Drink Driver Rehabilitation and Education in Victoria

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1 Drink Driver Rehabilitation and Education in Victoria April 2005 Research report 05/01

2 Royal Automobile Club of Victoria (RACV) Ltd RETRIEVAL INFORMATION Report No. Date ISBN Pages PP 05/01 April Title Drink driver rehabilitation and education in Victoria Authors Mary Sheehan, Barry Watson, Cynthia Schonfeld, Angela Wallace, Bradley Partridge Performing Organisation Centre for Accident Research and Road Safety - Queensland (CARRS-Q) Queensland University of Technology Beams Road Carseldine Qld 4034 Abstract RACV commissioned CARRS-Q to undertake a review of the current Victorian drink driver offender program as part of RACV s Road Safety Research Fund. The aim of this research was to: Determine what best practice drink drive rehabilitation is and compare this to what is currently delivered in Victoria. Obtain feedback from stakeholders and service providers on their perceptions of the effectiveness of the current Victorian program. An extensive literature review was completed, with interviews and focus groups undertaken with service administrators, service providers and magistrates. Despite the Victorian system s comprehensive approach to drink driving, this examination found that there were a number of areas where the program could be improved. Issues discussed in the report include: the general status of the program; legislation, penalties and the judicial process; monitoring, tracking and mentoring; the content of the education course; the assessment and reporting process; referral and treatment issues; the licensing restoration process and unlicensed driving; alcohol ignition interlocks and other sanctions and finally research priorities and developmental opportunities. Based on these responses and the findings from a review of relevant international literature a comprehensive range of recommendations in relation to these themes are provided. Keywords Drink driving, road user rehabilitation, Victoria, legislation, offender, recidivist, penalty, unlicensed driver, education, monitoring, ignition interlock, evaluation Disclaimer The research presented in this Report has been funded by RACV and is released in the public interest. The views expressed and recommendations made are those of the authors and do not necessarily reflect RACV policy. Although the Report is believed to be correct at the time of publication, RACV, to the extent lawful, excludes all liability for loss (whether arising under contract, tort, statute or otherwise) arising from the contents of the Report or from its use. Where such liability cannot be excluded, it is reduced to the full extent lawful. Discretion and judgement should be applied when using or applying any of the information contained within the Report. REPRODUCTION OF THIS PAGE IS AUTHORISED RACV RESEARCH REPORT NO 05/01

3 Table of Contents Executive Summary v 1. Introduction 1 2. Summary of Literature Review Effectiveness of Rehabilitation Best Practice Characteristics of Effective Rehabilitation Programs Enhancing the Management of Offenders Further Research and Evaluation Types of Offenders Penalty and Pre-requisite for Re-licensing Mandatory and Voluntary Programs Content of the Program Equity of Access, Cultural Relevance and Quality Control Alcohol Ignition Interlocks and Other Electronic Devices 8 3. The Victorian Drink Driver Education Program Background Overview Rationale Legislation Description Overview of the Program Accreditation Education Courses Assessment, Referral and Treatment Fees Re-Licensing Evaluation Policies and Practices in Other States and Territories Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Western Australia Offenders in Prison 20 DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA i

4 5. Methodology Introduction Participants Service Administrators Magistrates Program Providers Interviews and Questionnaires Service Administrators Magistrates Service Providers Procedure Service Administrators Magistrates Service Providers Ethical Approval Victorian Stakeholder Perceptions General Status of Victorian Drink Drive Program Overview Stakeholder Comments Priority Issues Legislation, Penalties and Judicial Processes Overview Stakeholder Comments Priority Issues Monitoring, Tracking and Mentoring Overview Stakeholder Comments Priority Issues Education Course Overview Stakeholder Comments Priority Issues Assessments and Reporting Process Overview Stakeholder Comments Priority Issues Referral and Treatment Overview Stakeholder Comments Priority Issues Licence Restoration Process and Unlicensed Driving Overview Stakeholder Comments Priority Issues 36 ii RACV RESEARCH REPORT NO 05/01

5 6.8 Alcohol Ignition Interlocks and Other Sanctions Overview Stakeholder Comments Priority Issues Research Priorities and Development Opportunities Overview Stakeholder Comments Priority Issues Discussion and Recommendations General Status of Victorian Drink Drive Program Legislation, Penalties and Judicial Processes Monitoring, Tracking and Mentoring Education Course Assessments and Reporting Process Referral and Treatment Licence Restoration Process and Unlicensed Driving Alcohol Ignition Interlocks Research Priorities and Development Opportunities 48 References 49 Appendices 54 DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA iii

6 Abbreviations BAC CBT CCO DHS DWI FORS LFT Blood Alcohol Concentration Cognitive Behavioural Therapy Community Correctional Officer Department of Human Services Driving While Intoxicated Federal Office of Road Safety Liver Function Test MUARC Monash University Accident Research Centre NESB RACV RBT RCM RTA TAC TIN TOP UTL VDDEP VADDS VP Non-English Speaking Background Royal Automobile Club of Victoria Random Breath Testing Regional Coordinating Magistrate Road Traffic Authority Transport Accident Commission Traffic Infringement Notice Traffic Offender Programs Under the Limit Victorian Drink Driver Education Program Victorian Association of Drink Driver Services Victoria Police iv RACV RESEARCH REPORT NO 05/01

