Drink Driving Rehabilitation Programs and Alcohol Ignition ...eprints.qut.edu.au/5946/1/5946_1.pdf · Rehabilitative Interventions 1 Freeman, ... as drink driving interventions have

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This is the author-version of article published as: Freeman, James and Liossis, Poppy (2002) Drink driving rehabilitation programs and alcohol ignition interlocks: Is there a need for more research?. Road and Transport Research 4:pp. 3-13. Accessed from http://eprints.qut.edu.au © 2002 ARRB Group

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Rehabilitative Interventions 1

Freeman, J., & Liossis, P. (2002). Drink driving rehabilitation programs and alcohol ignition interlocks: Is there a need for more research? Road and Transport Research, 4, 3-13.

Drink driving rehabilitation programs and alcohol ignition

interlocks: Is there a need for more research?

<Author Name> James Freeman and Poppy Liossis

<Subhead 2> Abstract

<Abstract> Drink driving continues to be a serious problem on Australian roads, as alcohol-

related crashes result in substantial injuries, fatalities and property damage. While

legal sanctions such as fines and licence disqualification periods have been effective

in preventing a large proportion of the population from drink driving, sanctions have

been relatively ineffective in reducing alcohol-impaired driving among ‘hard-core’

repeat offenders (Marques, Voas and Hodgins 1998). As a result, drink driving

rehabilitation programs and alcohol ignition interlocks are being employed as

additional countermeasures to reduce the prevalence of alcohol-related injuries and

fatalities on public roads. This report aims to review the current evidence regarding

the effectiveness of rehabilitation and interlock programs, and to provide support for

the expansion of upcoming Australian interlock trials to include (a) screening and

matching procedures, (b) intervention and/or support programs and (c) formative

evaluations that focus on a number of measurement outcomes.


Research has repeatedly demonstrated that between 20% and 30% of convicted drink

drivers re-offend (Buchanan 1995; Henderson 1996; Langford, 1998; Popkin 1994;

Ryan et al. 1996) and that this sub-group of drivers is disproportionately represented

in crash statistics (Hedlund and Fell 1995; Marques et al. 1998). The most common

strategy to deter convicted drink drivers has traditionally been to increase law-

enforcement activities such as arrests, convictions, fines and licence disqualification

periods (Longest 1999). This approach has proven extremely successful for the

majority of people who fear authority or perceive the probability of apprehension as

relatively high and sanctions as severe (Homel 1988; Ross 1992). However punitive

sanctions have not proven to be as effective for recidivist, habitual drink drivers who

have previously experienced punitive sanctions such as fines and licence

disqualification periods but continue to drink and drive.

There has been continued debate within the literature regarding the effectiveness of

legal sanctions to reduce recidivist drink driving compared with that of alternative

countermeasures such as rehabilitation programs (Nichols and Ross 1990). While

research has demonstrated that first-time offenders benefit most from licence

sanctions (e.g. disqualification periods), rehabilitation programs (often in combination

with legal sanctions) produce the greatest and longest reduction in repeat offending

for recidivist drink drivers (DeYoung 1997; McKnight and Voas 1991; Sadler,

Perrine and Peck 1991).

<Subhead 1> REHABILITATION PROGRAMS

<Body> Drink driving rehabilitation programs constitute a secondary form of prevention that

attempts to directly change offenders’ drink driving behaviour through education


and/or treatment. The primary aim of drink driving programs has generally been

accepted to be the process of separating drinking from driving by providing

participants with the knowledge, skills and strategies to avoid further offending

behaviour (Popkin 1994; Wells-Parker 1994). A secondary aim has often been to

reduce drinking levels by increasing participants’ awareness of the seriousness of

excessive alcohol consumption (Wells-Parker 1994).

Rehabilitation programs are not new, as drink driving interventions have been

implemented in the US, Canada and Great Britain since the 1960s (Mann, Vingilis

and Stewart 1988). The majority of research and work into drink driving has been

conducted in the US, with the first Australian program not being developed until 1973

at St Vincent Hospital, Melbourne (Homel, Carseldine and Kearns 1988). Since then,

rehabilitation programs have expanded and evolved to incorporate a range of

interventions and techniques designed to accommodate the changing characteristics

and circumstances of the drinking population.

