Brief motivational interventions and

Behavioral self-control training:

A demonstration project with DWI offenders.

Report on Year 1

Date:  August 29, 1997

By: Reid K. Hester, Ph.D. Bo Miller, MSW, & Mike Sergent, M.A.

This project has had two goals: to provide cost-effective treatment for DWI offenders in Torrance County and to evaluate its effectiveness. The project is examining the impact of providing a brief intervention and empirically supported self-help materials. Brief interventions hold great promise in reducing alcohol-related problems in DWI populations.

Participants received a brief motivational intervention known as the Drinker’s Check-up (DCU). They were also given a choice of two empirically supported self-help options: The Addictive Behaviors Change workbook (Horvath, 1996) or Behavioral Self-Control Training either via the Miller & Munoz (1984) book or the Behavioral Self-Control Training Program for Windows (BSCPWIN).

This project began with the recruitment and training of therapists. First we advertised for and interviewed a number of potential therapists. We chose four counselors who met our criteria of licensure, professional training, and clinical experience. We invited these four to participate in a 2 day training program in Motivational Interviewing and the clinical protocol. The two counselors we chose, Mike Sergent and Mary Beth Theisen, both had excellent credentials, clinical experience, and demonstrated good skills in the training workshop. We were also pleased with the performance of the other counselors and encouraged them to continue using the skills they had learned in the workshop in their clinical practices in the Moriarty area.

Once the counselors were selected we provided them with additional training in assessment and implementation of the protocol. We also developed forms for logging participation, noncompliance, feedback to the participants, etc.. We provided the counselors training in the use of the BSCPWIN software and guidelines in recommending the different self-help materials. Copyrighted assessment materials were ordered, received, and distributed to the counselors. Copies of the self-help materials were also acquired and provided to the counselors.

Prior to receiving the first referral, we made a change in the treatment program assessment protocol. On the basis of a factor analysis published in September, 1996 on the SOCRATES instrument we adopted the newer, shorter version. We also dropped the neuropsychological screening component in light of other recent data indicating that the component does not substantively contribute to outcome. In its place we added the World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT) and the Drinker’s Inventory of Consequences (DrInC). Both are measures of negative consequences with good psychometric properties.

Making these changes in the protocol resulted in an assessment that is more similar to the Motivational Enhancement Therapy intervention that was used with great success in the Project MATCH collaborative study.

Prior to receiving the first referral, we developed a liaison with the courts. Through telephone contacts and face-to-face meetings, we learned what the court personnel needed to facilitate referrals. They also learned what we needed from them to facilitate a smooth referral process. That liaison began in October, 1996 and has continued on a regular basis to the present.

Counselors were given close clinical supervision on their cases on a regularly scheduled basis. They also had access to supervision whenever needed. Sessions were audio taped and those tapes were reviewed in supervision sessions. The closeness of this supervision helped to ensure close adherence to the clinical protocol. Although supervision was more intense during the initial phases of the project, it continued on a regular basis throughout year 1.

Referrals began in mid-November, 1996. We received 32 referrals during this period and had six non-compliant clients. Of these six noncompliant clients, three had no contact with the program and three had contacted the program but did not keep their appointments. Twenty six offenders had been treated before the end of the fiscal year, June 30, 1997. Referrals began slowly and while the rate has fluctuated, there has been a noticeable increase in the last 3 months.

Although we were not funded to conduct data analysis, we have calculated the means of three critical drinking variables: Average number of standard drinks

per drinking day; total drinks per week; and estimated peak Blood Alcohol Concentration (BAC) per week. These data and sample size (N=13) reflect those who have completed their 3 month follow-ups through the end of August. The total sample size of individuals who should have completed their 3 month follow-ups is 17. We anticipate conducting an additional three 3 month follow-ups in the first week of September. This leaves one client for whom we do not anticipate being able to gather 3 month follow-up data. The table below lists the available data.

At pre-treatment, clients were drinking, on average, almost a six pack of beer per drinking day. They were achieving, on average, an estimated peak BAC of 159mg%. This is a BAC consistent with aggravated DWI. This is clearly a high risk population for multiple DWIs.

At 3 month follow-up, clients were drinking, on average, 2 beers per drinking day with an estimated weekly peak BAC of 52 mg%. This is well within the range of moderate drinking. In addition, while only 15% were abstaining following their DWI but before treatment, 61% were abstaining at the 3 month follow-up.

This is not to say that all individuals benefitted from this intervention. One individual did not change his drinking at all and has continued to achieve very high BACs. However, this client has continued to stay in touch with us as we continue to try to help him. We have attempted to refer him to Turquoise Lodge and these efforts are ongoing. We believe this reflects the importance of the 3 month follow-up to assess progress or deterioration.

We are aware of 2 individuals who have re-offended. One relapsed following treatment and did not return for his 3 month follow-up. The second individual did return for his 3 month follow-up and reported 40 days of abstinence after his second DWI. Although we have not had the budget to fully analyze other relevant data, it is our clinical impression that this population of individuals was at extremely high risk for future DWIs at the time they received treatment.

The data we have thus far suggest that this program has had a significant impact on the drinking behaviors of most, but not all, participants. Their outcomes are consistent with other brief intervention trials and are comparable to more expensive and intensive treatment protocols.

Current Status

We responded to the request of the County to continue providing services past the end of the original contract. As of the end of August, we anticipate having sufficient funds to treat clients until mid-September. At that time, we will be forced to suspend this treatment program pending further funding.

An additional follow-up at 12 months and data analyses had been planned for year 2. A 12 month follow-up is necessary to evaluate the effectiveness of this program over time. The potential relapse rate between 3 and 12 months is too great to assume stability of outcomes.