The neuroscience of recidivism in DWI offenders: implications for prevention and intervention

Transcription

1 The neuroscience of recidivism in DWI offenders: implications for prevention and intervention Marie Claude Ouimet 1, Thomas G. Brown 2,3, Robyn Robertson 5, Farah Averill 2 Marie.Claude.Ouimet@USherbrooke.ca 1 University of Sherbrooke, Longueuil, Quebec, Canada; 2 Douglas Mental Health University Institute, Montreal, Quebec, Canada; 3 McGill University, Montreal, Quebec, Canada; 4 Traffic Injury Research Foundation, Ottawa, Canada ICADTS, August

2 Goals of the Presentation Expose how actual laws appeal to logical decision making and favor punishment over rehabilitation Show how results of our studies suggest why these laws might not be effective with recidivists Discuss if interlock and evaluation/treatment interventions can be both conceived as punishment and rehabilitation promising interventions used with other population with treatment adherence and persistent problem behavior

3 DWI Laws and Regulations: Appeal to Logical Decision Making Process Deterrence Fear of (long-term) negative consequences (DWI arrests/convictions) will refrain people from DWI (Long-term) negative consequences = more weight in deciding not to DWI than positive shortterm benefits (driving home from the bar) Regulations for relicensing If convicted, long-term complex, expensive goal (getting back the license) will be chosen over short-term easy goal (driving without a license)

4 Correctional Dilemma Goals are to punish/sanction and rehabilitate Most programs based on punishment Better balance between both goals How do you rehabilitate in a punitive environment? Reinforcing positive behavior Interlock and evaluation/treatment interventions could both punish and rehabilitate, but they are mostly used as punishment

5 Effectiveness of DWI Laws Laws based on logical decision making (classical theories of criminology) and favoring punishment important decreases in DWI until mid-late 1990 s most people don t drink and drive DWI-related fatalities are, however, more or less stagnant since then Need for innovative strategies? Our research team has focused on neural processes to attempt to understand and prevent DWI

6 Factors Associated with DWI Neural processes Neurocognitive deficits Dysregulation of HPA axis Psychosocial variables: sensation seeking hostility Substance misuse: Alcohol and or drug misuse BAC at arrest Legal: other types of crimes tickets Driving file: tickets crashes DWI Demographics: Males

7 Why the Interest in Neural Processes in DWI Recidivists? In the alcohol domain, neurocognitive deficits and HPA-axis disregulation associated with persistence of problem behavior intervention non-compliance poorer outcome These characteristics apply to recidivists

8 Our Main Research Questions Can neuroscience help us understands why recidivists do not respond to the law as we would like them to? If yes, what are the possible interventions suited for people with neural challenges?

9 Results of 5 Studies

10 Neurocognitive Functioning: Study 1 N = 100 recidivists Memory, visuospatial capacities, and other executive functions Tests such as the Rey Complex Figure Test and the Trail Making Test Results Two thirds of recidivists suffered from neurocognitive deficits More deficits = more DWI convictions Ouimet et al., 2007, AAP, 39,

11 Neurocognitive Functioning: Study 2 n=46 offenders delaying engagement in relicensing programs vs. n = 74 non delayers Similar tests as in Study 1 Results Offenders delaying engagement had more cognitive deficits, more alcohol problem, and were more likely to report drinking and driving (while unlicensed) than licensed non delayers One of main self-report reasons for delay: $ Brown et al., 2008, TIP, 9,

12 Neurocognitive Functioning: Study 3 n= 24 recidivists vs. n = 23 controls Iowa Gambling Task Results Recidivists were found to exercise decisionmaking favoring immediate rather than longterm rewards Maldonado-Bouchard et al., 2010, ICADTS

13 Dysregulation of HPA Axis: Study 4 N=62 recidivists Salivary cortisol Results Attenuated cortisol response best predictor of recidivism status over and above selfreported and biological measures of chronic alcohol misuse Brown et al., 2005, Alcohol Alcohol, 40,

14 Dysregulation of HPA Axis: Study 5 n=41 recidivists vs. n = 11 controls Salivary cortisol Results As in Study 4, low cortisol response linked to higher number of past DWI offences Recidivists had lower cortisol response compared to controls Couture et al., 2008, AAP, 40,

15 Limitations and Sources of Bias Frequency of past DWI convictions may be influenced by non-random effects Participants self-selected into studies Sample mostly Caucasian Low socio-economic status Focus on alcohol vs. other substances Focus on males Cross-sectional retrospective studies Addressed in on-going studies

