWI Offenders. Buffalo, NY: Research Institute on Addictions.

Nochajski, T.H., Miller, B.A., Wieczorek, W.F. & Parks, K.A. “The Utility of Non-ObviousIndicators for Screening of DWI Offenders”. Paper presented at the annual meeting of the ResearchSociety on Alcoholism, San Antonio, Texas, June 19–24,1993.

Parsons, M., Wnek, I. & Huebert, K.M. (1993). A unique intervention program for repeatimpaired driving offenders. Journal of Alcohol Drug Education, 39, 34–40.

Peck, R.C., Arstein-Kerslake, G.W. & Helander, C.J. (1994). Psychometric and biographical corre-lates of drunk-driving recidivism and treatment program compliance. Journal of Studies on Alcohol,55, 667–678.

Polacsek, M., Rogers, E.M., Woodall, W.G., Delaney, H., Wheeley, D. & Rao, N. (2001). MADDvictim impact panels and stages-of-changes in drunk-driving prevention. Journal of Studies onAlcohol, 62, 344–350.

Preusser, D.F., Ulmer, R.G. & Adams, J.R. (1978). Driver record evaluation of a drinking driverrehabilitation program. Journal of Safety Research, 8, 98–105.

Price, E.J. (1993). Local Official Guide to Drunk Driving Prevention. Washington, DC: NationalLeague of Cities.

Quaye, K. & Boase, P. “Is the Short-Term Administrative Suspension a Second Best but NecessaryAlternative to Criminal Code Sanctions?” Paper presented at the 16th International Conference onAlcohol, Drugs and Traffic Safety – T2002, Montreal, Aug. 4–9, 2002.

Reis, R.E. (1982a). The Traffic Safety Effectiveness of Educational Counseling Programs for MultipleOffense Drunk Drivers. Washington, DC: National Highway Traffic Safety Administration. DOT-HS-806-557.


— — — . (1982b). The Traffic Safety Effectiveness of Educational Counseling Programs for FirstOffense Drunk Drivers. Washington, DC: National Highway Traffic Safety Administration. DOT-HS-806-558.

Robins, L.N., Helzer, J.E., Ratcliff, K. & Syfried, W. (1982). Validity of the Diagnostic InterviewSchedule. Version II: DSM-III diagnosis. Psychological Medicine, 12, 855–870.

Ross, H.L. (1984). Deterring the Drinking Driver: Legal Policy and Social Control. Lexington, MA:D.C. Heath and Company.

Schmidt, W., Smart, R. & Popham, R.E. (1963). The role of alcoholism in motor vehicleaccidents. In J.D.J. Harvard (ed.) Alcohol and Road Traffic: Proceedings of the Third InternationalConference on Alcohol and Road Traffic. London: British Medical Association.

Selzer, M.L. (1971). The Michigan Alcoholism Screening Test: The quest for a new diagnosticinstrument. American Journal of Psychiatry, 127, 89–94.

Shinar, D. & Compton, R.P. (1995). Victim impact panels: Their impact on DUI recidivism.Alcohol, Drugs and Driving, 11, 73–87.

Shuggi, R., Chipperfield, B., Flam-Zalcman, R., Nochajski T.H. & Mann, R.E. “Drinking-DrivingPrograms and Quality Control: Assessing Consistency of Program Implementation”. Paper presentedat the 14th International Conference on Alcohol, Drugs and Traffic Safety – T2002, Montreal, Aug. 4–9, 2002.

Single, E., Robson, L., Xie X. & Rehm, J. (1996). The Costs of Substance Abuse in Canada. Ottawa:Canadian Centre on Substance Abuse.

Skinner, H.A. (1982). The Drug Abuse Screening Test. Addictive Behaviours, 7, 363–371.

Smart, R.G., & Schmidt, W. (1961). Problem drinking as a factor in drinking-driving offences.Canadian Journal of Corrections, 3, 153–158.

Sobell, L.C. & Sobell, M.B. (1992). Timeline follow-back: A technique for assessing self-reportedalcohol consumption. In T.R. Litten and J. Allen (eds.), Measuring Alcohol Consumption:Psychological and Biological Methods. Totowa, NJ: The Humana Press, Inc.

Spitzer, R.L., Williams, J.B., Gibbon, M. & Forst, M.B. (1990). Structured Clinical Interview forDSM-III-R. Washington, DC: American Psychiatric Press.

Stoduto, G., Mann, R., Mitchell, B., Suurvali, H., Koski-Jannes, A., Room, R. & Harrison, S.(1998). Existing Programs for Convicted Drinking Drivers in Canada. Toronto: Addiction ResearchFoundation.

References | 97

Stoduto, G., Vingilis, E., Kapur, B., Shen, W., McLellan, B. & Liban, C. (1993). Alcohol and druguse among motor vehicle collision victims admitted to a regional trauma unit: Demographic, injuryand crash characteristics. Accident Analysis and Prevention, 25(4), 411–420.

Tarter, R.E., Hegedus, A.M. (1991). The Drug Use Screening Inventory. Alcohol Health andResearch World, 15, 65–75.

Taxman, F.S. & Piquere, A. (1998). On preventing drunk driving recidivism: An examination ofrehabilitation and punishment approaches. Journal of Criminal Justice, 26, 129–143.

The College of Family Physicians of Canada. (1994). Alcohol Risk Assessment and Intervention(ARAI): Resource Manual for Family Physicians. Mississauga, ON: College of Family Physicians of Canada.

