摘要：Objectives. This study was undertaken to assess a 28-day detention and treatment program’s effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). Methods. We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. Results. Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. Conclusions. Results suggest that this county’s program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites. Injuries sustained in motor vehicle crashes involving impaired drivers are among the most significant preventable health care problems in the United States. Since the early 1980s, driving while impaired (DWI) has received substantial public and political attention. Most states have revised laws and established programs directed at detecting, prosecuting, and imposing sanctions on drinking drivers. These measures are designed to deter impaired drivers through education, enhanced perception of risk of apprehension, and punishment. The programs and policies that have evolved from the deterrence model 1 have resulted in a dramatic increase in the public’s perception of impaired driving as an undesirable and risky behavior. Several analyses of policy-related interventions have suggested that for social drinkers, that is, individuals who are capable of making choices about when, what, and how much to drink, rates of alcohol-related crashes and arrests have declined. 2, 3 For problem drinkers or substance abusers, however, the choice to avoid driving while in an impaired state is reduced by the nature of their habitual or addictive behavior, and for this reason policy-related interventions may have been less effective. Overall, DWI deterrence policies and legislation appear to have had varying or minimal effect on recidivism rates, depending on the level of drivers’ alcohol involvement. An alternative approach to deterrence based on policy has involved intervention programs intended to educate DWI offenders about the consequences of impaired driving. However, studies in Sacramento 6 and in Edmonton, Alberta, 7 indicate that although knowledge about and attitudes toward impaired driving can be changed, such information-based educational efforts have minimal impact on alcohol consumption and related behaviors. 4, 5 Research on victim impact panels (VIPs), in which survivors of the victims in drunk-driving crashes relate their personal experiences to DWI offenders, indicates that this intervention, too, has very limited preventive impact. 8, 9 Comprehensive programs typically employ multiple intervention components: DWI prevention information, a variety of low-intensity therapeutic techniques, action planning to avoid impaired driving, aftercare, and, in some programs, incarceration. Research on these programs has indicated that they reduce DWI recidivism. 10– 17 Such programs have been implemented in several locations. One, in Massachusetts, demonstrated a 6% recidivism rate for program participants compared with 25% for all convicted drinking drivers. 18 In Prince George’s County, Maryland, 14 incarceration and treatment were combined (clients were assigned 7, 14, or 28 days of detention and treatment, depending on whether they had any prior DWI offenses). The program provided 48 hours of intensive group diagnostic activity, followed by counseling through the 28-day period, and the development of a personalized referral and aftercare plan for the postprogram period. Participants sentenced to the Prince George’s County facility demonstrated significantly lower recidivism rates than those not assigned to the program. Differences were most pronounced among first-time offenders, suggesting that this approach was particularly effective in this group. 14 In a meta-analysis of 215 evaluations of DWI programs of all types, Wells-Parker et al. 19 reported 2 important conclusions. Certain types of interventions had received very little empirical assessment; jail-based programs in particular had been infrequently evaluated. Also, interventions that combined education, counseling, and contact probation or client follow-up were more effective than interventions that included 1 or some combination of 2 of these intervention components. Finally, none of these programs has specifically targeted Native American populations. Research on alcohol treatment among Native Americans does not indicate much success in treatment outcome. 20 Furthermore, no studies have specifically addressed DWI intervention programs in Native American populations. This article provides preliminary findings from a comprehensive DWI intervention program that includes a high proportion of Native American clients in the treatment cohort.