The types and format of programs vary considerably from simple provisions of

reading materials to long-term treatment of alcohol problems (Ferguson et al. 1999;

Mann et al. 1988; Taxman and Piquero 1998). Specifically, interventions can consist

of either educative or health programs, skills-based programs, short-term and long-

term treatment programs, social skills and assertion training, other forms of

counselling or a combination of a number of treatments. More recently, technological

advances in alcohol assessment have lead to the inclusion in some programs of

biological measurements (e.g. gamma-glutamyl transpeptidase [GGT] and

carbohydrate-deficient transferrin [CDT] tests) to examine the alcohol consumption


levels of participants, with successful program completion being contingent upon low

biological readings (Glitsch et al. 2000; Popkin 1994).

Despite the diversity of programs, the overarching aims and goals of such

interventions have usually been accepted to be (a) education involving strategies that

highlight the risks and consequences of drink driving, and/or (b) psychotherapy or

treatment that aims to target and treat drinking problems, and/or (c) skills-based

interventions that teach behaviours that might prevent further offences (Ferguson et

al. 1999; Sanson-Fisher, Redman and Osmond 1986). Within Australia the majority of

rehabilitation programs have focused on health and education (Homel et al. 1988;

Sanson-Fisher et al. 1990; Social Development Committee 1988), with the aim of

producing attitudinal and behavioural change through education and increasing

awareness of the serious consequences of the offence.

<Subhead 2> Effectiveness of rehabilitation programs

<Body> The large variation in both the structure and content of programs has led to a number

of different outcome measures being used to evaluate the effectiveness of the

rehabilitation programs. These outcome measures have included reductions in

recidivism, accident and fatality rates; improved knowledge and attitudes towards

drink driving; recognition of alcohol-related problems; impact on lifestyle (e.g.

number of drinking days, and general driving behaviours) as well as cost-

effectiveness (Sanson-Fisher et al. 1986).


This variation in rehabilitation programs and outcome measures has often been

combined with numerous methodological weaknesses, and has resulted in conflicting

findings regarding the efficacy of programs to reduce recidivism. The range of

methodological limitations has included (a) a lack of random assignment of

participants to control and experimental groups (including judicial and self-selection

biases) (Ferguson et al. 2000; Wells-Parker et al. 1995), (b) follow-up periods that

have usually been short and reliant on recidivism rates, which has been suggested to

be an inaccurate measurement of treatment success (Mann et al. 1983), (c) assessment

difficulties such as the use of questionable psychometric assessment and diagnostic

screening procedures prior to the commencement of treatment (Mann et al. 1983;

Sanson-Fisher et al. 1986), and (d) lack of post-program participant assessment.

In relation to the Australian context, a comprehensive review of drink driving

programs in both Australia and New Zealand (Sanson-Fisher et al. 1986) reported that

the two major difficulties in evaluating programs are the large amount of variation

between interventions (including content, goals and implementation) and that few

evaluations have met the minimal methodological criteria needed for scientific

evaluations. For a complete summary of the difficulties experienced in reviewing

rehabilitation programs, the reader is directed to Mann et al. (1983), Wells-Parker et

al. (1995) and for Australian studies Sanson-Fisher et al. (1986) and Ferguson et al.

(1999).

Historically, there has been a tremendous amount of conflicting research regarding

the effectiveness of drink driving rehabilitation programs to reduce further offending.

A number of early evaluations in both America and Australia reported that such


programs did not reduce the prevalence of repeat offending (Foon 1988; Holden 1983;

Peck 1994; Sanson-Fisher et al. 1986) and that licensing sanctions were a more

effective countermeasure in combating drink driving (Popkin 1994). These studies

have suggested that few changes in drinking patterns or re-offending behaviour result

from rehabilitation programs (Beirness, Simpson and Mayhew, 1998). In relation to

the Australian context, a comprehensive review by Sanson-Fisher, et al. (1986)

indicated that, aside from the difficulties in assessing interventions, it is unlikely that

such programs would reduce the prevalence of repeat offending, as most programs do

not incorporate the ingredients that produce long-lasting behavioural change such as

screening and matching practices and the inclusion of maintenance procedures.

Despite these negative results and the previous methodological difficulties that have

plagued evaluations, more recent studies have begun to demonstrate that drink driving

rehabilitation programs can reduce drink driving recidivism and alcohol-related

crashes (DeYoung 1997; McKnight and Voas 1991; Pratt, Holsinger and Latessa

2000; Sadler, et al. 1991; Siegal 1990). Promising results have been demonstrated by

large-scale meta-analytic studies that have included a number of aspects in the

statistical analyses such as first time and multiple offenders, effect size, intervention

characteristics and the quality of research designs for each study (Wells-Parker et al.

