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Institute For Driver Research and Substance Abuse Inc., Post Office Box 10345, Pittsburgh, Pennsylvania 15234, USA
An analysis was conducted of the psychological profiles of women who either sought treatment for an addiction to alcohol (and had not been previously arrested for alcohol impaired driving) and of women stopped for alcohol impaired driving. One hundred and thirteen women participated in the assessment. The assessment included inquiry into states of alcoholism, depression and acute psychopathology.
Results suggest those women who present to treatment following an arrest for alcohol impaired driving have more acute psychiatric symptoms as a whole than those who present to treatment without an arrest. However, those women who presented without an arrest as a whole demonstrated more symptoms of depression. Comparison between groups will be presented along with treatment implications.
Women presenting for treatment of an addiction either voluntarily or by a court mandate in the case of arrest for driving under the influence (DUI), may have a variety of problems including an addiction to alcohol or drugs (Sutton, 1994, Fortini and Perine, 1992, Wieczorek, Miller and Nochajski, 1992). "Treatment" often includes treatment for the addiction and treatment of issues including another co-existing disorder, such as depression or a personality disorder. In a recent presentation to the Council on Alcohol, Drugs and Traffic Safety (October, 1992), I reported on a study of 61 female DUI offenders who were given a brief mental status examination which included several psychological instruments. In addition to appearing to be alcohol dependent, 37 percent of the sample had notable symptoms of either depression and/or psychotic processes with 87 percent of the sample achieving an M.M.P.I. t-score elevated sufficiently high enough to warrant a full mental status examination.
These result present quite a problem to the system attempting to "rehabilitate" or deter the alcohol impaired offender from repeating their offense, for in Pennsylvania traditionally those individuals who present for treatment of addictions are offered an assessment of their current or presenting condition. If however, "problems" other than an addiction are identified, particularly those of an emotional disorder, the individual is either referred "out" for treatment of that "other" problem or the "other" problem is not addressed.
It was speculated then that problems other than an addiction may co-exist for those female offenders who were seeking treatment. That is to say, there appeared to be issues or symptoms of an emotional disorder or of trauma in women who voluntarily sought treatment for an addiction. The Women's Center of the Ielase Institute (one of the two Centers where subjects were selected in this paper) is a treatment center for women who are addicted to alcohol and/or drugs or for women who are effected by someone who is addicted to alcohol and/or drugs (a spouse, child or parent). The Ielase Institute is a component of a larger organization, The Mon Yough Community MH/MR/D&A Program, which serves people in the general geographic area in and around McKeesport Pennsylvania. Within this system are Women who sought treatment for an "addiction" voluntarily or as a result of a legal charge of Driving Under the Influence of Alcohol. The purpose of this paper is to study those women who "voluntarily" sought help for addictions, to determine what if any "other" problem(s) co-exist which on their own require treatment.
All registered "clients" of the Women's Center of the Ielase Institute were asked to complete the following series of psychological tests: The Trail Making Test Parts A and B; The Becks Depression Inventory; The Becks Hopelessness Inventory; The Symptom Checklist 90 - Revised; The MacAndrews Alcoholism Scale; The Michigan Alcoholism Scale; Drug Use Screening Inventory - Revised; The Zuckermank-Kuhlman Personality Questionnaire, version 3 (neither of the later mentioned instruments are reported in this paper). A similar sample of female clients in recovery were included from the "Alternatives Center", located within the City of Pittsburgh. These instruments were administered by their primary therapist during individual sessions. At the completion of these instruments, a full mental status evaluation was provided on each client at the Ielase Institute, by a licensed psychologist using a standardized mental status format. The results of the psychological tests will be presented during this review.
84% of the sample was white, 16% black. The average age was 31 years. Most of the clientele had at least a high school education (12 years). 32% had received prior treatment for an emotional problem in the past. When compared to a matched sample of female DUI offenders, the offenders average age was 33.5 years, with an average educational level of 12.4 years. 15% of offenders had received prior treatment for emotional problems.
Emotional disorders as measured on the various instruments are reflected in Table 1, note the sample is compared to a matched female first offender DUI group.
Each of the women from the Ielase Institute Women's Center were offered a standard Mental Status examination which examined areas of memory function including current events, acute symptoms of depression, psychopathology (presence or absence of hallucinatory activity, or delusional thought processes), issues of anger management, social judgement, concentration and task persistence. One of those examined appeared to be acutely psychotic with no evidence of a current or active addiction, two women appeared acutely suicidal (both on the results of the tests and in the mental status examination) which required immediate hospitalization. All of the remaining clients met the criterion (DSM III-R) for both an addiction (all in some form of recovery) and for a major depression.
