AN EVALUATION OF SHORT TERM TREATMENT PROGRAM FOR PERSONS DRIVING UNDER THE INFLUENCE OF ALCOHOL P. A. V a le s, Ph.D.
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- Ashley Flowers
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1 AN EVALUATION OF SHORT TERM TREATMENT PROGRAM FOR PERSONS DRIVING UNDER THE INFLUENCE OF ALCOHOL P. A. V a le s, Ph.D. SYNOPSIS Two in d ep en d en t tre a tm e n t g ro u p s, p a r t ic ip a n t s in th e P u e rto R ic o S h o rt-t erm Trea tm en t Program ( f o r a lc o h o lis m ) w ere e v a lu a te d a c c o r d in g t o a g u a s i- e x p e r im e n t a l d e s ig n by w hich th e p o s t - t r e a t m e n t m easurem ents w ere c o n t r a s te d w ith th o s e p r e v a i l i n g in th e t o t a l p o p u la tio n a t th e tim e o f a d m ission t o tre a tm e n t. INTRODUCTION The r e s u lt s r e v e a l s i g n i f i c a n t changes w ere o b ta in e d in a lc o h o l consum ption p a t t e r n s. These changes o c c u rre d d e s p it e th e v a r i a t i o n s in th e grou ps in term s o f a g e, m a r it a l s t a t u s, and number o f o f f s p r i n g. D iffe r e n c e s in c lu d e d p r o p o r t io n o f p erso n s who d e v e lo p e d a lc o h o l a b s t e n t io n, changes in fre q u e n c y o f a lc o h o l consum ption, and ty p e o f a lc o h o l consumed. In a d d it io n in fo r m a t io n r e l a t e d t o c l i e n t s a t i s f a c t i o n w ith th e S h o rt Term T reatm en t Program was c o l l e c t e d. THEORETICAL DESCRIPTION The p r e v e n t io n o f t r a f f i c a c c id e n t s due t o a lc o h o l i n t o x i c a t i o n c o n s t it u t e s a j o i n t e f f o r t betw een th e T r a f f i c S a fe t y Commission o f th e T r a n s p o r t a t io n and P u b lic Works D epartm ent and th e A d d ic t io n S e r v ic e s D epartm ent o f th e Government o f P u e r to R ic o, and i s im plem ented w ith th e a s s is t a n c e o f th e P o l i c e D epartm ent and th e C ou rt System o f th e Commonwealth. T h is c o o p e r a t iv e v e n tu re ta k e s th e form o f an e x p e r im e n ta l re s e a r c h d e s ig n, w here a lc o h o l tre a tm e n t, b o th in i t s p h y s ic a l as w e l l as i t s s o c io p s y c h o lo g ic a l a s p e c ts, c o n s t it u t e th e in d ep en d en t o r e x p e r im e n ta l v a r i a b l e. The m a n ife s t in t e n t io n o f t h is ex p erim en t c o n s is t s o f th e m o d ific a t io n o f th e w h ole v a r i e t y o f b e h a v io r s r e l a t e d t o a lc o h o l consum ption and dependen ce. The u lt im a t e g o a l o f t h i s in t e r v e n t io n i s th e c o n t r o l, r e d u c t io n, and e lim in a t io n o f t r a f f i c a c c id e n t s due to a lc o h o l i n t o x i c a t i o n. * G radu ate S ch o o l o f S o c ia l Work, U n iv e r s it y o f P u erto R ic o, R o P ie d r a s, P u e rto R ic o 00928, U.S.A. 1367