1995). For example, an early review of rehabilitation programs in the 1970s and early

1980s by Mann et al. (1983) demonstrated that both education and treatment

programs may have reduced recidivism among convicted drink drivers. Furthermore,

Mann et al. reported that drink driving programs also have beneficial effects on traffic

safety measures (e.g. knowledge and attitudes) as well as driving behaviours. More

recently, Wells-Parker et al. (1995) conducted a now-famous comprehensive meta-


analysis of 215 drink driving rehabilitation programs and concluded that treatment has

a small but consistent effect (7–9% reduction in drink driving) compared to no

treatment, punishment or licence sanctions. The largest improvements in traffic safety

have been reported for rehabilitation programs that incorporate three intervention

aspects such as psychotherapy or counselling, education, and probation (Wells-Parker

et al. 1995) rather than single-mode or two-mode interventions (DeYoung 1997).

Wells-Parker et al. also confirmed that, despite the large number of methodological

difficulties that have limited previous intervention evaluations, such programs provide

positive effects on both recidivism rates and general traffic safety (e.g. alcohol-related

crashes). It has been suggested that the relatively small positive effect resulting from

rehabilitation programs is dramatically increased when evaluated against subsequent

reductions in drink driving related crashes and injuries (Beirness et al. 1998).

<Subhead 2> Recidivist offenders

The most promising indications regarding the effectiveness of rehabilitation programs

have been for those interventions that have focused primarily on recidivist drink

drivers (DeYoung 1997; Ferguson et al. 2000; Mann et al. 1994; Nickel 1991;

Taxman and Piquero 1998; Siskind et al. 2001, pers. comm.). Research has

demonstrated that such programs are most effective for serious repeat offenders who

are apprehended with blood alcohol content levels of 0.15 g/100 mL or greater

(Siskind et al. in press). These studies have demonstrated that rehabilitation programs

are most effective in reducing further offences when they are combined with licence

disqualification periods. First, the continued application of fines and licence

disqualification periods ensures offenders realise the punitive costs associated with re-


offending. Second, rehabilitation programs provide recidivist drink drivers with a

range of skills and strategies to avoid the drink driving sequence, which include

information regarding the effects of alcohol, drink driving laws, safe driving practices

and possible indicators of drinking problems.

Despite these reported reductions in drink driving behaviour resulting from

rehabilitation programs, some ‘hard core’ offenders continue to drink and drive after

completing such programs, while others fail to complete the programs. Alcohol

ignition interlocks have been proposed as a further intervention to reduce the

prevalence of recidivist drink driving (Morse and Elliott 1992; Popkin et al. 1992).

<Subhead 1> ALCOHOL IGNITION INTERLOCKS

<Body> An alcohol ignition interlock is a device that measures an individual’s blood alcohol

content (BAC). It is connected to the ignition and power system of a vehicle and is

designed to prevent the vehicle from being started if the driver’s BAC exceeds the

legal limit.

It has been suggested that, in contrast to other countermeasures that focus primarily

on traditional deterrence-based strategies (e.g. random breath testing, fines and

licence disqualification), interlocks provide drivers with the opportunity to develop

and practice strategies to avoid drink driving (Weinrath 1997). In addition, the device

allows drivers to re-enter the licensing system legally, with insurance rather than

permitting offenders to continue to drive unlicensed without supervision (Beirness

and Simpson 1991). Further benefits of interlocks include the prevention of the


vehicle being started if the driver exceeds the previously specified BAC level, and the

instrument serves as a constant reminder to the driver of possible alcohol problems

and the difficulties that have arisen from drink driving. Interlocks also offer many

offenders the opportunity to maintain employment (Beirness and Simpson 1991).