7 EXECUTIVE SUMMARY Background Significant reductions in drink driving have been achieved in Victoria in recent years, but drink driving remains a major economic, social, and public health problem. In 2002, 31 per cent of all drivers and riders killed in Victoria had a BAC of 0.05 or more and 2001 figures indicate that repeat drink driving offenders were responsible for 22 fatalities and 560 serious injuries. Such crashes cost the Victorian community approximately $81 million each year. RACV commissioned CARRS-Q to undertake a review of the current Victorian drink driver offender program as part of RACV s Road Safety Research Fund. The aim of this research was to: Determine what best practice drink drive rehabilitation is and compare this to what is currently delivered in Victoria. Obtain feedback from stakeholders and service providers on their perceptions of the effectiveness of the current Victorian program. In addition to an extensive literature review, interviews and focus groups were undertaken with service administrators, service providers and magistrates. Twenty-seven senior service administrators working in the field of drink driving, or who had extensive experience in associated areas were interviewed in July/August Twenty magistrates from six regions in Victoria also participated in an interview or focus group and all drink drive program agencies were surveyed by mail, with 14 responses received. The current Victorian drink driving program largely focuses on measures that offenders need to undertake as part of the re-licensing process. Accredited drink driving agencies provide an 8 hour education program that some offenders are required to attend prior to re-licensing. Recidivists and those convicted with high BAC levels are also required to attend one or more assessments to determine the nature of their alcohol problems prior to attending the education program, and many are also required to have an alcohol interlock fitted to their vehicles as a condition of re-licensing. Key findings Despite the Victorian system s comprehensive approach to drink driving, this examination found that there were a number of areas where the program could be improved. International research has shown that community drink driving programs for recidivist drivers need to be integrated and target both traffic and health-related outcomes. The most effective rehabilitation programs incorporate a combination of intervention modes including education/information, lifestyle change strategies, and probationary contact and supervision. The current Victorian drink driver education program does not include all of these elements. The focus of the Victorian program is not rehabilitation for high risk offenders, but focuses on assessment and education, not treatment. Solely focusing on education and assessment does not reflect current best practice drink driving rehabilitation. The current education and assessment process is a judicial requirement prior to re-licensing, and is not part of the penalty system. This system relies on offenders wanting to re-licence. This is not an effective mechanism for encouraging treatment and rehabilitation of offenders and could potentially discourage suspended drivers from getting re-licensed. DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA v

8 The current interlock program relies on high risk offenders wanting to get re-licensed after serving their suspension period, and may in fact be a disincentive for re-licensing. With no current monitoring of offenders through the suspension period, effectiveness of the program is difficult to determine, as are the re-licensing rates. There appears to be little communication between the agencies associated with the drink driver offender program and no clear leadership in ensuring that the program meets best practice and is effective in addressing addiction issues for high risk offenders. Recommendations In order to reduce the level of drink driving recidivism, CARRS-Q recommends that the Victorian Government should commission a detailed independent evaluation of the current drink driving system, and consider implementing the following improvements: Accountability for overseeing the program should be clearly allocated to one Government Department. A pre-conviction assessment should be completed and drivers with alcohol addiction problems should be directed at this early stage to rehabilitation programs. This should be a requirement for all offenders rather than being part of the re-licensing process for those who chose to get re-licensed. The benefits of the alcohol interlock program would be greater if involvement in the program also involved ongoing rehabilitation. The requirement that offenders must serve their full suspension period before participating in the interlock program needs to be reviewed. Allowing offenders to reduce the length of the suspension period if they participate in the program needs to be seriously considered in light of the research on best practice interlock programs. A system for monitoring offenders is necessary to determine the effectiveness of the current system. More specific recommendations and stakeholder views on the effectiveness of the Victorian drink driver offender program are including in the full report. vi RACV RESEARCH REPORT NO 05/01

9 1. Introduction The research team from The Centre for Accident Research and Road Safety Queensland (CARRS-Q) completed an extensive critical review of the literature on drink driving rehabilitation for RACV in August It focused on both process and outcome issues including: the relative effectiveness of judicial and administrative models; the characteristics of effective rehabilitation programs; strategies for integrating rehabilitation with other drink driving sanctions; the relevance of treatment models for alcohol dependency; the overall cost-effectiveness of rehabilitation; and the role of rehabilitation programs in encouraging re-licensing. Particular focus was placed on the integrated use of a range of drink driving management processes including licence actions, rehabilitation and alcohol ignition interlocks. This second report follows up the first with specific application to Victoria by examining the following issues: findings from the first critical literature review an in-depth review of drink driving rehabilitation policies and practices in Victoria in relation to other Australian jurisdictions a summary of evaluations of drink driving programs in Victoria findings from interviews with Victorian magistrates and key service administrators in the community corrections, police, transport, justice and health sectors findings from survey questionnaires with service providers (drink drive agencies) a comprehensive discussion with recommendations for improved practice based on the findings of the first report and the Victorian data. DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA 1

