Last year I presented at the Oregon DUII Multi-Disciplinary Driving Training Conference and was honored to be asked back this year. For those of you who came to my talk, thank you! Also, thank you for allowing me to open with some personal challenges, and supporting me throughout the presentation. As promised, feel free to download my slide deck, and check out last year’s presentation if you missed it. Here also are some key messages from the talk.
It’s about more than the DUII
A DUII is a consequence resulting from a variety of risk factors that all need to be considered if we are to effectively prevent future DUIIs. While alcohol and drug use disorders clearly need to be assessed, we also need to evaluate behavioral addictions, trauma, chronic medical problems, social isolation, and other lifestyle stress factors. The reason is that these other issues very often play a critical role in why someone ultimate drives under the influence.
It all starts with relationship
Most DUII clients are not excited to be in treatment and view it as an extension of the legal system and sanctions. This is not an ideal way to begin a counseling relationship! Therefore, we must find a way to help clients engage productively in the process, increase their own motivation for being in treatment, and make the experience worthwhile. While this can be challenging, tools including motivational interviewing, offering a menu of treatment options, and identifying what the client is motivated to address in their life can be helpful. Treatment absent a trusting therapeutic relationship, is doomed to fail.
Treatment programs need to get better
Despite everything we know about how best to help people with DUIIs, addictions, and other life challenges, our programs remain far from optimal. We rush evaluations, provide homogeneous group treatment when clients present with very different issues, fail to utilize evidence-based treatments like addiction medicines, and rarely treat trauma and development deficits and constrictions. And collectively we continue to offer acute care for chronic problems.
These failures are for the most part systems problems, and not the outcome of hardworking individuals on the front lines delivering care. From the top down, program owners and administrators need to set the bar higher in what they deliver to clients. How would Steve Jobs create a treatment program? I know he was a bit eccentric, but imagine the creativity, technology and design-sense he would bring to the business of treatment. We need his kind of passion and energy if programs are to significantly improve.
We all should be engaged in trauma informed care
I don’t think I mentioned trauma informed care in my talk, but I know I hit home the point that trauma – in all forms (adverse childhood experiences) – is among the most significant underlying factors linked to DUIIs. As a multi-disciplinary group we need to understand that it is not just DUII clients that often suffer from trauma, but us as well. Trauma on a continuum is a universal part of life, and when left untreated, can yield immense suffering.
Key to effective intervention is integration of the head and heart, which necessitates incorporating somatic (body-based) approaches in our healing work. There are many options for doing this, but one that I highlighted was Tension & Trauma Releasing Exercises (TRE). If you have an interest in learning more about TRE, I encourage you to contact a friend, Lynea Gillen, who has been instrumental in bringing it to Oregon. And, as I mentioned in the talk, I encourage you to read the book The Body Keeps the Score, it is among the best books you will ever read on trauma and its various treatments.
Mindfulness in all we do
As the Cookie Monster said, “Today me will live in the moment, unless it’s unpleasant, in which case me will eat a cookie.” Today, we are a culture that knows well how to stay out of the present moment. We drink, drug, work, sex, gamble, and yes, even eat our way out of the present. We do this because life is hard, and being present, fully in our bodies, requires effort. The fact that horrific images, videos and stories about human suffering are being streamed into our living rooms 24/7 by a media obsessed with sensationalism and profits does not help matters!
When we are not present and living life in the now, we perpetuate our suffering. This is because if we are not present we are not aware, we lack consciousness. Without awareness we live life on auto-pilot and our behavior is motivated by the pain of the past or fear of the future. So of everything I presented, perhaps the most important thing is that we all need to engage in regular practices that help us be at home in our bodies, in the present. Fortunately, there are no shortage of contemplative practices, so pick what suits you and stick with it.
To wrap up, thanks again for allowing me to be a part of your good work. What I have enjoyed most these past two years, are the engaging, committed, and thoughtful people I have met at the conference. Thank you for making our communities safer.
Michele Johnson says
I like your thinking and approach to the underlying issues and not just the DUII. I feel that there are many traumas in our lives that once enough time has passed, we tend to “stuff” the cold hard facts and the hurt/pain. If it is never discussed and we carry the resentment or suffering with us eventually it bubbles to the surface and we act out or react. I have recently been through a hard divorce and jumped right into another relationship. The feelings from the divorce have started to interfere with my current relationship and I am thinking that it is time to talk to someone professionally. The book “The Body Keeps Score” sounds like a good read and I will attempt to read it once school reading is complete.
Thank you for your excellent writing and I appreciate the hope you give to many people with your approach in addressing the underlying issues.
