POSITION PAPER- IMPACT DWI, INC.
This paper is prepared in anticipation of the significant additional funding being made available from an increase in the distribution of alcohol excise taxes to the County DWI Programs to fund the prevention and treatment of New Mexico's statewide alcohol abuse problems.

INFORMATION PAPER:
HOW ALCOHOL ABUSE THERAPY CAN BE MADE MORE EFFECTIVE

BACKGROUND:
Many existing treatment programs experience a success rate as low as 5%. This means that of all of the patients who enter these programs, only 5% are able to remain free from abusing alcohol one year after completing the program. Impact, DWI, Inc. interviewed Life Link's Ray Anderson to try and determine some of the reasons why the general failure rate is so high.
Ray Anderson is not only the Director of Operations and Training at The Life Link, but he is a respected consultant to treatment programs and to health agencies as faraway as New Zealand. Below is a summary of the two major points, which he brought up in response to our questions.

1. A low success rate may reflect the type of approach used by the treatment organization.
A valuable source of information about treatment approaches and their success rates is The University of New Mexico (Albuquerque). Two specialists there have authored a manual, which is one of the most definitive works written about alcohol abuse treatment and what works and why.
The book is entitled "Handbook of Alcohol Treatment Approaches", by Hester and Miller (ISBN 0205360645). In that book (p.19) they list the best and the least successful treatment approaches/methods. Their ratings are based upon the results of a compilation of multiple studies of treatment approaches. Thus, the effectiveness ratings are about as objective and comprehensive as is possible to achieve. Forty-eight treatment approaches were rated. The most effective showed an effectiveness rating of up to 95% and the least effective were less than 10% effective.

The most effective approaches were:
1. Brief intervention.
2. Motivational enhancement therapy.
3. Medication using "GABA" (acamprosate/Capral).
4. Communication reinforcement approach.
5. Self-help manuals.

The least effective but often used approaches were:
38. AA groups.
42. Anti-depressant based treatment.
45. Confrontational counseling.
46. Psychotherapy.
47. General alcohol counseling (the type which is often used by religious organizations and other non-experts).
48. Education (tapes, movies and lectures)

2. Addicts have been shown to be more cooperative in regard to treatment and experienced a higher success rate when CRAFT (Community Reinforcement And Family Training) was employed. CRAFT is a program designed to prepare the people who are attempting to persuade and to support an addict to enter and to successfully complete treatment.
This program, by being non-confrontational and focused upon supportive communication between the concerned party and the addict, avoids the usual nagging, threats and other behavior, which only makes the addict more resistant to treatment.
Instead, the concerned party usually reports that participation in CRAFT has helped them to personally feel less anger, anxiety and depression. This resulted in, after 12 CRAFT sessions, their convincing the addict to enter treatment almost 70% of the time.
For additional information about this complex subject, please refer to Hester and Millers text.

However, it can reasonably be stated that, given the generally low success rate of publicly funded alcohol abuse treatment programs, in this state, they should be periodically reviewed by an independent agency in order to insure that the most appropriate and effective science- and evidenced-based approaches are being employed.
As a result, Impact DWI, Inc. calls upon all funding organizations, which pay for alcohol abuse treatment with public money, to adopt appropriate auditing processes to insure that the treatment approaches used are effective (based on evidence), and then to publish those results.

For additional information about alcohol abuse and what the public can do about it, please refer to the websites:
IMPACTDWI.ORG and to ALCOHOLTAX INCREASE.ORG

RECOMMENDATIONS BY IMPACT DWI, INC.
(drawn from successful programs used in other states):

I. Recognize that persons arrested for alcohol-related offenses often are subject to different factors, which led to their offense. Roughly, these offenders fall into three groups:

A. Casual drinkers, who often have an "attitude" problem. They know or care little about the affects of consuming alcohol, since they do not see themselves as having any kind of alcohol problem, even when they do drink. Thus, they believe that they can drink and drive without consequence.
Often, these are people who have had "one to many" and were caught. It is important to distinguish between people, who, while they may have an "attitude" problem, are not alcoholics or borderline alcoholics.
They seldom consume alcohol in quantity, and are not dependent upon it. However, this group, if not treated with the seriousness, which their offense deserves, can easily develop the idea that alcohol abuse is not a serious offense against society.
Judges or prosecutors who allow "plea- bargaining" for first or second offenders, or who find reasons to dismiss the case, are just adding to the offender's perception that alcohol abuse is not a serious matter, which thus contributes to the overall abuse problem.

Therefore, it is essential that sure and quick punishment be administered. This punishment, which should be designed to address the typical first offender with an emphasis upon education, fines, and the installation of an ignition interlock, has been shown to constitute an effective form of "treatment" in itself.

B. Chronic alcoholics (or borderline alcoholics) who are dependent upon alcohol on a daily, or almost daily basis, and who often have an extensive history of abusive behavior.

