Internationally Recognised Best Practices for Drink Driver Rehabilitation and Drink Driver Rehabilitation in New Zealand

Transcription

1 Internationally Recognised Best Practices for Drink Driver Rehabilitation and Drink Driver Rehabilitation in New Zealand Gerald Waters 2012 Reducing Impaired Driving in New Zealand

2 Contents Foreword...2 Acknowledgements.3 Drink Driver Rehabilitation.4 Best Practice Characteristics of Effective Drink Driver Rehabilitation Programmes. 5 Assessment and Screening..5 DDR Methods...7 DDR Programme Effectiveness 10 DDR Programme Evaluation..10 Summary I..11 Drink Driver Rehabilitation Programmes in New Zealand.13 Overview of DDR Programmes available in New Zealand at a glance...29 Alcohol Ignition Interlocks and Rehabilitation..30 Other Drug Driving.31 The LTSA Assessment 33 Re-offending rates 33 A brief critique of steps in the license reinstatement process 34 Summary II 39 References.40 Page 1

3 Foreword This paper looks at current Drink Driver Rehabilitation (DDR) programmes available in New Zealand and investigates the available literature of internationally recognised best practice methods in this area. This paper will also look at the assessment process used under section 65 of the Land Transport Act that enables drivers who are given an indefinite disqualification to re-sit their test and re-apply for their licence after one year and one day. Also discussed is the use of alcohol ignition interlocks when combined with rehabilitative efforts and drug impaired driving. Page 2

4 Acknowledgements RIDNZ would like to thank all those who provided information for this paper both in New Zealand and worldwide including: New Zealand Transport Agency Ministry Of Transport Ministry of Justice Centre for Accident Research and Road Safety Queensland Pacific Institute of Research and Evaluation Dr David Timken Special thanks to Michelle Jackson MA HSc (Hons), contributing researcher, and Rachel Bowie, research compiler, for their help and support in the construction of this paper. Page 3

5 Drink Driver Rehabilitation Substance impaired driving is a major road safety problem in New Zealand and refers to driving under the influence of alcohol and other drugs or combinations of both. There is ample research on alcohol impaired drivers but more is needed on the involvement of other drugs.. The aim of this paper is to provide a review of initiatives and best practice of attempts to rehabilitate alcohol involved offending and reduce repeat drink driving. Drink driving rehabilitation (DDR) refers to a wide range of initiatives for offenders that attempt to reduce repeat drink driving (Ferguson et al, 2001). DDR programs can make use of psychotherapy/counseling to treat alcohol problems or education on the hazards of drink driving - or a combination of both. DDR programs also provide offenders with knowledge on the harm of excessive alcohol consumption and attempt to reduce the offenders drinking levels (Wells-Parker, 1994). The main objective of these programs is to separate drinking from driving by providing the offenders with skills and strategies to stop their drink driving behaviour (Popkin, 1994; Wells-Parker, 1994). Earlier research suggested the use of DDR programmes could reduce repeat offending by 7-9% (Wells- Parker, 1994). More recent data from Europe shows on average a reduction in re-offending of 45.5% can be achieved. (Boets et al, 2008). Programs that use a combination of education and psychotherapy/counseling along with some method of follow-up contact have been found to be the most effective in reducing repeat drink driving (Sheehan et al, 2005). In New Zealand almost one third of convicted drink drivers have a previous offence for drink driving. This figure is similar to observations in other countries (Sweedler & Smith, 1984). Reduced re-offending is a desirable goal not only from a road safety perspective but it also reduces the financial and personal cost to the individual offender and to society. Reducing excessive consumption can also have a positive impact on other areas of an offender s life (Stewart & Ellingstad, 1989). The literature reviewed included worldwide meta-analysis studies from The United States, Canada, Europe and Australia. It reveals that drink drivers are a heterogeneous group; there is no one common denominator (Sheehan et al, 2005). Drink drivers may be binge drinkers or may meet criteria for dependence as well as displaying a myriad of other problems that affect their everyday lives and influence their decision making (Ferguson et al, 1999). Best Practice characteristics of Effective DDR Programs Drink drive programmes need to identify the strengths/weaknesses of individual offenders, the severity of their problems and the level of intervention required. Best practice requires two or three levels of intervention with more education based responses at the lower end and intensive treatment responses for those at higher risk (Health Canada, 2004). Distinctions are often made between: First offenders or offenders who don t (yet) meet criteria for a drinking problem. Offenders who meet criteria for alcohol or drug abuse. Page 4