10 2. Summary of Literature Review This section provides a brief summary of relevant findings from a literature review of drink driving rehabilitation programs. 2.1 Effectiveness of Rehabilitation Drink driving rehabilitation is a broad term that is used to describe a variety of programs for offenders that aim to reduce recidivism (Ferguson, Schonfeld, Sheehan, & Siskind, 2001). The core models of rehabilitation for drink driving offenders currently involve either treatment of alcohol problems (psychotherapy/counselling based programs) or provision of knowledge (education-based programs), or a combination of both. Drink driving rehabilitation and treatment programs constitute a secondary form of prevention, attempting to treat drink driving offenders alcohol problems and thus change their behaviour. The primary aim of these programs has generally been accepted to be the process of separating drinking from driving by providing offenders with the knowledge, skills and strategies to avoid further drink driving behaviour (Popkin, 1994; Wells-Parker, 1994). A secondary aim has often been to reduce drinking levels by increasing offenders awareness of the seriousness of excessive alcohol consumption (Wells-Parker, 1994). Although rehabilitation programs for drink driving offenders have existed for some time, it has only been in the past decade that a consensus has emerged regarding the effectiveness of these programs in changing offenders drink driving behaviours, enhancing traffic safety, or alleviating alcohol problems in at-risk populations. This evidence suggests that drink driving treatment programs can be effective in offender rehabilitation and the use of programs should be included in policy decisions about future directions in the control of drink driving. The average effect of remediation on drink driving recidivism has been found to be a 7-9% reduction over no remediation with a similar effect size being found for alcohol involved crashes (e.g. Wells-Parker, Bangert-Downs, McMillen, & Williams, 1995). Combination programs (including education, psychotherapy/ counselling and follow-up contact/probation) have been found to be more effective than other evaluated modes for reducing drink driving recidivism. Studies conducted in the U.S. indicate that alcohol treatment/rehabilitation in conjunction with licence restriction remains the most effective sanction in reducing drink driving recidivism, while licence suspension remains the most effective sanction in terms of overall crash reduction. The period since 1990 has seen a growth in combination programs that provide education and psychotherapy/counselling. Such programs may use group education sessions to increase knowledge about the harmful outcomes of drink driving, while providing an offender with face-to-face psychotherapy/counselling to deal with the offender s drinking problem (DeYoung, 1997; Wells-Parker et al., 1995). Little research has been conducted examining the effectiveness of combination programs, although recidivism analyses from Wells-Parker et al s (1995) meta-analysis of drink driving interventions indicates that some combination of modalities, in particular those including education, psychotherapy / counselling and some follow-up, such as contact probation, showed larger effect sizes than other modes. The Under the Limit (UTL) drink driving rehabilitation program which was developed and initially implemented as part of a wider community intervention in the Central Queensland Region in 1993 is available through Magistrates courts in Queensland and delivered through the Technical and Further Education (TAFE) system. The initial design of this program recognised the growing belief that drink driving was an indicator of alcohol dependency and incorporated elements of best practice models of treatment for alcohol dependency in its design (Ferguson, Sheehan, Davey, & Worbon, 1999). This program uses a combined approach with group sessions based on cognitive behaviour therapy as the treatment mode. Evaluation suggests that it is effective in reducing recidivism in those multiple offenders who complete the program. 2 RACV RESEARCH REPORT NO 05/01

11 Motivation may be a particularly salient factor in the treatment of drink driving offenders and in general motivated people enter and participate in alcohol treatment at higher rates than do less motivated people (DiClemente, Bellino, & Neavins, 1999). Many people enter rehabilitation under judicial coercion and they may not be ready to change their drinking behaviour at the point of entry to the program. Therefore, understanding how to handle unmotivated or reluctant people entering rehabilitation and ensuring they actively participate in treatment is necessary for the optimal success of programs. Traditional approaches to treating unmotivated people have often used aggressive and confrontational strategies in response to the person s denial (Miller & Rollnick, 1991), while more recent evidence suggests that this approach fosters denial and resistance in the drinker (Miller, Benefield, & Tonigan, 1993). Although there is a strong rationale for the assessment, treatment and rehabilitation of drinkdrivers, the cost-effectiveness of these approaches remains unclear (Sheehan, 1994). 2.2 Best Practice Characteristics of Effective Rehabilitation Programs The literature review found support for the following best practice characteristics of rehabilitation programs: Programs are most effective in reducing recidivism when they are combined with licence disqualification periods. The evidence that rehabilitation programs are most effective in reducing recidivism when they are combined with licence disqualification periods is overwhelming (DeYoung, 1997; Mann et al., 1994; Popkin, Stewart, Martell, & Birckmayer, 1992; McKnight & Voas, 1991; Green, French, Haberman, & Holland, 1991; Sadler, Perrine, & Peck, 1991; Fell, 1990; Nichols & Ross, 1990; Sanson-Fisher, Redman, Homel, & Key, 1990). Improving psychosocial functioning has been found to improve the effectiveness of rehabilitation programs. Macdonald and Dooley (1993) using a matched sample of offenders and non-offenders reported that offenders were more likely to believe that some people drive better after drinking, that it takes more alcohol to be legally impaired and that there is an excuse for drink driving. They suggest that convicted drink drivers have poor knowledge and attitudes toward this behaviour and interventions aimed at the drinking driver should focus on varying these characteristics in order to reduce drink driving recidivism (Macdonald & Dooley, 1993). The most effective rehabilitation programs incorporate a combination of intervention modes including education/information, lifestyle change strategies and probationary contact and supervision. Wells-Parker et al. s (1995) meta-analysis indicates that drink driving program evaluations that have focused on lifestyle measures have shown an overall positive effect on knowledge and attitudes toward drink driving behaviours. In recent years, there has been a shift away from a focus on lifestyle and attitudinal factors to drink driving recidivism and crash rates as measures of program effectiveness. Evaluation processes that examine the potential benefits of drink driving programs on lifestyle measures as well as recidivism and crash rates would be optimal. Small group size (n = 8-10) is an important consideration to optimize success and fully engage adults in programs. Cognitive Behavioural Therapy (CBT) techniques and strategies provide the most effective process treatment for alcohol problems. Brief Interventions have been shown to reduce alcohol consumption by heavy drinkers as well as being inexpensive and should be included in rehabilitation programs. 2.3 Enhancing the Management of Offenders Drink driving offenders are a heterogeneous group so the most effective approach to the problem would be one that uses a multi-strategy method approach. These include the integration of rehabilitation, with legal and vehicle sanctions, as well as population-based approaches such as DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA 3

