Physical activity surveillance in parks using direct observation.

INTRODUCTION: Primary features of observational public health surveillance instruments are that they are valid, can reliably estimate physical activity behaviors, and are useful across diverse geographic settings and seasons by different users. Previous studies have reported the validity and reliability of Systematic Observation of Play and Recreation in Communities (SOPARC) to estimate park and user characteristics. The purpose of this investigation was to establish the use of SOPARC as a surveillance instrument and to situate the findings from the study in the context of the previous literature. METHODS: We collected data by using SOPARC for more than 3 years in 4 locations: Philadelphia, Pennsylvania; Columbus, Ohio; Chapel Hill/Durham, North Carolina; and Albuquerque, New Mexico during spring, summer, and autumn. RESULTS: We observed a total of 35,990 park users with an overall observer reliability of 94% (range, 85%-99%) conducted on 15% of the observations. We monitored the proportion of park users engaging in moderate-to-vigorous physical activity (MVPA) and found marginal differences in MVPA by both city and season. Park users visited parks significantly more on weekend days than weekdays and visitation rates tended to be lower during summer than spring. CONCLUSION: SOPARC is a highly reliable observation instrument that can be used to collect data across diverse geographic settings and seasons by different users and has potential as a surveillance system.

Underdiagnosis of comorbid mental illness in repeat DUI offenders mandated to treatment.

Repeat offenders for DUI are routinely mandated to undergo alcohol treatment. These individuals have been shown to have high rates of co-occurring psychiatric disorders, which can be important for the conduct and outcomes of alcohol treatment. The extent to which treatment providers are aware of these disorders and modify treatment accordingly is unknown. As part of a larger study to investigate the impact of sanction conditions on probation outcomes, we screened 233 patients for psychiatric conditions and compared the findings with the psychiatric conditions identified during mandatory treatment by independent treatment providers. Adjusted rates of underdiagnosis were commonly high: 97.2% of bipolar disorder cases, 67.5% of major depression cases, 100% of obsessive-compulsive disorder cases, and 37.3% of drug use disorder cases remained undiagnosed during treatment. Rates of overdiagnosis were low for all disorders, with the exception of drug use disorders. These rates of underdiagnosis represent missed opportunities to improve treatment outcomes among repeat DUI offenders.

Cognitive predictors of alcohol involvement and alcohol consumption-related consequences in a sample of drunk-driving offenders.

Motivational theories of alcohol involvement emphasize a wide range of cognitive factors as precursors to "heavy" or high-risk drinking. Central to this consideration has been expectancies, drinking urges, triggers, and situational cues, all of which can synergistically or independently stimulate drinking. Unfortunately, empirical studies have scrutinized low-level or moderate drinkers drawn from the general population, and less is known about the role of cognitive factors as precursors to high-risk drinking. The present study examines the unique contribution of several measures of cognitive motivation to harmful alcohol use in a sample of convicted drunk drivers. Confirmatory factor analysis indicated the psychometric soundness of a model positing four latent predictor constructs assessing drinking urges/triggers, situational cues, positive and negative expectancies and outcome constructs assessing harmful alcohol use and perceived consequences of harmful drinking. A structural equation model indicated that each motivational construct was associated uniquely with both drinking and perceived consequences, with the largest overall effect in both cases associated with situational cues. Results are discussed in terms of identifying prominent cognitive factors that may foster harmful drinking among high-risk populations and their implications for treatment.

Randomized sanctions to reduce re-offense among repeat impaired-driving offenders.