6 Offenders with serious substance use problems or dependency Programs should be linked to characteristics of the offender (Sheehan et al, 2005). Factors to determine classification may include: The number of previous convictions for drink driving The number of convictions for other kinds of criminal offending The severity of the drinking problem (abuse or dependence) The presence of mental health or personality problems The BAC level at time of detection Whether the driver was unlicensed at time of detection Reports show that unlicensed drivers are twice as likely to be involved in a serious injury crash than licensed drivers (Federal Office of Road Safety; FORS, 1997; Watson, 1997). The evidence suggests that the unlicensed recidivist offender is over represented in serious alcohol related crashes and more likely to have a serious drink driving problem (Sheehan et al, 2005). DDR interventions must be practical in terms of their availability and costs and consistently related to offender typographies (Boets et al, 2008). Assessment and Screening An assessment to evaluate the severity and extent of an offender s alcohol/ abuse problems should ideally take place prior to sentencing (Sheehan et al, 2005). The use of early assessment and/or screening allows judges to combine individual treatment into an offender s sentencing (Ericson, Freeman & Modeen, 2010). Generally, the justice sector accounts for nearly half of all referrals to community based treatment programs (Anglin et al, 1998). Community based DDR programmes (as opposed to treatment in prison) are generally the most effective method of providing DDR (McGuire et al, 1995). Assessments for drink drivers should include the possibility of co-existing mental health disorders in addition to alcohol and drug problems. (Chang, Gregory & Lapham, 2002). DDR programmes use both screening and assessment at the initial stage of intervention.. Screening generally refers to the use of brief questionnaires (such as the AUDIT or the DAST) to ascertain if the offender has a drinking or drug problem which requires further investigation. A more comprehensive assessment is conducted if screening indicates the need for it. Recently there has been a fusion of screening and assessment to create a one-step evaluation process (Ericson, Freeman & Modeen, 2010). The whole process comprises three main activities: Testing Using self report tools (screening questionnaires) to gauge the level of alcohol and other drug use and co-occurring disorders Assessment One on one interview by trained personnel. This includes a review of the offender s screening tests, investigation into the circumstances surrounding the arrest and Page 5

7 into the offender s personal, family, medical or legal problems which may complicate treatment Referral to an appropriate programme. This approach however may cause some problems with regard to the hard core offender who requires a more thorough approach to interrupt their addiction patterns (Robertson et al, 2008). There is no accepted definition of hard core offender it is vague and misleading and implies this is someone who is not like the rest of us. For a thorough summary of the problem read Hardcore Drinking Drivers and Other Contributors to the Alcohol-Impaired Driving Problem: Need for a Comprehensive Approach. (Williams et al, 2007). The use of screening to differentiate between different categories/typologies of offender is the first step to determining the extent of the offenders alcohol problems and at what level any form of intervention should take if necessary. The purpose of screening is to indicate the level of alcohol problems that may be present.the use of screening itself can also be considered a form of treatment as involvement in this process can have therapeutic benefits (Donofrio & Degutis, 2002; Wells-Parker & Williams, 2002). Screening should also address other drug use and mental health disorders that co-occur frequently with alcohol use disorders (Lapham, 2005). Screening can also be used during treatment to monitor the progress of the offender during this process. Studies show that screening, even briefly, should occur before conviction for repeat offenders (NHTSA & NIAAA, 1996). The two main reasons for this are firstly monetary using low-cost brief screening before conviction lessens the expense of a full assessment to an offender who is not in need of alcohol treatment and saves money by reducing repeat offending if this process identifies the need for treatment (Ericson, Freeman & Modeen, 2010). Secondly, the sooner repeat offenders come into contact with referral to substance abuse treatment the less likely they are to reoffend (Century Council, 2003). DDR programmes differ in how they evaluate offenders. Some programmes use a simple screening method by way of a brief questionnaire to decide if the offender should be directed to education or treatment (Lapham, 2005) but most screening programmes use both interviews and self report questionnaires (Chang et al, 2002). While there is evidence to suggest that coerced alcohol treatment can have similar reductions in illegal activity and alcohol use as those who enter treatment voluntarily (Hubbard et al, 2002; Summers, 2002) there are offenders who resist the process and under report their alcohol and other problems (Knight et al,2002; Chang & Lapham, 1996). This can make it difficult to accurately gauge the severity/level of the offenders problems (Chang et al, 2001). Well trained interviewers may be more able to elicit more accurate results (Lapham, 2005). The cost of such training though is unaffordable to many programs (Knight et al, 2002). Page 6

8 There are a multitude of standardized instruments used in the screening process involved in DDR programmes. 1 Not all of these instruments are directly related to drink drivers but mostly to alcohol use. Some instruments such as DRI, RIASI and SALCE were developed specifically for drink drive offenders (Chang, et al, 2002). Since Drink driving offenders are well known for their underreporting of alcohol use screening should also include some method of corroboration or biochemical testing (Chang, et al, 2002). The knowledge that self reported information will be backed up by such testing may also ensure more accurate and truthful reporting (Boets et al, 2008). The outcome of a Screening and/or assessment can be effectively used to divert the three offender types described earlier to either: Education - for low risk offenders Rehabilitation - Higher risk offenders Treatment of alcoholism for alcohol dependant offenders We will next look at the DDR methods used internationally for high risk offenders. DDR Methods The literature reveals that DDR programmes can take on a variety of forms. The most common components of DDR programmes use education and psychotherapy/counselling or a combination of both. The use of education-based programmes work on the assumption that the drink driving offence was caused by lack of knowledge (Ferguson et al, 1999). Reducing the drink drivers level of harmful alcohol consumption is addressed by programmes using psychotherapy/counselling. A combination of both these initiatives is recognized as being most effective for DDR programmes (Wells-Parker et al, 1995). Brief Intervention Brief interventions (BI) have been shown to reduce excessive alcohol consumption, are inexpensive, and should be included as part of any DDR programme (Sheehan et al 2005). Many studies show that brief interventions are effective, cost efficient and easy to administer (WHO, 2010). Education-Based Programmes The theory behind the use of educational programmes is that individuals drink and drive because they make poor decisions due to lack of knowledge (Popkin, 1994). The main focus of these programmes is to provide information about alcohol and the risks and effects of alcohol in relation to drink driving (Popkin, 1994; Sanson-Fisher et al. 1990). Education programmes attempt to break the connection between drinking and driving and not the offenders alcohol problems (Hall, 1997). 1 Overviews of the most common screening tools used can be found here: BehavioralHealth%2FDocument_C%2FCBONAddLinkView&cid= &pagename=CBONWrapper Page 7

