Unraveling the complexity of driving while intoxicated: a study into the prevalence of psychiatric and substance abuse comorbidity

Objective Research is beginning to provide an indication of the co-occurring substance abuse and mental health needs for the driving under the influence (DUI) population. This study aimed to examine the extent of such psychiatric problems among a large sample size of DUI offenders entering treatment in Texas. Methods This is a study of 36,373 past year DUI clients and 308,714 non-past year DUI clients admitted to Texas treatment programs between 2005 and 2008. Data were obtained from the State's administrative dataset. Results Analysis indicated that non-past year DUI clients were more likely to present with more severe illicit substance use problems, while past year DUI clients were more likely to have a primary problem with alcohol. Nevertheless, a cannabis use problem was also found to be significantly associated with DUI recidivism in the last year. In regards to mental health status, a major finding was that depression was the most common psychiatric condition reported by DUI clients, including those with more than one DUI offence in the past year. This cohort also reported elevated levels of Bipolar Disorder compared to the general population, and such a diagnosis was also associated with an increased likelihood of not completing treatment. Additionally, female clients were more likely to be diagnosed with mental health problems than males, as well as more likely to be placed on medications at admission and more likely to have problems with methamphetamine, cocaine, and opiates. Conclusions DUI offenders are at an increased risk of experiencing comorbid psychiatric disorders, and thus, corresponding treatment programs need to cater for a range of mental health concerns that are likely to affect recidivism rates.

Age and gender comparisons of driving while sleepy : behaviours and risk perceptions

To assist road safety professionals in developing effective strategies to combat the risk associated with driving while fatigued, a survey was administered to 1000 Australian drivers. Participants reported their past behaviours in regards to driving while sleepy and their perceptions of risk associated with driving fatigued as compared to speeding and driving under the influence of alcohol. Although participants appeared to be aware of the substantial risk associated with driving while sleepy, many drivers reported that they frequently drive when sleepy. Age and gender comparisons, revealed that risk taking behaviour in regards to driving while sleepy is occurring across all age groups and in both male and female drivers. Overall young to middle age drivers and male drivers reported the highest frequency of driving while sleepy and reported the lowest perceived personal risk in regards to driving while sleepy.

How do perceptions of risk associated with driving while fatigued and perceptions of effectiveness of countermeasures effect willingness to engage in fatigue reducing countermeasures?

Sleep-related and fatigue-related driving is an important contributory factor in fatal and serious injury crashes - Accounts for approx 19% - Similar in magnitude to drink driving

Self-reported circumstances and consequences of driving while sleepy

Driver surveys are indispensable sources of information when estimating the role of sleepiness in crash causation. The purpose of the study was to (1) identify the prevalence of driving while sleepy among Finnish drivers, (2) determine the circumstances of such instances, and (3) identify risk factors and risk groups. Survey data were collected from a representative sample of active Finnish drivers (N = 1121). One-fifth of the drivers (19.5%) reported having fallen asleep at the wheel during their driving career, with 15.9% reporting having been close to falling asleep or having difficulty staying awake when driving during the previous twelve months. Epworth Sleepiness Scale scores were found to be associated with both types of sleepiness-related driving instances, while sleep quality was associated only with the latter. Compared to women, men more often reported falling asleep at the wheel; the differences were somewhat smaller with respect to fighting sleep while driving during the previous twelve months. The reported discrepancy in sleepiness-related instances (high prevalence of fighting sleep while driving during the previous twelve months and lower proportion of actually falling asleep) identifies young men (⩽25 years) as one of the main target groups for safety campaigns. Approximately three-quarters of drivers who had fallen asleep while driving reported taking action against falling asleep before it actually happened. Furthermore, almost all drivers who had fallen asleep while driving offered at least one logical reason that could have contributed to their falling asleep. These data indicate some degree of awareness about driving while sleepy and of the potential pre-trip factors that could lead to sleepiness while driving, and supports the notion that falling asleep at the wheel does not come as a (complete) surprise to the driver.

