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Prevalence of Psychiatric Disorders Among Persons Convicted of Driving While Impaired
Sandra C. Lapham, MD, MPH;
Elizabeth Smith, PhD;
Janet C'de Baca, PhD;
Iyiin Chang, MS;
Betty J. Skipper, PhD;
George Baum, BA;
William C. Hunt, MA
Arch Gen Psychiatry. 2001;58:943-949.
ABSTRACT
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Background Large numbers of convicted drunk drivers are entering alcohol treatment
programs, yet little information is available about their need for psychiatric
treatment. This study of convicted drunk drivers estimates lifetime and 12-month
prevalence of DSM-III-R psychiatric disorders (alcohol
and drug abuse and dependence, major depressive disorder, dysthymic disorder,
generalized anxiety disorder, posttraumatic stress disorder, and antisocial
personality disorder) and compares rates with estimates from a US population-based
survey.
Methods Six hundred twelve women and 493 men, aged 23 to 54 years, convicted
of driving while impaired, who had been referred to a screening program in
Bernalillo County, New Mexico, were located and interviewed using the Diagnostic
Interview Schedule between January 25, 1994, and June 30, 1997. Psychiatric
diagnoses were compared with findings from the National Comorbidity Survey
for the western region of the United States, conducted between September 14,
1990, and February 6, 1992.
Results Eighty-five percent of female and 91% of male offenders reported a lifetime
alcohol-use disorder, compared with 22% and 44%, respectively, in the National
Comorbidity Survey sample. Thirty-two percent of female and 38% of male offenders
had a drug-use disorder, compared with 16% and 21%, respectively, in the National
Comorbidity Survey sample. For offenders with alcohol-use disorders, 50% of
women and 33% of men had at least 1 additional psychiatric disorder other
than drug abuse or dependence, mainly posttraumatic stress disorder or major
depression.
Conclusion Drunk-driving offenders need assessment and treatment services not only
for alcohol problems but also for drug use and the other psychiatric disorders
that commonly accompany alcohol-related problems.
INTRODUCTION
BETWEEN 1995 and 1998, more than 1.4 million Americans were arrested
annually for driving while impaired (DWI).1
Offenders are entering alcohol treatment programs in record numbers,2 and, for many, the DWI conviction presents an opportunity
for early intervention.2 But DWI treatment
programs have shown disappointing results, with neither recidivism nor alcohol-related
crashes substantially reduced.3, 4, 5
Several factors contribute to these findings. Typically, offenders are
coerced into treatment programs and may not be motivated to change their drinking
habits. The programs offered often are abstinence-oriented, an end point many
offenders believe is inappropriate.5 Also,
offenders are likely to have emotional and psychiatric problems in addition
to alcohol-related problems, making treatment more challenging.6, 7
Finally, "treatments" for DWI offenders often include short-term programs5 that focus primarily on educating offenders about
the effects of alcohol or about drunk-driving laws.8
Treatment programs should be tailored to clients' specific offense histories,
the severity of their drinking problems, and their other psychiatric problems.8, 9 But little systematic research has
examined the level of severity of drinking problems or other psychiatric problems
among arrested or convicted DWI offenders,2, 10, 11, 12
and often conclusions rely on self-reported information from coerced subjects.11, 13, 14 These studies also
suffer from methodological problems, inconsistencies in defining alcohol problem
status,2, 11 and use of samples
with more severe alcohol-related problems than are found in the overall population
of convicted offenders.7, 11
In a review of 22 studies on drinking-driving offenders and alcoholism,
the percentage of offenders considered to be "alcoholic" ranged from 4% to
87%.11 This wide range in the estimated prevalence
of alcohol problems among DWI offenders creates uncertainty about how to deal
effectively with these populations.11 The Institute
of Medicine2 draws the rather unhelpful conclusion
from the literature that convicted drunk-driving offenders referred to treatment
have higher rates of alcohol-use disorders than are found in the general population
and lower rates than clinical populations.
Less is known about the prevalence of this population's drug-use or
non–substance-abuse psychiatric disorders. Researchers have examined
the bodily fluids of crash-involved drivers, finding high rates of drug prevalence
in addition to alcohol (10%-22%).15 This says
little about offenders' drug-use disorders. Studies suggest that drunk-driving
offenders have high rates of antisocial behavior14, 16, 17, 18
and high levels of depression19, 20, 21
and that repeat offenders are particularly likely to exhibit antisocial tendencies
and other psychopathologic conditions.21, 22, 23
However, this literature provides an inadequate psychiatric profile of the
DWI-offender population.