2 The in d ep en d en t v a r i a b l e, as o r g a n iz e d in a tre a tm e n t p la n w it h in th e A lc o h o l T rea tm en t S e c r e t a r i a t o f th e A d d ic t io n S e r v ic e s D epartm en t, fo c u s e s on a b i o - c o g n i t i v e ap p roa ch. I t s r a t i o n a l e com bines a lc o h o l d e t o x ic a t io n and an e d u c a tio n p r o c e s s on th e s o c i a l e f f e c t s o f a lc o h o l abuse and dep en d en ce. The assu m ption i s t h a t so b e r and c o n s c ie n t io u s d r i v e r s w i l l c o n t r o l t h e i r m agnitu de and p a t t e r n s o f a lc o h o l d r in k in g, o r e lim in a t e a lc o h o l consum ption a l t o g e t h e r. The c o g n i t i v e component c o n s is t s o f th e tr a n s m is s io n o f in fo r m a t io n r e l a t e d t o th e a lc o h o l p rob lem in P u e rto R ic o, th e m e ta b o lic e f f e c t s o f a lc o h o l ab u se, and th e con sequ en ces o f a lc o h o l abuse and dependence on th e in d iv id u a l p s y c h o lo g y, b o th a t th e in t r a p s y c h ic l e v e l (d evelop m en t o f u r g e s, a t t i t u d e s, changes o f moods, memory, p e r c e p t iv e a l t e r a t i o n s, e t c. ) as w e l l as i t s b e h a v io r a l com ponents ( e. g., a b u s iv e a lc o h o l consu m ption, lan gu age d i f f i c u l t i e s, lo s s o f o r i e n t a t i o n, and la c k o f p r o p r i e t y ). T h is ta s k c o u ld be v e r y d i f f i c u l t due t o th e s o c i a l r e in fo r c e m e n t p r o v id e d by m a rg in a l grou ps in s o c i e t y t h a t v a lu e th e ty p e o f n e g a t iv e b e h a v io r r e l a t e d t o a lc o h o l abuse as d e s ir a b le and a c c e p ta b le. The S h o rt Term T rea tm en t Program in P u e rto R ic o i s m andatory by P u b lic Law 35 o f J u ly 4, The program i s m odeled a f t e r a s im ila r p r o j e c t d e v e lo p e d in th e S ta te o f M a ryla n d, U.S.A. I t com bines in d i v id u a l th e ra p y w ith group th e ra p y in an a m b u la tory system. S e s s io n s a re h e ld f o r 2 hours p e r week f o r an a v e ra g e o f 90 d a y s. Four c o g n i t i v e a re a s a re d e v e lo p e d in th e tre a tm e n t program : I. A lc o h o l e d u c a tio n program ; I I. A w aren ess; I I I. D evelopm ent o f a l t e r n a t i v e s ; and IV. D e c is io n m aking. Each c o g n i t i v e a re a in c lu d e s a s e r i e s o f b e h a v io r m o d if i c a t io n a l t e r n a t i v e s, such a s, " b r e a k in g th e i c e, " "th e g i f t o f h a p p in e s s," "t h e b o a t, " "th e m i r r o r, " and "th e l i f e - l i n e. " The in t e n t o f th e s e a c t i v i t i e s i s t o d e v e lo p i n s i g h t and s e l f - e v a l u a t i o n s k i l l s. 1368
3 The S h o rt Term T rea tm en t Program was im plem ented in m id The e v a lu a t iv e p r o c e s s w hich w i l l be p re s e n te d c o v e r s th e p e r io d from 1978 t o A t o t a l o f 1,148 d r i v e r s w ere t r e a t e d d u rin g th o s e 2% y e a r s. T h is p o p u la tio n was c l a s s i f i e d in t o 2 c o h o r t s. One in c lu d e d d r i v e r s c o n v ic t e d and t r e a t e d from th e b e g in n in g o f th e program and u n t i l th e b e g in n in g o f 1980; t h is c o h o r t co m p rised 819 c l i e n t s. The second c o h o r t in c lu d e d 329 c l i e n t s t r e a t e d from th e b e g in n in g o f 1980 t o th e b e g in n in g o f The t o t a l c l i e n t e l e was o r g a n iz e d in t o grou ps o f 8 t o 12 p erso n s ea ch. T h is a c t io n r e s u lt e d in 75 tre a tm e n t g r o u p s. SAMPLES The im p act e v a lu a t io n was p erfo rm e d in 1983 and c o n s is t e d o f a fo llo w - u p p r o c e s s o f 2 in d ep en d en t sam ples o f th e t r e a t e d p o p u la tio n. The sam ple f o r th e f i r s t c o h o r t was o f 168 s