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Persistence of addictive disorders in a first-offender driving while impaired population.

ABSTRACT: We compared the prevalence of alcohol use and other psychiatric disorders in offenders 15 years after a first conviction for driving while impaired with a general population sample.To determine whether high rates of addictive and other psychiatric disorders previously demonstrated in this sample remain disproportionately higher compared with a matched general population sample.Point-in-time cohort study.Pacific Institute for Research and Evaluation, Albuquerque, New Mexico.We interviewed convicted first offenders using the Composite International Diagnostic Interview 15 years after referral to a screening program in Bernalillo County, New Mexico. We calculated rates of diagnoses for non-Hispanic white and Hispanic women (n = 362) and men (n = 220) adjusting for missing data using multiple imputation and compared psychiatric diagnoses with findings from the National Comorbidity Survey Replication by sex and Hispanic ethnicity.Eleven percent of non-Hispanic white women and 12.8% of Hispanic women in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with 1.0% and 1.8%, respectively, in the National Comorbidity Survey Replication (comparison) sample. Almost 12% of non-Hispanic white men and 17.5% of Hispanic men in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with to 2.0% and 1.8%, respectively, in the comparison sample. These differences were statistically significant. Rates of drug use disorders and nicotine dependence were also elevated compared with the general population sample, while rates of major depressive disorder and posttraumatic stress disorder were similar.In this sample, high rates of addictive disorders persisted over 10 years among first offenders and greatly exceeded those found in a general population sample.

SUBMITTER: Lapham SC

PROVIDER: S-EPMC3210885 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Persistence of addictive disorders in a first-offender driving while impaired population.

Lapham Sandra C SC Stout Robert R Laxton Georgia G Skipper Betty J BJ

Archives of general psychiatry 20110704 11

<h4>Context</h4>We compared the prevalence of alcohol use and other psychiatric disorders in offenders 15 years after a first conviction for driving while impaired with a general population sample.<h4>Objective</h4>To determine whether high rates of addictive and other psychiatric disorders previously demonstrated in this sample remain disproportionately higher compared with a matched general population sample.<h4>Design</h4>Point-in-time cohort study.<h4>Setting</h4>Pacific Institute for Resear ...[more]

PMID: 21727248

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Project description:Addictions are common, chronic, and relapsing diseases that develop through a multistep process. The impact of addictions on morbidity and mortality is high worldwide. Twin studies have shown that the heritability of addictions ranges from 0.39 (hallucinogens) to 0.72 (cocaine). Twin studies indicate that genes influence each stage from initiation to addiction, although the genetic determinants may differ. Addictions are by definition the result of gene × environment interaction. These disorders, which are in part volitional, in part inborn, and in part determined by environmental experience, pose the full range of medical, genetic, policy, and moral challenges. Gene discovery is being facilitated by a variety of powerful approaches, but is in its infancy. It is not surprising that the genes discovered so far act in a variety of ways: via altered metabolism of drug (the alcohol and nicotine metabolic gene variants), via altered function of a drug receptor (the nicotinic receptor, which may alter affinity for nicotine but as discussed may also alter circuitry of reward), and via general mechanisms of addiction (genes such as monoamine oxidase A and the serotonin transporter that modulate stress response, emotion, and behavioral control). Addiction medicine today benefits from genetic studies that buttress the case for a neurobiologic origin of addictive behavior, and some general information on familially transmitted propensity that can be used to guide prevention. A few well-validated, specific predictors such as OPRM1, ADH1B, ALDH2, CHRNA5, and CYP26 have been identified and can provide some specific guidance, for example, to understand alcohol-related flushing and upper GI cancer risk (ADH1B and AKLDH2), variation in nicotine metabolism (CYP26), and, potentially, naltrexone treatment response (OPRM1). However, the genetic predictors available are few in number and account for only a small portion of the genetic variance in liability, and have not been integrated into clinical nosology or care.