9 Psychotherapy/Counselling Programmes Psychotherapy/counselling programmes work on the assumption that the offenders drink driving is a result of alcohol problems that may impact on many areas of their lives (Sadler et al, 1991). Many DDR programmes make use of Motivational Interviewing (MI) techniques that try to encourage the offender to accept their alcohol problems and understand the need for treatment. Motivational Interviewing allows professional staff to build a good rapport with the offender and try to get them to change on their own (Brown et al, 2010). Cognitive Behavioral Therapy (CBT) is a form of psychosocial therapy that attempts to reduce problematic behavior by dealing with thoughts and beliefs through psychotherapeutic approaches (Beck, 1993). The ultimate goal is to change an individual s behavior by changing their thoughts. Many studies support the use of CBT in treating alcohol abuse (Robertson & Holmes, 2011). Cognitive-behavioral treatment is the key approach for implementing learning and change (Timken, 2012) 2. Other Factors Involved in DDR Programmes The literature on Interventions to reduce repeat offending include the use of the principles of risk, need and responsivity (Andrews, 1994). Reductions in repeat offending of 25 to 20 percent have been suggested when treatment programs also involve the use of relapse prevention alongside the principles of risk, need and responsivity (Gendreau et al, 1996). The identification of personality traits that motivate high risk drivers need to be identified and considered in a DDR programmes development (Curtis & Meehan, 2003). Risk factors include: Prior driving records: Higher amount of records, the higher the risk of repeat offending Gender: Males are higher risk to drink drive and to re-offend Age: Alcohol re-offenders tend to be younger at the first offence than those who do not reoffend Those who show multiple risk factors require special attention as the more risk factors that are involved the higher the risk of repeat offending (Boets et al, 2008). As well as substance abuse, personality traits that motivate high risk drivers included: (Gendreau et al, 2002; Boets et al, 2008). Rebelliousness Lack of empathy Defiance of authority Non-conforming ideas (frequently anti-social) Weak problem solving skills Impulsivity Low levels of moral reasoning The extent to which drink drive offenders differ in their substance abuse and other factors that are involved in drink driving repeat offending require different levels of intervention (Health Canada, 2004). 2 Correspondence with Author, David S. Timken, PhD, is the Director of the Center for Impaired Driving Research and Evaluation in Boulder, Colorado Page 8

10 A report on the State of the Art on Driver Rehabilitation: Literature Analysis & Provider Survey carried out by DRUID (Driving under the Influence of Drugs, Alcohol and Medicines) in 2008 stated that: A combination of different approaches, as it is often used in clinical practice, provides the advantage to simultaneously address different factors and levels of influence. CBT offers a comprehensive treatment, including the modification of triggers and reinforcing consequences, the development of skills to deal with risk situations and to find alternative ways of coping with these risks. MI and BI can be used to increase the client s problem awareness and his intention to change and can thus be used to strengthen and maintain motivational processes at the beginning and during the course of treatment. 12-step programmes as realized e.g. by AA- or NA-meetings provide social support and help the patients to stay away from their former drinking and drug environment, which may especially be important in outpatient treatment settings or in the aftercare treatment of inpatient settings. (Page 267) Follow on care was also mentioned for all drink drive offenders sent on DDR programmes as a mandatory requirement for licence reinstatement (Health Canada, 2004). By targeting the high risk offenders and the associated needs and attitudes of drink driving behavior DDR programmes are likely to be more successful (Ferguson et al, 1999). Youth offenders were also recognized in the literature as maybe needing different focal points in DDR programmes (Boets et al, 2008). Social Factors Involved in DDR Programmes The involvement of social factors and behaviours that usually surround the drink driver and the negative effects of their behaviour include: Learned drinking behaviours through family influences Multiple social and personal problems Anti-social peers Social relationships with family and friends Marital problems By contrast the involvement of supportive relationships within an offender s circle of friends and family may reduce the potential to offend and even stop instances of drink driving. Friends and family members may provide positive reinforcement to rehabilitation efforts (Ferguson et al, 1999). DDR Programme Integrity and Training Treatment that is conducted with dedicated staff in a structured manner and in accordance with the principles of risk, need and responsivity, that have been outlined for the programme, are key to a programmes integrity (Bonta, 2001). It has also been noted that all those involved in the provision of rehabilitative efforts to drink drivers should be trained not only in substance use issues but also adult education, especially those that have education as their foundation. Training for group facilitation should also be included, especially for those who are using more therapeutic interventions (Health Canada, 2004). National training opportunities should also be supported for those providing rehabilitative efforts for drink drivers (Health Canada, 2004). Page 9