u b je c ts and th e second c o h o r t o f 133 s u b je c t s. The sam ples w ere drawn ran dom ly. The f i n a l l e v e l o f r e l i a b i l i t y was 95.2% f o r th e t o t a l sam ple, and o f 93.3% f o r th e f i r s t c o h o r t, and 93.4% f o r th e second c o h o r t. DATA COLLECTION An in t e r v ie w s c a le was e la b o r a t e d in o r d e r t o c o l l e c t d a ta p e r t a in in g t o a l c o h o l - r e l a t e d b e h a v io r, k n o w led ge, and a t t i t u d e s. The a lc o h o l consum ption p a t t e r n s w ere c o l l e c t e d f o r 2 d i f f e r e n t tim e p e r io d s : a t th e tim e o f in t e r v e n t io n by th e C ou rt System in P u e r to R ic o (Law 35) and a t th e p r e s e n t tim e (1983). One must r e c a l l t h a t th e f i r s t c o h o r t co m p leted th e s h o r t-te r m tre a tm e n t in t e r v e n t io n 3-4 y e a r s a g o, w hereas th e second c o h o r t co m p leted tre a tm e n t 2-3 y e a r s a g o. In a d d it io n, one must remember t h a t in most e x p e r im e n ta l d e s ig n s th e im p act o f th e in d ep en d en t v a r i a b l e d e c re a s e s as th e d is t a n c e (tim e ) from th e e x p e r im e n ta l im p o s it io n i s in c r e a s e d. One can r i g h t l y c la im t h a t any s i g n i f i c a n t change o b s e rv e d from 2 t o 4 y e a r s a f t e r i n t e r v e n t io n has ta k en p la c e, and d i r e c t l y r e l a t e d t o th e e x p e r im e n t, has t o be c o n s id e r e d as h a v in g a v e r y h ig h p r o b a b i l i t y o f b e in g a p erm a n en tly e s t a b lis h e d ch ange. 1369
4 FINDINGS A lc o h o l consum ption p a t t e r n s w ere c l a s s i f i e d in t o 8 c a t e g o r ie s o n ly on: 1) d a i l y o r a lm o st d a i l y consum ption ; 2) w eek -en d s; 3) once o r t w ic e a w eek; 4) e v e r y 2 o r 3 w eeks; 5) once a month; 6) 2 o r 3 tim e s a y e a r ; 7) u n s p e c ifie d ; and 8) n o t d r in k in g a t a l l. The i n i t i a l in t e r v i e w r e v e a le d t h a t in r e l a t i o n t o th e p a t t e r n o f a lc o h o l consum ption b e f o r e in t e r v e n t io n and tr e a tm e n t, 210 s u b je c t s, o r 90.5%, w ere consum ing a l c o h o l i c b e v e ra g e s a t l e a s t once a week and as o f t e n as d a i l y. The p a t t e r n was s i m i l a r in b o th c o h o r ts (89.6% and 91.8% ). In 1983, o r p o s t i n t e r v e n t io n, a lm o st 1 o u t o f e v e r y 5 p erso n s (18.9%) t r e a t e d in th e s h o r t term tre a tm e n t program w ere n o t consum ing any ty p e o f a l c o h o l i c b e v e r a g e. As a m a tte r o f f a c t, o n ly 42.5% w ere consum ing a lc o h o l a t l e a s t once a week as com paired t o a 90.5% p r i o r t o tr e a tm e n t. A m a jo r change was o b s e rv e d a t a.001 l e v e l o f s i g n i f i c a n c e in term s o f th e p a t t e r n s o f a lc o h o l consum ption p r i o r and a f t e r tre a tm e n t in t e r v e n t io n. The d i f f e r e n c e s o b s e rv e d w hich w ere v e r y s im ila r in b o th c o h o r t s, and c o u ld be a cco u n ted f o r by 2 im p o rta n t t r e n d s : 1) The r e s u l t i n g a b s tin e n c e t o a lc o h o l consumpt i o n ; and 2) th e s p a c in g o u t o f a lc o h o l consumpt io n among th o se t h a t w ere s t i l l d r in k in g i t. The c l i e n t e l e ' s p e r c e p t io n o f th