This past Friday I had the honor of speaking to the Oregon house and senate committees on Judiciary about the effectiveness of Oregon’s DUII reduction approach. My friend and colleague, Heidi Brockman-Astrue, joined me to also share her experience as someone working in the trenches daily treating DUII offenders. One reason for our testimony, is that despite the good work being done by many people to address this public health problem, about 14,000 Oregonians are arrested each year for driving under the influence of some drug (alcohol obviously being the most common). Most of these are first time offenders, but the total number of arrests only provide a metric for those that get caught, which to a large extent is based on law enforcement resources. Add more patrols to the roads and arrests would increase.
- 86 drunk driving deaths in 2012
- 10 of those under the age of 21
We need to do all we can to reduce these tragedies. While I appreciated the opportunity to speak, as I have reflected on the experience, a number of things have come up for me that I thought I would share.
There were a total of five speakers, myself included, that testified in about an hour’s time. This meant I needed to reduce my normal hour-long talk about addiction and treatment down to about 15 minutes, which in all honesty, I don’t think worked very well. I had to rush through parts, cut stories short, and was not able to link the problem and solution together in a cohesive way. I know many TED talks brilliantly reduce complex topics down to 18 minute presentations, so I know it’ possible, I just need a lot more practice!
The power of one
One individual on the committee who made it known he has been in recovery for decades, believed addiction treatment has not progressed in 40 years. I was saddened by the comment because I have seen many times how one very opinionated individual can influence group process.
While I share his frustrations about the pace of progress, it’s simply not true that treatment has not improved in four decades. Since 2000 the National Drug Abuse Treatment Clinical Trials Network (CTN) has significantly increased the collaboration between clinicians and researchers, pushing use of evidence-based practices like never before. It’s important to acknowledge just how how hard so many people have worked to improve treatment, even though we have a long ways to go.
Top 5 recommendations
While I will not speak to all recommendations made by those who testified, here were the ones I pushed:
#1 Length of time
Extend length of time in treatment for first time DUIIs to a minimum of 6 months and one year for multiple DUII offenders. Treatment now averages 3-4 months for most offenders, which is far too short a time period based on what we know about the brain and behavior change.
#2 Evaluation process
Improve the evaluation process. Some discussion included whether the Alcohol and Drug Evaluation and Screening Specialists (ADES) provide effective evaluations and should continue to be part of the system. Their primary purpose is determining level of treatment independent of treatment programs as an oversight function.
In my opinion, there is incredible leverage in dialing in effective treatment from a solid evaluation, but doing one requires a lot of clinical skill. There are concerns about the quality of ADES evaluations, and the fact that treatment programs have to do one anyways seems like a waste of time and resources.
In the future I hope we can leverage technology to improve the quality, consistency, and accuracy of evaluations (see my previous post on prison education and treatment).
#3 Evidence-based practices
Encourage use of evidence-based practices in treatment. This includes use of addiction medications such as Vivitrol for alcohol and opioid use disorders, increased attention to the treatment of underlying adverse childhood experiences, and interventions such as the Community Reinforcement Approach (CRA).
#4 Address entire package
Treatment needs to address the entire package of addictive behavior. Heidi testified that a quarter of her clients now report an opioid being their primary drug of choice, even though most received a DUII for alcohol. Programs that focus on alcohol and ignore other addictions and co-occurring disorders will never produce good outcomes.
#5 Positive psychology
Recognize that DUII offenders are more than the constellation of their life problems, and all stakeholders involved in their cases should consider the value of interventions from the field of positive psychology. I have written about this before, but the idea is that the best relapse prevention plans facilitate leveraging the natural talents of those getting treatment.
We need to help offenders move beyond their pathologies and problems, and find constructive ways to engage in society. If you doubt how powerful this approach can be, check out SAMHSA’s Eight Dimensions of Wellness.
A final story
A client I was treating for multiple DUIIs was sentenced to two weeks in jail. He told me that his sanction would consume all of his vacation time for the year, which would mean he would get no extended periods of time with his five-year old daughter.
We talked about his situation at great lengths until he agreed that he would remain in treatment with me – or someone at our clinic if I left – for a total of fives years in exchange for not having to do the jail time. It was not that he was afraid to do it, he had done it before, and knew it had little impact on his drinking behavior.
It was more that he knew he would never get that time back with his daughter. We put together a packet of journal articles related to addiction being a chronic relapsing medical condition, and the benefits to society by having him stay connected with treatment for five years, and sent it off to his Judge.
When the final verdict came in, I knew we had a long way to go in educating stakeholders about addiction. He denied the request. While I understand the value of sanctions, if they do the opposite of their intended purpose, then it’s time we reconsider their use in our overall DUII reduction approach.
There are no simple solutions to addiction, or for reducing impaired driving from substance abuse. I do worry that as marijuana becomes legally more available in Oregon, risks for impaired driving will increase. While most would agree that our best method of intervention for offenders is a combination of sanctions and treatment, there are no studies to my knowledge that help answer what is the correct formula or recipe. Clearly, until science can provide more direction, an individualized approach makes the most sense.