11 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). (Sheehan et al, 2005). Addiction and literacy problems have been shown to be the most frequent reasons for excluding participants either before or during a DDR programme (Boets et al, 2008). DDR programmes should have: Clearly stated realistic course objectives Identifiable course content in relation to desired knowledge, attitude and behavioural changes hoped for Interactive teaching strategies (Curtis&Meehan,2003). Cultural Factors Involved in DDR Programmes In the paper Drink Driver Rehabilitation and Education in Victoria, 2005 the authors stated that: 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). This would be appropriate wherever similar offender cultural issues may arise. DDR Programme Effectiveness In a meta- analysis study on DDR programmes by Wells-Parker et al. (1995), it was found that DDR had a positive but small influence (7-9% reduction) on reducing repeat offending. However more recent data from Europe shows that on average a reduction of 45.5%, for group intervention DDR programmes with a variation ranging from 15.4% and up to 71.9% has been achieved (Boets et al, 2008). DDR programmes have also been shown to have longer lasting effects than other sanctions for drink driving (Ferguson et al, 1999). DDR Programme Evaluation The literature reveals that evaluations of DDR programmes are Plagued with methodological problems (Ferguson et al, 1999). However, evaluation should be an integral part of any DDR programme (Health Canada, 2004). The lack of control groups used in evaluations because of the ethical considerations of providing treatment to all those who need it makes systematic evaluations of DDR programmes difficult. (Sheehan et al, 2005). Recent evaluation methods are mainly based on the repeat offending rates of those who have completed a DDR programme but since most DDR programmes are only part of an intervention, along with licence sanctions and other conditions imposed, reoffending rates may not reflect the effectiveness of the DDR programme (Sheehan, et al, 2005). Low detection rates may also impact on the use of reoffending as an evaluator measure (Mills et al, 2008). Other aspects that should be taken into consideration to evaluate a DDR programmes effectiveness may include health, alcohol use, lifestyle and attitudinal changes (Ferguson et al, 1999). DDR Page 10

12 programmes that have focused on these lifestyle issues have been shown to have a positive effect overall (Wells-Parker et al, 1995). 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). (Sheehan, et al, 2005). The RACV paper Drink Driver Rehabilitation in Victoria, 2005 notes that the cost effectiveness of any evaluation should also take into account: Estimated loss of productivity due to injury or death Property damage Medical, legal, employer, prison and funeral costs Police and emergency costs Overall economic impact on family and community Summary Effective DDR programmes were seen to include: Screening and assessment that diverted offender types to appropriate intervention Use appropriate instruments in screening process having two or three levels of DDR intervention use a combination of education and psychotherapy/counseling along with some method of follow-up contact Take place within the community Factors influencing adult learning to maximise learning outcomes for participants Involve supportive relationships within an offender s circle of friends and family Take into account cultural issues Take into account offender risk/needs Use relapse prevention Use interactive techniques Clearly stated goals and aims Appropriate level of training Evaluations that include multiple measures Page 11

13 Impaired driving is a serious problem in New Zealand. Recognising that more needed to be done the Government, in 2011, allocated $1 million towards drink driver rehabilitation. The effort is towards reducing the harm from drink driving. The Ministry of Health is looking at ways in which this money can be used effectively. The following is a brief overview of programmes currently available in New Zealand. Page 12

14 Drink Driver Rehabilitation Programs Currently Available in New Zealand Whilst there are many providers who will attempt treatment/rehabilitation as part of a general approach to AOD problems for drink drivers, we have identified 8 programs that are specifically designed for drink drive offenders: 1. Ashburton Driving While Impaired Programme (Ashburton)* 2. Drink Drive Programme Nelson (Nelson) 3. Drive Soba Programme (Whangarei) 4. Driving Forward / On the Road (Auckland, Christchurch, Hamilton, Waikato, Wellington)** 5. One for the Road (Auckland) 6. Stopping Drinking and Driving Programme (Manurewa) 7. The Repeat Drink Driving Interventions Programme (Wellington)*** 8. The Right Track (Auckland, Hamilton) *A programme using the Ashburton model has also been run at Rangiora since last year **No detailed information was available for these programmes *** This programme is also being used by Odyssey House in Christchurch Page 13