<Subhead 2> Effectiveness of Interlocks

<Body> Since the 1980s there have been a number of interlock trials in the US and Canada

(Beck, Rauch and Baker 1997; Jones 1992; Popkin et al. 1992; Weinrath 1997) and

two preliminary trials in Australia (Coxon and Earl 1998; Spencer 2000). Early

evaluations of interlocks suggest that the devices have the potential to significantly

reduce recidivism rates among convicted drink drivers (Baker 1987; Beck et al. 1997;

Collier, Comeau and Marples 1995; Morse and Elliot 1992; Weinrath 1997). For

example, Morse and Elliot (1992) in Ohio reported that when interlocks were

installed, recidivism rates were lower (65% reduction) than for offenders given only

licence suspension sentences during the same period of time, while unlicensed driving

was reduced by 91%. Furthermore, Popkin et al. (1992) in North Carolina and Jones

(1992) in Oregon performed quasi-experimental interlock trials and reported

significant reductions in re-arrest rates for interlock participants while the interlock

was installed. Beck et al. (1997) in Maryland conducted the only complete

randomised interlock trial and also reported a 65% reduction in recidivism rates while

the interlock was installed. Finally, Weinrath (1997) examined the combination of

interlocks with a support program, which produced the most promising results

including significant reductions in drink driving recidivism and in the number of other

dangerous driving practices (e.g. those resulting in collisions and injuries).


However, like rehabilitation programs, interlock evaluations have also been plagued

by methodological difficulties including small sample sizes, self-selection and judicial

biases, non-random assignment of groups, unmatched intervention and control groups,

and short follow-up evaluation periods. Coben and Larkin (1999) reviewed 31

interlock studies in North America and found that only 6 studies could be

comprehensively reviewed, due to methodological weaknesses with research designs

such as non-random sampling procedures, sole reliance on recidivism rates and the

failure to control for exposure (e.g. number of kilometres driven).

In addition, the majority of interlock studies have reported that once the interlock was

removed from the vehicle many drivers returned to re-offending (Beck et al. 1997;

Jones 1992; Morse and Elliot 1992; Popkin et al. 1992; Voas et al. 1999). For

example, the majority of interlock trials report significant reductions in the prevalence

of re-offending while the device was installed to the vehicle (50% to nearly 100%

reduction), but there have been no reported significant reductions in re-offending

compared to control groups once the device is removed (Voas et al. 1999). Overall,

the research suggests that interlocks may merely incapacitate or restrict individuals

from drink driving while installed in the vehicle, but the device loses any beneficial

effect upon removal (Weinrath 1997). At present it remains unclear why offenders

continue to drink and drive once the device is removed from the vehicle, nor what (if

any) beneficial effects are derived from interlock usage.

There have only been two prior interlock trials in Australia to determine the feasibility

of such programs. Both trials consisted of volunteer participants. The first study was


conducted in Riverland, South Australia, over a 6 month period in 1998 and consisted

of 24 volunteers who were employees or were affiliated to one of a number of road

safety departments in South Australia (Coxon and Earl 1998). The second trial was

conducted in New South Wales between January 1999 and March 2000 and consisted

of 23 repeat offenders who volunteered to install an interlock to their vehicle and

were interviewed both during interlock installation and when the device was removed

from their vehicles (Spencer 2000).

Both studies demonstrated that interlocks were a viable countermeasure in Australia

(e.g. reliability and servicing of the device) with participants reporting positive

experiences regarding the use of interlocks. For example, participants reported that

using the device increased their knowledge regarding appropriate drinking levels to

remain under the blood alcohol limit and most believed that the device was a viable

sentencing option to traditional legal sanctions (Coxon and Earl 1998; Spencer 2000).

Despite these positive reviews of interlock trials of volunteer participants, a major

limitation of interlock research (involving court-ordered installation of the device),

has been that evaluations have failed to examine the impact that interlocks have on

offenders’ lifestyles, motivations, attitudes, driving and drink driving behaviours. It is

unclear what psychological and behavioural changes occur while the device is

installed (e.g. attitudes and driving habits), or why the majority of participants

continue to drink and drive after the interlock is removed from their vehicles.

Interestingly, at present it is not clear what the offenders believe is the purpose or aim

of the interlocks. Program facilitators and researchers have suggested that interlocks


have two main aims: (a) behavioural control and/or incapacitation, which is attained

through technological advances designed to minimise the risk of harm and re-

offending (Henderson, 1999), and (b) rehabilitation/education, which aims to provide

users with knowledge and skills/strategies to avoid driving after exceeding the legal

blood alcohol limit (Ferguson et al. 2000; Weinrath 1997). It is important is to

determine whether users have the same beliefs as interlock administrators regarding

the purpose of the device (e.g. rehabilitation and incapacitation), and what

consequences arise if perceptual disparities exists between the groups. Examination of

these factors may provide valuable insight into the effect that perceptions of and

attitudes to interlocks have on frequent usage of the device as well as on successful

program outcomes e.g. the avoidance of further offending.

