SUBTYPES AMONG RISKY AND DRUNK DRIVERS: IMPLICATIONS FOR ASSESSMENT, AND REHABILITATION

Dennis M. Donovan, Ph.D.Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Addictions Treatment Center,VA Medical Center, Seattle, Washington, U.S.A.

SUMMARY. The present paper has four primary goals: (1) to review those personality and attitudinal characteristics associated with increased driving risk with or without the influence of alcohol; (2) to present data concerning the empirical derivation of subtypes based upon such measures among samples of risky and drunk drivers and their relationship to subsequent driving records; (3) to present findings concerning the increased likelihood of an initial DWI arrest among risky drivers; and (4) to discuss the implications of these findings for assessment, prevention, and treatment of drinking driving.

Considerable emphasis has been placed on the role of alcohol in increasing the risk of traffic violations, accidents, and fatalities. While alcohol does play an important role in the risk-enhancement process, continued emphasis on its effects as the primary contributing factor shifts attention away from the role of other important human factors that also contribute to driving risk (Donovan, 1989) .

RISK ENHANCING INDIVIDUAL DIFFERENCE VARIABLES

Our previous review of the literature (Donovan, Marlatt, & Salzberg,1983) revealed several constellations of such personality characteristics and driving-related attitudes that appear to covary with driving risk. These can be condensed into four rationally derived categories: (1) emotional lability, (2) impulsiveness and thrill seeking, (3) overt and covert expressions of anger and hostility, and (4) feelings of dysphoria, depression, and low levels of perceived personal control. These traits are often manifested in driving-related attitudes and behaviors. In particular, driving as a means of reducing emotional distress, increasing the perception of personal control, expressing acute anger and long-standing resentment, and seeking thrills and excitement also appeared to be related to increased driving risk. While these personality and attitudinal factors appear to contribute independently to the risk process, the greatest driving risk appears to be associated with drinking followed by driving by individuals having high levels of such personal characteristics.

My colleagues and I (Donovan, et al., 1985) have found that men who had been arrested for driving while intoxicated (DWI) and drivers (HRD) who have had multiple nonalcohol-related moving violations and/or accidents in a one year period share many of these risk-enhancing characteristics. They were found not to differ from one another on a number of personality measures. In comparison to a group of males from the general driving population, these two bad driver groups were significantly more depressed, less emotionally adjusted and more external in their perception of control, had a higher level of sensation seeking, and had higher levels of physical assaultiveness, verbal hostility, and resentment. They were also less likely to be married, were significantly younger and less well educated, and had lower status jobs and social positions. While the DWI subjects had the highest levels on all of the

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drinking-related measures, the HRD subjects, although selected for the absence of alcohol-related offenses on their previous driving records, had intermediate levels on the drinking measures. In comparison to the general driving population subjects, they consumed more alcohol per drinking occasion, were more likely to be classified as medium- or high-volume drinkers (e.g., over 17.5 drinks per month) and as high-maximum drinkers (e.g., over 5-6 drinks per occasion at least once in a while), and were more likely to drive after drinking. In addition, the HRD subjects had significantly higher levels of driving aggression and competitive speeding, a lower level of assuming personal responsibility for accident causation, and were more likely to drive for tension reduction than either the DWI arrestees or general driving group.

The results of this study are consistent with the assumption that it may be necessary to identify a group of high-risk drivers whose deviant behavior leads to crash involvement with or without alcohol use (Donovan, et al., 1983). As such, the DWI offenders and the bad driving group (HRD) could be conceptualized as subgroups within this larger high-risk population.

INDIVIDUAL DIFFERENCES WITHIN THE DWI AND BAD DRIVER POPULATIONS

While it appears that DWI offenders and bad drivers share many commonalities and may represent subgroups within the same population of high-risk drivers, it is important to take a more differentiated look at each of these groups. In an attempt to do so, my colleagues and I (Donovan &Marlatt, 1982; Donovan, Umlauf, & Salzberg, 1988) conducted cluster analyses of the driving-attitudinal, personality, and hostility measures of the previously described DWI offenders and bad drivers. The procedure resulted in five subgroups in the DWI sample and three subgroups in the bad driving sample which are listed in Table 1.

Based upon the pattern of their scores on the variables entered into the analysis, the following descriptions characterize the five DWI subgroups groups. Two of the clusters would be described as Well Adjusted and Moderately Adjusted respectively. The former group evidenced the greatest overall degree of affective and behavioral adjustment. These individuals were the least depressed and had the highest level of emotional adjustment, relatively low levels of risk-enhancing driving aggression, and the lowest levels on sensation seeking and on each of the five measures of hostility. The Moderately Adjusted subjects were noteworthy for the highest overall level of assertiveness and the lowest levels of competitive speed and driving for tension reduction. These groups drank the least and had the safest driving records overall.

