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

描述(申请人提供)：酒后驾车(酒后驾车)是一种重大的公共健康危害。在美国，2008年有13,846人死于酒后驾车(美国国家公路交通安全管理局(NHTSA)，2009年a)。新墨西哥州部门。交通部(DOT)报告称，仅在2007年，新墨西哥州的DWI总成本就超过10亿美元(NM DOT，2008)。在新墨西哥州，43%的酒后驾车违法者是惯犯。这是不可接受的。具体地说，需要做更多的工作来防止初犯者成为累犯。这项提议是开发一种新的网络应用程序，可以持续地提供有效的干预，有可能减少这些罪犯的大量饮酒。然而，目前在向罪犯提供经验性干预方面存在重大挑战。首先，只有一小部分酒后驾车罪犯被转介接受治疗，尽管有证据表明，短暂的激励性干预可以减少罪犯的大量饮酒。其次，对于那些被转介治疗的人来说，通过药物滥用辅导员提供这种干预面临着重大挑战：1)许多药物滥用辅导员没有经过经验支持的方案培训；2)经过经验支持的干预方案培训的临床医生往往随着时间的推移而“偏离”方案；以及3)物质滥用方案咨询人员的年平均周转率为50%(McLellan等人，2003年)。这种更替意味着，为工作人员提供经验支持方案培训的项目往往需要培训新的顾问，而项目很少得到成本补偿。然后，培训就变成了一项偶然的活动。因此，辅导员可能没有机会接受培训，如果接受培训，往往会随着时间的推移而偏离经验支持的方案。这项提议提供了另一种选择。我们建议开发一种网络应用程序，它可以持续提供干预，有可能减少这些违规者的大量饮酒。饮酒的减少将降低他们未来酒后驾车、与酒精相关的撞车、受伤和死亡的风险。利用这一“可教的时刻”，该项目将把两项有经验支持的简短动机干预(一项针对年轻人，一项针对老年人)和一项以禁欲为导向的认知行为干预纳入一个名为Right Turns的新项目。这项建议有两个创新：1)基于网络的、适合年龄的BMI，它是为罪犯量身定做的，并在接下来的时候考虑他们是否愿意改变；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。第二阶段提出的研发计划是为了完成该计划的开发，在BMI系统中增加一个后续组件，并为计划管理员增加一个包括广泛结果报告功能的“后台”模块。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.