15 Ashburton Driving While Impaired Programme The Ashburton Community Alcohol and Drug Service (ACADS) established this educational and therapeutic treatment programme in 2005 to change the behaviour of drink drivers and reduce the number of recidivist drink driver convictions in Ashburton. So far twenty three Driving While Impaired programmes have been run by ACADS. Groups range from between 4 to 11 participants. The Ashburton DWI programme encompasses the principles of criminogenic risk, criminogenic need, responsivity, treatment integrity and relapse prevention. The programme is facilitated by a trained & qualified ACADS Alcohol & Drug counselor and a ACADS Public Health workers. Facilitators are trained in group work and facilitation skills as well as the theory behind the programme and programme content. New facilitators are screened prior to training to determine suitability and training needs. Facilitators are observed directly and provided with feedback on their delivery of the session. The selection criteria and training for the programme are intensive. PARTICIPANTS To be involved in the programme, participants must repeatedly drive after drinking or have had a very high breath or alcohol level. They may be referred through the Community Probation Service, lawyers, the Courts, the Police, ACADS clinical service or self-referrals. Participants are screened using the Audit tool & complete an alcohol & drug assessment before undertaking the programme. OVERVIEW The DWI programme is a structured group and the programme is broken into six sessions consisting of one and a half hour sessions once a week. The participants must attend all six sessions to complete the programme. Group sessions are partly educational but have the scope for deeper exploration of values and processes. Participants engage in meaningful discussions guided by facilitators, which lead them to make positive decisions and choices. Individuals develop personal skills relative to lifestyle changes using a lifestyle audit. Group members complete a lifestyle journey booklet using a set process to write aims and objectives to work towards during the week. Participants are assessed throughout the course. if it is deemed appropriate they may be referred back to their ACADS counselor for one on one counseling sessions to provide extra support while they are Page 14

16 completing the programme Several DVD s are shown over the course highlighting drinking patterns and behaviours and the effect of drink driving on the self and others. Facilitators engage group members in self-reflective thought, exercises and role play to heighten participant s awareness of the impact of their actions. Participants maintain a drinking diary, complete questionnaires and alcohol education exercises where participants identify their personal attitudes, strengths and skills. Participants are encouraged to attend a follow up session after completing the programme with their councillor. Some may continue with counselling, others are encouraged to contact the service in the future if they need help. PARTICIPANT EVALUATION Participants keep a drinking diary throughout the length of the course. A number of questionnaires are administered to participants to monitor changes in their attitudes and behaviour towards drink driving. Participants complete questionnaires at the beginning and the end of the programme. Participants agree to ACADS monitoring for a period of two years to ascertain if they reoffend following completion of the programme. COURSE EVALUATION Exit questionnaires completed by participants provide programme evaluation and at 3,6,12 and 24 months participants are sent follow up questionnaires for them to complete and return. This programme was evaluated for effectiveness in December 2008 by Karen MacKenzie and in 2009 by Bronwen Wood. Page 15

17 Drink Drive Programme Nelson The Nelson based Programme is primarily a drink driver education and training programme. Participants work through their sessions with the use of worksheets and group discussion. Facilitators guide participants through their sessions and support group discussions. Drink driving information is revisited at each session to assist individual learning. Group members benefit from interaction with their peers, guidance from group leaders and regular meetings. The Nelson Drink Driver Education Programme does not formally use MI or CBT to address participant drink driving behaviour. PARTICIPANTS Individuals are referred to the programme where drink driver education and training is deemed an appropriate course of action, however group members are not screened or assessed. OVERVIEW Group learning focuses on the effects of alcohol on the body and health problems associated with heavy drinking. Personal limits for safe drinking are discussed. Participants are asked to reflect on their drinking levels and record their problem solving ideas in an effort to stimulate behaviour change. Group members keep detailed individual drinking logs. Group sessions assist members to highlight their drinking patterns and identify problem areas and drinking solutions. Participants work through role-play situations to assist in the formulation of real life alternatives to drink driving. Participants are given guidance locating alcohol support services. Drug use and driving is discussed and participants use worksheets to identify barriers to change and support options. PARTICIPANT EVALUATION Participants are at each session and in their own time, self-evaluating. Their evaluations are recorded then discussed in the group setting and with facilitators. Ongoing participant evaluation is a key feature of the programme. Page 16

18 COURSE EVALUATION The Nelson Drink Driver Education Programme does not currently provide a Course Evaluation. Page 17

19 Drive Soba Programme The aim of the Drive Soba Programme is to reduce recidivism in recidivist drink drivers and reduce the overall alcohol consumption of those that complete the group. The programme is multi-modal encompassing a combination of cognitive behavioural techniques, alcohol education, motivational interviewing and relapse prevention. The programme is based on the principles of what works to reduce recidivism, the principles of criminogenic risk, criminogenic need, responsivity, treatment integrity and relapse prevention all of which have an impact on reducing recidivism for drink drivers. The DSP operates with the understanding that all principles need to be included for an intervention to be effective. The Drive Soba Programme is a total of 14 sessions, 12 of which are in a group setting and are designed to last two hours and two individual sessions, which are both one hour in length. The last session of the DSP is inclusive of Whanau members. The content of each session is prescribed and structured, staff members are appropriately trained and skilled to deliver the programme. PARTICIPANTS Participants are referred from Judges, Lawyers, Probation, General Practitioners, Police, Family and/or Self. Each offender referred is assessed for suitability. The Risk Principal specifies that treatment should be provided to those at high risk of recidivism for example 3 rd or subsequent EBA or 2 nd offence if under 20. Offenders are assessed in terms of their alcohol use by administering the Alcohol Used Disorders Identification Test (AUDIT) screening tool. (Rated 92% effective in detecting harmful drinking, and accurate across gender and ethnic groups) OVERVIEW The theoretical model of the programme aims to reduce drink driving in recidivist offenders by addressing the following criminogenic needs : Weak problem solving skills and inability to generate alternatives Lack of knowledge about impairment from alcohol and standard drinks, substance abuse Lack of adequate planning Page 18

