Thomas G. Brown

Aims: Male driving while impaired (DWI) offenders are at heightened risk for engaging in risky driving. Males in a depressed mood are also more prone to alcohol misuse, which may further contribute to risky driving. This manuscript investigates the predictive potential of combined depressed mood and alcohol misuse on risky driving outcomes 3 and 9 years after baseline in male DWI offenders. Methods: At baseline, participants completed questionnaires assessing depressed mood (Major Depression scale of the Millon Clinical Multiaxial Inventory-III), alcohol misuse (Alcohol Use Disorders Identification Test), and sensation-seeking (Sensation Seeking Scale-V). Risky driving data (Analyse des comportements routiers; ACR3) were collected at follow-up 3 years after baseline. Driving offence data were obtained for 9 years after baseline. Results: There were 129 participants. As 50.4% of the sample were missing ACR3 scores, multiple imputation was conducted. In the final regression model, R² = 0.34, F(7,121) = 8.76, P < 0.001, alcohol misuse significantly predicted ACR3, B = 0.56, t = 1.96, P = 0.05. Depressed mood, however, did not significantly predict ACR3 and sensation-seeking was not a significant moderator. Although the regression model predicting risky driving offences at Year 9 was significant R² = 0.37, F(10,108) = 6.41, P < 0.001, neither depressed mood nor alcohol misuse was a significant predictor. Conclusions: These findings identify alcohol misuse as a predictor of risky driving 3 years after baseline among male DWI offenders. This enhances our prediction of risky driving, extending beyond the widely researched acute impacts of alcohol by exploring chronic patterns.

Background: Alcohol control has emerged as an important global health challenge due to the expanding influence of alcohol companies and limited control measures imposed by governments. In the Peruvian Andean highland, the ritual function of collective drinking is reported to have been weakened in response to the increased availability of alcohol and the experience of political violence. This study seeks to merge the broader political economy with local experience and culture to provide a deeper understanding of the dynamic between global processes and local realities. Methods: We used purposive sampling to recruit participants. We conducted in-depth interviews (n = 28) and focus group discussions (n = 19) with community participants, teachers, health workers, alcohol vendors and police officers. Thematic analysis identified patterns of individual and collective meaning situated in relation to social, political and economic factors. Results: Local perspectives and behaviour regarding loss of control over alcohol are shaped through the complex patterns of power and meaning exerted and experienced by different actors. Participants’ emphasis on parents’ lack of control over alcohol use by “abandoned” children reflects the structural vulnerability of some Andean families struggling with economic hardships. Participants also emphasized how alcohol consumption was tied to forms of control exerted by men in households. Participants expressed that some men demonstrated their masculine identity and symbolic power as the breadwinner through spending on alcohol. The third emphasis was tied to the market economy. Participants expressed that the expansion of the alcohol market and perceived absence of government control coupled with macroeconomic conditions, like poverty, shaped patterns of alcohol consumption. Conclusion: Our findings illustrate how problem drinking is shaped not simply by an individual drinker’s lack of self-control but also by a regulatory environment that enables the unrestrained marketing of alcohol products and the creation of a culture of consumption. Harmful consumption is mediated by the reshaping of the Andean cultural practice of collective drinking. Attending to local perspectives is essential for policies and interventions that connect structural dynamics with the cultural and experiential aspects of alcohol consumption.

Aim: We investigated whether individuals varied in their satisfaction with being randomized to an extension of early intervention (EI) for psychosis or regular care after 2 years of EI, and whether satisfaction was associated with service engagement 3 years later.Methods: Following randomization, patients (N = 220) indicated if they were happy with, unhappy or indifferent to their group assignment. Follow‐up with service providers was recorded monthly.Results: Patients randomized to extended EI were more likely to express satisfaction with their group assignment than those in the regular care group (88.2% vs 31.5%, χ² = 49.96, P < .001). In the extended EI group, those happy with their assigned group were likelier to continue seeing their case manager for the entire five‐year period than those who were unhappy/indifferent (χ² = 5.61, P = .030).Conclusions: Perceptions about EI, indicated by satisfaction with being assigned to extended EI, may have lasting effects on service engagement.

With driving while impaired by alcohol (DWI) representing a persistent burden on global health, better understanding and prevention of recidivism following a first-time DWI conviction are needed. Progress towards these goals is challenged by the marked heterogeneity in offender characteristics and a traffic safety literature that relies on subjective self-report measures and cross-sectional study designs. The present study tested the hypothesis that an objective neurobiological marker of behavioural maladjustment, the cortisol stress response (CSR), predicts future DWI and other traffic convictions over a 9-year follow-up period.

Aims Heterogeneity in the driving while impaired (DWI) offender population and modest outcomes from remedial programs are fueling interest in clarifying clinically significant DWI subtypes to better assess recidivism risk and target interventions. Previously, Brown et al. (2016) identified two putative behavioral phenotypes of DWI offenders with distinct behavioural, personality, cognitive and neurobiological profiles: 1) offenders primarily engaging in DWI (pDWI); and 2) offenders engaging in DWI and other traffic violations (MIXED). Here we evaluate these phenotypes’ clinical significance for prediction of recidivism and intervention targeting. Method DWI recidivists participating in a previous randomized controlled trial (N = 184; Brown et al., 2010; Ouimet et al., 2013) comparing brief Motivational Interviewing (BMI) and an information and advice control condition (IA) were retrospectively classified as either pDWI (n = 97) or MIXED (n = 87). Secondary analyses then evaluated the effect of this phenotypic classification on self‐reported 6‐ and 12‐month alcohol misuse outcomes and documented 5‐year DWI recidivism violations, and in response to either BMI or IA (i.e., pDWI‐BMI, n = 46; MIXED‐BMI, n = 45; pDWI‐IA, n = 51; MIXED‐IA, n = 42). Two hypotheses were tested: 1) MIXED classification was associated with poorer alcohol misuse outcomes and recidivism outcomes than pDWI classification; and 2) pDWI paired with BMI was associated with better outcomes compared to MIXED paired with BMI. Results MIXED classification was associated with significantly greater risk of recidivism over the 5‐year follow‐up compared to pDWI classification. Moreover, the pDWI‐BMI pairing was associated with significantly decreased recidivism risk compared to the MIXED‐BMI pairing. Analyses of 6‐ and 12‐month alcohol use outcomes produced null findings. Conclusions The clinical significance of phenotypic classification for risk assessment and targeting intervention was partially supported with respect to recidivism risk. Prospective investigation of this and other behavioural phenotypes is indicated.