<Subhead 3> The combination of rehabilitation programs and interlocks

<Body> In the past, the majority of drink driving interventions implemented to reduce the

prevalence of repeat offending have incorporated uni-module characteristics. That is,

previous studies have not combined interlock installation with some form of drink

driving rehabilitation or support program and thus drivers are not provided with either

(a) the appropriate knowledge, skills and strategies to avoid the drink driving

sequence or (b) treatment for alcohol-dependency problems before interlock

installation and removal. Whether this occurrence has contributed to the substantial

proportion of offenders continuing to drink and drive once the device is removed

remains unproven, but what is evident is that interlock installation alone may not be

an adequate tool to stop recidivism.


The exceptions to this pattern are a small number of current interlock trials in North

America (Maryland, Alberta) and in Europe (Sweden) which include treatment,

rehabilitation and/or intensive supervision programs with interlock installation (Beck

et al. 1997; Marques et al. 2001). Although most of these programs are currently

being implemented and have not been comprehensively evaluated, early indications

suggest that the inclusion of such support initiatives with interlock programs provides

positive results, e.g. lower rate of failed start-up attempts (Marques et al. 2001). For

example, the Alberta trial has combined interlocks with a harm-reducing and

motivational intervention technique which includes (a) education and support to

offenders regarding interlock usage, (b) case management support (e.g. family

counselling), (c) motivational enhancement therapy (e.g. raising awareness regarding

the seriousness of drink driving), and (d) protective planning (e.g. assistance in

planning for driving without the interlock) (Marques et al. 1999). At present it appears

that while the device is installed participants who receive the combined intervention

are less likely to record failed BAC start-up attempts than individuals who do not

receive the intervention. However, follow-up research has yet to be completed to

determine whether the combination of interlocks with support or intervention

programs provides long-term benefits once the device is removed. Preliminary results

indicate that combining interlock usage with compatible rehabilitation and/or support

programs may produce beneficial results. Such practices may ensure that offenders

address their drinking and/or drink driving problems by developing new skills and

strategies to avoid re-offending before applying these strategies to driving with the

assistance of interlocks. Conversely, it may be unrealistic to enforce interlock


installation without addressing the individual factors that ultimately affect successful

program outcomes such as the ability to control alcohol consumption.

<Subhead 3> Formative evaluations and process outcomes

<Body> Previous evaluations of drink driving rehabilitation programs have predominantly

focused on summative outcomes such as recidivism rates and alcohol-related crashes

(Popkin 1994). Archival data such as recidivism rates are perhaps the simplest and

most accessible outcome measure (Buchanan 1995) and have continually been used as

the major indicator of program effectiveness (Ferguson et al. 2000; Sanson-Fisher et

al. 1986). However, a number of researchers have highlighted difficulties associated

with using recidivism rates, and have questioned the accuracy and validity of the

measure as a reflection of the prevalence of drink driving on public roads (Fitzpatrick

1992; Marques et al 2001; Popkin 1994; Ross 1984; Sanson-Fisher et al. 1986).

For example, in America it has been estimated that the chances of a driver with a

BAC of .10% or greater being arrested are 1 in 500 (Fitzpatrick 1992). A similar

estimation for the Australian context offered by Homel et al. (1988) suggests that only

0.5–1.5% of intoxicated drivers are detected by the police at any one time.

Considering that many drink drivers report that they continually offend without

apprehension, and often employ techniques to avoid detection (Ross 1992; Voas,

Tippetts and Lange 1997), it may be argued that the probability of repeat offenders

being caught also remains relatively low. Therefore the accuracy of measures such as

recidivism rates (which are continually used as the dominant outcome measurement


of programs) may be heavily dependent on the level and effectiveness of law-

enforcement activities in jurisdictions.

As a result, accurate indications of the effectiveness of rehabilitative interventions

have not yet been attained. For the above reasons, there is a need for research that

incorporates formative and process outcomes that measure change from multiple

perspectives, as the possibility of drawing misleading conclusions increases when one

simple index is used to measure change (Lambert and Hill 1994). A possible initiative

to improve the accuracy of current knowledge regarding the impact of drink driving

rehabilitation and interlock programs is to conduct formative evaluations and thus

include several measures of program effectiveness such as self-reported changes in

lifestyles, attitudes, motivations, self-efficacy and drinking and drink driving

behaviour. A broadening of measurement outcomes would result in improved

detection of both behavioural and psychological changes resulting from completing

either drink driving programs or interlock trials. Fitzpatrick (1992) has highlighted

that this lack of multiple measures of program effectiveness incorporating clear goals

and objectives has contributed to the uncertainty regarding the effectiveness of

rehabilitation programs.

