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Rehabilitation of DrinkingDrivers: The Practice inGermanyTom Waldmann a & Peter Henderson ba Trinity College , Dublinb The Queen’s University of BelfastPublished online: 13 Nov 2012.

To cite this article: Tom Waldmann & Peter Henderson (1992) Rehabilitation ofDrinking Drivers: The Practice in Germany, The Irish Journal of Psychology, 13:2,258-263, DOI: 10.1080/03033910.1992.10557884

To link to this article: http://dx.doi.org/10.1080/03033910.1992.10557884

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The Irish Journal of Psychology. 1992.13. 2. 258-263 .. , ..................................................................................................... .

Rehabilitation of Drinking Drivers:

Tom Waldmann

Trinity College, Dublin

& Peter Henderson

The Practice in Germany

The Queen's University of Belfast

The Gennan Federal Ministry for Road Transport (BASt) published a five-year evaluation of the effectiveness of treatment for persistent drink-drivers in Germany. Convicted drink-drivers who received treatment relapsed significantly less often than comparable drink·drivers who had not received treatment. The treatment was conducted by psychologists who had different theoretical orientations. However, success rates did not differ between these psychological • schools , . It is therefore likely that the success of the various treatments depended on what the treatments had in common. All treatments provided a similar information package to the course participants, but the informative content of the courses was unlikely to have been sufficient to have changed the rigid perceptions of the course participants. The convicted drink-drivers had to be given the opportunity to compare themselves with their peers, and they had to be given couselling of one form or another for the information provided to sink in .

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In Germany all drivers who have been caught driving so drunk that they had commiued a crime (with a blood alcohol content greater than 0.13%), or who have been convicted of drinking and driving more than once with a blood alcohol content greater than 0.08% are considered to be unsuitable to have a driving licence. They have to undergo a medico-psychological test which is designed to assess whether they should get their driving licence back after a period determined by a coun There are drivers who fail this test and who are given no opportunity to get their licence back, drivers who fail this test but are· recommended to auend a rehabilitation course, and a group who 'pass' the test - that is, they do not have to attend any courses in order to get their driving licence back. Test results tend to be fairly evenly divided into

Address for correspondence: DrTom Waldmann, Department of Psychology, Trinity

College. Dublin 2, Ireland.

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Rehabilitation of drinking drivers In Germany 259 ......................................................................................................... one-third outright • fails' • one-third recommended for a course. and one-third allowed to get their driving licence back after a period determined by the courts.

Winkler. Jacobshagen and Nickel (1991) reponed on the success oC three German courses which treated persistent drink-drivers. The success of these courses. which were attended by 1,667 participants, was measured by comparing recidivism rates over five years. Success rates between panicipants on the different courses did not vary with the ideological orientation of the course organisers: the models employed were Adlerian, behaviourist or group dynamiC. Although there may have been subtle differences in the effect of these three approaches. different courses were offered in different regions, so there were too many confounding variables, such as diverse drinking patterns and dissimilar police strategies, to allow for detailed comparisons. All courses had similar recidivism rates after their participants regained their driving licences.

Within five years of regaining their licence more than one-fifth of treated drivers were caught drinking and driving again. If we want to call this a success of psychological treatment, this result must compare well with the recidivism rates of an appropriate comparison group. The only reasonable comparison group available is that of convicted drinking drivers who did not have to attend a course.

Winkler, J acobshagen and Nickel (1988) found a statistically significant difference between the two groups in the rate at which they reoffended within three years of regaining their licence: 13.4% of those who went on a course reoffended, compared to 18.8% of those who did not. In their repon for the subsequent two years. Winkler et a1. (1991) observed that, although rates increased for both groups, the gap between them did not narrow significantly: 21% of those who went on a course and 26.95% of those who did not were caught drinking and driving again.

Buikhuisen and van Weringh (1968) suggested a method for estimating expected recidivism. and when expected recidivism was calculated according to their method. courses reduced recidivism by 47% after five years. which is only a small deterioration from the effect of the courses over three years, when the reduction was 52%. Therefore, it may be concluded that the effect of the courses is not temporary, and that there is no 'rebound effect'.

When the recommendation of 'retraining' as an outcome of the medica-psychological test was introduced, it was suspected that only testees from the proportion of drivers who had previously passed the test outright would now be recommended for retraining. However, this does not seem to have been the case, and the outcome of the test has been that approximately one-third of testees pass the test outright, one-third is recommended for retraining. and one-third will not get their licence back.