16 On-Going Studies Study 6: Neurocognitive functioning as a prospective predictor of recidivism: sex and gender differences Preliminary findings (baseline measures): Brown et al., 2010, ICADTS Study 7: HPA-axis dysregulation as a prospective predictor of recidivism Preliminary findings (baseline measures): Couture et al. 2010, ICADTS

17 Discussion

18 What these results may mean? Cognitive deficits could = difficulty for offenders to Choose delayed over immediate reward Inhibit previously rewarded behavior Engage in remedial program Plan and remember alternative solutions to DWI (especially after drinking?) Bio deficits could explain lack of: emotional reaction, enduring negative memory of DWI event, risk aversion These characteristics and lack of $ could explain lower involvement in programs

19 Does That Profile Fit a Logical Decision Making Process? Results suggest that recidivists operate within a very different paradigm than the premises underlying the law i.e., logical decision making process/ classical theories of criminology underlying deterrence, rehabilitation, and relicensing focus mostly on punishment vs. punishment + rehabilitation

20 Rehabilitation and Relicensing: Example of Quebec, Canada Second DWI convictions (BAC 0.08 and 0.16) Total costs = $8000 CDN Lic. suspension after arrest Legal driving Lic. revocation 30-40% Interlock possible until end Left to offenders logical decision making and often conceived only as punishment 50% End Evaluation & treatment Day 1 Mth 3 Mth 8 Mth 14 Illegal driving Mth 32 Mth 44

21 Interventions: Our Results are Consistent with Early mandatory affordable interlock and evaluation/treatment programs for recidivists conceived to both punish and rehabilitate Brief interventions are particularly suited for these phases ICADTS Working Group Alcohol Interlocks, 2001 Effective brief motivational interventions with recidivists, as shown by randomised controlled trials (e.g., Brown et al., 2010) Studying contingency management with recidivists?

22 Positive Reinforcement or Immediate Positive Contingencies Contingency management Use of positive reinforcement to promote adherence to treatment and behavioral improvement Several meta-analysis showing positive results of CM in treatment adherence and outcome for substance use disorder and other behaviors

23 Meta-Analysis of Voucher-based Therapies for Substance Use 30 studies ( ) Outcome: 0.32 (95% CI ) Adherence: 0.15 (95% CI ) Factors associated with increased efficacy immediate voucher delivery greater monetary values Lussier et al., 2006, Addiction, 101,

24 Meta-Analysis of Contingency Management Therapies for Substance Use 47 studies ( ) Outcome: 0.42 (95% CI ) Effective approach for abstinence during treatment Allows clients to benefit from therapy Prendergast et al., 2006, Addiction, 101,

25 Meta-Analysis of Psychosocial Interventions for Substance Use Disorders 34 studies ( ) CM Highest effect size on outcome 0.58 (95% CI ) Highest level of adherence (71.5%) Dutra et al., 2008, Am J Psychiatry, 165,

26 Positive Reinforcement and Traffic Safety? (non DWI) Exemples of positive reinforcement for non speeding and non close following (e.g., Mazureck & van Hattem, 2006) Popular approach for increasing safety belt use and child restraints

27 Meta-Analysis of Incentives to Increase Safety Belt Use 34 studies 136 short-term effects (12.0% ± 1.9%) 114 long-term effects (9.6% ± 1.2%) Factors increasing effect size Immediate reward Factors not related to effect size Amount of $ Hagenzieker et al., 1997, AAP, 29(6),

28 Positive Reinforcement and DWI Recidivists? One rare example: Refundable deposit of $50 Randomised controlled trial Experimental group: treatment + $5 for each session attended and completion of weekly drinking forms; if non attendance $5 given to the Fraternal Order of Police Control group: treatment + no incentive Experimental group: higher attendance and higher completion forms Ersner-Herschfield et al 1981, Beh Res Therapy, 19,

29 Positive Reinforcement and DWI Recidivists? For offenders, the word reinforcement is often a synonym of punishment avoidance Examples: if you install the interlock You will benefit from a reduced period of license suspension You won t go to jail or be under house arrest Can we consider studying contingency management (positive reinforcement) with recidivists?