Process outcomes may be defined as the changes that occur through the rehabilitation

process and include participants’ hopes, expectations, values, and intentions that can

be demonstrated through actions, behaviours, statements and non-verbal

communication (Robertson and Colborn 1998). Such measures have successfully been

incorporated in health, business, and education sectors to explain how change occurs

(Robertson and Colborn 1998). This information would not only provide more


accurate indications of the effectiveness of drink driving rehabilitation programs but

also provide information regarding program strengths and deficiencies that would

benefit policy and program development.

<Subhead 2> Previous formative evaluations

<Body> At present, only a minority of research has incorporated formative aspects in program

evaluations such as participants’ self-report data regarding knowledge and attitudes

towards drink driving, alcohol consumption levels, etc. (Ferguson et al. 2000).

Despite this, initial studies have provided rich contextual information regarding the

impact that interventions have on a range of psychological and behavioural factors.

For example, Ferguson et al. (2000) demonstrated that although knowledge and

attitudes do not necessarily change through program completion, participants are

significantly more likely to adopt newly learned strategies to avoid further drink

driving. Furthermore, Wells-Parker et al. (1998, 2000) highlighted that program

participants are more likely to be motivated to change their drink driving rather than

their drinking behaviours. In addition, the researchers demonstrated the important

effect that perceived self-efficacy to avoid drink driving has on further offending

behaviour, as individuals who report low levels of control over both their drinking

and drink driving behaviours are at the greatest risk of re-offending (Wells-Parker et

al. 2000).

In relation to process evaluations of interlock programs, a small series of studies from

the Alberta interlock trial have incorporated vehicle-based measurement outcomes

such as the number of times participants start and use their vehicles, days of the week,

BAC readings, and distance travelled (Marques et al. 1999, 2000, 2001). These


studies have demonstrated that participants use the device on approximately 80% of

days and usually record a steep decline in the number of failed start-up attempts

during the life of the trials, with the highest number of failed attempts being on

weekends (Marques et al. 1999). Furthermore, there have been indications that

participants are less likely to use the device on the weekend and that higher numbers

of failed start-up attempts during the trial proves to be a reliable indicator of further

offending once the interlocks are removed (Marques et al. 2001; Voas et al. 2000).

These studies have focused on interlock recordings and have provided valuable

insight into the driving and drink driving patterns of interlock participants, such as the

frequency of interlock usage, BAC readings, circumvention attempts etc. However,

such studies have once again relied on indirect measurements of drinking and drink

driving occurrences (e.g. interlock recordings) and do not provide an accurate

indication of the impact that interlocks have on participants’ lifestyles, the possible

changes that may result from intervention completion, or of participants’ perceptions

regarding the effectiveness or convenience of the device in comparison to traditional

legal sanctions.

The authors of this paper recognise that questions remain regarding the applicability

and reliability of formative measurements. The major limitations of formative

evaluations include (a) the cost of completing such tasks (both time and money), (b)

the sensitivity of self-reported data (confidentiality and accuracy) and (c) the

reliability of responses when they are dependant upon an outcome, e.g. licence

reinstatement (Sanson-Fisher et al. 1986). Popkin (1994) suggested that self-report

data is extremely subjective and may be influenced by the individual’s inability or

denial to recall events accurately. Therefore, issues have been raised regarding


whether measures such as knowledge and attitudes towards alcohol and drink driving

accurately reflect changes in drink driving behaviour (Sanson-Fisher et al. 1986).

<Subhead 2> Combine summative and formative outcomes

<Body> A possible solution to these evaluation difficulties is to incorporate both summative

and formative measurement outcomes in research designs. Researchers are now

beginning to suggest that interviews with participants that involve questionnaires

concerning self-reported behaviour (i.e. actual recidivism rates) can provide realistic

and valuable indicators of offending behaviour in addition to official offending

statistics (Buchanan 1995; Siskind et al. in press). For example, the inclusion of

recidivism rates with intermediate outcomes such as changes in attitudes, knowledge

and motivation would provide a more complete description of attitudinal and

behavioural changes resulting from successful program completion. As Robertson and

Colborn (1998, pp.39) highlight, ‘summative evaluations describe an end product;

formative evaluations are performed at specified intervals to assure the end product is

obtained.’ The researchers go on to suggest that the real strength of a rehabilitation

program is found in the link between the program and the process outcomes, as it

demonstrates how and why, for whom and under what circumstances programs work.