20 Criminal associates Antisocial Attitudes, values and beliefs Lack of empathy, impulsive behaviour, anger, low self control The responsivity principle refers to what treatment approaches are best used with the offender population. The Drive Soba Programme therefore chooses a multi-modal approach as drink drivers are not a homogenous group. Various methods of delivering Cognitive Behavioural Therapy, Motivational Interviewing as well as varied adult learning principles such as role plays, group work, individual work and kinesthetic learning. PARTICIPANT EVALUATION Participants are asked to provide feedback at the end of each session so facilitators can determine participants learning. Participants are asked to keep a self-monitoring alcohol diary, which is a simple and effective tool of behaviour therapy. This is used to help clients focus on the behaviour they want to change, identify high-risk situations and consequences of their behaviour. Participants are also asked to complete an evaluation form at the end of the Programme which is anonymous. This data is coded and at the end of each year a summary of findings in reported. In addition participants are asked to sign a consent form giving permission for the Programme evaluator to gather information on rates of re-offending for those that have completed or did not completed the DSP. COURSE EVALUATION The programmes with the highest course integrity scores have shown the greatest reduction in recidivism. Facilitators are observed delivering the programme both directly and via video recording to evaluate programme integrity and provide feedback to the facilitators. Evaluations focus on providing well structured programmes that follow the course principles and employ well selected, specifically trained, motivated and supervised staff. In addition to the above the DSP in evaluated by the Consumer Advisors who are part of NDHB. The consumer advisors seek feedback from participants independently from the facilitators during the last session of the Programme. They also contact participants with permission three months post programme to obtain feedback. Page 19

21 One for the Road The One for the Road programme is a brief, intensive, therapeutically based repeat drink driver programme in New Zealand. PARTICIPANTS One for the Road is suitable for people who have a court case pending, have been referred by the court, the police, probation, or are re-applying for their licence under section 65 of the Land Transport Act Clients need not show motivation to change, but must have some motivation to attend a group programme. Participants have relatively high previous drink drive convictions (average 4 plus) compared to overseas programmes, and a high proportion of Maori and Pacific participants. Referrals to the programme come from lawyers, the Police, Probation, Courts, New Zealand Transport Agency, GP s or Alcohol and other drug agencies. Participants will be referred to appropriate agencies if they need ongoing therapy and support. Pre and Post group screening of each participant is completed during the programme using the following alcohol screens. AUDIT (Alcohol Use Disorders Identification Test- pre group only) LDQ (Leeds Dependency Questionnaire pre group only), RTC (Readiness to Change Motivational Screen) and the RODD (a 12 question scale to assess change in drink driving risk during group participation). PROGRAMME OVERVIEW One for the Road consists of a one-hour group assessment with the group facilitator, a six hour daytime group session and a four hour evening session two days later. The group accommodates a maximum of twelve attendees and is led by two qualified facilitators. Facilitators typically hold qualifications in psychology, counselling and social work. Motivational speaker Tamati Paul attends sessions and provides an important catalyst for change. A BI (Brief intervention) approach is run over three sessions. This is designed to develop empathy, discrepancy, support self efficacy, change talk and commitment language. Group therapy sessions involving 12 group members and 2 facilitators are held to achieve a 1:6 ratio. Sessions held over weekends to enable people to relate their learning to their most likely drinking times and to have a real chance to practice homework. Page 20

22 Attendance of support people encouraged to both support and challenge group members. The group is therapeutic and experiential (action and activity) based rather than educational. A resource booklet is provided and DVDs are shown but these are secondary to group process. Therapy processes are drawn from motivational interviewing, CBT (Cognitive Behaviour Therapy), group process, gestalt, transactional analysis, role play and relapse prevention. The group is designed to cater for Pacific and Maori as well as Pakeha participants. Maori and Pacific cultures are represented in the group facilitators and related processes. The group can be delivered at a nominated venue in different locations. PARTICIPANT EVALUATION Harmony Trust systematically collects participant data for all groups and with participant consent reoffending data have been obtained by the programme facilitator from NZTA as at the end of August Qualitative feedback from participants has been collected from group 7 onwards. COURSE EVALUATION Scores on the RTC (readiness to change) and Risk of Drink Driving (RODD) showed improvement between pre and post programme. Feedback from group participants is also highly positive. Longer term evaluation of programme effectiveness is conducted through gaining client consent to access New Zealand Transport Agency records regarding re-conviction rates following group completion. This data collection is ongoing. The results of evaluation have not been compared to a comparison group or other control and therefore limit and conclusions regarding the effectiveness of this intervention in relation to people who have no intervention. Page 21