e e f f i c a c y o f th e program can be sum m arized, in term s o f th e r e a c t io n o f 92% o f th e c l i e n t e l e t r e a t e d, as f o llo w s : 1) 55% ackn ow ledge th e use o f a lc o h o l sh ou ld be m oderate o r w ith p r o p ie t y ; 2) 21.6% th in k s th a t t o t a l a b s t e n t io n sh ou ld be th e g o a l; 3) 12.6% in d ic a t e t h a t a lc o h o l sh ou ld be used o n ly on s p e c ia l o c c a s io n s ; and 4) 10.8% a re aware th a t a lc o h o l consum ption sh ou ld be a v o id e d when d r i v i n g. The s p e c i f i c r e s u lt s r e v e a l t h a t b o th c o h o r ts e x p re s s e d s im ila r r e a c t io n s. 1370
5 TABLE 2 CLIENTELE PERCEIVED IMPACT OF THE SHORT TERM TREATMENT PROGRAM BY COHORTS, PUERTO RICO, 1983 Clientele First Cohort Second Cohort Frequency Percent Frequency Percent Frequency Percent IMPACT: clientele Respondents Moderate or appropriate use Abstention Use on special occasions Avoid use while driving An a n a ly s is o f 6 d i f f e r e n t a re a s o f re s p o n s e s r e v e a le d th e l e v e l o f th e c l i e n t e l e s ' s a t i s f a c t i o n w it h th e program. F iv e o f 6 a re a s a re r e l a t e d t o th e o p e r a t io n a l d evelop m en t as w e l l as t o th e c o n te n t o f th e program. O v e r a ll re sp o n se s showed t h a t o v e r 95% o f th e re s p o n d e n ts w ere s a t i s f i e d w ith th e le n g th o f tre a tm e n t a p p roa ch, q u a n t it y and q u a l i t y o f t h e r a p i s t s, tre a tm e n t s e t t i n g, and th e c o n te n t o f th e in t e r v e n t io n (s e e T a b le 3). 1371
6 TABLE 3 CLIENTELE OPINION OF THE SHORT TERM TREATMENT PROGRAM BY CATEGORY OF EVALUATION AND BY COHORTS Categories Sample Percent of First Cohort Percent of Second Cohort Percent of Response (n=301) Response (n=168) Response (n=133) Program personnel were well trained Time was sufficient Treatment setting was adequate Number of therapists was sufficient Treatment content was very effective Program was a success One o u t o f e v e r y 2 p erso n s t r e a t e d f e l t t h a t th e program was a s u c c e s s. T h is o p in io n c o u ld v e r y w e l l be r e l a t e d t o th e f a c t th a t n o t a l l s u b je c ts d e v e lo p e d a lc o h o l a b s tin e n c e o r changed s i g n i f i c a n t l y t h e i r i n i t i a l p o s i t i o n, w hich c o u ld have been t h e i r e x p e c t a t io n. N e v e r t h e le s s, th e changes o b s e rv e d r e la t e d t o a lc o h o l consum ption p ro v e d t o be s i g n i f i c a n t a t a v e r y h ig h l e v e l o f r e l i a b i l i t y. A dem ograph ic d e s c r ip t i o n o f th e 2 c o h o r ts r e v e a le d t h a t a lth o u g h t h e r e w ere some d i f f e r e n c e s in term s o f a g e, l e v e l o f e d u c a tio n, m a r it a l s t a t u s, and number o f c h ild r e n, th e c l i e n t e l e e v a lu a te d w ere r a t h e r s i m i l a r. I t c o n s is t e d o f m ature m ale s u b je c ts w ith an a v e r a g e age o f 36 y e a r s and w it h 9 h y e a r s o f s c h o o lin g. E ig h t o u t o f 10 w ere m a rrie d and had a fa m ily t h a t in c lu d e d 3.4 c h ild r e n. 1372