Best practice in peer-led curriculum content : informing an interactive program to improve passenger safety among high school seniors

Despite ongoing improvements in behaviour change strategies, licensing models and road law enforcement measures young drivers remain significantly over-represented in fatal and non-fatal road related crashes. This paper focuses on the safety of those approaching driving age and identifies both high priority road safety messages and relevant peer-led strategies to guide the development school programs. It summarises the review in a program logic model built around the messages and identified curriculum elements, as they may be best operationalised within the licensing and school contexts in Victoria. This paper summarises a review of common deliberate risk-taking and non-deliberate unsafe driving behaviours among novice drivers, highlighting risks associated with speeding, driving while fatigued, driving while impaired and carrying passengers. Common beliefs of young people that predict risky driving were reviewed, particularly with consideration of those beliefs that can be operationalised in a behaviour change school program. Key components of adolescent risk behaviour change programs were also reviewed, which identified a number of strategies for incorporation in a school based behaviour change program, including: a well-structured theoretical design and delivery, thoughtfully considered peer-selected processes, adequate training and supervision of peer facilitators, a process for monitoring and sustainability, and interactive delivery and participant discussions. The research base is then summarised in a program logic model with further discussion about the quality of the current state of knowledge of evaluation of behaviour change programs and the need for considerable development in program evaluation.

“I drove after drinking alcohol” and other risky driving behaviours reported by young novice drivers in Queensland, Australia

Background. Volitional risky driving behaviours such as drink- and drug-driving (i.e. substance-impaired driving) and speeding contribute to the overrepresentation of young novice drivers in road crash fatalities, and crash risk is greatest during the first year of independent driving in particular. Aims. To explore the: 1) self-reported compliance of drivers with road rules regarding substance-impaired driving and other risky driving behaviours (e.g., speeding, driving while tired), one year after progression from a Learner to a Provisional (intermediate) licence; and 2) interrelationships between substance-impaired driving and other risky driving behaviours (e.g., crashes, offences, and Police avoidance). Methods. Drivers (n = 1,076; 319 males) aged 18-20 years were surveyed regarding their sociodemographics (age, gender) and self-reported driving behaviours including crashes, offences, Police avoidance, and driving intentions. Results. A relatively small proportion of participants reported driving after taking drugs (6.3% of males, 1.3% of females) and drinking alcohol (18.5% of males, 11.8% of females). In comparison, a considerable proportion of participants reported at least occasionally exceeding speed limits (86.7% of novices), and risky behaviours like driving when tired (83.6% of novices). Substance-impaired driving was associated with avoiding Police, speeding, risky driving intentions, and self-reported crashes and offences. Forty-three percent of respondents who drove after taking drugs also reported alcohol-impaired driving. Discussion and Conclusions. Behaviours of concern include drink driving, speeding, novice driving errors such as misjudging the speed of oncoming vehicles, violations of graduated driver licensing passenger restrictions, driving tired, driving faster if in a bad mood, and active punishment avoidance. Given the interrelationships between the risky driving behaviours, a deeper understanding of influential factors is required to inform targeted and general countermeasure implementation and evaluation during this critical driving period. Notwithstanding this, a combination of enforcement, education, and engineering efforts appear necessary to improve the road safety of the young novice driver, and for the drink-driving young novice driver in particular.

On-road driver sleepiness : what are Australian drivers experiences and awareness of sleepiness while driving?

Objectives: Driver sleepiness contributes substantially to road crash incidents. Simulator and on-road studies clearly reveal an impairing effect from sleepiness for driving ability. However, drivers might not appreciate the dangerousness of driving while sleepy and this could translate to their on-road driving behaviours. This study sought to determine drivers’ on-road experiences of sleepiness, their sleep habits, and personal awareness of the signs of sleepiness. Methods: Participants were a random selection of 92 drivers travelling on a major highway in the state of Queensland, Australia, who were stopped by Police as part of routine drink driving operations. Participants completed a brief questionnaire that included: demographic details, awareness and on-road experiences of sleepy driving, and sleep habits. A modified version of the Karolinska Sleepiness Scale (KSS) was used to assess subjective sleepiness during the last 15 minutes of driving. Results: Participants rating of subjective sleepiness was quite low with 90% reporting at or below 3 on the KSS. Participants were reasonably aware of the signs of sleepiness; with a number of these correlated with on-road experiences. The participants sleep debt correlated with their alertness (r = -.30) and the hours spent driving (r = .38). Conclusions: These results suggest that drivers had moderate or substantial experience of driving when sleepy and many were aware of the signs of sleepiness. As many of the participants reported driving long distances after suboptimal sleep durations, it is possible that their risk perception of the dangerousness of sleepy driving maybe erroneous.

