Treatment of DUI’s

Background

Legislative changes in Sweden during 1994 when the legal BAC level for Gross Drunken Driving was reduced to 0.1% gave rise

to two new special prisons for DUI’s.

Since the 1980’s promises of improved alcohol treatment outcomes had been reported, indicating that patient characteristics interacted

with treatment set-ups affecting outcome results.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) in USA then initiated the project “Matching Alcoholism Treatments to

Client Heterogeneity" (Project MATCH) in 1989

Special prisons for DUI’s

Rostorp in MalmöRostorp in Malmö

Östragård in VänersborgÖstragård in Vänersborg

The programsThe treatment programs chosen for implementation were

“The Minnesota 12-step model” (12-step) based on the principles of the Minnesota model (Reality Therapy) and Rational-Emotive Therapy (RET).

“Dynamic Cognitive Behaviour Modification” (DCB) based on social learning theory.

“The Steering-Wheel Trap” (SWT) or just “The Trap”, based on education and motivational psychology.

Objectives

(1) Is it possible to categorize clients in meaningful subgroups with respect to psycho-social and personality characteristics?

(2) Will certain client types benefit from certain programs in terms of an improved psycho-social situation, including less alcohol use at follow-up?

(3) Is any program superior to the others, disregarding type of client?

(4) If so, does the program effect varies with type of institution?

During the years 1996 to 1998 5 330 persons of both sexes were convicted to prison in Sweden because of one or several

DUI crimes.

980 (1.2%) male clients were brought to the DUI-specialized prisons of Rostorp and Östragård.

804 clients (82%) accepted participation in the study and were randomly allocated to one of the programs. 216 (26.9%) at Rostorp and 588 (73.1%) at Östragård.

.

Subjects

Materials

All clients were investigated with respect to their social situation, health, work and income, criminality, alcohol– and drug use and

personality at intake.

Mean treatment time was 6 weeks

Voluntary participation in research program

Random allocation of participants to treatment programs

Clients were followed up 2 years after treatment

Instruments Addiction Severity Index

Physical healthWork and incomeAlcohol useDrug useCriminalityRelations to family and friendsPsychic health

NEO-PI-R Neuroticism Extraversion Openness Agreeableness Conscientiousness

Statistical analysisPSD-delta scores (Psycho-Social Development) The difference between the ASI pre and post index scores

PDM-delta scores (“Problem Days last Month) Pre- and post difference for number of days with problems last month.

•Cluster Analysis: Client typology.•Main effects for programs, institutions and client typology: One-way ANOVA´s•Interactions between program and client typology and between program and institution: Two-way ANOVA´s

Statistical methods

Results: Cluster Analysis (I)

46.90 63.90

53.94 45.14

50.36 47.17

50.73 45.27

51.17 36.87

48.18 53.65

47.88 54.86

46.20 57.61

47.73 55.86

48.16 54.14

48.21 53.86

45.76 57.41

Neuroticism

Extraversion

Openness

Agreableness

Conscientiousness

Physical problems

Work related problems

Alcohol related problems

Drug related problems

Problems related to criminality

Problems with relations to family and friends

Psychic problem

1 2

Cluster

Results: Main effects for psycho-social developement (PSD)

Main effectsPhysical health

Work & income

Alcohol use

 Drug use

 Crimina-lity

 Relations

 Psychic health

Institution 

n.s 

n.s 

n.s 

n.s 

n.s 

n.s 

n.s

Program 

n.s 

n.s 

n.s 

n.s 

n.s 

n.s 

n.s

Client type 

F = 6.97, Df: 1, p<-05

F = 10.86, Df: 1, p<-05

  F = 26.0,

Df: 1, p<-05

  n.s

  F = 7.65,

Df: 1, p<-05

n.s

  F = 7.65, Df: 1, p<-05

Results: Interaction between program and client typology

Delta scoresPhysical health

 Work & income

Alcohol use

 Drug use

 Criminality

 Relations

 Psycic health

PSD 

 n.s

 n.s

 n.s

 n.s

 n.s

 n.s

 n.s

  PDM

 n.s

 n.s

F = 5.85, Df: 2, P<-05

F = 3.54, Df: 2, p<-05

 n.s

 n.s

 n.s

In conclusionThe results in this study support the conclusions of Project Match.All the treatments

were effective but none was shown to be superior to any other.

There was a client effect indicating that criminal, neurotic and antisocial DUI´s generally have more to gain from the treatments than more “normal” DUI´s with less

psycho-social problems.

There were few interactions between treatments and clients and the “matching hypo-thesis” got meagre support, but a trend was observed the “antisocial and neurotic”

DUI’s benefit particularly from the DCB program.