This study, by systematically collecting diagnostic data, strives to
determine (1) the prevalence of DWI offenders' alcohol use and comorbid psychiatric
disorders and (2) how much this differs from that of the general community.
We argue that primary care and mental health care professionals need to understand
DWI offenders' alcohol use, drug use, and other non–substance-abuse
psychiatric disorders. Only then can more appropriate and effective treatment
interventions be designed.
SUBJECTS AND METHODS
SUBJECTS
The sample was drawn from a database of convicted DWI offenders referred
to and screened by the Lovelace Comprehensive Screening Program (LCSP).24 This program contracted with the Bernalillo County
Metropolitan Court, Albuquerque, NM, to provide screening services to convicted
first offenders. Although the LCSP was a first-offender program, about 20%
of referrals were repeat offenders at the time of their referral.25
Details about the LCSP have been published.24
Previous studies in this population found characteristics similar to those
of DWI-offender populations described elsewhere in the United States with
respect to age, sex, and marital status,24, 25, 26
but this population has higher proportions of Hispanics and American Indians
than those in other geographical areas (see Vingilis,11
Perrine et al,13 and Moskowitz et al27). The mean blood alcohol concentration at arrest
for offenders in the LCSP is 0.16 g/dL, which is in the middle range of mean
blood alcohol concentrations for drunk drivers arrested elsewhere in the United
States.28
The sample for the present study included 1208 consecutive women referrals
from April 4, 1989, through March 31, 1992, and 1407 men drawn from all men
referred for screening during the study. Subjects were selected weekly, corresponding
to the 5-year anniversary of their LCSP referral. Men were frequency matched
to women by date of screening referral and ethnicity and were oversampled,
as a previous survey conducted in a New Mexico community revealed higher refusal
rates among men (39%) than women (21%).29
Information about nonlocated subjects was sent to the National Death
Index to match against death certificates filed in all states (excluding New
York, NY), identifying 18 women and 38 men as deceased. Of the remaining 2559
subjects, 2062 (81%) were located (1005 women and 1057 men) and 1396 were
interviewed. Most (85%) resided in New Mexico; the remainder lived in 37 other
states. Two women and 5 men were excluded because of incomplete information.
Analyses to determine differences between interviewed and noninterviewed subjects
showed that, after controlling for demographic factors, the interviewed and
noninterviewed subjects had similar blood alcohol concentrations at arrest
and similar diagnoses of alcohol abuse and dependence at screening.30
Also eliminated were 127 women and 107 men who were not either white
or Hispanic and 19 women and 31 men older than 54 years. These limitations
were imposed to enable comparisons with the national sample. This yielded
a final DWI sample of 612 women and 493 men. Sex comparisons revealed that
they were similar with respect to age, ethnic distribution, and educational
level, but differed with respect to marital status, income, and number of
prior DWIs (Table 1).
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Table 1. Characteristics of the DWI-Offender Sample*
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Complete methods for locating and interviewing subjects are published.30 The primary data source for locating clients was
LCSP record data; other databases also were used. A comprehensive location
protocol was used by bilingual (English and Spanish) staff, including a letter
sequence, telephone calls, and home visits. (Subjects were mailed a series
of letters at 2-week intervals. A letter sequence included 5 identical letters
explaining the study and asking the client to participate, and 1 "pleading
letter" emphasizing the importance of the study.) About 32% were telephone
interviews, conducted with out-of-state subjects and those unwilling or unable
to be interviewed in person. In-person interviews were conducted at our office,
at a neutral location, or in the subjects' own home. Once located, willing
participants provided written informed consent and were given a monetary incentive
to complete the interview. The protocol was approved by an institutional review
board.