AIMS: This study, conducted within a driving under the influence (DUI) court intervention, evaluated the degree to which removing electronic monitoring (EM) and/or mandatory vehicle sales requirements increased rates of post-sentence traffic violations among repeat DUI offenders. DESIGN: Randomized trial. SETTING AND PARTICIPANTS: A total of 477 repeat DUI offenders entering the Driving under the Influence of Intoxicants (DUII) Intensive Supervision Program (DISP), Multnomah County, Oregon. INTERVENTION: Subjects were randomized into four intervention groups. Group 1: standard DISP with EM and vehicle sales requirements; group 2: standard DISP with mandatory vehicle sale, but without EM; group 3: standard DISP with EM, but without mandatory vehicle sale; and group 4: standard DISP without EM or mandated vehicle sale. Standard DISP includes treatment for alcohol abuse and dependence, polygraph testing, regular court appearances, and probation or court-based monitoring. MEASUREMENTS: The risk of re-arrest for traffic violations was compared among the four groups using hazard ratio estimates from complementary log-log regression models. FINDINGS: Compared with group 1, subjects in group 2 initially had increased re-arrest risks, but this effect dissipated within 3 years of entering DISP. Group 3 subjects had a 96% increase in re-arrest rates. Group 4 subjects had smaller increased risks than predicted, with re-arrest rates similar to those of group 1 at the end of the follow-up period. CONCLUSIONS: Although some of the findings suggest that mandatory vehicle sales may deter future traffic violations, inconsistent results across groups make this finding equivocal. Positive effects of EM, while large in the short term, appear to have a relatively small long-term value in reducing traffic arrest rates.

Geographic variability in alcohol-related crashes in response to legalized Sunday packaged alcohol sales in New Mexico.

On July 1, 1995 the state of New Mexico lifted its ban on Sunday packaged alcohol sales. Legislation lifting the ban included a local option allowing individual communities within the state to hold an election to reinstitute the ban on Sunday packaged alcohol sales. Previous research has shown a clear statewide increase in alcohol-related crash and crash fatality rates after the ban was lifted. The goal of this study is to measure county-level variability in changes in alcohol-related crash rates while adjusting for county socio-demographic characteristics, spatial patterns in crash rates and temporal trends in alcohol-related crash rates. Bayesian hierarchical binomial regression models were fit to the observed quarterly crash counts for all counties between July 1, 1990 and June 30, 2000. Results show marked variability in the impact of legalized Sunday packaged alcohol sales on alcohol-related crash rates. Relative risks of an alcohol-related crash for the post-repeal versus pre-repeal period vary across counties from 1.04 to 1.90. Counties with older population suffered a greater negative impact of legalized Sunday packaged alcohol sales. Counties with communities that quickly passed the local option to re-ban packaged sales on Sundays were able to mitigate most of the deleterious impact of increased alcohol availability that was observed across the state.

Psychiatric disorders in a sample of repeat impaired-driving offenders.

OBJECTIVE: This study was conducted to assess alcohol- and drug-use disorders and other psychiatric disorders in a sample of repeat driving under the influence (DUI) offenders. METHOD: We interviewed offenders to estimate lifetime and 12-month prevalence of psychiatric disorders as designated by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (alcohol and drug abuse and dependence, major depressive or dysthymic disorder, bipolar disorder, post- traumatic stress disorder [PTSD], and obsessive-compulsive disorder). The offenders interviewed (385 men, 74 women) were those who had been adjudicated in the Multnomah County, OR, Driving Under the Influence of Intoxicants Intensive Supervision Program. Psychiatric diagnoses were assessed using the Composite International Diagnostic Interview. RESULTS: The majority of respondents (53.8%) were alcohol dependent. Sixty-five percent of men and 79.7% of women had at least one lifetime disorder comorbid with alcohol abuse or dependence. The most prevalent lifetime non-substance-use disorder was major depressive or dysthymic disorder (30.9%) followed by PTSD (15.3%). Approximately 40% of subjects reported meeting criteria for lifetime nonalcohol drug abuse for at least one drug type, and 30% were drug dependent for at least one drug type; overall, 54% of all offenders had drug abuse or dependence disorders. CONCLUSIONS: Assessment and treatment services for repeat alcohol-impaired driving offenders should be sufficiently comprehensive to provide care for drug-use disorders and other psychiatric problems.