Sarah W Jeong says
It was a very new way of approaching the subject of pain. I did not go in depth with pain until I got to hear Dr. Fitzgerald in our class (PHE 323). Body and pain is something that is connected and if we do not treat our trauma then sooner or later our body and mind will react to it. Just because it doesn’t show right away, that does not mean it is gone but it’s hidden somewhere. It was refreshing to know how pain and trauma is relevant to our everyday life. Who we surround ourselves with, what we do and how we cope with certain things. It’s amazing how our upbringing is so important and so connected to our later on outcomes. Poverty, Education, Friends and Family can influence you to either find dependency on other things like drugs or alcohol or rather improve in life. Addiction is not a brain disease but it is a response to prior traumatic experiences. Seeing the passion in your talk about improving more treatment options and helping your clients has just brought comfort to me and I feel like to many people who have read and hear your voice on this. I personally realized pressing down on my past isn’t such a healthy way to deal with it but to talk about it and find a solution to my deep down struggles.
Sebastian Branton says
To add onto this post,I would like to begin by stating that your blog post brought a new perspective into an old topic that has always been at the back of my head.
Dui’s are seen as somebody idiotically driving under the influence of a substance but the topic shouldn’t end there. Underlying problems are evident when somebody has the green light in their head to proceed to drive intoxicated. Why is this exactly? This seems to be the biggest barrier between ridding somebody of their issues and just charging them with a crime only to have them do it again.
Understanding addictions from the root of the issue seems to be the best means of fully solving the problem because if you don’t tackle the underlying problems, you may find yourselves dealing with a patient in and out for years on end. The fact of the matter is, a person will continuously repeat their action until the issue that makes their brain think what they are doing is okay,is eliminated from the equation. Doing this, (like Dr.Fitzgerald said when he lectured in our hall) requires full want from the abuser to cure themselves, because the biggest barrier they have towards success is themselves.
Upon analyzing the Tree of Contemplative Practices, you can break down self healing into seven categories full of valuable information. Stillness through meditation and silence can help you hone into the problems you are feeling, allowing you to identify what is making you feel a certain way. Using the creative branch and singing or Journaling, allows you to put your thoughts on paper, providing an outlet to your own thought by being able to transcribe them into a way you can read or see them. However out of all the options, I value movement the most. Being physically active brings all sorts of benefits to ones self esteem and image of themselves. This is because when you burn calories and push yourself, you are surpassing what you believed you could achieve, therefore improving your self esteem. This could be a very important factor in ridding yourself of problems stemming from your own self image.
All in all, this blog post was a huge eye opener towards a law a lot of adults seem to break as well as teenagers, and it is a huge issue in society. However I do think that our image on this topic is skewed because we don’t really think about the real reason somebody may decide to hop in a car after a few drinks compared to taking an uber home. It’s more than just deciding you’re okay to drive and is more so towards issues that make themselves either not care about their own well being or rather that they cant see where they are wrong in their own judgement.
belem shankle says
We should find a way to challenge our way of motivation of offering treatment options. This way life can be more helpful. As they say in this article that treatment absent a trusting therapeutic relationship ids doomed to fail. Fail to utilize evidence based treatments like addiction medicines and rarely treat trauma and development deficits and constrictions. Without awareness we try to live life on auto pilot and our behavior is so motivated by the pain of the past or the fear of the future.
Shayla A. says
Thank you for all that you do in the community in outreach and treatment. Your expertise on micro, mezzo, and macro levels are making a difference. It must be just as stressful as it is rewarding working in so many different areas. There were several parts of this post that really engaged me.
The first thing that caught my eye is the part about building a relationship with the DUII clients. I can’t imagine that may people are excited for their “punishment” treatment for driving under the influence. You hit it on the head when you mentioned that engaging them and getting them motivated will be very helpful in starting a productive treatment process. You mentioned interviewing the client, offering various treatment options, an identifying what they’re willing to address. All wonderful ideas. I just wonder what this interview process would look like, and what sort of prompt questions would encourage willingness and cooperation? Are there standard treatment methods that are offered to specific clients?
Thank you again for your thoroughness and solution-based input. I love the part about mindfulness as well!
Rohan Wanchu says
I thoroughly loved your post and really liked some of the view points you talked about. The sentence that drew a lot of my attention was “Acute care for chronic problems.” I believe that the DUI system is set up to catch offenders and punish them instead of actually trying to offer them help for their underlining problem. As I dug deeper into your slides I found a statistic that truly shocked me “Repeat offenders and chronic drunk drivers make up about 1% of all drivers on weekend nights, but account for 50% of all fatal crashes.”