Rates of substance abuse and other psychiatric disorders in the general
adult population from the National Comorbidity Survey (NCS)31
were compared with those of DWI offenders. The NCS is based on a stratified,
multistage area probability sample of noninstitutionalized civilians aged
15 to 54 years living in the 48 contiguous states and includes more than 8000
respondents. The survey was conducted between September 14, 1990, and February
6, 1992. Only subjects who lived in the western region of the United States
(Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington,
Oregon, California, Alaska, or Hawaii) were included for comparison with the
DWI sample. The NCS assessed DSM-III-R32
criteria using the Composite International Diagnostic Interview,33
which is derived from, and a refinement of, the Diagnostic Interview Schedule
(DIS).31
DIAGNOSIS
Interviewers were trained by one of us (E.S.) and met weekly to monitor
consistency and discuss coding issues. Interviews, conducted from January
25, 1994, to June 30, 1997, included demographic information and a computerized
version of the DIS.34, 35 The DIS,
structured and designed for use by lay interviewers, has good to acceptable
levels of validity and reliability with general population samples.36, 37, 38, 39, 40, 41
The interviewers read the DIS questions to subjects and entered their responses
into the computer. The DIS determines symptoms of disease, diagnoses, and
age when the subject met criteria for the diagnosis corresponding to the DSM-III-R.35 Disorders assessed
for the present study include rates of lifetime and 12-month alcohol and drug
abuse and dependence, major depressive disorder, dysthymic disorder, generalized
anxiety disorder, posttraumatic stress disorder (PTSD), and antisocial personality
disorder. Lifetime prevalence is the percentage of
persons who met diagnostic criteria for a disorder at any time in their lives
and 12-month prevalence is the percentage of subjects
who experienced the disorder within the 12 months before the follow-up interview.
COMPARISON SAMPLE
National Comorbidity Survey data were obtained from the public-use data
file, downloaded from the Internet site maintained by the Inter-university
Consortium for Political and Social Research. Neither the NCS data nor the
DWI data included information that would allow identification of the Hispanic
subgroup (eg, Mexican American, Cuban American, or Puerto Rican). However,
most Hispanic populations in the western United States are Mexican American.42
DATA ANALYSES
Comparisons between the 2 samples were made by weighting the NCS sample
to match the DWI-offender sample by age (23-29, 30-34, 35-44, or 45-54 years),
ethnicity, and educational level (0-11, 12, or  13 years). All comparisons
between the 2 samples were made separately for men and women. For the NCS
sample, all observations in a specific age, ethnic group, or educational level
stratum were assigned a weight, computed as the ratio of the proportion of
DWI offenders to the proportion of NCS respondents in that stratum. Weights
for all observations in the DWI-offender sample were set to 1.0. All proportions,
SEs, and tests of significance were computed using the SUDAAN procedure CROSSTAB.43 The sampling design was specified as stratified sampling
with replacement. Taylor series linearization was selected as the method for
variance estimation. Tests for statistically significant differences between
the 2 samples were made using a  2 test statistic analogous
to the Pearson 2.43
RESULTS
PREVALENCE OF LIFETIME AND 12-MONTH PSYCHIATRIC DISORDERS IN THE DWI
SAMPLE
Eighty-five percent of women and 91% of men reported lifetime alcohol-use
disorders (abuse or dependence) (P<.01) (Table 2). More than 30% of women and 35%
of men had a 12-month diagnosis of alcohol dependence. About one third of
offenders met criteria for lifetime drug-use disorders (abuse or dependence)
(Table 2), most having drug dependence.
Ten percent of women and 12% of men reported a 12-month drug dependence disorder.
The percentage of interviewees reporting neither alcohol nor drug diagnoses
was 13% for women and 8% for men.
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Table 2. Prevalence of Psychiatric Disorders (DWI-Offender vs NCS [Western
US] Sample)*
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Lifetime major depressive disorder was found in 28% of women and 13%
of men. Major depressive disorder was experienced by 17% of women and 7% of
men in the 12 months before the interview. A higher proportion of women than
men experienced lifetime and 12-month dysthymic disorder, generalized anxiety
disorder, and PTSD. A higher proportion of men than women met criteria for
antisocial personality disorder.
COMPARISONS WITH THE NCS SAMPLE
The prevalence of lifetime alcohol abuse and dependence, and drug dependence
for both sexes was much higher in the DWI than in the matched NCS sample (Table 2). For example, at 61% for women
and 70% for men, the rates of lifetime alcohol dependence among DWI offenders
were more than twice those of the respective NCS samples. Reported 12-month
symptoms of alcohol and other drug dependence diagnoses in the DWI population
also exceeded those in the NCS population.
Among offenders with alcohol abuse or dependence, similar proportions
of women in the DWI and NCS samples (about half) reported at least 1 additional
psychiatric disorder (Table 3).