Reclassifying DIS-III-R alcohol use disorders to DSM-IV criteria in a sample of convicted impaired drivers.

OBJECTIVE: This study used data gathered from the Diagnostic Interview Schedule, Version Three, Revised (DIS-III-R), which calculated diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), criteria and rescored the data to be compatible with the criteria of the Fourth Edition of the DSM (DSM-IV) for lifetime alcohol abuse and dependence. METHOD: A psychologist reassigned questions from the DIS-III-R according to DSM-IV criteria. Another clinician evaluated the rescoring criteria and discrepancies were discussed and resolved. Using these criteria, SAS code was written to automate the rescoring of responses to DIS-III-R questions to DSM-IV diagnoses from a population of DWI offenders. RESULTS: There was a fair-to-good level of agreement between the DSM-III-R and rescored DSM-IV diagnoses (kappa = .65). Three hundred forty-eight subjects classified as alcohol dependent using DSMIII- R were reclassified as alcohol abuse in the DSM-IV rescore. Among subjects who were alcohol dependent based on DIS-III-R criteria, the distribution of DSM-IV diagnoses was similar across gender, age, and ethnic groups. There was no difference in agreement between DSMIII- R and the rescored DSM-IV diagnoses by age category. However, women and Hispanics had significantly higher weighted kappa statistics than men and non-Hispanic whites. CONCLUSIONS: Our rescoring results were consistent with earlier studies that compared DSM-III-R and DSM-IV diagnoses. Here, we offer an approach that may be useful to investigators who used the DIS-III-R in earlier studies. The DIS-III-R questions corresponding to DSM-IV criteria for alcohol abuse and alcohol dependence are on our Web site at www.bhrcs.org, along with the scoring algorithm.

Impaired-driving recidivism among repeat offenders following an intensive court-based intervention.

PURPOSE: Repeat impaired-drivers resist successful rehabilitation. This paper describes and evaluates an innovative court-based intervention for repeat impaired-driving offenders, the driving under the influence (DUI) Intensive Supervision Program (DISP) developed in Multnomah County, Oregon. METHODS: The hazard of re-offending was compared between DISP participants (N=460) and a comparison group (N=497). The stratified Cox proportional hazards model was used to model the hazard of re-offense, adjusting for matching criteria and stratified by county of residence. RESULTS: Adjusted hazard of DUI re-offense for DISP participants was 0.52 that of comparison offenders (95% CI=0.36-0.76). DISP clients also had lower arrest rates for driving while revoked/suspended and for all other traffic offenses. CONCLUSION: Preliminary results suggest the DISP is an effective means of reducing recidivism among repeat impaired-driving offenders.

How important is perception of safety to park use? A four-city survey.

PURPOSE: To determine individual- and park-related characteristics associated with adults visiting their closest neighborhood park and involvement in sports, walking, and sedentary activities. DESIGN: Cross-sectional study. SETTING: Neighborhoods surrounding 24 parks in four United States metropolitan areas. SUBJECTS: Adults (N = 3,815) (25% African American, 12% Hispanic, and 56% Non-Hispanic White) living within .5 mile of one of 24 public parks. MEASURES: Anonymous surveys and park observations. ANALYSIS: Chi-square statistics and logistic regression including individual and park characteristics. RESULTS: Thirty-seven percent reported never having visited their park; 16% reported using it for regular exercise. Respondents who perceived the parks as safe or very safe had 4.6 times the odds of visiting the parks. Active sports participation was associated with being male, ages 18 to 24, and of African American heritage. Walking was associated with being female, age 47+, and reporting fair or poor health. Females, Hispanics, and those reporting fair/poor health were more likely to report sedentary activities. Park characteristics associated with park use included fewer physical incivilities, closer proximity to homes, more facilities, and organized activities. CONCLUSIONS: Perceptions of park safety were strongly associated with ever having visited a respective park, while park characteristics appeared to influence the types of activities performed. Increasing the number of organized activities and offering a variety of different facilities may encourage park use.