C. Evolving alcohol abusers, who consume alcohol periodically and often in dangerous amounts -- this group includes youth who "binge" drink.

II. Then screen and assess each person, who is arrested for an offense, where alcohol is a contributing factor, and identify which group they belong in.
This screening would also apply to people who request or who are referred for treatment, but who have not committed an offense. Next, based upon the screening results, place the person into a mode of monitoring, treatment or sanctions, which is designed, to best fit their profile.

III. Based on the above screening and assessment, offenders are then classified into one of the three groups with appropriate sanctions and/or treatment applied:

A. Casual alcohol consumers, whose behavior and attitude could benefit from court ordered sanctions such as a night or two in jail, fines, ignition interlock, and education-based action, such as the Victim Impact Panel. Compliance monitors, who would report exceptions to the court of jurisdiction for follow-up, would monitor their future performance.
Treatment is not recommended for this group, unless future behavior, as determined by the compliance monitors, indicates it.

B. Chronic Alcoholics. These, by definition and, often, their own history, are people who pose a definite danger to society. It is recommended that people who are classified into this group not be given rehabilitative treatment (see below).
Experience has shown that people who fit into the Chronic Alcoholic group do not respond effectively to conventional, rehabilitative treatment programs, and probably have already attended a least one such program in the past. These people are hard-core alcoholics, whose desperate dependence upon a daily dose of alcohol, often because of advanced underlying emotional and/or physiological problems renders them unreceptive to treatment programs. Because of the danger and the cost, which these repeat offenders pose to society, they should be, once arrested, and if found guilty, sanctioned under both existing civil "public nuisance" law, as well as relevant criminal law.
This type of repeat offender's ability to cause further harm to society must be recognized, and be curtailed by the use of appropriate options available to the courts in New Mexico.
These options include: electronic monitoring (ankle bracelet), ignition interlock on all vehicles, which that person has access to, as well as possible confinement in prison or a mental institution for those whose history demonstrates that they are incorrigible.
There should be no "second chance" given to this classification of people, because society's protection must take preference.

C. Evolving Alcohol Abusers. This group represents a numerically large percentage of the total of people arrested for alcohol abuse-related offenses (second only to first and second offenders). Thus, the potential to reduce the alcohol abuse problem, in a substantial manner, lies with this group, if the proper treatment is applied.
The emphasis with this group, in regard to treatment, should be on limiting their ability to cause further damage to society, by applying effective treatment and follow-up as explained below:

Like the people who are Chronic Alcoholics, these people usually consume alcohol because of underlying medical, emotional and/or physiological problems. What differentiates people in this group from Chronic Alcoholics is often their age, their attitude toward changing their behavior, and the number of years since they began consuming alcohol.
Because of their younger age and other factors, which can be identified during the screening process, the success factor in effectively treating underlying medical, emotional, physiological, educational, job skill and other limiting factors has been shown to be worth the cost and effort, if it is done properly and in a scientific manner… For this group it is recommended that a new treatment program be created. The program's procedure and scope would draw from effective treatment programs now in use in other states. This program would contain the following basic elements:

1. The program would be residential. This element has been shown to be essential to the process of assisting people, who have alcohol abuse problems. A major cause for the failure of non-residential programs to produce substantial positive results is the fact that change is all but impossible, when a person is not removed from the environment, which either caused their problem or enables it.

2. Necessary medical treatment to obtain complete mental, emotional and physical health on an individual basis, if possible.

3. Formal, basic, educational, work-related and other life skills, relative to each individual's ability.

4. Upon "graduation" from this program, reasonable financial and mentoring assistance to help ensure each "graduate's" successful re-entry into the community.

5. Ongoing, periodic monitoring to determine if additional assistance is required, and to assess the program's effectiveness and possible need for modification.

SUMMARY:
People who have been subject to a combination of negative and often traumatic experiences in life have no reason for hope, or the desire to develop, or acquire the education or other life-skills required to live productive and satisfying lives. These are people who live from day-to-day and often from moment-to-moment.
Thus, particularly if they also possess medical or emotional problems, they often make poor choices, which, in turn, negatively impacts society.
The effective addressing of the varying causal factors through new and effective residential treatment programs, while increasing the emphasis upon protecting society from the abuses of the chronic alcoholic, must be adopted to break that cycle.
Until this occurs on a statewide basis, there can be no logical reason to expect different behavior from alcohol abusers, or a substantial change in the state's alcohol abuse problem.

However, these new programs will take millions of dollars to set-up and to operate. It is Impact DWI's position that this money should not come from the public at large in the form of income or gross receipt taxes. The only reasonable source of the required money is from the consumers of alcohol. It only seems fair that those who consume alcohol pay-forward, as they purchase their alcohol and, thus, fund the cost of dealing with alcohol abuse.