Repeat drunk drivers represent at least one-third of all DWI arrests and likely contribute to consistent rates of DWI deaths and injuries on our nation’s highways. These statistics emphasize the need to identify and address the factors that influence DWI recidivism.
Research continues to find strong links between substance use, DWI, criminal behavior, homelessness, and underlying mental health issues. More and more research has identified the fact that repeat DWI offenders often suffer from a number of disorders. In one study, in addition to a lifetime alcohol disorder, 41 percent of the participants had an additional drug-related disorder and 44 percent had a major mental health disorder that was not alcohol or drug-related (Shaffer et al., 2007). However, treatment for DWI offenders, which has been part of the criminal justice system for more than 30 years, most commonly consists of alcohol education and possibly some form of alcohol treatment only.
The Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, is working to expand and test a Computerized Assessment and Referral System (CARS) for use with a structured diagnostic mental health assessment in DWI treatment settings. Already piloted with support from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and now supported by The Foundation for Advancing Alcohol Responsibility, the CARS project examines the relationship between psychiatric profiles and repeat drunk driving offenders. The project is in the testing phase now and will be available to the public for use in 2014.
As a computerized clinical report generator tool, CARS is used with a structured diagnostic mental health assessment, effectively bringing comprehensive mental health assessment “from bench to bedside.”
Comprehensive clinical assessment tools can provide volumes of high quality diagnostic information that can facilitate effective treatment planning, but commonly are not user- friendly. Because such tools frequently require more time and expertise than many would-be users might have available, their use is limited. CARS will package a powerful mental health assessment tool with a user-friendly interface, increased flexibility, and immediate personalized output, to create a tool that can be used easily by lay people to administer comprehensive mental health assessments.
Research has shown that people with one mental health problem (e.g., a substance use disorder) also are at high risk for other mental health problems. For example, in DWI populations, additional mental health problems are prevalent and linked to recidivism. CARS provides a cost-effective tool that treatment programs in general and substance use programs in particular can use to screen their populations for mental health disorders.
Treatment programs and other settings that address mental health issues often employ staff who do not have expertise in mental health issues. CARS provides a computerized tool that allows these staff members to effectively screen for mental health issues. The reports CARS generates assist staff by providing personalized information about disorders and possible referral sources for their clients. Because CARS uses the internationally-recognized Comprehensive International Diagnostic Interview (CIDI), suitable for use by lay interviewers, programs can be confident that the assessments they conduct are well-validated and reliable.
Treatment programs around the world concerned with addressing mental health issues will be interested in CARS. Substance use programs and DWI treatment programs, as well as court settings and primary care settings have reason to screen for mental health issues in their clientele.
As this research increases, so will the interest from programs that address behavioral problems. CARS can be adapted for use in many kinds of community programs, as well as educational and primary care settings.