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）是一种主要的公共健康危害。2008年，美国有13846人死于酒后驾驶。（美国国家公路交通安全管理局，2009a）。新墨西哥州交通部（DoT）报告称，仅2007年，新墨西哥州的DWI总成本就超过了10亿美元（NM DoT, 2008）。在新墨西哥州，43%的酒后驾车罪犯是惯犯。这是不可接受的。具体来说，需要做更多的工作来防止初犯成为累犯。这个建议是开发一个新的网络应用程序，可以持续地提供有效的干预，有可能减少这些酗酒者的酗酒。然而，目前在向罪犯提供经验支持的干预措施方面存在重大挑战。首先，尽管有证据表明，短暂的动机干预可以减少酗酒者的酗酒行为，但只有一小部分酒后驾车者接受了治疗。第二，对于那些接受治疗的人来说，通过药物滥用顾问提供此类干预面临着重大挑战：1)许多药物滥用顾问没有接受过经验支持协议的培训；2)接受过经验支持干预措施培训的临床医生往往会随着时间的推移而“偏离”协议；3)药物滥用项目辅导员的平均年流失率为50% （McLellan et al., 2003）。这种人员流动意味着，为工作人员提供经验支持协议培训的项目往往需要培训新的咨询师，而这些项目很少得到成本补偿。训练就变成了一个偶然的事件。因此，咨询师可能没有机会接受培训，如果接受培训，随着时间的推移，他们往往会“偏离”经验支持的协议。这个建议提供了另一种选择。我们建议开发一个网络应用程序，可以持续提供干预措施，有可能减少这些违规者的酗酒。减少饮酒量将降低他们未来罹患DWIs、与酒精有关的车祸、受伤和死亡的风险。利用“教育时刻”的优势，该项目将把两种经验支持的简短动机干预（一种针对年轻人，一种针对老年人）和一种以禁欲为导向的认知行为干预纳入一个名为“右转”的新项目。这项提案有两个创新之处：1)一个基于网络的、与年龄相适应的BMI指数，它是为罪犯量身定制的，并在结束时考虑到他们是否愿意改变；2)一个以认知行为、禁欲为导向的网络应用程序，帮助他们实现并保持清醒。第二阶段建议的研发工作是完成项目的开发，向bmi添加后续组件，并为项目管理员添加“后台”模块，其中包括广泛的结果报告功能。该计划的有效性将在随机临床试验中进行评估，并进行3个月的随访。

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 (DoT) reported the total DWI cost to New Mexico in 2007 alone was over one billion dollars (NM DoT, 2008). In New Mexico, 43% of DWI offenders are repeat offenders. This is unacceptable. Specifically, more needs to be done to prevent first-time offenders from becoming recidivists. This proposal is to develop a new web application that could consistently deliver an effective intervention that has the potential to reduce heavy drinking in these offenders. Currently, however, there are significant challenges to delivering empirically supported interventions to offenders. First, only a small proportion of DWI offenders are referred for treatment, despite evidence that brief motivational interventions reduce heavy drinking in offenders. Second, for those referred to treatment, providing such interventions through substance abuse counselors faces significant challenges: 1) Many substance abuse counselors are not trained in empirically supported protocols; 2) clinicians who are trained in empirically supported interventions 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 turnover means that programs that provide training for staff in empirically supported protocols often need to train new counselors, and programs are rarely compensated for the cost. Training then becomes an occasional event. As a result, counselors may not have the opportunity to be trained, and if trained, tend to "drift" from empirically supported protocols ove time. This proposal provides an alternative. We propose to develop a web application that could consistently deliver an intervention that has the potential to reduce heavy drinking in these offenders. This reduction in drinking would reduce their risk for future DWIs, alcohol-related crashes, injuries, and death. Taking advantage of a "teachable moment," the program will incorporate two empirically supported brief motivational interventions (one for younger and one for older adults) and an abstinence-oriented, cognitive behavioral intervention into a single, new program called Right Turns. There are two innovations in this proposal: 1) A web-based and age-appropriate BMI that is tailored to offenders and that takes their readiness to change at the end of it into account when segueing to; 2) a cognitive behavioral, abstinence-oriented web application to help them achieve and maintain sobriety. The R&D proposed in Phase II is to complete the development of the program, adding a follow-up component to the BMIs and a "back office" module for program administrators that include extensive outcome report functions. The program's effectiveness will then be evaluated in a randomized clinical trial with a 3 month follow-up.