Using the Bivariate Dale Model to jointly estimate predictors of frequency and quantity of alcohol use.

OBJECTIVE: This study demonstrates the usefulness of the Bivariate Dale Model (BDM) as a method for estimating the relationship between risk factors and the quantity and frequency of alcohol use, as well as the degree of association between these highly correlated drinking measures. METHOD: The BDM is used to evaluate childhood sexual abuse, along with age and gender, as risk factors for the quantity and frequency of beer consumption in a sample of driving-while-intoxicated (DWI) offenders (N = 1,964; 1,612 men). The BDM allows one to estimate the relative odds of drinking up to each level of ordinal-scaled quantity and frequency of alcohol use, as well as model the degree of association between quantity and frequency of alcohol consumption as a function of covariates. RESULTS: Individuals who experienced childhood sexual abuse have increased risks of higher quantity and frequency of beer consumption. History of childhood sexual abuse has a greater effect on women, causing them to drink higher quantities of beer per drinking occasion. CONCLUSIONS: The BDM is a useful method for evaluating predictors of the quantity-frequency of alcohol consumption. SAS macrocode for fitting the BDM model is provided.

New Mexico's 1998 drive-up liquor window closure. Study II: economic impact on owners.

AIMS: This study examined the economic impact of the New Mexico legislative action closing drive-up liquor windows on the retail establishments that operated them. DESIGN: A telephone survey was conducted 20 months after the closure seeking information and owners' opinions about how their outlets had changed since the closure and how this affected their business. In addition, 2 years of aggregated pre- and post-closure total gross receipts revenues were obtained from the New Mexico Taxation and Revenue Department, with convenience stores as a comparison group. FINDINGS: Interviews were completed for 149 of 220 establishments. Over one-quarter of former drive-up liquor windows (28%) had been converted to 'step-in' sales, defined as an outside door where customers can stop and enter the premises while their car is running. Almost two-thirds (61%) of owners reported decreased annual gross revenues following closure, with a reported average 15% reduction in alcohol sales. This is consistent with findings of decreased gross receipts for operators of non-urban, but not urban, drive-up liquor windows compared to convenience store gross receipts. Almost three-quarters (72%) of those surveyed would re-open the drive-up window if the law were rescinded. CONCLUSION: Over one-quarter of the drive-up owners converted to step-in alcohol sales that still allow a form of drive-up liquor sales. Despite this, the forced closure of New Mexico's drive-up liquor windows negatively impacted total sales and liquor sales revenues of establishments that operated them.

Does moderate alcohol use affect health-care costs? A propensity analysis of female health-care workers.

AIMS: To determine differences in health-care costs associated with moderate alcohol consumption among female health-care workers while controlling for other risk factors that may be correlated with alcohol use. DESIGN AND SETTING: Non-randomized, prospective, observational study of health-care costs by female health-care workers in a large managed care organization recruited between 1 January 1998 and 1 July 2000. PARTICIPANTS: Six hundred and eighty-five female employees, continuously and stably employed by the managed care organization, who received health-care through the affiliated managed care organization. All women completed a health risk appraisal as part of the company's Employee Wellness Plan; 218 women were categorized as moderate drinkers and 467 as abstainers/light drinkers. MEASUREMENTS: Total costs of in-plan and out-of-plan health-care utilization, by type of service, during the 6 month period after completing the health risk survey were calculated. FINDINGS: Using 218 one-to-one matched pairs of moderate drinkers and abstainers/light drinkers, no significant differences in total, outpatient or inpatient costs were observed during the 6 month observation period. Pharmacy costs were significantly lower for moderate drinkers (-43 dollars, 95% CI = -88.82 dollars to -2.41 dollars), primarily due to differences in costs from anxiolytic (including barbiturates and benzodiazepines), hypnotic and sedative drug fills. CONCLUSIONS: Findings demonstrate the value of risk factor matching when studying the relationship between alcohol use and health-care utilization. The discovery of differential pharmacy utilization raises the possibility that alcohol consumption may reduce the use of prescribed central nervous system depressants.