From this it appears that the combination of both measurement outcomes (carefully

chosen to reflect goals and aims of programs) may prove valuable measures of

program strengths and weaknesses.

<Subhead 2> Matching

<Body>


Finally, the implementation of formative evaluations may reinforce the need for

screening, tailoring and matching procedures, which would assist in directing

offenders to the appropriate forms of drink driving interventions, to ensure that

maximum rehabilitative effects are attained. Researchers have continually suggested

that the effectiveness of rehabilitation programs may be dependent upon recognising

specific individual characteristics of drink drivers and matching participants to the

appropriate interventions (Ferguson et al. 2000; Glitsch, et al. 2000; Nochajski,

Stasiewicz and Gonzalez, 2000; Sanson-Fisher et al. 1986). According to the

matching hypothesis, different types of drink driving offenders require different forms

of interventions such as skill-based, educational or treatment programs to ensure

successful outcomes (Wells-Parker 1994). Program participants are beginning to be

assessed for a range of psycho-biological factors (e.g. alcohol dependence and

psychological problems), as these factors have been recognised to affect successful

program completion and re-offending rates (Andren et al. 2000; Wells-Parker et al.

2000).

However, these procedures have yet to be transferred to interlock programs, and to

date there has been very little examination of the needs and requirements of interlock

users before installation. Pre-interlock assessment is vital to ensure that the device can

provide the maximum benefits to participants. Assessment may include an

examination of the participants’ driving requirements and family circumstances

before interlock installation to determine whether offenders are in fact going to use

the interlock-installed vehicle and to estimate what impact the interlock may have on

other family members. Previous research has demonstrated that many interlock

participants regularly use non-interlock installed vehicles and may be likely to not use

the device at ‘high-risk’ periods, e.g. weekends (Voas et al. 2000). Pre-and-post


interlock assessment of participants’ attitudes and circumstances may lead to the

development of tailored programs that are compatible with offenders’ lifestyles and

thus ensure regular use of the device.

<Subhead 1> CONCLUSION

<Body> To answer the question posed in the title of this paper, the effectiveness of both drink

driving rehabilitation programs and the use of interlocks may be clarified by

conducting processes and evaluations that examine the impact of such interventions

on a range of outcomes. First, when considering the impending increase in the

prevalence of interlock trials in Australian, the inclusion of formative outcomes in the

research design may prove to be extremely valuable, considering the number of

factors that presently remain unclear. Second, combining interlocks with an

associated intervention and/or support program may produce an additive affect that

provides participants with the opportunity to practice and consolidate newly

developed skills and strategies to avoid the drink driving sequence. Finally, assessing

and matching participants’ needs to suitable programs may ensure that offenders

receive the appropriate treatment which would ultimately improve the effectiveness of

rehabilitative interventions. This might result in alcohol-dependent individuals being

directed towards therapeutic programs addressing alcohol-related issues before

interlock installation, while young offenders may need to confront issues relating to

drinking in the social context and the effects of peer group pressure. Although the

implementation of such research initiatives may well be governed by the practical

reality of allocating precious resources (time and money), such practices will provide

a means of monitoring referral patterns, and forming databases for the examination of


treatment effects and characteristics of clients (Sanson-Fisher et al. 1986), as well as

developing screening mechanisms that facilitate the development of programs that

accommodate specific individual needs.

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<Bio/Contact> James Freeman is a PhD scholar at the Centre for Accident Research and Road Safety–Queensland and he is currently part of a research team that is implementing the first Australian court-ordered trial of alcohol ignition interlocks for recidivist drink drivers. James is a registered psychologist and his current research interests focus on producing behavioural change, including punishment and models of deterrence and the processes of change produced by rehabilitative interventions. Poppy Liossis completed her PhD at the University of Queensland and is currently a lecturer at the Queensland University of Technology (developmental psychology). Her current research interests focus on the nature of the changing family. Poppy is also a private practitioner.

Contact

James Freeman Centre for Accident Research and Road Safety–Queensland, (CARRS-Q) Queensland University of Technology Beams Rd, Carseldine, QLD 4034. Email: [email protected]

mailto:[email protected]


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