7 My c o lle a g u e s and I con ten d t h a t th e S h o rt Term Trea tm en t Program f o r A lc o h o l I n t o x ic a t e d D r iv e r s has been a v e r y e f f i c a c i o u s and e f f i c i e n t approach t o d e a l w ith t h is phenomenon in a s o c i e t y w here a lc o h o l abuse i s e x tr e m e ly h ig h. We recommend fu r t h e r fo llo w - u p s t u d ie s o f tre a tm e n t p o p u la tio n in o r d e r t o see how lo n g th e e f f e c t s o f th e e x p e r im e n ta l v a r i a b l e l a s t and t o m o n ito r w h a te v e r a t t r i t i o n p r o c e s s may o c c u r. In a d d it io n, we s u g g e s t t h a t t h is approach c o u ld be w e l l e x e c u te d as p a r t o f a c l a s s i c e x p e r im e n ta l d e s ig n in w hich more s o p h is t ic a t e d and r ig o r o u s a n a ly s e s a re made. ACKNOWLEDGEMENTS T h is p r e s e n t a t io n summ arizes th e e v a lu a t iv e r e s e a rc h p erfo rm e d o f th e S h o rt Term T rea tm en t Program, w hich i s p a r t o f th e A lc o h o l T rea tm en t S e c r e t a r i a t o f th e A d d ic t io n S e r v ic e s D epartm ent o f P u e r to R ic o. The e v a lu a t io n i s b e in g co m p leted d u rin g th e te n u re o f th e Hon. Jose Ram6n C o rd ero R o d rig u e z as S e c r e ta r y o f th e A.S.D., M rs. S on ia Zayas P u ig as A s s is t a n t S e c r e t a r y f o r A lc o h o l T re a tm e n t, and Mr. F e l i x G. Muniz B a r r e r a s, D ir e c t o r o f th e R esea rch I n s t i t u t e. The S h o rt Term T rea tm en t Program i s one o f an e x t e n s iv e number o f e x p e r im e n ta l and o n -g o in g ap p roa ch es t o th e tre a tm e n t and p r e v e n t io n o f a lc o h o l and dru g abuse d e v e lo p e d and im plem ented a t th e A d d ic t io n S e r v ic e s D epartm en t. One must t r u t h f u l l y ackn ow led ge t h a t by no means i s i t a s u f f i c i e n t a l t e r n a t i v e t o d e a l e f f i c i e n t l y w it h th e a lc o h o l p rob lem in our s o c i e t y. N e v e r t h e le s s, i t has p ro ve n t o be an e x tr e m e ly e f f i c a c i o u s mechanism in th e tre a tm e n t o f p erso n s c o n v ic t e d f o r d r i v i n g under th e in flu e n c e o f a lc o h o l. We must thank a l l th e p e rs o n s who w ere r e s p o n s ib le f o r th e d evelop m en t o f th e e v a lu a t iv e p r o c e s s, as w e l l as th o s e who h e lp e d in th e o r g a n iz a t io n o f th e d a ta t h a t w ere a n a ly z e d. Mr. R adal C in t r o n, A s s is t a n t D ir e c t o r o f th e S c i e n t i f i c R esea rch I n s t i t u t e, A.S.D. was r e s p o n s ib le f o r th e fo r m u la tio n o f th e e v a lu a t iv e d e s ig n, c o l l e c t i n g th e d a ta, and d e v e lo p in g th e b a s ic s t a t i s t i c a l t a b l e s. D r. Rosa C e le s t e M a rin, D.S.W., R esea rch C o n s u lta n t f o r A.S.D., a n a ly z e d and w ro te th e f i r s t d r a f t o f th e e v a lu a t io n r e p o r t. Mr. I s r a e l R eyes was th e R esea rch A s s is t a n t r e s p o n s ib le fo r o r g a n iz in g and t a b u la t in g th e d a ta in c o r p o r a t e d in t h is p r e s e n t a t io n and in th e o v e r a l l e v a lu a t iv e r e s e a r c h r e p o r t. P r o fe s s o r N e ls o n M iranda o f th e U n iv e r s it y o f P u e rto R ic o Cayey Campus re a d and ty p e d th e o r i g i n a l d r a f t. M iss Norma T ir a d o, S e c r e t a r y o f th e R esea rch I n s t i t u t e, ty p e d th e f i n a l r e p o r t. 1373
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