New Mexico's 1998 drive-up liquor window closure. Study I: effect on alcohol-involved crashes.

AIMS: To determine the spatial relationship between drive-up liquor window locations and alcohol-related traffic crashes for 2 years before and after New Mexico banned drive-through alcohol sales. DESIGN: Current liquor licenses, crash data, roadway information and US Census data were used in this analysis. Cross-sectional and longitudinal regression analyses were applied to the entire state, and to Albuquerque only. FINDINGS: Of all NM liquor licenses, 189 (9%) included drive-up sales, which co-occurred with on- or off-premise licenses (94%). The rate of non-pedestrian alcohol-related crashes relative to non-pedestrian total crashes showed an increasing trend prior to closure and a decreasing trend after the closure. Cross-sectional analyses in Albuquerque revealed that the percentage of alcohol-involved crashes was not related to densities of on- or off-premise outlets per kilometer of roadway, or to percentage of drive-up outlets. Statewide, the percentage of drive-up outlets was not significantly related to the percentage of alcohol-related crashes within census tracts but was associated positively with the percentage of alcohol-related crashes in surrounding census tracts. There was no statistically significant relationship between number of drive-ups and percentage of alcohol-related crashes in either longitudinal model. CONCLUSIONS: Despite the declining rate of alcohol-related crashes following closure of drive-up liquor windows, both in Albuquerque and statewide, regression models using spatial data do not demonstrate definitively an association between the decline and the closure of the drive-up liquor windows.

Accuracy of alcohol diagnosis among DWI offenders referred for screening.

BACKGROUND: Most US courts use screening programs to evaluate substance-abuse problems of convicted driving while impaired (DWI) offenders. Typically self-report information determines need for treatment. However, little is known about the accuracy of self-reports of alcohol-use problems in this population. METHODS: DSM-III-R alcohol abuse and dependence diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted DWI offenders were compared with diagnoses and other self-reported information from a voluntary, noncoerced interview 5 years after the screening referral. RESULTS: At initial screening, 16.8% of offenders were diagnosed with alcohol abuse and 20.1% with alcohol dependence. At the 5-year interview, 19.9 and 60.1% received a retrospective diagnosis of alcohol abuse or dependence at the age at which they were screened. Significantly fewer of those with a retrospective alcohol diagnosis reported that their alcohol use self-reports at screening were "very accurate" compared to those with no retrospective diagnosis. CONCLUSIONS: Although many DWI offenders undergoing screening have diagnosable alcohol-related problems, underreporting is common, leading to inaccurate diagnosis and, therefore, a missed treatment opportunity. The research community and policymakers should review and reform the current screening system for alcohol-impaired drivers to better address this serious public health problem.

Are drunk-driving offenders referred for screening accurately reporting their drug use?

Several studies report that a substantial percentage of offenders arrested for impaired driving test positive for drugs of abuse besides alcohol. Current guidelines recommend screening offenders for both alcohol and other drug use, yet little is known about the accuracy of self-reports of drug use in this population. We compared drug abuse and dependence DSM-III-R diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted drunk-driving offenders with diagnoses obtained via a voluntary, non-coerced interview 5 years later. At initial screening, fewer than 6% of offenders were diagnosed with drug abuse or dependence. Among offenders who did not receive an initial drug diagnosis, 28% subsequently reported having experienced drug use problems consistent with a retrospective diagnosis of drug abuse or dependence by the age at which they were screened. Half of those with a retrospective diagnosis of drug dependence reported their initial screening responses were "very accurate". We conclude that, although many drunk-driving offenders undergoing screening have diagnosable drug problems, a high proportion under-report their drug use. We suggest that certain modifications to screening procedures, such as urine drug screening, reducing barriers to treatment, and training counselors in motivational interviewing techniques, may increase accurate identification of drug use problems in this population.