The 3 most common additional disorders were drug dependence, major depressive
disorder, and PTSD. Compared with the NCS sample, a lower percentage of men
(DWI sample, 33%; NCS sample, 42%) had at least 1 additional psychiatric disorder,
the most common being drug dependence, major depressive disorder, antisocial
personality disorder, and PTSD.
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Table 3. Prevalence of Psychiatric Disorders Among Those With a Lifetime
Alcohol Abuse or Dependence Disorder (DWI Offender vs NCS [Western US] Sample)*
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COMMENT
Common sense and previous research have already informed researchers
that the DWI-offender population has high rates of alcohol–use disorders.
What is significant about this report's findings is how high these rates are,
especially when compared with those of the general community sample. In addition
to the high rates, most individuals involved with alcohol or other drugs in
the DWI sample met criteria for lifetime dependence, whereas in the general
population sample there was a higher proportion with abuse (without dependence).
These data suggest that as a group the population of DWI offenders is closer
to a clinical than a nonclinical population. Furthermore, 12-month diagnoses
indicate a high degree of symptoms in the ensuing years following the DWI
referral, which underscores the need for effective therapies in this population.
Some studies suggest that the proportion of alcoholics in DWI-offender
populations is lower than that reported in the present study. Fine and colleagues44 classify 50% of first-DWI offenders as beginning
problem drinkers, with only 8% evaluated as having serious alcohol-related
problems. Stewart et al45 studied more than
5000 first-DWI offenders, finding that 92% had low scores on the Alcohol Dependence
Scale.46 However, no diagnostic interviews
were conducted in this population.
Conversely, several studies find rates approaching those in the present
study. A longitudinal study17 of a community
sample of young men reports that among those later convicted of drunk driving,
about half were alcohol dependent at follow-up. Clinical evaluations of consecutive
first offenders in a Massachusetts court found that 82% were alcoholics or
problem drinkers.47 Small48
suggests that 50% of all first-time, 70% of second-time, and 100% of third-time
DWI offenders are alcoholics. Results of these studies support our suggestion
that any history of conviction for drunk driving should alert the examining
physician to evaluate the patient for alcohol abuse and dependence.
Only 2 previously published studies have used structured diagnostic
interviews to determine diagnoses of alcohol abuse or dependence in DWI-offender
populations. The first was conducted among 617 New York offenders (men, 85%;
white, 86%; repeat offenders, 56%) referred for alcohol evaluation.49 The authors' findings were similar to ours with respect
to the proportion of women with alcohol dependence (61%) but higher for men
(82%). Another New York study,50 conducted
among 184 convicted DWI-offender volunteers, found alcohol dependence in 66%
of first and 87% of repeat offenders.
This is the first study to evaluate rates of drug abuse and dependence
in a DWI-offender sample. Findings demonstrate a high degree of involvement
with drugs other than alcohol. Drug abuse or dependence was reported by an
estimated 32% of women and 38% of men. These rates greatly exceed those in
the general community sample. Findings are consistent with research showing
that a high percentage of crash drivers15 and
drivers suspected of impaired driving51, 52
have used other drugs in addition to alcohol. It also is consistent with investigations
done in community and clinical samples of persons with alcohol-use disorders,
finding high rates of drug problems.53 These
data suggest that all persons with drunk-driving offenses should also undergo
evaluation for drug-use disorders.
Study limitations include the low participation rates and the procedures
used to assign diagnoses. Low participation rates are addressed in another
report,30 which showed that alcohol diagnosis
and blood alcohol concentration at arrest of subjects interviewed were similar
to those of subjects not interviewed, suggesting that bias was not a factor
with respect to alcohol diagnoses. Possible biases with respect to other psychiatric
disorders, however, were not evaluated.
Comparison between the DWI and NCS surveys indicates that although both
used the same diagnostic criteria (DSM-III-R), the
interviews were not identical, with the NCS interview perhaps yielding higher
prevalence estimates than the DIS.31 Also,
the DWI and NCS surveys were administered by lay interviewers. Neither interview
yields results as accurate as those of clinicians skilled in assigning diagnoses.31 The study limitations would be expected to lead to
conservative prevalence estimates for most diagnoses in the DWI sample.
New Mexico is notorious for its high alcohol-related traffic fatality
rates,54 which may suggest that these offenders
may have higher rates of psychiatric problems than offenders from other states.