Continuing to drive while sleepy : the influence of sleepiness countermeasures, motivation for driving sleepy, and risk perception

Driver sleepiness is a major contributor to road crashes. The current study sought to examine the association between perceptions of effectiveness of six sleepiness countermeasures and their relationship with self-reports of continuing to drive while sleepy among 309 drivers after controlling for the influence of age, sex, motivation for driving sleepy, and risk perception of sleepy driving. The results demonstrate that the variables of age, sex, motivation, and risk perception were significantly associated with self-reports of continuing to drive while sleepy and only one countermeasure was associated with self-reports of continuing to drive while sleepy. Further, it was found that age differences in self-reports of continuing to drive while sleepy was mediated by participants’ motivation and risk perception. These findings highlight modifiable factors that could be focused on with interventions that seek to modify drivers’ attitudes and behaviours of driving while sleepy.

Medications and driving : community knowledge, perceptions and experience

There is increasing awareness of the potential for any medication that acts on the central nervous system to impair judgement and motor functioning, including driving performance. This paper reports community knowledge, perceptions and experience in relation to driving while taking medications. A community-based survey (n=316) revealed that of those who had taken any type of medication in the last 7 days (n=193), a quarter (24%) had driven while taking a medication that they thought could affect them. Of those who drove for work, a quarter (26%) of the respondents reported that they had changed or stopped their work-related driving because they were taking a medication that displayed a warning label about driving. Outside of work, a third (35%) of the total number of respondents reported that they had done so. Of those who had taken any type of medication in the last 7 days, 62 were taking on a daily basis one or more medications classified as being likely to have a warning label about driving, such as sedatives, tranquilizers, antidepressants, analgesics and anticonvulsives. This paper will examine community knowledge, perceptions and experience surrounding medications and driving with particular reference to those persons who were taking drugs with a warning label, and the barriers to following such warnings.

Safety in occupational driving : development of a driver behaviour scale for the workplace context

International statistics indicate that occupational, or work-related driving, crashes are the most common cause of workplace injury, death, and absence from work. The majority of research examining unsafe driver behavior in the workplace has relied on general road safety questionnaires. However, past research has failed to consider the organizational context in the use of these questionnaires, and as such, there is ambiguity in the dimensions constituting occupational driving. Using a theoretical model developed by Hockey (1993, 1997), this article proposes and validates a new scale of occupational driver behavior. This scale incorporates four dimensions of driver behavior that are influenced by demanding workplace conditions; speeding, rule violation, inattention, and driving while tired. Following a content validation process, three samples of occupational drivers in Australia were used to assess the scale. Data from the first sample (n=145) were used to reduce the number of scale items and provide an assessment of the factorial validity of the scale. Data from the second sample (n=645) were then used to confirm the factor structure and psychometric properties of the scale including reliability and construct validity. Finally, data from the third sample (n=248) were used to establish criterion validity. The results indicated that the scale is a reliable and valid measure of occupational driver behavior.

Big-five personality factors affecting driving behaviours

The factors affecting driving behaviors are various and interact simultaneously. Therefore, study of their correlations affecting on driving behaviors is of interest. This paper reports a questionnaire survey in China, focusing on the effect of Big-Five factors on speeding, drink driving, and distracted driving while Akers' social learning theory and Homel's deterrence theory were applied. The results showed that personalities had significant effect on speeding and drink driving; social factors had significant effect on speeding and distracted driving; deterrence had significant effect on speeding and drink driving; however, social learning theory did not contribute to drink driving; deterrence did not affect distracted driving. The results were discussed along with the limitation of this study.

Do people gamble with their lives : The relationship between risky driving behaviour and other risky behaviours

General risky behaviour is explored for correlation with risky driving behaviour in light of two theories, self-control and cross-situational consistency. Identification of general risky behaviours associated with risky driving behaviour, and the theory that best predicts the behaviours, will enable better targeting of intervention and education strategies to reduce driving related fatalities and injuries. A correlational study using participants (N=152) drawn from first year university undergraduates and the public surveyed their lifestyle and behaviours. Relationships were found between risky driving behaviours and other risky behaviours such as alcohol consumption, cannabis use and performing unlawful activities. No significant differences were found between genders, with the exception that males were more likely to believe that they were at risk of injury from their employment, χ2 (1, N = 152) = 4.49, p = .03, were more likely to have performed an unlawful offence, χ2 (1, N = 152) = 11.77, p = .001 and were more likely to drink drive, t (55.41) = -3.87, p < .001, mean difference = -0.63, CI 95% (-0.9, -0.37). People engaged in risky driving behaviours were more likely to engage in other risky behaviours. The theories that were explored were unable to accurately predict an association between general risky behaviour and driving without a license or when disqualified. Cross-situational consistency explained 20% (R2adj = .16) of the variance in which people engaged in risky driving with low self-control theory explaining an additional 0.3% variance (R2change = .003), F (8,143) = 6.92, p < .001. Driving while under the influence of alcohol could be predicted by risky behaviours in lifestyle, health, smoking, cannabis use and alcohol consumption, F (8,143) = 6.92, p < .001. The addition of self-control was not significant.