Tornos, J. (1994). Rattfallan (The trap): Evaluation of an educational programme for imprisoneddrunk drivers in Sweden. Recidivism rate within four years. Journal of Traffic Medicine, 2, 15–18.

Transport Canada (2002). Road Safety Vision 2010. Ottawa: Minister of Public Works andGovernment Services. Cat. No. T45-1/2001-1E

Van Whitlock, R. & Lubin, B. (1998). Predicting outcome of court-ordered treatment for DWIoffenders via the MAACL-R. Journal of Offender Rehabilitation, 28, 29–40.

Vingilis, E. (1983). Drinking drivers and alcoholics: Are they from the same population? In: R.G.Smart, F.B. Glaser, Y. Israel, H. Kalant, R.E. Popham, W. Schmidt. (eds.), Research Advances inAlcohol and Drug Problems, vol. VII, pp. 229–342. New York: Plenum Press.

Vingilis, E.R., Adlaf, E.M. & Chung, L. (1981). The Oshawa impaired drivers program: Anevaluation of a rehabilitation program. Journal of Criminology, 23, 372–374.

Voas, R.B. & Fisher, D.A. (2001). Court procedures for handling intoxicated drivers. AlcoholResearch and Health, 25, 32–42.

Walsh, G. & Mann, R.E. (1999). On the high-road: Driving under the influence of cannabis inOntario. Canadian Journal of Public Health, 90, 260–263.

Wells-Parker, E. & Williams, M. (2002). “Enhancing the Effectiveness of Traditional Interventions withDrinking Drivers by Adding Brief Individual Intervention Components”. Unpublished manuscript.

Wells-Parker, E., Anderson, B.J., McMillen, D.L. & Landrum, J.W. (1988). Interactions amongDUI offender characteristics and traditional intervention modalities: A long term recidivism follow-up. British Journal of Addiction, 84, 381–390.


Wells-Parker, E., Bangert-Drowns, R., McMillen, R. & Williams, M. (1995). Final results from ameta-analysis of remedial interventions with drink/drive offenders. Addiction, 9, 907–926.

Wells-Parker, E., Cosby, P.J. & Landrum, J.W. (1986). A typology for drinking driving offenders:Methods for classification and policy implications. Accident Analysis and Prevention, 18, 443–453.

Wells-Parker, E., Keene, D.R., Spratke, K.L. & Williams, M.T. (2000). Self-efficacy and motivationfor controlling drinking and drinking/driving: An investigation of changes across a driving underthe influence (DUI) intervention program. Addictive Behaviors, 25, 229–238.

Whitehead, P.C., Hylton, J. & Markovsky, R. (1984). Alcoholics on the Road: Evaluation of anImpaired Driver Treatment Program. Regina: Saskatchewan Alcoholism Commission.

Wieczorek, W.F. & Miller B.A. (1992). Preliminary typology designed for treatment matching ofdriving-while-intoxicated offenders. Journal of Consulting and Clinical Psychology, 60, 757–765.

Wieczorek, W.F., Miller, B.A. & Nochajski, T.H. (1992). The limited utility of BAC for identifyingalcohol-related problems among DWI offenders. Journal of Studies on Alcohol, 53, 415–419.

Wilson, R.J. (1991). Subtypes of DWIs and high-risk drivers. Alcohol, Drugs and Driving, 7, 1–12.

Winters, K. (1991). Manual for the Personal Experience Screening Questionnaire (PESQ). LosAngeles: Western Psychological Services.

Zelhart, P.F., Schurr, B.C. & Brown, P.A. (1975). The drinking driver: Identification of high-riskalcoholics. In S. Israelstam and S. Lambert (eds.), Alcohol, Drugs and Traffic Safety: Proceedings ofthe 6th International Conference on Alcohol and Traffic Safety. Toronto: Addiction ResearchFoundation.

Appendix | 99

This scale used constructs and items from the meta-analysis project of Wells-Parker and colleagues(1995). However, given our more modest objectives, studies were not discriminated to the same degree.The aim was to indicate methodological rigour and thus the credibility of the reported results.

* If evident or suspected biases were corrected using appropriate statistical methods.

** Including unplanned remediation or other interventions received by members of the control or comparison groups.

Appendix A: Rating Scale for Recent Studies

Issues Rating

Grouping strategies

Integrity of the intervention(s)

Random assignment with rigorous monitoring and no evidence of significant bias associated with deviations from the randomization process and extensive evidence that groups did not differ significantly on numerous pre-treatment variables (demographics, violation history, etc.)

10

Random assignment but little descriptive information about monitoring or group equivalence 9

Random assignment with low to moderate attrition (<15%) unrelated to assignment 8*

Random assignment with higher rates of attrition (15%–30%) unrelated to assignment 7*

Random assignment with evidence of non-adherence possibly related to assignment 6*

Comparison group design with good evidence for group equivalence on key variables 5

Comparison group design but less evidence that the groups were equivalent on key variables 4*

Randomized assignment but poorly documented and indications of bias 3*

Comparison group design but little evidence that the groups were equivalent on key variables 2*

Non-randomized design involving self-selected groups or randomized designs with high(>50%) group attrition

1*

Obvious and uncorrected biases 0

Maximum score 12

Evidence that the intervention(s) and the experiences of the control or comparison groupswere as planned

Good evidence = 2

Some slippage evi-denced or suspected= 1**

Major slippage ornot described = 0

archived content contenu archivé - public safety canadadiskette/large print/audio-cassette/braille)...

Documents