Psychiatric disorders of convicted DWI offenders: a comparison among Hispanics, American Indians and non-Hispanic whites.

OBJECTIVE: Alcohol-impaired offenders have high prevalence rates of psychiatric disorders; however, differences in prevalence rates among ethnic minorities have not been investigated. This study compares lifetime prevalence estimates of DSM-III-R psychiatric disorders (alcohol and drug abuse and dependence, nicotine dependence, major depressive disorder [MDD], dysthymia, generalized anxiety disorder, posttraumatic stress disorder and antisocial personality disorder [ASPD]) among Hispanics, American Indians and non-Hispanic whites convicted of driving while alcohol-impaired. METHOD: Offenders (758 women, 631 men) previously referred to a screening program in Bernalillo County, NM, were interviewed for this study using a structured diagnostic interview. RESULTS: Adjusting for age, education, income and marital status, Hispanic women had significantly higher rates of alcohol abuse (odds ratio [OR] = 2.2) and lower rates of alcohol dependence (OR = 0.3), drug abuse (OR = 0.4) and nicotine dependence (OR = 0.3) than non-Hispanic white women. American-Indian women showed significantly lower rates of alcohol dependence (OR = 0.5), nicotine dependence (OR = 0.2) and MDD (OR = 0.3) than non-Hispanic white women. Hispanic men had significantly lower rates of alcohol dependence (OR = 0.6), drug dependence (OR = 0.5), nicotine dependence (OR = 0.2), MDD (OR = 0.5) and ASPD (OR = 0.4) than non-Hispanic white men. American-Indian men also reported significantly lower rates of drug dependence (OR = 0.5), nicotine dependence (OR = 0.2) and ASPD (OR = 0.3) than non-Hispanic white men. CONCLUSIONS: After statistically adjusting for demographic differences, minority groups were in general less affected by substance abuse problems and had similar or lower rates of other psychiatric disorders when compared with non-Hispanic whites.

Behavioral health and social correlates of reincarceration among Hispanic, Native American, and white rural women.

OBJECTIVE: To identify community reentry needs, this study examined mental illness, substance dependence, and other correlates of reincarceration in an ethnically diverse, rural population of women prisoners. METHODS: A purposive, cross-sectional sample of 98 women in a New Mexico state prison completed structured interviews. Analyses examined associations of substance dependence, mental illness, lifetime trauma, and sociodemographic variables with previous incarceration. RESULTS: Eighty-five percent screened positive for substance dependence, 50% for current mental disorders, and 46% for both. Exposure to trauma was pervasive (100%), especially physical or sexual trauma (83%). In adjusted analyses, previous incarceration was associated with precarious housing before imprisonment (odds ratio [OR]=2.19, p=.038) and with having co-occurring mental illness and substance dependence (OR=2.68, p=.019). CONCLUSIONS: Findings support those of similar studies in urban areas and with other ethnic groups. Wraparound programs focusing on harm reduction, housing, and treatment and support services are needed for successful reentry of these underserved women.

Do deterrence and social-control theories predict driving after drinking 15 years after a DWI conviction?