This concern is mitigated by the similarities of our sample to other DWI-offender
populations and by our sample's nonclinical nature. If anything, these factors
would lead to projected underestimates of the true rate of alcohol diagnoses,
compared with national rates.
This study is also unique in its inclusion of a large sample of female
offenders. Because women constitute a small proportion (13%-18%) of all DWI
arrests nationally, only a few studies55, 56, 57, 58
have focused on female offenders. We found that rates of alcohol-use disorders
are higher for male than female offenders. This is inconsistent with findings
of a 1970s study59 suggesting that women arrested
for DWI may have higher levels of substance-use disorders compared with male
offenders. But recent studies23, 60, 61
report lower or similar sex-specific rates of alcohol dependence among female
offenders. In the present study, there were no sex differences among subjects
in drug abuse or dependence.
Our findings also agree with study results from a nonclinical sample
of DWI offenders that found women who are alcohol dependent report higher
levels of depression symptoms than men who are alcohol dependent.23 Other sex differences in the offender population
are consistent with characteristics of the general population.62
However, our findings that female offenders are more likely than male offenders
to have affective disorders and PTSD, but not antisocial personality disorder,
do not support the conclusion of Argeriou and Paulino59
that female DWI offenders may have higher levels of "social pathologic conditions"
than men. Our data suggest that female DWI offenders diverge more from the
general population of women with respect to overall psychiatric morbidity
than male offenders diverge from the general male population.
Considering the high rate of alcohol and other drug dependence diagnoses
in the DWI-offender population, a high level of comorbidity is expected, because
individuals with alcohol-use disorders, in clinical and community samples,
often have additional comorbid disorders.63
A study50 conducted among DWI offenders using
the SCL-90-R64 self-report
inventory for psychopathologic conditions found that the prevalence of psychiatric
symptoms was strongly related to whether the individual had a DSM-III-R diagnosis of alcohol dependence. Comparison of overall rates
of these disorders in the subset of DWI offenders with alcohol-use disorders
in a comparable NCS sample reveals high rates of other co-occurring disorders
in both samples.
Studies5, 9, 21
have pointed to the heterogeneity of DWI-offender populations and the need
for typologies to better match offenders with treatments geared to their specific
needs. Our study suggests that, while there is a great deal of heterogeneity
with respect to psychiatric comorbidity, only a small percentage (men, 9%;
women, 15%) did not meet lifetime criteria for alcohol-use disorders, far
exceeding the rates in the general population. Our findings also indicate
that treatment providers for DWI populations should be prepared to evaluate
for and address psychiatric problems commonly co-occurring in populations
with alcohol-use disorders. This is especially important because studies of
comorbid psychiatric disorders among persons with alcoholism find that the
severity of psychiatric symptoms is often predictive of poor treatment outcome
for those who are substance abusers.65, 66
Furthermore, more intense interventions at an early stage may reduce recidivism
and crash rates.3 Early detection is particularly
important for women, who are more likely to experience psychiatric comorbidity
and less likely to seek early help for drinking problems.67
AUTHOR INFORMATION
Accepted for publication April 3, 2001.
This study was funded by grant RO1 AA09620 from the National Institute
on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda,
Md.
We thank the Bernalillo County Metropolitan Court and the Lovelace Respiratory
Research Institute, Albuquerque, NM, for their support of our program, Joyce
Welt and Don Peyton, BA, BS, for manuscript preparation, Charles Paine, PhD,
and Paula Bradley for editorial assistance; and gratefully acknowledge all
the men and women who participated in this research.
From the Behavioral Health Research Center of the Southwest, Albuquerque,
NM. Dr Smith is deceased. Dr Smith was affiliated with the Department of Psychiatry,
Washington University, St Louis, Mo.
Corresponding author and reprints: Sandra C. Lapham, MD, MPH, Behavioral
Health Research Center of the Southwest, 6624 Gulton Ct NE, Albuquerque, NM
87109 (e-mail: slapham{at}bhrcs.org).
REFERENCES
| |
1. FBI Web Site. Uniform crime reports for the United States. Available at: http://www.fbi.gov/. Accessed December 22,
1999.
2. Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems:
Report of a Study by a Committee of the Institute of Medicine, Division of
Mental Health and Behavioral Medicine. Washington, DC: National Academy Press; 1990:1-629.
3. Mann RE, Leigh G, Vingilis ER, De Genova K. A critical review on the effectiveness of drinking-driving rehabilitation
programs. Accid Anal Prev. 1983;15:441-461.