30 Conclusion Results of our studies support the examination of approaches that emphasize reinforcement for positive behavior in addition to punishment Research is needed to demonstrate efficacy and effectiveness of positive reinforcement on recidivists treatment adherence (interlock program and evaluation and treatment) and outcome (lower DWI)

31 Conclusion If positive reinforcement is proven effective, costs-benefits analyses will be needed Cost of DWI, driving unlicensed, alcohol consumption, etc. vs. cost of reinforcement program Use of reinforcement with recidivists Will require important paradigm shift from main focus on punishment to focus on punishment and rehabilitation (linked positive reinforcement)

32 References Brown, T.G., Dongier, M., Ouimet, M.C., Tremblay, J., Chanut, F., Legault, L., & Ng Yin Kin, N.M.K. (2010). Brief Motivational Interviewing for refractory DWI offenders not participating in mandated DWI intervention: a randomized controlled trial. Alcoholism: Experimental & Clinical Research, 34(2), Brown, T.G., Gianoulakis, C., Tremblay, J., Nadeau, L., Dongier, M., Ng Ying Kin, N.M.K., & Ouimet, M.C. (2005). Salivary cortisol: A predictor of convictions for driving under the influence of alcohol? Alcohol and Alcoholism, 40(5), Brown, T.G., Ouimet, M.C., Nadeau, L., Lepage, M., Tremblay, J., Dongier, M., Ng Ying King, N.M.K. (2008). DUI offenders who delay relicensing: A quantitative and qualitative investigation. Traffic Injury Prevention, 9(2), Brown, T.G., Ouimet, M.C., Nadeau, L., Gianoulakis, C., Lepage, M., Tremblay, J., Dongier, M., & Ng Ying King, N.M.K. (2009). From the brain to bad behaviour and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol. Drug and Alcohol Review, 28, Couture, S., Brown, T.G., Ouimet, M.C., Gianoulakis, C., & Carbonneau, R. (2008). Hypothalamic-pituitary-adrenal axis response of driving to stress in male DUI recidivists. Accident Analysis and Prevention, 40(1), Dutra, L., Stathopoulou, G., Basden, S.L., Leyro, T.M., Powers, M. B., & Otto, M.W. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. American Journal of Psychiatry, 165, Ersner-Herschfield, S.M., Connors, G.J., & Maisto, S.A. (1981). Clinical and experimental utility of refundable deposit. Behaviour Research and Therapy, 19,

33 References Hagenzieker, M. P., Bijleveld, F. D., & Davidse, R. D. (1997). The effects of incentives to stimulate safety belt use: a meta-analysis. Accident Analysis & Prevention, 29(6), ICADTS Working Group on Alcohol Ignition Interlocks (2001). Alcohol Ignition Interlock Devices I: Position Paper. International Council on Alcohol, Drugs and Traffic Safety (ICADTS). Lussier, J.P., Heil, S. H., Mongeon, J. A., Badger, G. J., & Higgins, S. T. (2006). A metaanalysis of voucher-based reinforcement therapy for substance use disorders. Addiction, 101, Mazureck, U., & van Hattem, J. (2006). Rewards for safe driving behavior influence on following distance and speed. Transportation Research Record, 1980, Maldonado-Bouchard, S., Brown, T.G., & Nadeau. L. (2010, August). Multiple DWI offenders show poorer decision making performance than healthy controls. Presented at the Conference on the International Council on Alcohol, Drugs and Traffic Safety, Oslo, Norway. Marques, P. R., Voas, R. B., Tippetts, S., & Beirness, D. J. (1999). Behavioral monitoring of DUI offenders with the Alcohol Ignition Interlock Recorder. Addiction, 94(12), Ouimet, M.C., Brown, T.G., Nadeau, L., Lepage, M., Pelletier, M., Couture, S., Tremblay, J., Legault, L., Dongier, M., Gianoulakis, C., & Ng Ying Kin, N.M.K. (2007). Neurocognitive characteristics of DUI recidivists. Accident Analysis & Prevention, 39, Prendergast, M., Podus, D., Finney, J., Greenwell, L., Roll, J. (2006). Contingency management for treatment of substance use disorders: a meta-analysis. Addiction, 101,

34 Granting Agencies Team grant: Canadian Institutes for Health Research (CIHR): Team In Transdisciplinary Studies In DWI Onset, Persistence, Prevention And Treatment Specific studies: Canadian Institutes for Health Research (CIHR) Canadian Safety Council Fondation for Alcohol Research (ABMRF) Fonds québécois de la recherche sur la nature et les technologies, Ministère des transports du Québec, Société de l assurance automobile du Québec Fonds québécois de la recherche sur la société et la culture Career award to first author: Fonds québécois de la recherche en santé

35 QUESTIONS?