12 media campaigns. Evaluating the effectiveness of such countermeasures is fraught with difficulty, as it is subject to a number of methodological limitations. The success of any particular intervention is highly dependent upon the outcome measure utilised. Licence disqualification is the most common sanction used in the punishment of drink driving offenders in Australia, as it is widely regarded as a just and appropriate penalty for drink driving (Ross, 1991; Williams, Weinberg, & Fields, 1991; Smith & Maisey, 1990). However it cannot prevent an offender from driving as a result of their drink driving offence. This limits the ability of licence sanctions to act as a specific deterrent (DeYoung, 1999; Marques, Voas, & Hodgins, 1998; Ward, 2000; Watson 2002; Watson, 2003). Offenders learn through disqualified driving that holding a drivers licence is not essential in transportation so long as care is taken with the amount of driving, nature of driving and location (Ross, 1991). Consequently, unlicensed driving has the potential to damage any benefits that may be gained through the use of licence sanctions as a drink driving countermeasure. Despite the difficulty in monitoring and controlling unlicensed driving, recent evidence suggests that licence disqualification can also impact on alcohol-related incidences. A study conducted in Queensland indicated that the use of licence suspension was associated with a two-thirds reduction in both crashes and drink driving recidivism (Siskind, 1996). Licence disqualification has also shown to improve overall road safety by reducing the general level of traffic violations and crashes (DeYoung, 1997; Mann, Vingilis, Gavin, Adl af, & Anglin, 1991; McKnight & Voas, 1991; Nichols & Ross, 1990; Peck, 1991; Vingilis & Coultes, 1990). A large volume of literature has demonstrated that licence disqualification is an extremely effective method for reducing further drink driving (Jones & Lacey, 1991; McArthur & Kraus, 1999; Nichols & Ross, 1990; Vingilis et al., 1990). Numerous studies with a variety of methodologies have indicated that this sanction, at least in the short term, is more effective in preventing drink driving recidivism than other forms of punishment or remedial education programs unaccompanied by withdrawal of driving rights (Mann et al., 1991; Peck, 1991; McKnight & Voas, 1991). An efficient system in imposing and enforcing licence sanctions requires: (a) prompt and certain suspension of licence; (b) better updated traffic records to provide magistrates with a more complete offender history prior to sentencing; (c) recognition and promotion of driving while disqualified as a serious offence; and (d) the use of treatment in addition to licence sanctions (Transportation Research Board, 1995). Vehicle impoundment is a less common management measure. This is because this type of control measure is problematic due to legal issues with confiscation, storage problems (eg. costs), and cars being shared with persons other than the offender (Stewart, 1995; Weinrath, 1997). With drink driving having gained great attention over the past two decades, a wide variety of countermeasures exist. These strategies are generally divided into two groups depending on the primary target: general interventions and specific interventions. General intervention strategies target the community in which the socially unacceptable behaviour is occurring (random breath testing and media campaigns), while specific intervention strategies target the convicted offender with the aim of reducing their potential to re-offend (licence sanctions and alcohol ignition interlock devices) (Ferguson et al., 1999). 2.4 Further Research and Evaluation The cost-effectiveness of different approaches to drink driving rehabilitation needs to be examined. An adequate cost analysis needs to include issues such as the estimated loss of productivity due to injury or death, property damage, medical, legal, employer, prison and funeral costs, as well as costs to police and emergency services. The overall economic impact on the family and community should also be considered as well as the social and economic benefits in reducing crashes. 4 RACV RESEARCH REPORT NO 05/01

13 Selection of participants needs further research. Ethical and equity considerations dictate that programs should be made available to all drink driving offenders with these constraints often making systematic controlled evaluation of programs complicated. Motivation to change appears to be a critical factor and understanding how to handle unmotivated or reluctant offenders entering rehabilitation programs under judicial coercion, is essential to the success of programs. Voluntary participation in rehabilitation suggests that control groups used in evaluations will comprise those offenders who have chosen not to participate which may severely affect the comparability of study groups (Weinrath, 1997). This constraint has particular relevance in our evaluation of the Victorian model in which participants in rehabilitation programs are directly motivated to achieve relicensing. Many evaluations of programs fail to include a comparison or control group (Hall, 1997). Ethics and equity advocates argue that denying rehabilitation to those people who may benefit greatly from it, should not be sacrificed for research reasons. Quality control of drink driving rehabilitation programs is of utmost importance but is mostly ignored in program evaluation. It is astounding that there are currently no guidelines for quality control in drink driving rehabilitation programs. The issue of outcome measures needs much more thorough investigation. It has been suggested that multiple measures should be used so that the strengths of one counteract the deficiencies of other measures while adding a new element to the measurement of the construct. Because of the number and variety of drink driving rehabilitation programs available, screening and assessment often become a part of the drink driving control system (Wells-Parker & Popkin, 1994). However, since alcohol problems and drink driving are complex behaviours, any screening or assessment procedure must be able to reliably measure the complexity and multidimensionality of these behaviours (Institute of Medicine, 1990). The goal of screening is to identify individuals who are at risk of developing alcohol-related problems. Screening is important given that with appropriate support and help, people who are not alcohol dependent may reduce or stop their consumption (Holmwood, 2002). Once alcohol dependence has developed, cessation or changes to consumption are much more difficult and usually require specialised treatment (Commonwealth Department of Veterans Affairs, 2002). Often, hazardous drinking is undetected and many people may present to a primary care setting with signs and symptoms that would not necessarily be related to their drinking. Therefore, screening maybe is a simple way to identify people whose drinking may pose a risk to their health or that of others, as well as those who are already experiencing alcohol dependence. Screening and assessment techniques are often used in association with drink driving rehabilitation programs to aid in better matching strategies to the needs of the individual offender. Screening is defined as a process that differentiates people who have, or are at risk of having, a medical condition from those who do not (Babor & Higgins-Biddle, 2000, p678). Wells-Parker et al. (1995) suggested that two essential criteria for the effective use of screening techniques are firstly, that the techniques can predict potential risk (e.g. risk of recidivism) and secondly, that the techniques can identify appropriate cut points to define risk groups. However, the difficulty in determining the degree of alcohol dependency, particularly where it involves self reported behaviour, has long been recognized as a serious problem when assessing drink driving offenders prior to licence reapplication (Conigrave & Carseldine, 1996). Nonetheless, a number of rehabilitation programs for drink driving have involved the initial screening of offenders. Most evaluations focus on reduction of recidivism or time to subsequent offence as measures of program effectiveness. There are however, limitations in using recidivist rates in determining program effectiveness. Probably the most notable empirical support for not using recidivism as the main outcome measure is illustrated in Wells-Parker et al s (1995) meta-analysis. According to results from this meta-analysis, recidivism effect size was found to increase in magnitude and variation with poorer methodological quality. DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA 5