23 Driving Forward Several attempts were made by telephone and to gather information on this programme run by Care NZ but elicited no response. However some general information was gathered from the internet at Driving forward is a FREE 10 hour treatment course for people who have lost their license because of repeat drink driving. You re probably not thinking about how another offence is going to affect you when you get behind the wheel after having a few. But you can lose more than your license by repeat drink driving jobs, family/whanau, money, friends and your mana. Driving Forward is designed to help you stop drink driving. Held over two sessions participants will cover the following topics: Alcohol and your driving Safe driving and sober fun How drugs effect your driving Also referred to is another programme entitled On the Road which describes itself as follows: If you have been indefi nitely disqualified from driving you might be able to have your license reinstated and get back on the road. CareNZ offer NZTA application assessments for people who are indefinitely disqualified from driving. As part of the process you will be required to attend our driver awareness education programme. Topics covered during these sessions include: Alcohol/drugs and your driving: effects of alcohol on driving Alcohol/drugs and your health: effects of alcohol on the body Safe driving and sober fun The process also requires you to get a blood test and to visit a CareNZ GP. A report will be sent to the NZTA for consideration. To find out more about this process and to see if your application will be funded, contact your nearest CareNZ Community Clinic. Page 22

24 Stopping Drinking and Driving Programme The Stopping Drinking and Driving Programme has aimed to maximise engagement and motivation to change for the 5 years they have so far operated. Participants are encouraged to identify and challenge their own attitudes and beliefs associated with drinking and driving. The programme assists group members in identifying personal factors that influence drink driving behaviour and improve coping skills. The CADS Offender Programme treatment model is based on evidence of best practise in working with pre-contemplative clients, which covers the majority of programme referrals. The Pilot has developed various offender pathways and processes between and within CADS and CPS and is constantly refined. The Programme provides ten by two hour group work interventions based on motivational enhancement and cognitive behavioural strategies. They are designed to encourage behaviour and attitude changes in recidivist drink drivers and address the drinking as well as the driving. The programme operates out of 16 CPS centres and provides Getting Started groups in 12 CPS centres. PARTICIPANTS CADS is approved to assess people sentenced under section 65 of The Land Transport Act 1998, who after serving the mandatory minimum disqualification period wish to have their disqualification removed (as per section 100 of the Act), and to re-apply for their driver licence. It is only available at Community Probation Services for people with current conviction and sentence for third and subsequent driving with Excess Breath Alcohol and referred by their Probation Officer. Participants may be recommended to more intensive treatments or specialist programmes by CADS clinicians if they meet the criteria and agree to the referral. OVERVIEW Three main treatment options are: Option one Getting Started 4 group (Four sessions). Focus on Education, Problem Recognition and Motivation. Option two Getting Started 8 group (Eight sessions). Focus on Behaviour Change. Option three. Stopping Drinking and Driving Group. (Ten sessions) Focus on Behaviour Change. PARTICIPANT EVALUATION Participants may undergo a variety of assessment measures. These may potentially include AUDIT, RDD Attitudes- The Behaviours and Attitudes Drinking and Driving Scale (2007) and Depression measures CES-D. COURSE EVALUATION Page 23

25 Internal reviews have taken place. These have so far resulted in revised pathways for taking into account recommendations from various stakeholders. Page 24

26 The Repeat Drink Driving Interventions Programme The programme aims to provide engagement, information and empathy building for participants. The Repeat Drink Driver Interventions Programme (RDDIP) uses Cognitive Behavioural Therapy and Motivational Interviewing as key tools in the implementation of each session. The programme also includes empathy building sessions using discussion with fire service and a former drink driver who has killed someone. The goals of the programme are twofold. First, to encourage participants to reduce their alcohol consumption. However, it is not an abstinence-based program - unless participants are clearly dependent on alcohol. The second goal is to teach participants to think ahead and develop a plan to avoid drink driving when they intend to drink. Participants are required to develop a written plan describing their high-risk situations and how they propose to avoid impulsive decision-making which leads to drink driving. Participants are screened with AUDIT and an attitudinal scale developed by the programme providers. ENTRY CRITERIA Participants will have a minimum of three convictions for EBA. Clients who meet the criteria for severe dependence may be referred elsewhere. OVERVIEW Each group consists of 12 participants who meet for a weekly 2 hour session for 10 weeks. Each session is reviewed at the beginning of the following session and homework sheets are given at many of the sessions. The sessions cover the following topics over the 10 week programme. Discussion with a previous group member, sharing of personal stories. Discussion of a DVD interview with Frances Stubbs who killed a mother of five. Learning about physical alcohol effects, discussion on the function of drinking. Statistics about alcohol/drugs and drink driving discussed. The impact of drugs on driving and statistics related to the impact of hangover studied. Establishment of personal values, personal strengths, and goal setting. Identification of high-risk situations for drink driving and formulation of a personal relapse plan created. Discussions of the impact of drink driving on the self and others. Presentation by a drink driver who has killed someone. Discussion of the Ripple Effect after watching 2 DVDs of drink driving scenarios. Guest speakers from the Police Serious Crash Unit or Fire Service Participants bring a family member to the final session. Sharing of learning, goals and plans in a graduation ceremony. Presentation of certificates and completion of the outcome questionnaire. Page 25

27 PARTICIPANT EVALUATION Before and after the programme, participants take part in AUDIT and the programme screen to evaluate shifts in attitude and behaviour. COURSE EVALUATION Participants provide feedback on their learning and course facilitators record personal assessments. The feedback is recorded on an ongoing basis and used to measure programme effectiveness. Page 26

