1. Drunk Driving: A Strategy for Reducing Recidivism 12 th Annual Michigan Traffic Safety Summit Tuesday March 13, 2006 Bradley Finegood, MA, LLPC

2. A Problem Snapshot From 2002 and 2003, persons between the ages of 16 to 20 (Age group of which the leading cause of death is traffic fatalities) –21 % reported driving under the influence of alcohol and drugs –17% reported driving under the influence of alcohol –14% reported driving under the influence of illicit drugs –8% reported driving under the influence of both a the same time. –Of those who reported driving under the influence 4% reported being arrested / cited with a DUI offense. –National Survey on Drug Use and Health, 12-31-04

3. Drinking and Drugged Driving In 12 states including Michigan it is illegal to drive with any detectable level of illicit drug or it’s metabolite. As a person get older, the less likely they are to drive under the influence of alcohol or drugs in the past year. –21 to 25 years old (33.8%) –26 to 34 years old (24.3%) –Over 35 continues to go down. –NHTSA

4. More Drinking and Drugged Driving In a Maryland Trauma Center, driver’s admitted from automobile accident: –34% tested positive for drugs only. –18% tested positive for alcohol only –50% under 18 tested positive for alcohol and / or drugs. Studies in a number of localities point to 4 to 14 percent of traffic accidents causing injury or death, a driver tests positive for marijuana. NIDA

5. How is Recidivism Reduced Stop Alcohol and Other Drug Use, i.e. increase abstinence, sobriety and recovery –Poly and cross addicted persons Change cognitive / emotional / behavioral patterns that leads to breaking the law and endangering other’s lives.

6. Changing Paradigm Public Safety vs. Rehabilitation – –With DUI these are dependent systems –95-98% of incarcerated people will be released Does Hierarchical Systems (State / DOC) see these concepts as integrated?

7. Issues for Consideration Type / Intensity of Supervision Coordination of Services from Incarceration / Probation / Parole / Community Traditional Schisms in the System Availability of Services Harm Reduction Models Pharmacotherapies in conjunction with treatment.

8. NIDA Principles of Drug Abuse Treatment for Criminal Populations: An Evidenced- Based Approach July, 2006

9. 13 Principles 1.Drug Addiction is a Brain Disease Chronic / No Acute Long Lasting Relapse Potential

10. 13 Principles – cont. 2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time. Not necessarily fixed length treatment. Case Management and Contingency Management Following through and monitoring with client’s treatment and case management regimen. Effective Incentives and Sanctions for appropriate and specific behaviors.

11. 13 Principles – cont. 3. Treatment must last long enough to produce stable behavioral changes. Cognitive and Behavioral Patterns and Cycles Substance Abuse is often a Ritualistic Process Stability in Recovery –Changing paradigm in modalities.

12. 13 Principles – cont. 4. Assessment is the first step in treatment. Co-occurring issues –Mental Health, Other Bio-Psycho-Social Issues Effective Treatment Planning Assessment is also: –Second step, Third Step……Last Step; meaning assessment must be an ongoing process.

13. 13 Principles – cont. 5.Tailoring services to fit the needs of the individual is an important part of effective substance abuse treatment for the criminal justice populations. Appropriate, age, gender, ethnic / cultural factors Problem severity level Motivational level of change

14. 13 Principles – cont. 6.Drug and alcohol use during treatment should be carefully monitored. Addiction is “cunning, baffling and powerful”, but also manipulative. Identify Relapse. –Encourage Honesty –Relapse as a part of Recovery Addiction

15. 13 Principles – cont. 7. Treatment should target factors that are associated with criminal behavior. Criminal Thinking, Lifestyle, Behavior Patterns DUI Specific. –Social Interest / Empathy Building Skills –MADD Victim Impact Panel

16. 13 Principles- cont. 8. Criminal justice supervision should incorporate treatment planning for substance abusing offenders, and treatment providers should be aware of correctional supervision requirements. Triangulation Coordination of needs, resources. Community Transitioning. Continuum of Care Transition.

17. 13 Principles- cont. 9.Continuity of care is essential for drug abusers re-entering the community. Re-entry Programs MPRI Sober / Recovering Communities ¾ way houses / Transitional Living Environments.

18. 13 Principles- cont. 10. A balance of rewards and sanctions encourages pro-social behavior and treatment participation. Carrot or Stick. Remember the context of the population. –Often Abused, Demeaned, Low Sense of Self-Worth.

19. 13 Principles- cont. 11.Offenders with co-occurring alcohol / drug abuse and mental health problems often require an integrated treatment approach. High degree of mental health issues. Schism in the community. Severe and Persistent vs. Moderate.

20. 13 Principles- cont. 12. Medications are an important part of treatment for many drug abusing offenders. Need for Addictionologist Cross-Pharmaco issues w/ high degree of abuse. Cross-Coordination with physicians

21. 13 Principles – cont. 13. Treatment planning for drug abusing offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, Hep. B and C, and TB.

23. Brad’s 14 th Principle Effective treatment must be based on “What Works” or evidenced based practices. –Cognitive-Behavioral Treatment –Motivation Enhancement Therapy –Support Groups. Drug Courts