A web application to reduce heavy drinking in first-time DWI offenders

描述（由申请人提供）：醉酒驾驶（DWI）是一个重大的公共健康危害。在美国，2008年有13，846人死于酒精受损的司机（国家公路交通安全管理局（NHTSA），2009年a）。新墨西哥州警局交通部报告称，2007年新墨西哥州的DWI总成本超过10亿美元（NM DoT，2008）。在新墨西哥州，43%的DWI罪犯是惯犯。这是不可接受的。需要做更多的工作来防止初犯者成为累犯。我们建议开发一个新的网络应用程序，可以持续和具有成本效益地提供干预，有可能减少大量饮酒的初犯者45 - 55%。这种饮酒的减少，以及一些人的戒酒，将降低他们未来发生DWI、与酒精相关的撞车、受伤和死亡的风险。利用"可教的时刻"，该计划将把两个基于证据的简短动机干预（BMI）和一个原型认知行为干预（CBI）纳入一个单一的新计划。该提案有四项创新：1）基于网络的、与年龄相适应的BMI; 2）针对有严重酒精相关问题历史的罪犯的、以禁欲为导向的CBI; 3）将用户从该计划中获得的内容合并在一起的短信功能，这些短信在用户指定的酗酒高风险时间发送;以及4）CBI计划中的电子邮件功能，其鼓励用户返回到该计划并坚持他们的努力来戒除。这里提出的R & D是为了测试以下可行性：1）将三个独立的Web应用程序组合在一起，这样集成的程序就可以在不冻结或崩溃的情况下运行; 2）将三个独立的数据库（2个MS SQL Server和1个MySQL）组合成一个数据库，可以为新程序的所有数据调用提供服务; 3）将定制和个性化的手机短信功能纳入程序。研发还将测试其使用的DWI罪犯样本的可行性。通过药物滥用咨询师向DWI罪犯提供基于证据的干预措施有可能减少DWI罪犯的大量饮酒。然而，存在重大挑战：1）许多物质滥用咨询师没有接受过循证方案的培训; 2）即使是接受过培训的临床医生也倾向于随着时间的推移而"偏离"方案;以及3）物质滥用项目中的咨询师的平均年周转率为50%（McLellan等人，2003年）。这意味着为工作人员提供循证方案培训的方案往往必须持续进行，而且很少得到这方面的补偿。我们建议通过此Web应用程序来解决实施循证干预的挑战。我们已经成功地开发和传播了基于证据的软件程序，从我们已经完成的每一个第二阶段的酗酒者。 公共卫生相关性：酒后驾车是一个主要的公共卫生危害，2008年在美国造成13,846人死亡。如果该计划被证明是有效的，它可能成为一个可靠的，具有成本效益的，并以证据为基础的干预首次DWI罪犯。减少这一人群中的饮酒、酒精相关问题和酒后驾车将使个人、他们的家庭和他们的社区受益。

DESCRIPTION (provided by applicant): Driving while intoxicated (DWI) is a major public health hazard. In the U.S. there were 13,846 deaths in 2008 caused by alcohol-impaired drivers (National Highway Traffic Safety Administration (NHTSA), 2009a). The New Mexico Dept. of Transportation reported the total DWI cost to New Mexico in 2007 was over one billion dollars (NM DoT, 2008). In New Mexico, 43% of DWI offenders are repeat offenders. This is unacceptable. More needs to be done to prevent first-time offenders from becoming recidivists. We propose to develop a new web application that could consistently and cost-effectively deliver an intervention that has the potential to reduce heavy drinking in first offenders by 45-55%. This reduction in drinking, and abstinence in some, would reduce their risk for future DWIs, alcohol-related crashes, injuries, and death. Taking advantage of a "teachable moment," the program will incorporate two evidence-based brief motivational interventions (BMIs) and a prototype cognitive behavioral intervention (CBI) into a single, new program. There are four innovations in this proposal: 1) a web-based and age-appropriate BMI; 2) an abstinence-oriented CBI for offenders with a history of significant alcohol-related problems; 3) a text messaging feature that incorporates users' content from the program, with the texts being sent at the users' designated high risk times for heavy drinking; and 4) an email feature in the CBI program that encourages users to return to the program and persist in their efforts to abstain. The R&D proposed here is to test the feasibility of: 1) combining three separate web applications so that the integrated program can run without freezing or crashing; 2) combining three separate databases (2 MS SQL Server and 1 MySQL) into a single database that can serve all of the data calls from the new program; and 3) incorporating a customized and personalized cell phone text messaging feature into the program. The R&D will also test the feasibility of its use by a sample of DWI offenders. Providing evidence-based interventions to DWI offenders through substance abuse counselors has the potential to reduce heavy drinking in DWI offenders. There are, however, significant challenges: 1) many substance abuse counselors are not trained in evidence-based protocols; 2) even clinicians who are trained tend to "drift" from protocols over time; and 3) there is an average annual turn-over rate of 50% in counselors in substance abuse programs (McLellan et al., 2003). This means that programs providing training for staff in evidence-based protocols often have to do so on an on-going basis and are rarely compensated for this cost. We propose to address this challenge of implementing evidence-based interventions with this web application. We have successfully developed and disseminated evidence-based software programs for heavy drinkers from every Phase II we have completed. PUBLIC HEALTH RELEVANCE: Drunk driving is a major public health hazard that caused 13,846 deaths in the U.S. in 2008. If this program proves to be effective, it could become a reliable, cost-effective, and evidence- based intervention for first-time DWI offenders. Reducing the drinking, alcohol-related problems and drunk driving in this population would benefit the individuals, their families, and their communities.