OBJECTIVE: This study investigates the utility of deterrence and social-control theories for prospective prediction of driving-while-impaired (DWI) outcomes of first-time DWI offenders. METHOD: The sample consisted of a subset of 544 convicted first-time DWI offenders (N=337 females) who were interviewed 5 and 15 years after referral to a Screening Program in Bernalillo County, New Mexico. Variables collected at the 5-year (initial) interview were used in structural equation models to predict past 3-months, self-reported DWI at the 15-year follow-up (follow-up) interview. These variables represented domains defined by deterrence and social-control theories of DWI behavior, with one model corresponding to deterrence theory and one to social-control theory. RESULTS: Both models fit the data. DWI jail time was positively related to perceived enforcement, which was negatively but not significantly related to self-reported DWI. Neither jail time for DWI nor perceived likelihood of arrest was linearly related to self-reported DWI at follow-up. Interactions between jail time and prior DWI behavior indicated relatively weaker associations between initial and 15-year DWI for those reporting more jail time. CONCLUSION: Our prospective study demonstrated that for this convicted DWI offender cohort, classic formulations of deterrence and social-control theories did not account for DWI. However, results suggest that punishment may decrease the likelihood of DWI recidivism.

Life-time drinking course of driving-while-impaired offenders.

AIMS: This retrospective study compared drinking histories of 283 men and 413 women convicted of driving while impaired (DWI) in New Mexico and interviewed 15 years following a first conviction and screening referral. DESIGN: We characterized drinking course and plotted drinking status (stable abstainers, abstainers, moderate or risky drinkers) from age 15 to 60 years. SETTING: Pacific Institute for Research and Evaluation, Albuquerque, New Mexico. PARTICIPANTS: Community sample of previously convicted DWI offenders. MEASUREMENTS: Psychiatric disorders from the Comprehensive International Diagnostic Interview; drinking histories from the Cognitive Lifetime Drinking History. FINDINGS: Risky drinking was prevalent at all ages for both genders. Almost half the population reported either a life-time drinking course of risky drinking (19%) or resumed risky drinking after at least one interval of abstinence or moderate drinking (25%), while about one-fifth followed a never risky or risky to moderate drinking course. Offenders with a life-time diagnosis of substance dependence more often transitioned to risky drinking, and those with life-time alcohol dependence were more prone to transition to abstinence. Across time, those who began risky drinking at age 15 years or later quit at double the rate of those who began before age 15 years. Women's and men's drinking courses were similar, but women began risky drinking at a later age and moved to abstinence more often. CONCLUSIONS: Among people convicted of driving while impaired in the United States, younger age of initiation of drinking and co-occurrence of psychiatric and substance use appear to be associated with a poorer trajectory of subsequent risky drinking behaviour. Women who are convicted of driving while impaired appear to start drinking later in life and be more likely to subsequently become abstainers.

Open-label pilot study of extended-release naltrexone to reduce drinking and driving among repeat offenders.

OBJECTIVES: A high proportion of persons convicted of driving while impaired repeat the offense. Many continue drinking and driving, even when faced with long jail terms. Hence, they pose a serious public health threat. This preliminary study evaluated extended-release, injectable naltrexone suspension (XR-NTX) and supportive therapy in reducing (1) drinking and (2) attempts to drive after drinking among repeat driving while impaired offenders with an ignition interlock device installed in their vehicles. METHODS: Treatment-seeking volunteers received medical management therapy and 3 monthly injections of XR-NTX. We compared data on alcohol consumption, alcohol biomarkers, and interlock information before, during, and after treatment using summary measures and Sign tests. RESULTS: Of 12 consented subjects, 10 received at least 1 injection, and 7 received all 3 injections. All subjects receiving medication reported a decrease in average drinks per day (P < 0.01) and abstinent days (P = 0.02) while on treatment versus pretreatment levels. Average daily drinks decreased by 77%, from 3.0 to 0.69 (P < 0.01), during treatment with XR-NTX. Average drinks per drinking day also declined by 39% during treatment, from 6.6 to 4.0 (P = 0.04). Percent days abstinent increased by 31%, from 56.8 to 81.96 (P = 0.02), which persisted after treatment completion. Biomarkers were consistent with reduced drinking. The percentage of vehicular failures to start due to elevated breath alcohol decreased from 3.1% of tests to 1.29% of tests. CONCLUSIONS: A randomized, controlled clinical trial is needed to demonstrate the efficacy of this promising treatment regimen for repeat offenders.