Sleepy driving and pulling over for a rest : investigating individual factors that contribute to these driving behaviours

Driver sleepiness is a substantial crash risk factor and as such, is a major contributor to crash statistics. A number of individual factors (i.e., psychological factors) have been suggested to influence driving while sleepy. However, few studies have examined the influence of these individual factors for sleepy driving in combination. The current study sought to examine how various demographic factors, attitudes, perceived legitimacy, personality constructs, and risk taking variables were associated with self-reported likelihood of driving sleepy and pulling over and resting when sleepy. The results show that being a younger driver, having positive attitudes towards driving sleepy, and high levels of emotional stability were related to self-reported likelihood of driving sleepy. Whereas, being an older driver and having negative attitudes towards driving sleepy were associated with self-reported likelihood of pulling over and resting when sleepy. Overall, the obtained results suggest that the age and attitudes of the driver have greater influence than personality traits or risk taking factors. Campaigns focused on changing attitudes to reflect the dangerousness of sleepy driving could be important for road safety outcomes.

Knowledge and behaviours of drunk driving offenders in Guangzhou, China

Background Alcohol is a major contributor to road crashes in China (Li, Xie, Nie, & Zhang, 2012; Cochrane, & Chen, 2003). Two levels of offence are defined in legislation: the lower level is driving under the influence (DUI, also translated as “drink driving”) and the higher level is driving while intoxicated (DWI, also translated as “drunk driving”, where the driver has BAC>0.08mg/100ml). This study focuses on a 2011 legislative amendment that made drunk driving (DWI) a criminal offence. However, it is not known whether drivers are aware of the law, and whether this knowledge, their exposure to enforcement and the existence of alcohol use disorders relate to their drink driving behaviour. This study explored these relationships in a sample of convicted drunk drivers. Method A survey collected information about offenders’ knowledge and practices related to drunk driving in Guangzhou. The Alcohol Use Disorders Identification Test (AUDIT) (Babor, & Grant, 1989; Chen, & Cheng, 2005) assessed hazardous drinking levels. In total, 101 drunk driving offenders were recruited while in detention. Results Males represented 90% of the sample; the average age was 33.6 years (SD=8.7; range 17-59 years). The average age at which offenders reported starting to drink alcohol was 19.5 years (SD=4.1; range 8-30 years). Driver’s licences had been held for a median of 7 years. Knowledge about legal limits for DUI and DWI offences was surprisingly low, at 27.7% and 40.6% respectively. On average, offenders had experienced 1.5 police alcohol breath tests in the previous year (SD=1.3; range 1-10). AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol use disorders. Higher AUDIT scores were found among the least experienced drivers, those with lack of knowledge about the legal limits, and recidivist drunk drivers. Discussion and conclusions Limited awareness of legal alcohol limits might contribute to offending; high levels of alcohol consumption by many offenders suggest that hazardous drinking levels may also contribute. Novice drivers are a concern and their higher AUDIT scores merit some followup. Overall, this study provides important information to assist in refining community education and prevention efforts to align with China’s new regulations.

Report to VicRoads: Vehicle based sanctions to address drink driving

Licence sanctions including suspension, disqualification, or revocation have been effective in reducing recidivism and crash rates among those convicted of driving while under the influence of alcohol and/or drugs. Nonetheless, studies have indicated that many offenders continue to drive while they are unlicensed. Consequently, more recent attention has been given to vehicle sanctions that separate the offender from their vehicle. Vehicle based interventions focus on incapacitating the vehicle or separating it from the offending driver rather than relying on the threat of further sanctions to encourage compliance. Following on from a previous review conducted by Dr. Ron Christie (2006) for VicRoads, which examined the effectiveness of vehicle based sanctions in deterring unlicensed driving, this report considers the effectiveness of the aforementioned vehicle based sanctions for addressing drink driving.