It seems like we have a lot of people who have really bad relationships with alcohol and other substances which leads to their DUI. I also think that we need a multi dimensional approach to solve this problem since people are not the same and their addiction problems are not the same. I truly believe that if we can get these people the right kind of help and improve their relationships with drugs, we can reduce the number of DUIs and also the number of fatal crashes associated with DUIs. Great post.
As I was reading I was wondering and I had the question of how to motivate a person into getting care but as I read you talked about offering a few options and interviewing a person before hand. And how trust is an important part of that treatment for the person. I think this was important because I see people pushing others to treatment (with good faith) but not looking at the “pain” that, that person may have been feeling and actually solving the problem.
You also mentioned being in the present, something I feel is hard to do! I found some things that help but at the end of the day back to the past or thinking of the future. Why is it so hard to get away from that? and is it really that bad that a person may be in the past for future.
Beau Duronslet says
One thing that really stood out in your post is your opinion that the treatment facilities need to be better. You mentioned that all of the people have their own individual problems and need to be treated in their own individual ways. They are all facing the consequences of driving under the influence, but everyone has their own reasons for using drugs, and leading them to driving while under the influence. I thought it was interesting that you said the relationship with the client needs to be improved. What could be done to increase their motivation to be in treatment and get them to become engaged? It seems to me that many DUII clients do not exactly see a problem with driving under the influence or they would not have done it. This would lead to them not understanding why they have to do the treatment and not being engaged.
Elizabeth K. says
“Most DUII clients are not excited to be in treatment and view it as an extension of the legal system and sanctions. This is not an ideal way to begin a counseling relationship!” I really liked how you made this an important and vital point in your post. Wanting to get better can be a driving factor in rehabilitation and counseling about your problems. It seems that someone who doesn’t even want to be in rehab or treatment, would take quite some time to truly open up and start to work through the underlying issues that caused their addiction. Having their experience in treatment be valuable and relevant to them would greatly increase their chances of staying clean and sober.
I also really like how you related trauma to DUIIs. It would make a lot of sense if someone who was exposed to many traumas, would be more likely to be reckless with their life. And I don’t think they ever intend on hurting people outside of themselves, but do because they aren’t able to fully process the danger they’re in. They’re just self-medicating.
John Fitzgerald says
Thanks Rohan, appreciate your comment!
John Fitzgerald says
Thanks for your kind feedback Shayla! Yes, there is a bit of method to the evaluation madness :) The quick answer is we use lots of open-ended questions, incorporate motivational interviewing techniques, listen emphatically, and let the relationship guide the process. As to treatment methods, check out my page on the 5 actions.
John Fitzgerald says
Sebastian, appreciate much what your bring to the table regarding this post, thanks!
John Fitzgerald says
Thanks Michele for your kind feedback. The trauma book is good, hope it brings some light to the messiness of relationships :)
Babetta Bogia says
I want to thank you for this informing post. I am very impressed with your ideas and how you help the community. I really liked how you mentioned about it starts with relationships and that treatment centers need to be improved. Relationships are the key to success and are helpful to the people in the relationship. Treatment centers are a tricky subject and have a lot of controverse. I like how you addressed them and brought new prospectives to this subject and what should be done. What other ways would you suggest that treatment centers help the person and also change? Have you worked alongside treatment centers?
Stefanie S. says
“Most DUII clients are not excited to be in treatment and view it as an extension of the legal system and sanctions”. Having gotten a DUI a few years ago when I was 19 this statement really resonates with me. After pushed court dates, lawyer fees, suspended license, court fees, and community service that I had to pay to do they also slapped me with 35hrs of Drug and Alcohol counseling classes all because I was honest (even after friends in a similar situation told me to lie, this particular therapist didn’t like if anyone ever smoked weed before) during my initial evaluation. Knowing that being honest gave me the harshest punishment only made me dread the upcoming counseling classes/sessions. Though the material was interesting the whole process was repetitive and felt like it was just another money maker.
I’m glad that you talked about the need to revamp treatment programs because from my experience I got nothing out of it. I just did my work and assignments and told them what they wanted to hear so I could get out of there faster. Now that I’m older I realize this wasn’t the best way for me to go about the processes but as a 19yr old in college I didn’t see the benefit and if they didn’t seem to care about me actually benefiting form the process why should I?
John Fitzgerald says
Thanks for your feedback Stefanie, very supportive of the need for why we need to change things!
John Fitzgerald says
Babetta, thanks for the nice feedback! I think treatment centers should adopt my 5 Actions model as their overarching approach to interventions. And yes, I presently am the Clinical Director of one of the largest treatment programs in the Portland area.