14 The issue of drink driving as a social problem has been addressed by only a few evaluations. Hedlund (1995) suggested that while this is an important traffic safety outcome, it does not address the changes in the health, lifestyle and alcohol-related problems that may be a significant correlate of reduced drink driving. Since drink driving offenders generally have many social and personal problems (Hedlund, 1995; Isaac, 1995), the omission of measuring changes in lifestyle factors of offenders is noteworthy. Measuring changes in lifestyle factors may be a more sensitive and reliable measure of the effects of drink driving rehabilitation programs (Hall, 1997; Sheehan, Schonfeld, & Davey, 1995). It is recommended that a more holistic approach to the evaluation of drink driving programs is needed to guide the development of empirically-based models of drink driving rehabilitation (Fitzpatrick, 1992). This means that multiple measures should be used so that they counteract the deficiencies of other measures while adding a new element to the measurement of the construct (Fitzpatrick, 1992). What does emerge from the earlier review is that the control and management of drink driving through rehabilitation is a complex issue. It requires more complex and systematic approaches than have as yet been realised in Australian jurisdictions. There are a number of core issues that need to be taken into account in any attempt to develop model policy or programs in the area. These are discussed below and underlie the directions of this second report. 2.5 Types of Offenders Types and models for rehabilitation should be linked to the types of offender. They can be usefully categorised in terms of the level or degree of offending, that is first, second or more frequent offender and the extent to which the offender has an associated alcohol dependency. BAC level at the time of apprehension is sometimes used as proxy for the latter but this may not be the most valid or reliable measure of likelihood of re-offending. Research aimed at profiling drink drivers has mainly focused on the recidivist drink driver, with greatest effort being given to the predictors of recidivism (Ferguson et al., 1999). The profile of a recidivist drink driver is one that is of great interest to road safety researchers and practitioners alike. Recidivist drink drivers are consistently identified in the research literature as those more likely to be resistant to change and least responsive to legislative changes, harsher penalties and educative strategies for remediation (Hedlund, 1995; Simpson, 1995; Tornros, 1994). Although recidivists are not a homogenous group, as noted earlier, they have been more likely to be reported as: male; young; single, separated or divorced; unemployed or in a blue collar occupation; with a history of other traffic or criminal offences; personality problems such as anti-social attitudes and poor impulse control (Bailey & Bailey, 2000; Beck, Rauch, & Baker, 1997; Moloney & Palaia, 1997; Ryan, Ferrante, Loh, & Cercarelli, 1996; Wilson, 1996). A third important but relatively under-investigated way in which offenders may vary is whether they were driving unlicensed at the time of the index offence. The evidence suggests that the unlicensed recidivist offender is most likely to have a serious drink driving problem and to be over represented in serious alcohol related crashes. Unlicensed drivers have been reported to be twice as likely as licensed drivers to be involved in a serious injury crash (Federal Office of Road Safety: FORS, 1997; Watson, 1997). These findings challenge previous research that suggests unlicensed drivers tend to drive in a relatively safe manner compared with the general driving public in order to avoid detection (Smith & Maisey, 1990; Voas, 2001). Furthermore, crashes involving unlicensed drivers often involve a cluster of high-risk driving behaviours (Parliamentary Travelsafe Committee, 1997). These high risk behaviours include: driving while impaired by alcohol and drugs; motorcycle riding; exceeding the speed limit; and driving at excessive speed for the prevailing conditions (Harrison, 1997; Federal Office of Road Safety: FORS, 1997; Watson, 1997). Alcohol and other drugs were involved in 22.5% of the serious casualty crashes involving unlicensed drivers compared to only 7.5% involvement in serious casualty crashes involving licensed drivers and riders (Watson, 1997). These three issues have particular relevance to the type of rehabilitation program or model of countermeasures that might be recommended and the policy issues that arise if these particular types of offenders are to be systematically managed. 6 RACV RESEARCH REPORT NO 05/01

