Evaluating the Computerized Assessment and Referral System (CARS) Screener: Sensitivity and Specificity as a Screening Tool for Mental Health Disorders among DUI Offenders

Abstract

Background/Purpose: A growing body of evidence suggests that people who are arrested for driving under the influence (DUI) of alcohol are more likely to screen positive for psychiatric disorders than the general population. Additionally, psychiatric comorbidity has been shown to increase vulnerability to criminal re-offense. However, DUI programs face many barriers to screening for psychiatric disorders. This paper evaluates the sensitivity and specificity of a screening tool developed for these programs, the Computerized Assessment and Referral System (CARS) Screener. Methods: We used data from 381 DUI offenders in Massachusetts, as well as a secondary data source, the National Comorbidity Survey-Replication (NCS-R: N = 9,282) to examine the accuracy of the CARS Screener when compared to full assessment. Results: Based on both sets of analyses, we found that the CARS Screener offers a sensitive and specific method to screen for many psychiatric disorders. Specifically, the CARS Screener has a high sensitivity and specificity for bipolar disorder, intermittent explosive disorder, depressive disorders, generalized anxiety disorder, alcohol and drug use disorders, gambling disorder, post-traumatic stress disorder, panic attacks, and social phobia. Conclusion: The CARS Screener appears to be an effective tool that will help DUI programs better understand and address the mental health issues facing their clients.

Keywords:

• Impaired driving
• alcohol
• DUI
• comorbidity
• screening

Acknowledgments

We would like to recognize the staff and clients at the Middlesex DUIL Program and the Behavioral Health Network DAE Program for their participation in and contribution to this research. We would also like to thank Dr. Debi LaPlante for her review of this manuscript, Dr. Howard Shaffer for his contribution to the project and review of this manuscript, and Layne Keating, Kat Belkin, and John Kleschinsky for their contributions to this project.

Declaration of interest

This manuscript was supported by a research contract between the Division on Addiction and the Foundation for Advancing Alcohol Responsibility (FAAR). FAAR is a national nonprofit 501c4 organization funded by the distilled spirits industry. FAAR had no involvement with the development of the content of the Computerized Assessment and Referral System, the data collection/analysis, or development of this manuscript.

Additional information

Funding

The Division on Addiction currently also receives funding from the Addiction Treatment Center of New England via SAMHSA; EPIC Risk Management; DraftKings; the Gavin Foundation via the Substance Abuse and Mental Health Services Administration (SAMHSA); GVC Holdings, PLC; The Healing Lodge of the Seven Nations via the National Institutes of Health (National Institute of General Medical Sciences and National Institute on Drug Abuse); Health Resources in Action via the Massachusetts Department of Public Health Office of Problem Gambling Services; The Integrated Center on Addiction Prevention and Treatment of the Tung Wah Group of Hospitals, Hong Kong; St. Francis House via the Massachusetts Department of Public Health Bureau of Substance Addiction Services; and the University of Nevada, Las Vegas via MGM Resorts International. During the past 5 years, the Division on Addiction has also received funding from Aarhus University Hospital with funds approved by The Danish Council for Independent Research; ABMRF – The Foundation for Alcohol Research; Caesars Enterprise Services, LLC; the David H. Bor Library Fund, Cambridge Health Alliance; DraftKings; Fenway Community Health Center, Inc.; Massachusetts Department of Public Health, Bureau of Substance Addiction Services; and the Massachusetts Gaming Commission, Commonwealth of Massachusetts.