4. Foon AE. The effectiveness of drinking-driving treatment programs: a critical
review. Int J Addict. 1988;23:151-174.
ISI
| PUBMED
5. Wells-Parker E, Bangert-Drowns R. Meta-analysis of research on DUI remedial interventions. Alcohol Drugs Driving. 1990;6:147-160.
6. Timken DS. Motivational Interviewing and Counseling: Preparing
Offenders to Change Drinking and Driving Behaviors. Boulder, Colo: Timken & Associates Inc; 1995.
7. Miller BA, Windle M. Alcoholism, problem drinking, and driving while impaired. In: Wilson RJ, Mann RE, eds. Drinking and Driving:
Advances in Research and Prevention. New York, NY: Guilford Press;
1990:68-95.
8. Nichols JL. Treatment versus deterrence: the impact of education and treatment
versus deterrent approaches. Alcohol Health Res World. 1990;14:44-51.
9. Wells-Parker E, Landrum JW, Topping JS. Matching the DWI offender to an effective intervention strategy: an
emerging research agenda. In: Wilson RJ, Mann RE, eds. Drinking and Driving:
Advances in Research and Prevention. New York, NY: Guilford Press;
1990:267-289.
10. Donovan DM, Marlatt GA, Salzberg PM. Drinking behavior, personality factors and high-risk driving: a review
and theoretical formulation. J Stud Alcohol. 1983;44:395-428.
ISI
| PUBMED
11. Vingilis E. Drinking drivers and alcoholics: are they from the same population? In: Smart RG, Glaser FB, Israel Y, Kalant H, Popham RE, Schmidt W,
eds. Research Advances in Alcohol and Drug Problems.
Vol 7. New York, NY: Plenum Press; 1983:299-342.
12. Perrine MB. Varieties of drunken and of drinking drivers: a review, a research
program, and a model. In: Noordzij PC, Roszbach R, eds. Alcohol, Drugs
and Traffic Safety, T86. Amsterdam, the Netherlands: Elsevier Science
Publishers; 1987:105-113.
13. Perrine MW, Peck RC, Fell JC. Epidemiologic perspectives on drunk driving. In: Surgeon General's Workshop on Drunk Driving:
Background Papers. Rockville, Md: Office of the Surgeon General, US
Dept of Health and Human Services, Public Health Service; 1989:35-76.
14. Beerman KA, Smith MM, Hall RL. Predictors of recidivism in DUIs. J Stud Alcohol. 1988;49:443-449.
ISI
| PUBMED
15. US Department of Transportation. Presidential Initiative on Drugs, Driving, and Youth:
Recommendations From the Secretary of Transportation and the Director of National
Drug Control Policy. Washington, DC: US Dept of Transportation, National Highway Traffic
Safety Administration; 1997. Prepared by the Dept of Transportation and the
Office of National Drug Control Policy in conjunction with the Depts of Education,
Health and Human Services, and Justice.
16. Sutker PB, Brantley PJ, Allain AN. MMPI response patterns and alcohol consumption in DUI offenders. J Consult Clin Psychol. 1980;48:350-355.
FULL TEXT
|
ISI
| PUBMED
17. McCord J. Drunken drivers in longitudinal perspective. J Stud Alcohol. 1984;45:316-320.
ISI
| PUBMED
18. Argeriou M, McCarty D, Blacker E. Criminality among individuals arraigned for drinking and driving in
Massachusetts. J Stud Alcohol. 1985;46:525-530.
ISI
| PUBMED
19. Donovan DM. Assessment of expectancies and behaviors associated with alcohol consumption:
a cognitive-behavioral approach. J Stud Alcohol. 1980;41:1153-1185.
ISI
| PUBMED
20. Donovan DM, Marlatt GA. Personality subtypes among driving-while-intoxicated offenders: relationship
to drinking behavior and driving risk. J Consult Clin Psychol. 1982;50:241-249.
FULL TEXT
|
ISI
| PUBMED
21. Simpson HM, Mayhew DR. The Hard Core Drinking Driver. Ottawa, Ontario: Traffic Injury Research Foundation of Canada; 1991.
22. Nochajski TH, Miller BA, Parks KA. Comparison of first-time and repeat DWI offenders. Alcohol Clin Exp Res. 1994;18:428.