15 2.6 Penalty and Pre-requisite for Re-licensing There are two models or approaches to the implementation of rehabilitation currently being used in Australia. The first is a penalty approach in which an offender is required as part of the sentencing for the index offence to undertake a rehabilitation program. The second model is that used in Victoria in which rehabilitation is independent of the sentencing system but is an administrative requirement for re-licensing. It is likely that both these models are accessed by different types of offenders and this in turn probably has a direct impact on the measured effectiveness of programs. Laws and enforcement programs have been implemented to increase the certainty, swiftness and severity of punishments for drink driving (Grosvenor, Toomey, & Wagenaar, 1999). Certainty rather than severity of punishment may be the most important deterrent to drinking and driving among the general population (Grosvenor et al., 1999; Ross, 1992b). Legal sanctions consisting of both a period of licence disqualification and monetary fine are the chief sentencing options for drink driving offenders in Australia. Such legal sanctions can act to reform convicted drink driving offenders to be less likely to repeat this behaviour in the future (Ross, 1992; Watson, 1998). The objective of legal sanctions (particularly licence disqualification periods) is to put drink driving offenders out of action by preventing them from committing the offence again, even if they wish to do so (Beirness, Simpson, & Mayhew, 1997; Ross, 1992). Major differences can exist in the way these sanctions are administered, depending on whether the primary objective is to punish, restrain or reform offenders (Watson, 1998). This process of specific deterrence is seen as the primary objective of legal sanctions (Watson, 1998). Specific deterrence is based on changing the behaviours of those drivers who have been identified as drink driving: these drivers behaviours are controlled to some degree by the imposition of a penalty such as loss of licence, fine, rehabilitation or vehicle impoundment (McArthur et al., 1999). 2.7 Mandatory and Voluntary Programs The issue of whether attendance at a rehabilitation program should be mandatory or voluntary may ultimately be linked to research on the treatment and management of alcohol dependency. The literature on this issue is not clear. Emerging research suggests that drink driving rehabilitation programs that enable participants to obtain insight and understanding of the practical and social costs of their drinking and driving as well as of their personal dependency do in fact move participants in their motivation to change their dependency. The issue then may be the need to ensure that persons completing drink driving rehabilitation programs have access to specialised ongoing programs directed towards reducing their dependency. Motivation may be a particularly salient factor in the treatment of drink driving offenders and in general motivated people enter and participate in alcohol treatment at higher rates than do less motivated people (DiClemente et al., 1999). Many people enter rehabilitation under judicial coercion and they may not be ready to change their drinking behaviour at the point of entry to the program. Therefore, understanding how to handle unmotivated or reluctant people entering rehabilitation and ensuring they actively participate in treatment is necessary for the optimal success of programs. Traditional approaches to treating unmotivated people have often used aggressive and confrontational strategies in response to the person s denial (Miller & Rollnick, 1991), while more recent evidence suggests that this approach fosters denial and resistance in the drinker (Miller et al., 1993). Assessment of motivation presents a significant challenge as external influences and pressures, as well as internal thoughts and feelings, contribute to a person s motivation to change (DiClemente et al., 1999). Evaluating a person s motivation to change requires assessment of the person s attitudes and intentions, confidence and commitment, and decision-making ability (DiClemente & Prochaska, 1998). Researchers have attempted to measure change in motivation in numerous ways, including questioning patients about their intentions and plans to change and asking multiple questions reflecting the different stages of change (DiClemente & Prochaska, 1998; Miller & Tonigan, 1996; Rollnick, Heather, Gold, & Hall, 1992) and other researchers have attempted to develop measures of motivation for treatment (DeLeon, Melnick, & Kressel, 1997; Simpson & Joe, 1993). DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA 7

16 2.8 Content of the Program There are four identifiable components of currently well evaluated rehabilitation programs. These are not interchangeable and it is arguable from a wide variety of research sources that all are required for successful rehabilitation of the serious recidivist offender. The first component involves education relating to the core issues of alcohol and its impact on the individual and on their driving skills. Education-based programs attempt to assist the drink driver in separating future episodes of drinking from driving and assume that it is a lack of knowledge that led to the drink driving offence. It is important to recognise that education programs are not treatment programs. The theoretical basis on which education programs are developed assumes that individuals drink and drive due to a lack of knowledge that results in poor decisions being made (Popkin, 1994). Education is a necessary but does appear to be a sufficient component of rehabilitation for drink driving as many offenders fail to see that they might have a drinking problem and therefore without insight they do not have the knowledge (or the power) to change their drinking habits (Macdonald & Dooley, 1993). The second essential element is alcohol treatment through lifestyle change and social skill development. Thirdly, effective programs are well run, systematic and conducted by well trained and professional therapists (Heather, 2000). Finally, the classical study by Wells Parker et al., (1995) in this area indicates that rehabilitation outcomes are enhanced by the requirement for offenders to be on probation and by the provision of programs personalised support systems throughout the rehabilitation program. 2.9 Equity of Access, Cultural Relevance and Quality Control Two issues that have emerged in two Australian studies, but remain under investigated in international work, are the need to include processes that ensure equity of access and quality control mechanisms built in to any policy regarding rehabilitation programs. People in prison, who are often the most serious offenders, remain a group that are not specifically targeted by current research programs. However, the international literature suggests that interventions at this point in time are not typically effective. This is an area requiring further research in the Australian context. In Australia, in order to enable rehabilitation to be available to all people, whether they live in metropolitan, rural or remote areas, distance education modes should also be available (Sheehan et al., 1995). To ensure client literacy does not become a problem in the implementation of the program, the program should only have a small component of written work (Sheehan et al., 1995). Catering for Aboriginal and Torres Strait Islander offenders requires a specific package to be appropriate both in content and language styles for these offenders (Sheehan et al., 1995). Facilitators and program coordinators need adequate training to be competent and aware of factors influencing adult learning to maximise learning outcomes for participants (Newman, DiPietro, Catchpole, Stephenson, & Taylor, 2002) Alcohol Ignition Interlocks and Other Electronic Devices There are a number of vehicle control sanctions that have been trialled internationally and appear to have potential to provide positive effects in terms of drink driving control. However, with the exception of alcohol ignition interlocks their contribution to rehabilitation is untested. The technology of interlocks is developed, and the guidelines for their use are now well clarified. They appear, along with other electronic car devices, to significantly reduce drink driving by offenders whilst they are in place. Comprehensive Canadian research however suggests that optimal results from interlock use require associated rehabilitation and probationary mentoring. An alcohol ignition interlock is designed to prevent the vehicle being started if the driver s blood alcohol concentration exceeds a specific limit. In addition to preventing the vehicle from starting, the 8 RACV RESEARCH REPORT NO 05/01

