The Treatment Plan

The treatment plan for the hardcore drunk driving offender should be based on a criminogenic needs assessment, a diagnostic and/or mental health assessment and a substance abuse assessment, as indicated. These assessment results collectively identify areas in need of intervention and assist the treatment provider in devising a comprehensive plan.

Ensuring Solutions to Alcohol Problems (ESAP) is a research-based project at George Washington University Medical Center that has identified 13 active ingredients of effective alcohol treatment.

The nation’s system for treating alcohol problems continues to fall short of the comprehensive model envisioned more than 10 years ago by the Institute of Medicine. While several of
the active ingredients identified by ESAP have long been prescribed for treating alcohol dependent individuals, many, including the use of prescribed medications to support clinically proven psychosocial therapies, are not widely found in clinical practice.

Ensuring Solutions to Alcohol Problems' 13 active ingredients of effective alcohol treatment

  1. Early detection, including screening and brief interventions (for non-dependent problem drinkers). The earlier the treatment for drinking problems begins, the better the chance for success.
  2. A comprehensive assessment and individualized treatment plan. Treatment for alcoholism and drug abuse is not a one-size-fits-all proposition. Not all patients require the “acute care” approach.
  3. Care management. Treatment programs need to be carefully managed every step of the way, sometimes involving family members and friends, from the initial assessment through continued follow-up after the intervention program ends.
  4. Individually delivered, proven professional interventions. Several interventions, based on different treatment philosophies, can be effective in reducing alcohol consumption depending on the patient’s gender, severity of dependence and motivation to change. Effective treatment programs will offer more than one approach.
  5. Contracting with patients. Also called contingency management or behavior contracting, this rewards good behavior and punishes bad behavior to improve treatment outcomes.
  6. Social skills training. People with alcohol problems can be taught to recognize stressful situations in which their drinking has been a problem in the past, and taught skills to help them cope with those situations.
  7. Medications. Medical treatments cannot “cure” drinking problems, but they can be combined with other interventions and therapies to produce treatment that is even more effective. Medication-assisted treatment is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. Medication-assisted treatment (MAT) is clinically driven with a focus on individualized patient care. Learn more about MAT.
  8. Specialized services for medical, psychiatric, employment or family problems. Treatment programs need to be targeted at the individual needs of the patient through “problem-to-service matching.”
  9. Continuing care. Most offenders that enter treatment have at least one relapse. Follow- up contact as well as participation in support groups have both been shown to improve long-term treatment outcomes.
  10. Strong bond with therapist or counselor. Research shows that counselors and therapists, who bond with patients through empathy rather than confrontation, are powerful motivating influences in alcohol treatment.
  11. Longer duration (for alcohol dependent drinkers). How long a patient stays in treatment matters more in most cases than if a patient is treated in an inpatient or outpatient setting. Studies indicate that outpatient treatment lasting less than 90 days results in poorer outcomes.
  12. Participation in support groups. Project MATCH and other studies in the 1990s definitively proved that participation in support groups, such as Alcoholics Anonymous and other faith-based programs, can be an active ingredient of treatment — both during a professional intervention and after.
  13. Strong patient motivation. All approaches to alcoholism recovery depend on the desire of the person to get and remain sober. Effective treatment programs enhance this motivation with intervention and therapy.

Source: Ensuring Solutions to Alcohol Problems, The George Washington University Medical Center. The Active Ingredients of Effective Alcohol Treatment (PDF). June 2003.

What are DWI Courts?

Except where DWI Courts have already been instituted, it has been left to the traditional courts and criminal justice system to deal with DWI cases, and it has become clear that the traditional process is not working for repeat offenders. Punishment, unaccompanied by treatment and accountability, is an ineffective deterrent for the repeat DWI offender. The outcome for the offender is continued dependence on alcohol; for the community, continued peril. However, a proven strategy exists to fight these repeat DWI offenders. It is called DWI Court.