28 The Right Track The Right Track Te Arar Tutuki Pai Driver Rehabilitation Programme is delivered across the Auckland isthmus in Waitakere, Central, North and South Auckland, Hamilton and Christchurch. The initiative involves a series of multi dimensional learning, interactive, education sessions. NZ Police, Fire Service, District Health Boards and a range of other agencies are involved in the programme and are in attendance at many of the sessions. PARTICIPANTS Young people aged between are referred from the District Court, Youth Court, Community Magistrates, Department of Corrections, CYF through the Family Group Conference Process, NZ Police through Alternative Action or Diversion plans or directly through Youth Aid; individual self referrals are also accepted. All learners are identified as high risk and are either first time or recidivist offenders. Participants are screened for suitability by the referral agency, are interviewed prior to course acceptance and placement to ensure that they fit within the criteria. PROGRAMME OVERVIEW Right Track involves seven sessions (nine in Christchurch) where participants interact with presenters from Hospitals, Police, Fire Service and Funeral Directors, among others. Participants are encouraged to deal with their thoughts and beliefs about drink driving and other abhorrent behaviours as a road user and to increase their awareness of the consequences of these behaviours. The following sessions are typical of those used in Right Track Programme. Court mock sentencing, cells - Is this where you want to be?. Presentations from the Police Serious Crash Unit, Funeral Directors and others involved in the reality of crashes. The Ripple Effect. The NZ Fire Service describes their job as they cut people from cars as a result of an MVA. A practical risk management session. Presentation by a range of speakers that have been directly affected by the behaviours of drink drivers as both victims and perpetrators Visit to a trauma unit and spinal unit to emphasise the reality of injury. Graduation All of the participants present their thoughts and opinions about the impact of Right Track. PARTICIPANT EVALUATION Evaluation occurs at all stages of the programme through informal dialogue, a caregivers meeting during Session 4, written evaluations from all participants after every session, and a video interview that is used Page 27

29 as part of the evaluator process during the first and final sessions. Evaluations show extensive evidence that participants are learning from the sessions. COURSE EVALUATION Driving offences and criminal offences committed by participants within one year of course completion and post one year course completion are recorded for evaluation by NZ Police. From April 2007 recorded incidences of drink driving and criminal behaviour have reduced significantly. This holds true for one year post course completion and beyond Page 28

30 Overview of DDR Programmes available in New Zealand at a glance Assessment Screening Education BI MI CBT Training Evaluation Whanau* Ashburton Y Y Y Y Y Y Y Y N Nelson N N Y Y N N Y N? Drive Soba Y Y Y Y Y Y Y Y Y OFTR Y Y Y Y Y Y Y Y Y DF????????? SDDP Y Y Y Y Y Y Y Y Y RDDIP Y Y Y Y Y Y Y Y Y Right Track Y Y Y Y Y Y Y Y Y *Inclusion of family/whanau in any part of the programme Page 29

31 Alcohol Ignition Interlock Devices and Rehabilitation This year New Zealand will be launching its first Alcohol Ignition Interlock Device (AIID) programme. Evidence from studies shows a percent reduction in drink driving while the device is fitted to an offender s vehicle. However once the device is removed levels of offending return to those similar to offenders who have not had an interlock fitted (NHTSA, 2010). Support programs, mentoring by probation or DDR programmes to assist offenders during a period of interlock use would be of great benefit to AIID programmes (Sheehan et al, 2005). The combination of AIID programmes with rehabilitative efforts may also provide offenders with the opportunity to practice newly acquired skills regarding their drink driving habits (Freeman&liossis, 2002). The report, referred to earlier State of the Art on Driver Rehabilitation: Literature Analysis & Provider Survey carried out by DRUID (Driving under the Influence of Drugs, Alcohol and Medicines) in 2008 stated of interlocks that: All results indicate that an ignition interlock use needs the offenders motivation and readiness for change to be successful in a long-term. This must be supported at least by medical counselling or other psychological/psychotherapeutic interventions in order to result in a treatment process. The integration of ignition interlock devices in these rehabilitative measures may even be helpful as the recorded breathtest data can serve as behavioural evidences. Hypothetically, the records may even be used as a counselling tool in different ways. First of all, recorded breath-test data could serve as an objective feedback for the counsellor or therapist about the treatment progress. Secondly, it could be used to confront the client with hard facts (e.g. failed start attempts). Thirdly, regarding the fact that recent research indicates that it is possible to predict subsequent DUI behaviour with the data from the ignition interlock recorder the data could be used in order to shape the therapeutic intervention. Also reported by Elder et al (2011): Building a comprehensive rehabilitation program for DWI offenders that incorporates interlocks is a worthy endeavor and one that has tremendous potential for a substantial overall impact on alcoholimpaired driving. Experts suggest that the data recorded by the Alcohol ignition interlock could also provide critical information in the driver license restoration decision (Marques, 2008). The average drink drive offender does not reduce drinking during the program (as measured by alcohol markers at start and end of program), therefore an important adjunctive would be to make licence restitution contingent on reduced alcohol consumption (Marques et al 2010). Page 30