Individuals in the Depressed group were characterized by the highest levels of depression and resentment as well as the lowest levels of assertiveness and emotional adjustment. They also perceived themselves as having the least personal control over the outcome of significant events in their lives and assumed the least personal responsibility for accident involvement. However, they had only mild to moderate elevations on most of the remaining driving-attitudinal and hostility measures.

Members of the fourth subtype, labeled Hostile, had the highest levels on sensation seeking, assaultiveness, indirect and verbal hostility, and irritability. In addition, these individuals had moderate levels of depression, emotional instability, and external perception of control. The final subtype,

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labeled Tension Reduction, was similar to but less marked than the Hostile group. Members of the Tension Reduction subtype were particularly noteworthy for their high levels of driving for tension reduction, low levels of general and driving-related externality, and relatively low levels of depression and resentment. These two groups were composed of individuals who were younger, had heavier drinking patterns, and had the poorest driving records. They were also found to have the poorest driving records during a subsequent 3-year follow-up period (Donovan, Queisser, Umlauf, & Salzberg, 1986). No differences were found across the five subgroups with respect to the incidence of accidents or alcohol-related violations. The DWI recidivism rate for the entire sample was 30.5%.

The results of these studies (Donovan & Marlatt, 1982; Donovan, et al., 1986) suggest that individual differences in driving-related attitudes, personality function, and hostility are related to pre-arrest drinking and driving behavior. Similarly, they also appear to have prognostic value with respect to subsequent driving risk. Of particular note is the continued risk of the Hostile and Tension Reduction groups. At the time of initial assessment, subjects in these two groups were the youngest, drank more heavily per drinking occasion, and manifested relatively high levels of driving-related and general impulsiveness and aggressive behavior. The covariation of driving risk with these behavioral characteristics suggests that such factors in addition to alcohol may contribute to an increased driving risk.

A parallel series of cluster analytic procedures was conducted among the high-risk, bad drivers described above (Donovan, Umlauf, & Salzberg, 1988). Three subtypes were derived and were found to differ on a number of demographic and drinking measures. One of the groups was well adjusted on the measures used; the remaining two groups evidenced high levels of risk-enhancing characteristics. Both of these latter groups were composed of younger subjects of lower social position who drank relatively heavily. One subgroup was characterized by sensation seeking, impulsivity, and aggressive acting-out behavior. Bad driving among members of this group appeared to be just one facet of a more general pattern of antisocial or irresponsible behavior and attitudes as well as an inability to exert control over impulses to take risks while driving. The other subgroup was characterized by high levels of dysphoria, emotional distress, resentment, and a sense of minimal personal control over the outcome of significant life events. The pattern of findings suggests a group of bad drivers who are under personal stress going through difficult periods in their lives with insufficient alternative coping skills.

Although no differences were found across these three HRD subtypes with respect to the average number of DWI arrests across the 3-year follow-up period, it was found that 11.4% of the overall HRD sample received their first alcohol-related arrest during follow-up period (Donovan, Umlauf, & Salzberg, in press). This rate is approximately five to six times greater than the 2.0% initial DWI arrest rate over the same time frame for the sample of the general male driving population. At the initial assessment those HRD subjects who subsequently received their first DWI reported significantly more drinking occasions per month, more occasions per month in which they consumed five or more drinks, more total drinks consumed in a month and also rated their drinking as heavier than did those who did not receive a DWI.

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IMPLICATIONS FOR PREVENTION, ASSESSMENT, AND TREATMENT

The results of this series of studies have a number of potential practical implications. First, bad drivers, particularly those with heavier alcohol use patterns, appear to have an increased likelihood of getting subsequent arrests for DWI. As such, the population of bad drivers represents an appropriate target for secondary intervention strategies, one that may be identified at an earlier and potentially more amenable point along the road to alcohol abuse or dependence than those already having received a DWI arrest (Donovan, et al., in press). Second, it is necessary to move beyond the "uniformity myth" concerning both bad drivers and DWI arrestees. Neither of these two populations represents homogeneous groups of individuals (Donovan & Marlatt, 1982; Donovan, et al., 1988) . It is important to begin looking in a more refined and differentiated way at these groups in order to determine clinically meaningful subtypes.

