Pain Interference in Individuals in Driver Intervention Programs for Driving Under the Influence Offenders

Abstract

Pain-related problems among individuals in court-mandated Driver Intervention Programs (DIPs) for “driving under the influence” (DUI) offenders have not been well studied. This project examines 3,189 individuals from a DIP in Dayton, Ohio. Over 11% of participants reported significant pain-related interference in the past 4 weeks. Pain was significantly more likely in those with depression, more childhood conduct problems, and recent use of multiple illicit drugs. Many individuals seen in court-mandated DIP programs for DUI offenders also report difficulties with pain. DIP programming should address pain in relation to substance use and mental health issues.

RÉSUMÉ

Les problèmes Douleur-connexes dans les individus dans des programmes d’intervention cour-exigés de conducteur pour des contrevenants de « conduire sous l’influence » (DUI) n’ont pas été bien étudiés. Ce projet examine 3.189 individus d’un programme d’intervention de conducteur à Dayton, Ohio. Plus de 11% de participants a rapporté l’interférence douleur-connexe significative en dernières quatre semaines. La douleur était plus probable en ceux avec la dépression, plus de problèmes de conduite d’enfance et l’utilisation récente des drogues illicites multiples. Beaucoup d’individus vus dans des programmes d’intervention cour-exigés de conducteur pour des contrevenants de DUI rapportent également des difficultés avec douleur. Les matériaux de programme d’intervention de conducteur devraient adresser la douleur par rapport aux issues de santé mentale d’utiliser-et de substance.

Mots-clés: Douleur, alcool, dépression, penchant, conduire sous l’influence

RESUMEN

Los problemas relacionados con el dolor de individuos son los programas de intervención asignados por la corte por mandato del conductor para los delincuentes por “conducir bajo los efectos” (DUI) no han sido estudiados. Este proyecto examina a 3,189 individuos de un programa de intervención del conductor en Dayton, Ohio. Sobre el 11% de participantes divulgó interferencia, dolor-relacionado significativo en las últimas cuatro semanas. El dolor era más probable en estos individuos con depresión, más problemas de la conducta de la niñez y el uso reciente de drogas ilícitas múltiples. Muchos individuos vistos en los programas de intervención asignados por la corte por mandato del conductor para los delincuentes del DUI, también divulgan dificultades con dolor. Los materiales del programa de intervención del conductor deben tratar el dolor en lo referente a adicciones del uso de la sustancia y de la salud mental.

Palabras claves: Dolor, alcohol, depresión, apego, conducir bajo los efectos

Keywords :

• pain
• alcohol
• depression
• addiction
• driving under the influence (DUI)

THE AUTHORS

Dr. Kristen L. Barry is a research associate professor in the Department of Psychiatry Addiction Research Center and the associate director of the Department of Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC). She has a number of active and pending National Institutes of Health university-based grants and Department of Veterans Affairs grants. Dr. Barry's primary research foci include: substance use screening and brief interventions in medical care settings, substance use problems in older adults, the relationship between substance abuse and depression, and treatment efficacy for adults with co-occurring mental health and substance use disorders. She was the chair of the SAMHSA Treatment Improvement Protocol (TIP) # 34, “Brief Interventions and Brief Therapies for Substance Abuse.”

Dr. Brenda M. Booth, Ph.D., is a professor in the Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences. She is a nationally recognized expert in substance abuse and health services research. She was a principal investigator on the Rural Alcohol Study (RAS), a six-state telephone longitudinal survey of rural and urban at risk drinkers, and her currently funded research includes a multistate natural history study that examines stimulant use, including cocaine and methamphetamine use, in rural counties of Arkansas and Kentucky.

Frederic C. Blow, Ph.D., is a professor and a research professor, and the director of the Mental Health Services Outcomes and Translation Section in the Department of Psychiatry at the University of Michigan Medical School, and the director of the National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) for the Department of Veterans Affairs, Ann Arbor, MI. Additionally, he is the first National Huss/Hazelden Research Co-Chair for the Butler Center for Research at the Hazelden Foundation located in Center City, Minnesota. He is a national expert in mental health and substance abuse services research and policy, with a focus on older adults. His areas of research expertise include substance abuse prevention from a lifespan developmental perspective, alcohol screening and diagnosis for older adults, mental disorders and concurrent substance abuse, alcohol and drug abuse brief interventions in healthcare settings, and mental health services research.

Mark Ilgen, Ph.D., received his doctorate in clinical psychology from the University of Colorado at Boulder. Currently, Dr. Ilgen is with the VA Serious Mental Illness Treatment Research and Evaluation Center in Ann Arbor, Michigan, and the Department of Psychiatry at the University of Michigan. Much of his current research is focused on addressing chronic pain and risk factors for suicide in individuals with alcohol or drug problems. Additionally, Dr. Ilgen is interested in developing strategies to increase treatment engagement in patients with both psychiatric and substance use disorders.

Christopher McLouth received his undergraduate degree from the University of Michigan. In the fall of 2009, he will be starting a Ph.D. program in clinical psychology at the University of New Mexico. His primary interests are the identification and treatment of drug and alcohol problems.

Michael Paul Dabrowski, M.R.C., P.C., L.I.C.D.C., has been a member of the Weekend Intervention Program staff at the Wright State University Boonshoft School of Medicine since 1991 and became an assistant director in 2005. He has substantial experience working with adults and children who have substance abuse and/or mental health problems. As a trained clinician, he has worked in outpatient and residential/hospital settings as well as private practice. He holds a bachelor's degree in Psychology from Wright State University and a Master of Rehabilitation Counseling in Chemical Dependency from Wright State University. He is licensed by the State of Ohio Chemical Dependency Professionals Board as an independent chemical dependency counselor and by the State of Ohio Counselor, Social Worker and Marriage and Family Therapist Board as a professional counselor.

Phyllis Cole is the program director for the Weekend Intervention Program at Wright State University Boonshoft School of Medicine where she is also an assistant professor in the Department of Community Health. She has been with the School of Medicine since 1986 and has been responsible for the overall operation of the Weekend Intervention Program (WIP) since 1989. In addition to her work with WIP, Ms. Cole assists with research conducted by the Center for Interventions, Treatment and Addictions Research and has contributed to many articles published by the Center. Ms. Cole holds a bachelor's degree in Sociology from Miami University of Ohio and a Master of Arts degree from Wright State University.

Dr Walton is a research assistant professor in the Substance Abuse Division, Department of Psychiatry at the University of Michigan. Her research interests include the spectrum of treatments for alcohol and drug problems, from brief interventions in community settings to specialized substance abuse treatment and relapse prevention. She is currently a coinvestigator on two emergency-department-based projects: “Youth Violence Prevention Center Emergency Department Pilot Project” (funded by the CDC) and “Cocaine and Chest Pain in the ED: Services and Outcomes” (funded by NIDA). Dr. Walton and colleagues recently completed a study “Tailored Alcohol Messages in the Emergency Department” (funded by NIAAA). Dr. Walton's publications focus on treatment outcome, particularly among traditionally understudied populations including women, African Americans, and older adults; substance use and service utilization among emergency department patients; the relationship between violence and substance use; and on tracking issues in longitudinal research. Dr. Walton received a Ph.D. degree in Ecological and Community Psychology from Michigan State University and an M.P.H. degree in Health Promotion from San Diego State University.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal-directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA,NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QOL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Treatment is implemented in a range of environments; ambulatory, within institutions that can include controlled environments. Editor's note