Emotional Disorder Measures
|BDI||22.45||moderate to severe depression|
|BDI - dui||7.44||some - mild symptoms|
|BHI - dui||2.96||not significant|
|MAC - dui||22.85||significant|
|MAST - dui||9.49||significant**|
|SCL-ANX - dui||.28||t-score 53|
|SCL-DEP - dui||.52||t-score 56|
|SCL-PAR - dui||.44||t-score 56|
|SCL-PSY - dui||.20||t-score 57|
|Trail Making Tests|
|Part A||31.87||seconds Low average|
|Part A dui||32.33||seconds Low average|
|Part B||67.64||seconds Low average|
|Part B dui||64.88||seconds Low average|
One of the purposes of this paper was to determine if significant emotional problems co-existed with an addiction in two samples of clients from female addiction treatment centers. Each of the clients agreed to complete a 20 minute battery of psychological testing instruments which were designed to identify symptoms of depression, hopelessness, psychopathology, addictions and problems with information processing. Additionally, one of the treatment centers protocols required a full mental status examination be administered to each client.
With a few noted individual exceptions, most clients presented with an addiction. As a whole, the sample had significantly positive results on both the MacAndrews alcoholism scales as well as the Michigan Alcoholism Screening Test (MAST). This was to be expected, particularly with the MAST as most of those interviewed in the mental status examination were working a recovery program which included multiple weekly attendance at some form of a self-help group, either Alcoholics Anonymous or Narcotics Anonymous and were attending weekly counseling sessions.
Major Depression was clearly diagnosable through both the testing results and the clinical interviews. The testing results however proved to be of mixed value. The mental status examinations were prioritized in administration based in part upon the acuteness of symptoms measured on the psychological tests. The Becks Depression and Hopelessness Scales taken together were given significant priority when both were significantly elevated, that is a Becks Depression Inventory score of 20 or greater and Becks Hopelessness Inventory score of 10 or greater. Although this was a common combination, in only two instances were the symptoms found to be so acute that the clients had to be hospitalized. In each of the other instances, although each individual was enduring severe symptoms of depression and did not have clear plans for the future, suicidal ideation was not present. Most of these women were surviving and functioning in both daily living and general child rearing activities in very adequate ways. These two instruments clearly identified emotional symptoms, but in these limited examples, most of the women were functioning in adequate ways in their day to day lives.
The results of the Trail Making Test Part B although not significant (mean scores were in the low average range), suggested the beginning signs of problems in information processing. The problems included concentration and becoming lost in the task. Part A was completed in an adequate fashion overall.
In this brief sample, women presenting for a problem with an "addiction" appeared to have also met the criterion for a diagnosable emotional disorder. The Ielase Institute was selected as an example of a Center in Pennsylvania who is equipped to simultaneously "treat" both an addiction and an emotional disorder or trauma. It is speculated that most females presenting to these clinics for a problem with alcohol or drugs, either voluntarily or through the court order (in the case of a DUI offender), may have a co-existing emotional disorder. If this is the case, traditional treatment programs which treat only the addiction may not be adequately addressing all of the needs of the person presenting for help.
Further study of women seeking treatment must continue. These studies should develop or re-norm testing instruments on female samples so that the highest value of results can be utilized. Brief testing batteries can assist the treatment staff or the DUI assessment centers in helping the person presenting for help to prioritize issues in treatment, recovery and in preventing a re-occurrence of the alcohol impaired driving offense. Holistic treatment then, can only begin with adequate diagnostic assessments of those who present and then only with a staff who has the ability to see or facilitate treatment of the various needs of those who seek help.
Fortini, M.E. and Perine, M.W. Characteristics of the Female Drinking Driver. Vermont Alcohol Research Center. Alcohol, Drugs and Traffic Safety T-89, Chicago, Illinois 1989.
Sutton, L.R. Assessment of Alcohol Dependence and Other Psychiatric Disorders: Implications For Rehabilitation Programs of the DUI Offender. Blutalkohol, Vol 31, 1994.
Wieczorek, W.F., Miller, B.A., Nochajski, T.H. Differences in Alcohol Dependence Between Male and Female DWI Offenders. Presented at the Research Society on Alcoholism Annual Meeting, June 13-18, 1992, San Diego, CA, U.S.A.