A third, and resultant, implication is to underscore the importance of broadening the base of assessment of both bad drivers and DWI arrestees. The DWI offenders come to the attention of authorities and assessment agencies because of their combined drinking and driving behaviors. As such, the focus of assessment is often placed on evaluating one's drinking pattern, attempting to determine the presence and severity of an alcohol problem. Such diagnostic decisions guide placements of DWI arrestees into the appropriate level of alcohol-related treatment, ranging from alcohol information schools to intensive inpatient treatment. However, the present results suggest that an exclusive focus on drinking behavior will exclude from consideration a number of individual difference variables that appear to have a bearing on both reasons for drinking and subsequent driving risk. Thus, in addition to a thorough delineation of drinking styles, benefits, and consequences within the population of DWI offenders, it would be important to include an assessment of potentially risk-enhancing driving attitudinal and personality characteristics. An analogous shift is needed in the evaluation of bad drivers, moving away from an exclusive focus on specific driving behaviors to include an assessment of both drinking and other relevant individual difference variables.

A final implication bears on therapeutic interventions with both bad drivers and DWI offenders. Again, given the target behaviors involved, most treatment approaches deal with traffic safety and/or drinking behavior. While these remain necessary and important foci for such interventions, they may be insufficient strategies in and of themselves to be maximally effective in preventing subsequent drinking-driving and alcohol problems among these groups. The pattern of results suggests that therapeutic interventions must also attend to the potentially problematic aspects of personality function and behavior among such individuals.

It has been suggested that much of the mixed success involved in intervention programs for DWI offenders is attributable, in part, to such programs treating such individuals as a homogeneous group (Donovan & Marlatt, 1982; Selzer, Vinokur, & Wilson, 1977; Steer, Fine, & Scoles, 1979; Wells- Parker, Cosby, & Landrum, 1986). The model of differential assessment suggested by the present results potentially would lead to a closer match between DWI arrestees and those interventions most appropriate to their needs.

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REFERENCESDonovan, D.M. (1989). Driving while intoxicated: Different roads to and from the problem. Criminal Justice and Behavior. 16, 270-298.

Donovan, D.M., Marlatt, G.A. (1982). Personality subtypes among driving-while-intoxicated offenders: Relationship to drinking behavior and driving risk. Journal of Consulting and Clinical Psychology. 50, 241-249.

Donovan, D.M., Marlatt, G.A., Salzberg, P.M. (1983). Drinking behavior, personality factors and high-risk driving: A review and theoretical formulation. Journal of Studies on Alcohol. 44, 395-428.

Donovan, D.M., Queisser, H.R., Salzberg, P.M., Umlauf, R.L. (1985). Intoxicated and bad drivers: Subgroups within the same population of high-risk men drivers. Journal of Studies on Alcohol. 46, 375-382.

Donovan, D.M., Queisser, H.R., Umlauf, R.L., Salzberg, P.M. (1986). Personality subtypes among driving-while-intoxicated offenders: Follow-up of subsequent driving records. Journal of Consulting and Clinical Psychology. 54, 563-565.

Donovan, D.M., Umlauf, R.L., Salzberg, P.M. (1988). Derivation of personality subtypes among high-risk drivers. Alcohol. Drugs and Driving. 4 (3-4), 1-12.

Donovan, D.M., Umlauf, R.L., Salzberg, P.M. (in press) Bad drivers: Identification of a target group for alcohol-related prevention and early intervention. Journal of Studies on Alcohol.

Selzer, M.L., Vinokur, A., Wilson, T.D. (1977). A psychosocial comparison of drunken drivers and alcoholics. Journal of Studies on Alcohol. 38. 1294-1312. Steer, R.S., Fine, E.W., Scoles, P.E. (1979). Classification of men arrested for driving while intoxicated, and treatment implications: A cluster analytic study. Journal of Studies on Alcohol. 40. 222-229.

Wells-Parker, E., Cosby, P.J., Landrum, J.W. (1986). A typology for drinking driving offenders: Methods for classification and policy implications. Accident Analysis and Prevention. 18, 443-453.

Table 1. Relationship of DWI and Bad Driving Subtypes to the Larger Population of High Risk Drivers

HIGH RISK DRIVER SUBTYPESDWI ARRESTEE SUBTYPES "BAD DRIVER" SUBTYPESWELL ADJUSTED WELL ADJUSTED

MODERATELY ADJUSTED IMPULSIVE/SENSATION SEEKINGTENSION REDUCTION DYSPHORIC/COPING ATTEMPT

HOSTILEDEPRESSED

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