17 interlock records data on the use of the vehicle and any attempts to evade the interlock, such as roll starting (Victorian Government, 2002). Alcohol ignition interlock programs allow people who have lost their driver s licences through impaired driving convictions to gain conditional driving privileges by using the device. The objective of this program is to modify the behaviours of drivers who have impaired driving convictions. Latest research seems to indicate that interlocks work best when they are combined with probation or treatment such as counselling or medical monitoring (Voas, Marques, Tippetts, & Beirness, 1999; Longest, 1999). A sample of current interlock trials in North America (Maryland and Alberta) and in Europe (Sweden) are combining treatment, rehabilitation and intensive supervision programs with interlock installation with the intention of increasing the likelihood of long-term behavioural change (Beck et al., 1997; Marques et al., 2001). These programs have yet to be comprehensively evaluated, although early indications suggest that the combination of supportive initiatives with interlock programs provide lower rates of failed start-up attempts and post-interlock recidivism (Marques et al., 2001). It is evident that there are many effective road safety countermeasures for drink driving. Recent research, which may reflect the fact that offenders include more hard core recidivist drink drivers in the post RBT era, suggests that rehabilitation programs can be more effective in reducing alcoholrelated offences and possible crashes, than are licence sanctions. This success most probably reflects their ability to more effectively address the factors contributing to drink driving behaviour. Given that drink driving offenders are a heterogeneous group, the most effective approach to the drink driving problem would be one that uses a multi-strategy approach. There is a need to develop and evaluate systems for managing drink driving offenders that support the complementary use of licence actions and rehabilitation programs. This would enable further research into the development of cost effective processes which are designed to match offenders to the most suitable intervention. In the following section a detailed analysis of the Victorian system of managing drink driving offenders is provided. It is followed by a survey of management policies and practices in other states of Australia. DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA 9

18 3. The Victorian Drink Driver Education Program 3.1 Background Overview Although significant reductions in drink driving have been achieved in Victoria in recent years, drink driving remains a major economic, social and public health problem. The monetary cost to the Victorian community each year for accidents involving recidivist drink driving is approximately $81 million. In 2001, 24 per cent of all drivers and riders killed in Victoria had a BAC of 0.05 or more, with repeat drink driving offenders being responsible for 22 fatalities and 560 injuries each year (VicRoads, 2002). Since the late 1980 s there has been a steep decline in the number of alcohol-related deaths involving drivers and motorcyclists. In 2002, a total of 72 drivers and motorcyclists were killed with a Blood Alcohol Concentration (BAC) of 0.05 g/100ml and over (TAC, 2003). Over half of these drivers and riders were more than three times over the legal limit (TAC, 2003). Since the introduction of Random Breath Testing (RBT) in Victoria in 1976, but particularly since its re-structuring in 1989, there has been a dramatic reduction in drivers killed over In late 1989, an initiative which involved a substantially different method of RBT enforcement compared with past operations was introduced. Bus-based RBT stations using highly visible Booze Buses largely replaced car-based stations, and a multi-million dollar, statewide anti-drink driving publicity campaign through all mass media, was launched in mid December 1989, and reinforced throughout 1990 and 1991 (Drummond, Sullivan & Cavallo, 1992). Designed to both heighten perceptions of extended enforcement and sensitize the public to the consequences of drink driving, this campaign was the cornerstone of public perceptions of the program (Drummond, Sullivan & Cavallo, 1992). In 1977, 49% of all drivers killed were found to be in excess of 0.05% and in 1992 that figure was reduced to an all time low of 21%. The progressive introduction nationwide, has seen it intensified and refined to be one of the most extensive programs for mass breath testing of drivers worldwide (FORS, 1998). Evaluations conducted by Monash University Accident Research Centre (MUARC) have shown substantial reductions in road trauma in Victoria due to increased RBT using booze buses and the new speed camera program, each supported by the Transport Accident Commission (TAC) advertising (Newstead, Cameron, Gantzer, & Vulcan, 1995). A study of recidivist drink drivers in Victoria indicated that the offender profile is predominantly males, aged between years, whose blood alcohol levels increased with subsequent offences (Moloney & Palaia, 1997). Results from this study suggest that over 30% of these recidivist drink drivers had one or more previous convictions, and almost 11% had two or more previous convictions (Moloney & Palaia, 1997). Many of these characteristics may be linked with serious and long-term alcohol dependency. There are two models or approaches to the implementation of rehabilitation currently being used in Australia. The first is a penalty approach in which an offender is required as part of the sentencing for the index offence to undertake a rehabilitation program. The second model is that is used in Victoria in which rehabilitation is independent of the sentencing system but is an administrative requirement for re-licensing. The Victorian program is managed through the courts and is a compulsory requirement for the subgroup of offenders who wish to have their drivers licence re-instated. Prior to 1990, it was not compulsory for the majority of convicted drink drivers who had their licence disqualified to attend a drink driver education program as a prerequisite for re-licensing (Hennessy, 1998). Alcohol interlock legislation came into effect on 13 th May 2002 in Victoria and the law applies to repeat offenders and some serious first time offenders who commit an offence on or after this date. 10 RACV RESEARCH REPORT NO 05/01