DWI Courts utilize all criminal justice stakeholders (judges, prosecutors, defense attorneys, probation, law enforcement, and others) coupled with alcohol or drug treatment professionals. This group of professionals comprises a “DWI Court Team,” which uses a cooperative approach to systematically change offender behavior. This approach includes identification and referral of participants early in the legal process to a full continuum of drug or alcohol treatment and other rehabilitative services. A DWI Court’s coercive power is the key to admitting DWI offenders into treatment and ensuring that they remain there for a period of time that is long enough to make a difference.

Compliance with treatment and other court-mandated requirements is verified by frequent alcohol/drug testing, close community supervision and ongoing judicial supervision in non-adversarial court review hearing. During the frequently held review hearings, the judge employs a science-based response to participant compliance (or non-compliance) in an effort to further the team’s goal to encourage pro-social, sober behaviors that will prevent future DWI recidivism.

Accordingly, if treatment is to fulfill its considerable promise as a key component of DWI reduction policy, DWI offenders not only must enter treatment but must remain in treatment and complete the program. To do so, most will need to be ordered or coerced into treatment. In the context of treatment, the term coercion - used more or less interchangeably with “compulsory treatment,” “mandated treatment,” “involuntary treatment,” “legal pressure into treatment”- refers to an array of strategies that shape behavior by responding to specific actions with external pressure and predictable consequences. Moreover, evidence shows that substance abusers who get treatment through a court’s order benefit as much as, and sometimes more than, their counterparts who enter treatment voluntarily. DWI Court is the best vehicle within the criminal justice system to expedite the time interval between arrest and entry into treatment, and provide the necessary structure to ensure that a DWI offender stays in treatment long enough for treatment benefits to be realized.

Most importantly perhaps, DWI Courts serve as a potential unifying hub for the myriad agencies and organizations that have been part of piecemeal attempts to plug the gaps in the drunk driver control system. DWI Courts can and should serve as a unifying venue of accountability for the repeat DWI offender. By partnering with the respective state’s department of motor vehicles, Governor’s Highway Safety Commission, highway patrol, local law enforcement accident prevention squads, MADD and other crash prevention and victim support groups, DWI Courts can add teeth to the justice system’s response to repeat drunk driving.

Where are they being used?

In 2004 there were 176 DWI Courts–86 designated DWI, and 90 “hybrid” courts. (Hybrid DWI Courts are courts that started as Drug Court, and then added a DWI offender track to the Drug Court program.) As of 2011, there were 192 designated DWI Courts, and 406
“hybrid” Drug Courts for a total of 598 in 39 states and territories. That is over a 339 percent increase in seven years.

How Effective Are They?

Evaluation studies are vital in sustaining DWI Court programs. This understanding is discussed in Guiding Principle #9 of the Ten Guiding Principles for DWI Courts. Courts conduct outcome evaluation studies to demonstrate the dramatic effect of DWI/Drug Courts on the community, to assess relative costs, and to maintain or seek funding.

Additionally, other broader studies have been completed. An evaluation of three DWI Courts in Georgia asked the ultimate question: Were DWI Courts more effective than traditional courts in reducing recidivism? The conclusion was a clear yes; DWI Courts were more effective. The evaluation was conducted by the Pacific Institute for Research and Evaluation (PIRE) and funded by NHTSA, and it found:

  • Repeat DWI offenders graduating from DWI Courts were up to 65 percent less likely to be re-arrested for a new DWI offense.
  • All DWI Court participants had a recidivism rate of 15 percent, whether or not they graduated or were terminated, versus a recidivism rate of up to 35 percent for those not in DWI Court.
  • The three DWI Courts prevented between 47 and 112 more repeat DWI arrests.

The study noted that the DWI Courts saved the Georgia courts a substantial amount of taxpayer money that would have been needed for incarceration, court time, and probation supervision.

Positive findings were also reported in a three-county evaluation of DWI Courts in Michigan. In nearly all of the comparisons, the trends favored better outcomes for the DWI Court participants. In one county, the participants were up to 19 times less likely to reoffend. The finding also noted that DWI Courts saved the criminal justice system time and money when compared to a traditional court.

Other Actions Judges Can Take to Better Prepare Themselves for Hardcore Drunk Driving Cases