This proposal is in response to the Recovery Act Limited Competition: NIH Challenge Grants in Health and Science Research (RC1). The broad challenge area is Comparative Effectiveness Research (05). The specific topic is Use of Innovative Technologies in Alcohol Treatment Research (05-AA-103), a topic assigned highest priority. Alcohol-related motor vehicle accidents (AR-MVA) are a significant public health concern. AR-MVA fatalities account for the largest proportion of MVA fatalities. In 2006, 41% of vehicle-related fatalities were alcoholrelated (17,000 deaths) and 86% of these fatalities involved a driver with a blood alcohol content of 0.08 or greater. Traffic accidents are among the top 10 leading causes of disability in the US. Together, alcoholrelated crashes cost society about 51 billion dollars every year. Evidence-based interventions to reduce the frequency of AR-MVA are urgently needed because the consequences are costly, and often lethal. Need and Challenge Addressed. The prevalence of AR-MVAs and the disturbing cost and health outcomes pose a dual challenge. The scientific challenge is how to increase access to effective care for 1st time DUI offenders and keep them from becoming repeat offenders. We address this challenge by asking whether providing brief interventions in alcohol education programs (AEP), the traditional method for preventing future alcohol-related incidents among 1st-time DUI offenders, is feasible and acceptable to offenders and providers, and whether adding a BI decreases alcohol consumption and risky drinking behaviors. We know that BIs are effective at reducing risky alcohol use and alcohol-related consequences with at-risk drinkers in diverse populations and settings, and there are good reasons to believe BIs might be efficacious in the AEP setting. We also ask whether the mode of BI delivery differentially affects outcomes. The public health challenge is to improve outcomes for AEPs, which have only modest effects on reducing alcoholism and AR-MVAs. In California, as in other areas, more than a third of all DUI convictions are repeat offenders, and a disproportionate number of DUI fatalities are caused by drivers previously convicted of an ARMVA. These rates of recidivism suggest that AEP programs are a missed opportunity for alcohol prevention and treatment. The opportunity could be especially valuable for Hispanic offenders, who are disproportionately more likely to be arrested for a DUI compared to other race/ethnicities in California, have higher rates of recidivism, and are more likely to die in alcohol-related crashes than their White counterparts. AEP programs may have only modest effects because the programs are primarily psychoeducational, and program content is not driven by an underlying theory of behavior change. By its nature, the mandated AEP program cannot provide individualized normative feedback, an essential element of BIs. In contrast, BIs are theory-based. They address intrinsic motivation and self-efficacy, which are key to changing behavior. Since clients convicted of a DUI are frequently upset about their mandatory sentence and resistant to change, the motivational interviewing style used to deliver the BI may help clients become more willing to change, which may affect outcomes. However we lack scientific evidence for the efficacy of BIs in the AEP context and the use of BIs is limited by the availability of trained therapists, the cost of their time, and the difficulty of implementing the BI uniformly and reliably. Using web-based technology to deliver the brief intervention (WBBIs) is an efficient and innovative way to address these limitations.
Aim 1. To develop an individualized, interactive, web-based brief intervention for English- and Spanishspeaking DUI offenders in AEPs and evaluate its feasibility and acceptability to English- and Spanishspeaking offenders, clinicians, and AEP programs.
Aim 2. To conduct a pilot randomized trial comparing usual AEP care to two methods of delivering a brief intervention (IP-BI and WB-BI) to 1st-time DUI offenders in reducing alcohol consumption and at-risk drinking. Innovation. The proposed work is innovative because it evaluates a proven intervention (BIs) with a new population (1st time DUI offenders) and compares the differential effectiveness of alternative delivery systems (WB and IP). Evaluating the effectiveness of BIs for the Spanish speaking DUI population is also innovative. By evaluating the use of the web to deliver the intervention we directly address the need to develop innovative treatment technologies specified in the Challenge topic. This research area is one that would benefit substantially from two-year jump-start funds. With these funds, we can develop a WB-BI and pilot test the differential efficacy of WB-BI and IP-BI relative to usual care, in preparation for a larger efficacy trial. This study meets the goals of the American Recovery &Reinvestment Act. It fills a significant knowledge gap in the research field and may help a population likely to be highly affected by the recession, as research suggests that individuals are using alcohol to cope with the stressful economic environment.
Enormous unmet needs for alcohol prevention and treatment exist among individuals arrested for driving under the influence (DUI), as nearly one third recidivate and have a subsequent arrest. The DUI arrest represents a critical opportunity for early intervention and prevention. We propose to develop a brief intervention for English and Spanish-speaking DUI offenders and evaluate the differential effectiveness of two methods of delivering a brief intervention, in person and by the web. The study has the potential to promote the public welfare by preventing first-time DUI offenders from becoming repeat offenders, thereby reducing the enormous financial and societal costs associated with having drunk drivers on the roads.
|Osilla, Karen Chan; Paddock, Susan M; Leininger, Thomas J et al. (2015) A pilot study comparing in-person and web-based motivational interviewing among adults with a first-time DUI offense. Addict Sci Clin Pract 10:18|
|Osilla, Karen Chan; D'Amico, Elizabeth J; Diaz-Fuentes, Claudia M et al. (2012) Multicultural web-based motivational interviewing for clients with a first-time DUI offense. Cultur Divers Ethnic Minor Psychol 18:192-202|