19 Approaches used in the U.S. where most program evaluation has been undertaken, appear to be of the former type though with mandatory application. It is likely that both these models are accessed by different types of offenders and this in turn probably has a direct impact on the measured effectiveness of programs. The Victorian program is most likely to attract those persons who are eligible for re-licensing and motivated to stay in or rejoin the system rather than drive unlicensed. It is also more likely to attract persons who are employed or seeking employment in a position that requires a licence. The current Victorian system which is designed to attract persons who do not want to drive unlicensed, the proactive and self-directed natured of accrual toparticipation in the programs may exacerbate the numbers who elect to drive without ever going through the process of rehabilitation and re-licensing. It leaves unresolved the important issue of the identification and management of those persons who do not complete these programs unresolved Rationale Although significant reductions have been achieved in Victoria in recent years, drink driving remains a major problem. Each year: drink drivers cause approximately 20% of all fatalities recidivist cause approximately 5% of the annual road toll (an average of 22 fatalities) on average 220 road users are seriously injured and an estimated 340 suffer minor injuries as a result of drink driving accidents caused by recidivists (Victorian Government, 2002). In Victoria, drink driving education programs provide a service for a majority of drink drivers who will apply for licence restoration, some of whom do not require a court order for restoration. Prior to 1990, it was not compulsory for the majority of convicted drink drivers who had lost their licence to attend a drink driver education program as a pre-requisite for licence restoration. However, attendance at an education course was compulsory for offenders under the age of 21 and was strongly recommended by court staff to other offenders to enhance their chance of obtaining a licence restoration order by a magistrate to regain their licence. Thus, attending an education program had become well-established in Victoria as a procedure in the licence restoration process for convicted drink drivers. In 1987, the Victorian Parliamentary Social Development Committee recognised the need for an evaluation of the drink driver education courses and held an inquiry into the management of convicted drink drivers in Victoria (Hennessy, 1998). In response to this inquiry, compulsory drink driver program attendance and re-licensing assessments were introduced from 1 st October 1990 for certain convicted drink drivers apprehended with a BAC above the prescribed limit. Since the introduction of the program in 1990, approximately offenders complete education courses and/or assessments each year (Department of Human Services, 1998) Legislation There are a number of different kinds of drink driving offences in the Victorian Road Safety Act Such offences include: driving under the influence [Section 49(1) (a)] driving while exceeding the prescribed concentration of alcohol [Section 49 (1) (b)] Failing the test offences [Section 49 (1) (f) and (g)] refusing to provide a breath or blood sample or to stop at a Random Breath Test (RBT) station [Section 49(1) (c), (d) and (e)] (VicRoads, 2002). On October 1 st 1990, the Victorian Road Safety Act was amended to contain provisions requiring drink driving first offenders and recidivists to undergo assessment and/or attend a drink drive DRINK DRIVER REHABILITATION AND EDUCATION IN VICTORIA 11

20 education course as part of their licence restoration process (Department of Human Services, 1998). This amendment stated that offenders must follow procedures under Section 50(4B) of the Road Table 1 Guidelines for re-licensing drink driver offenders Offence Requirements One offence 1, One offence 1, One offence 1, One offence 1 Second or BAC of BAC of BAC of of at least more , or offence 3 within non-bac 10 years driving offence 2 10 Demerit Yes (when No No No Only if your Point licence has BAC was less not been than 0.05 and cancelled 4,5 ) the Court does not cancel your licence Education Yes, if under 25 Yes, if under 25 Yes, if under 25. Yes, if under 25. Yes, if under 25. Course If not, check If not, check If not, check with court with court with court Assessments No No No Yes Yes Licence No No Yes Yes 5 Yes Restoration Order (LRO) 4 and Z condition 5 Alcohol Interlock No No No Court decides Yes 6 licence condition (when re-licensed) Source: VicRoads, (2005) The Next Step for Driving Offenders, VicRoads. 1 You have no prior offences, or the prior offence is more than 10 years old at the time of application. 2 Non-BAC drink driving offences include driving under the influence of alcohol, refusing to provide a test sample, and refusing to stop at a breath testing station or to co-operate in the conduct of the test. These requirements also apply to drivers found guilty of manslaughter, culpable driving causing death, dangerous driving causing death or serious injury where alcohol was a contributing factor. 3 You have at least one prior offence within the last 10 years at the time of application. A second or more offence is one where there is a prior offence within the last 10 years at the time of application. Prior offences include all drink driving offences including interstate ones; and: culpable driving causing death dangerous driving causing death or serious injury, and negligently causing serious injury, where alcohol was a contributing factor. These count as prior offences whether or not a conviction was recorded. 4 For more information on how to apply for an LRO contact your local Magistrates Court. 5 If the LRO is not subject to an I condition (that you only drive a vehicle fitted with an alcohol interlock), then your licence permit will be subject to a Z condition for 3 years. This restricts you to zero BAC when driving. If the LRO is subject to an I condition you will be restricted to zero BAC when driving for 3 years, or until the I condition is removed, whichever is longer. 6 If your licence was cancelled on or before 13 May 2002, the court will decide whether you have an interlock condition on your licence. 12 RACV RESEARCH REPORT NO 05/01

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