23. Windle M, Miller BA. Alcoholism and depressive symptomatology among convicted DWI men and
women. J Stud Alcohol. 1989;50:406-413.
ISI
| PUBMED
24. Lapham SC, Skipper BJ, Owen JP, Kleyboecker K, Teaf D, Thompson B, Simpson G. Alcohol abuse screening instruments: normative test data collected
from a first DWI offender screening program. J Stud Alcohol. 1995;56:51-59.
ISI
| PUBMED
25. Lapham SC, Skipper BJ, Simpson GL. A prospective study of the utility of standardized instruments in predicting
recidivism among first DWI offenders. J Stud Alcohol. 1997;58:524-530.
ISI
| PUBMED
26. Lapham SC, Skipper BJ, Hunt WC, Chang I. Do risk factors for rearrest differ for female and male drunk-driving
offenders? Alcohol Clin Exp Res. 2000;24:1647-1655.
FULL TEXT
|
ISI
| PUBMED
27. Moskowitz H, Walker J, Gomberg C for the California Dept of Alcohol and Drug Abuse. Characteristics of DWIs, Alcoholics and Controls. Los Angeles: University of California; 1979.
28. The Century Council: Looking Back, Moving Forward. Los Angeles, Calif: The Century Council; 1997.
29. Samet JM. Respiratory diseases and cigarette smoking in a Hispanic population
in New Mexico. Am Rev Respir Dis. 1988;137:815-819.
ISI
| PUBMED
30. Lapham SC, Baum G, Skipper BJ, Chang I. Attrition in a follow-up study of DWI offenders: who is lost? Alcohol Alcohol. 2000;35:464-470.
FREE FULL TEXT
31. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R
psychiatric disorders in the United States: results from the National Comorbidity
Survey. Arch Gen Psychiatry. 1994;51:8-19.
FREE FULL TEXT
32. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders,
Revised Third Edition. Washington, DC: American Psychiatric Association; 1987.
33. World Health Organization. Composite International Diagnostic Interview [computer program]. Geneva, Switzerland: World Health Organization; 1991.
34. C-DIS Interview Manager, Version 3.0. Ottawa, Ontario: C-DIS Management Group Inc; 1990.
35. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule:
its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381-389.
FREE FULL TEXT
36. Robins LN, Helzer JE, Ratcliff KS, Seyfried W. Validity of the Diagnostic Interview Schedule, Version II: DSM-III diagnoses. Psychol Med. 1982;12:855-870.
ISI
| PUBMED
37. Warner LA, Kessler RC, Hughes M, Anthony JC, Nelson CB. Prevalence and correlates of drug use and dependence in the United
States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:219-229.
FREE FULL TEXT
38. Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stoltzman RK, Farmer A, Brockington IF. A comparison of clinical and Diagnostic Interview Schedule diagnoses:
physician reexamination of lay-interviewed cases in the general population. Arch Gen Psychiatry. 1985;42:657-666.
FREE FULL TEXT
39. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH Epidemiologic Catchment Area program: historical context,
major objectives, and study population characteristics. Arch Gen Psychiatry. 1984;41:934-941.
FREE FULL TEXT
40. Greist JH, Klein MH, Erdman HP, Bires JK, Bass SM, Machtinger PE, Kresge DG. Comparison of computer- and interviewer-administered versions of the
Diagnostic Interview Schedule. Hosp Community Psychiatry. 1987;38:1304-1311.
FREE FULL TEXT
41. Ross HE, Swinson R, Doumani S, Larkin EJ. Diagnosing comorbidity in substance abusers: a comparison of the test-retest
reliability of two interviews. Am J Drug Alcohol Abuse. 1995;21:167-185.
ISI
| PUBMED
42. US Department of Commerce. 1990 Census of Population and Housing. Washington, DC: Government Printing Office; 1990.
43. Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual, Release 7.5. Research Triangle Park, NC: Research Triangle Institute Inc; 1997.
44. Fine EW, Scoles P, Mulligan M. Under the influence: characteristics and drinking practices of persons
arrested the first time for drunk driving, with treatment implications. Public Health Rep. 1975;90:424-429.
ISI
| PUBMED
45. Stewart K, Epstein L, Gruenewald P, Laurence S, Roth T for the California Office of Traffic Safety. The California First DUI Offender Evaluation Project. Walnut Creek, Calif: Pacific Institute of Research and Evaluation;
1987.
