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Article Excerpt
Convicted DWI offenders (N = 549) were assessed for alcohol use disorders. Repeat offenders had twice the rate of both lifetime and current alcohol use disorders compared with 1st-time offenders. Guidelines for determining alcohol problems in DWI offenders are recommended.
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Individuals convicted of driving while intoxicated (DWI) are often court-mandated to undergo an assessment to evaluate their substance abuse problems. A primary goal of the assessment process is to determine a person's need for substance abuse treatment. Although some studies have reported high rates of alcohol use disorders among DWI offenders, the rates vary widely among those studies investigating alcohol problems in DWI offenders. For example, in a review of 22 published studies between 1955 and 1981, the proportion of DWI offenders meeting criteria for "alcoholism" ranged from 4% to 87% (Vingillis, 1983). In a review of more recent studies (1990-2004), we found that rates of alcohol use disorders ranged from 4% to 92%. (See the References section for the list of studies used in this review. The following keywords were used when conducting a search of several databases: alcoholism, alcohol screening, assessment, diagnosis, alcohol related accidents, DWI, DUI, drunk drivers, DWI offenders, and drinking and driving.) Such wide variation contradicts the commonsense notion that the DWI offender population has a uniformly high rate of alcohol use disorders and raises the question of why such variability exists between studies of DWI offenders.
In the literature reviewed for this study, a number of methodological factors were identified that may have contributed to the variation in rates of alcohol use disorders found among samples of DWI offenders. Contributing factors included (a) a failure to distinguish between lifetime versus current (i.e., past 12 months) alcohol diagnoses, (b) the use of screening instruments as diagnostic tools, (c) the use of terms not included in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) nomenclature (e.g., alcohol problems or alcoholic), (d) a failure to distinguish between first-time and repeat offenders, and (e) the underutilization of structured and semistructured diagnostic interviews. The first four (a-d) factors may have contributed to the higher rates of alcohol disorders reported in some studies. For example, given that lifetime rates of alcohol abuse or dependence are approximately 3 times that of current rates (APA, 2000), those studies that failed to distinguish between lifetime versus current diagnoses were most likely overestimating the rate of current alcohol use disorders among DWI offenders. Moreover, if the primary goal of assessment in these studies was to determine the need for substance abuse treatment, then a person who carried a lifetime diagnosis (rather than current) may not have perceived the need for a full-scale treatment effort. These individuals may have either failed to engage in the treatment process or dropped out because the treatment was not viewed as relevant to their current drinking status. Clearly, these individual levels of participation would have affected the prevalence rates found in several studies.
The inconsistent use of screening tools also likely affected the varied prevalence rates reported in the aforementioned studies. Screening tools are sometimes used in place of diagnostic measures to help identify those who may meet criteria for an alcohol use disorder. Because screening instruments are often brief and have high sensitivity (Carey & Teitelbaum, 1996), they cast a wide net to identify as many cases as possible. However, high sensitivity is often accompanied by lower levels of specificity. For example, some screening instruments often place greater weight on positive responses to such questions as "Have you ever had a DWI?" Although one DWI does not necessarily indicate the presence of an alcohol use disorder, the use of screening tools in this manner could result in the overidentification of alcohol use disorders (resulting in false positives) in samples of DWI offenders.
Additional factors complicating reported prevalence rates are the imprecise use of terms such as alcohol problems or alcoholic and insufficient information about how such problems were defined and identified. Because rates of alcohol use disorders are higher in repeat offenders (e.g., Lapham, Skipper, & Simpson, 1997; Wieczorek & Nochajski, 2005), the failure to report the number of first-time versus repeat offenders in the sample obscures the "true" rate of such disorders in these subgroups of DWI offenders. There is also a significant association between DWI offender status and gender, with men being much more likely than women to be repeat offenders (Nochajski & Stasiewicz, 2006). Thus, failure to present results separately for first-time and repeat offenders could obscure potential gender differences among subgroups of DWI offenders. Comparisons between studies would be better facilitated if researchers used a reliable and valid diagnostic measure and reported separately both...
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