I enjoyed reading your post because the way you explained the problem is not how many people think about it. One thing that really stood out to me is when you mentioned that we are a culture that knows how to stay out of the present moment by drinking, doing drugs, sex, working, gambling, or even eating. I completely agree with you on that. Too often I hear about and see people consuming alcohol and drugs in an unsafe manner, engaging in sexual relationships that are inappropriate, allowing work to take over their life, or overeating. All of this can have a negative impact on one’s life because their are harming their body and mind through the process. Many of us look at these people in disgust, however, we don’t know the reason behind it. Like you said, life is hard and the fact that stories about humans suffering are constantly being displayed by the media is only making it worse. I also think that it’s about more than the DUII. Thank you for sharing your thoughts!
John Fitzgerald says
Thank you for the nice feedback!
I think the biggest take away I got from this article was in the section titled “It all Starts with Relationship” and “Treatment Programs need to get Better.” I found it extremely interesting to think about the investment of the individuals. Yes, treatment is generally required and not an option, however, if one is not invested in it, or doesn’t feel/see that it is worth their time, the odds are when treatment is complete, they will make the same mistake down the road. It is vital to help one understand their decisions as well as why they pose a problem and how they can grow. Yet, if the treatment, like stated in the article, doesn’t “identify what the client is motivated to address in their life” then what good is it really doing? It is hard to become invested in anything that you don’t feel connected to or a part of. If we truly want to make a turn for the better, I agree that treatment programs need to become more creative and more appealable to it’s clients in many different ways.
I agree with what Kelly has said about Relationships and how Treatment Programs need to get better. If an individual is not interested in the treatment and is only there because it is mandatory then the individual is likely to make the same mistake again because he/she does not care. I believe it is important to understand the person and see what kind of problems they are going through, in other words, it’s important to build a connection with the individual to help them grow through the problem. As stated in the article “Most DUII clients are not excited to be in treatment and view it as an extension of the legal system and sanctions”. The clients feel as they are just being told not to drive under the influence and this is why. Most clients know the outcome of a DUII but the question is what made the client operate a vehicle under the influence in the first place?
“We are a culture that knows well how to stay out of the present moment. We drink, drug, work, sex, gamble, and yes, even eat our way out of the present.” We need to face our problems and learn how to cooperate with them instead of temporary running away from them because the problem will still exist.
I have never thought of trauma being the most significant underlying factors linked to DUIIs. However, it makes complete sense. Since before I could legally drink, i knew that at the end of a hard day or if something horrible happens, drinking makes you feel better. Both of my parents have never drank alcohol due to religious reasons. So my perception of alcohol all came from the media and what I saw on TV and in movies. Now that I am older I understand that all alcohol does is help numb the emotions, but the problem still remains. So if we try to drink ourselves out of the moment and not face what has actually happened, it will eventually catch up with us. This is why, like you said, it is so important to live in the “now” and face the present.
Savannah D says
I personally feel like DUIIs are a very sensitive topic to talk about with all the death that are surrounded around them. Rather the death be from the driver or an innocent bystander, it is something very hard to discuss but that means it often gets ignored, making the issue even worst. I really enjoyed reading this post because I see many people committing the act of driving under the influence. It is important to try to find the reason why so many people are committing this act and try to find a way to help them. Treatment centers are good for some people but it does not work for everyone. Many people go into these treatment centers, just to come right back out and relapse. I love what you said about our culture with we have with drugs and sex, etc. It really is true. We live in a world where we party to get away from our everyday struggles but this is putting people at risk of hurting themselves and the people around them.
I never thought about these ideas when I thought about DUI. When thinking about it I never thought that it was because of issues in their past that had them drink, but just because they were okay with driving drunk. A lot of people have gotten more then one DUI and don’t always learn from their experiences when attending a DUI class because like you said they see it as a punishment and something they just have to get over with in order to drive again. But I do feel like if the classes were more creative and enjoyable but at the same time a learning experience people would get a lot more out of it. As well as getting to know why the DUI happened in the first place. But I do agree and feel that we should take steps forward in making this happen.
I just wanted to say that I really enjoyed how you mentioned the various causes of why someone might be driving under the influence. I think that there are many factors that can play a role into making such a decision, and sometimes it may be the only way of getting out of a bad situation. Instead of stigmatizing DUII clients there should be a support system, especially those that have gone through great life trauma. Helping create these treatment relationships are what will help many individuals come out of their trauma. I think that many people think that those driving under the influence do it for fun, but many do not think about the actual problems that they may be facing. I’d like to think that it was not just for fun or to get the rush out of it, but that it was because something terrible in their life happened that put them in such a situation. I think that your presentation was inspiring and that it helped open up many minds to the unknown information that comes with DUII clients. Thank you for all your input!