Project description:ObjectiveAlcohol-impaired driving is a significant public safety concern and is highly prevalent among young adults. Considerable research has examined between-person predictors of alcohol-impaired driving, but there has been little research on factors that predict alcohol-impaired driving at the event level. This pilot/feasibility study was designed to identify within-person, event-level predictors of alcohol-impaired driving intentions in the natural environment using an ecological momentary assessment (EMA) design.MethodThirty-six young adult, moderate drinkers (M age = 22.9 years; 72.2% female; M drinks per occasion = 3.2) were recruited from a university area to complete 2 weeks of EMA. They reported on their subjective levels of intoxication, perceived dangerousness of driving, and driving intentions during real-world drinking episodes. Breath alcohol concentrations were collected with a portable breath alcohol analyzer.ResultsEvent-level perceived danger and subjective intoxication most strongly predicted intentions to drive after drinking, such that higher perceived danger and intoxication predicted lower willingness to drive, after adjusting for baseline alcohol-impaired driving attitudes (ps < .001). When we accounted for perceived danger during drinking episodes at the event and person level, baseline attitudes were no longer predictive of willingness to drive. Higher event-level breath alcohol concentration also predicted lower willingness to drive (p = .003).ConclusionsThis study is the first to demonstrate that event-level risks of alcohol-impaired driving can be collected during drinking episodes in the natural environment. Findings indicate that subjective perceptions of intoxication and risk more strongly predict alcohol-impaired driving intentions than objective intoxication. Findings also suggest that event-level perceptions of intoxication and driving risk may be fruitful targets for interventions to reduce alcohol-impaired driving.

Project description:BACKGROUND:Psychopathy is a personality disorder characterised by two underlying factors. Factor 1 (affective and interpersonal deficits) captures affective deficits, whilst Factor 2 (antisocial and impulsive/disorganised behaviours) captures life course persistent antisocial behaviours. Impaired processing of threat has been proposed as an aetiologically salient factor in the development of psychopathy, but the relationship of this impairment to the factorial structure of the disorder in adult male offenders is unclear. OBJECTIVES:To investigate whether threat processing deficits are characteristic of psychopathy as a unitary construct or whether such deficits are specifically linked to higher scores on individual factors. DATA SOURCES:A systematic review of the literature was conducted by searching PubMed, Web of Science and PsycINFO. METHODS:Studies were included if they (1) reported physiological measures of threat response as the primary outcome measure (2) indexed psychopathy using a well-validated clinician rated instrument such as the PCL-R (3) investigated male offenders between 18 and 60 years of age (4) reported threat processing analyses using both Factor 1 and Factor 2 scores (5) provided sufficient data to calculate effect sizes and (6) were published in English-language peer-reviewed journals. We identified twelve studies with data on 1112 participants for the meta-analysis of the relationship with Factor 1 scores, and nine studies with data on 801 participants for the meta-analysis of the relationship with Factor 2 scores. We conducted the meta-analyses to calculate correlations using random-effects models. RESULTS:PCL-R/SV Factor 1 scores were significantly and negatively related to threat processing indices (r = -0.22, (95%CI [-0.28, -.017]). Neither PCL-R/SV Factor 2 scores (r = -0.005, 95%CI [-0.10, 0.09]), nor PCL-R total score (r = -0.05, (95%CI [-0.15, -0.04]) were related to threat processing indices. No significant heterogeneity was detected for the Factor score results. CONCLUSIONS:The meta-analyses of the distinct psychopathy factors suggest that the threat processing deficits observed in male offenders with psychopathy are significantly associated with higher scores on Factor 1. A similar relationship does not exist with Factor 2 scores. Our findings highlight the importance of investigating the potentially discrete relationships between aetiological variables and the two factor constructs in the disorder.

Dataset Information

Persistence of addictive disorders in a first-offender driving while impaired population.

Publications

Persistence of addictive disorders in a first-offender driving while impaired population.

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