46. Skinner HA, Horn JL. Alcohol Dependence Scale (ADS) User's Guide. Toronto, Ontario: Addiction Research Foundation; 1984.
47. Kramer AL. Judge calls the last shot. Traffic Safety. March/April 1991:10-13.
48. Small J. DWI intervention: reaching the problem drinker. Alcohol Health Res World. 1982;7:21-23.
49. Wieczorek WF, Callahan CP, Miller BA. Victimization experiences and problem drinking among DWI offenders. Alcohol Clin Exp Res. 1994;18:475.
50. Pristach EA, Nochajski TH, Wieczorek WF, Miller BA, Greene B. Psychiatric symptoms and DWI offenders. Alcohol Alcohol Suppl. 1991;1:493-496.
PUBMED
51. Saylor KE, DuPont RL, Brown H. The high way: driving under influences other than alcohol [letter]. JAMA. 1992;267:652.
FREE FULL TEXT
52. Brookoff D, Cook CS, Williams C, Mann CS. Testing reckless drivers for cocaine and marijuana. N Engl J Med. 1994;331:518-522.
FREE FULL TEXT
53. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drugs. JAMA. 1990;264:2511-2518.
FREE FULL TEXT
54. Governor's Cabinet Council on DWI Reduction. Report to the Governor: DWI Deaths and Injuries in
New Mexico Are Preventable. Santa Fe, New Mexico: Governor's Cabinet Council on DWI Reduction;
September 1996.
55. Argeriou M, McCarty D, Potter D, Holt L. Characteristics of men and women arrested for driving under the influence
of liquor. Alcohol Treatment Q. 1986;3:127-137.
56. McCarty D, Argeriou M, Blacker E. Legislated policies and recidivism for driving under the influence
of liquor in Massachusetts. J Stud Alcohol. 1985;46:97-102.
ISI
| PUBMED
57. Shore ER, McCoy ML, Toonen LA, Kuntz EJ. Arrests of women for driving under the influence. J Stud Alcohol. 1988;49:7-10.
ISI
| PUBMED
58. Yu J, Essex DT, Williford WR. DWI/DWAI offenders and recidivism by gender in the eighties: a changing
trend? Int J Addict. 1992;27:637-647.
ISI
| PUBMED
59. Argeriou M, Paulino D. Women arrested for drunken driving in Boston: social characteristics
and circumstances of arrest. J Stud Alcohol. 1976;37:648-658.
ISI
| PUBMED
60. Wells-Parker E, Pang MG, Anderson BJ, McMillen DL, Miller DI. Female DUI offenders: a comparison to male counterparts and an examination
of the effects of intervention on women's recidivism rates. J Stud Alcohol. 1991;52:142-147.
ISI
| PUBMED
61. Wieczorek WF, Miller BA. Preliminary typology designed for treatment matching of driving-while-intoxicated
offenders. J Consult Clin Psychol. 1992;60:757-765.
FULL TEXT
|
ISI
| PUBMED
62. Hesselbrock MN, Hesselbrock VM. Gender, alcoholism, and psychiatric comorbidity. In: Wilsnack RW, Wilsnack SC, eds. Gender and Alcohol:
Individual and Social Perspectives. New Brunswick, NJ: Rutgers Center
of Alcohol Studies; 1997:49-71.
63. Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol
abuse and dependence with other psychiatric disorders in the National Comorbidity
Survey. Arch Gen Psychiatry. 1997;54:313-321.
FREE FULL TEXT
64. Derogatis LR. SCL-90-R Administration, Scoring & Procedures
Manual: II. Towson, Md: Clinical Psychometric Research; 1983.
65. LaPorte DJ, McLellan AT, Erdlen FR, Parente RJ. Treatment outcome as a function of follow-up difficulty in substance
abusers. J Consult Clin Psychol. 1981;49:112-119.
FULL TEXT
|
ISI
| PUBMED
66. McLellan AT, Luborsky L, Woody GE, O'Brien CP, Druly KA. Predicting response to alcohol and drug abuse treatments: role of psychiatric
severity. Arch Gen Psychiatry. 1983;40:620-625.
FREE FULL TEXT
67. Wilsnack RW, Wilsnack SC. Introduction. In: Gender and Alcohol: Individual and Social Perspectives. New Brunswick, NJ: Rutgers Center of Alcohol Studies; 1997:1-16.
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