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260 Waldmann & Henderson

"'i~'i~'~~'i~~iti~~~~'~'~~~~~~'tl;~'~~~~~~~'~'i';~'h~b'iij~ti~~'~~~~~';iili therapies for alcoholism directly, because one would expect to find most of those drink-driving offenders who would be labelled alcoholics among those who failed the medico-psychological test outright. This does not mean, however, that the data obtained from rehabilitation courses are irrelevant to those helping people with a drink problem. The courses for drink-driving offenders are interesting to therapists because the follow-up has been for a relatively long time span, and the measure of success is relatively objective. All of the courses aim to help a convicted drinking driver organise his drinking and his driving in such a way that he will not drink and then drive. The courses do not aim to cure alcoholism. However, it is reasonable to assume that if the courses are successful in their aim, they will also help people organise drinking and activities other than driving.

The courses which employ predominantly behaviour therapy seek to teach 'self control' . Examples of their aims are learning to refuse drink and to avoid situations where the offer of drink is likely, learning to interrupt thoughts about the desirability of a drink, learning to record behaviour that is connected with drinking and driving, and learning to construct alternatives to critical situations.

The course described here as 'Adlerian' seeks to help people experience that they can be in control of their lives without drinking alcohol. This approach assumes that drinking alcohol is motivated by the desire to overcome helplessness. The third approach evolved from conversation groups but now includes elements of behaviour therapy. h would be improper to categorise the approaches very rigidly, because they all have some elements in common, and it is probably these which account for the success of the courses.

Jensch and Lemm-Hackenberg (1981) described the approach derived from depth psychology which is practiced in Cologne. The Cologne-based model was developed in 1977. Psychologists trained in depth psychology run these courses for eight to ten drivers at a time over four to six weeks. The drivers pay for these courses out of their own pockets. If they are disruptive and over the legal drink-driving limit when they attend a session, they are dismissed with no reimbursement.

The course provides information covering ten topics and an individual life-style analysis. With the aid of group work, participants are offered the opponunity to learn about problem-solving strategies they themselves and others are using when confronted with the alternative between drinking and driving. Excessive alcohol consumption is seen as an attempt to protect oneself from life's difficulties. If the 'protection mechanisms' employed by the individual and the individual's peers can be recognised, the panicipants can learn to tackle tasks which would otherwise be avoided.

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Rehabllhatlon of drinking drivers In Germany 261 ..........................................................................................................

As the Cologne model is as successful as the others, but probably not significantly more so, it may not be fruitful to discuss its underlying theory in detail. It seems more important to highlight the content of the ten instructional sessons that provide the course partiCipants with information. However, some remarks on the psychological aspects of 'conspicuousness through alcohol' may be necessary. German publications concatenate the expression in inverted commas to the one word 'AlkoholauflUligkeit'. This is an attempt to coin a neutral expression with which to label the course participants. Most drivers in Germany and in Ireland are neither teetotal nor alcoholics. If we defined these drivers as problem drinkers, rather than alcoholics, if they were caught repeatedly for drinking and driving, we would only be replacing one inexact label with another. In general, these drivers are social drinkers: a label that most therapists do not mind giving to themselves as well.

On the other hand, many reoffending drink-drivers do differ somewhat from the general population. Some of these people have been discovered driving with a blood alcohol content of more than 0.3%, although all the police may have noticed at first was that their cars' lights were not working properly. Toffel-Nadolny (1981) reponed an average blood alcohol content of 0.18% in those Berliners involved in traffic accidents and being tested by the police. Similar figures are commonplace for various regions in Germany; most offenders are not just over the legal limit of 0.03% or 0.08% (the lower one relates to culpability in an accident. the higher one to random checks). In fact, it is not all that easy to reach 0.18%. In a trial reported by Stephan (1988) only five out of 45 men with free access 10 wine. beer and schnapps 'managed' to reach 0.13%, and the record was only 0.169%. These volunteers, who worked in the area of road safety. mainly in the Civil Service, were given the opportunity to drive before and (under supervision and not on a public road!) after drinking. Observers noticed clear signs of intoxication in most of them. The alcohol levels reponed for this study correspond well with levels reponed for people who do not have any serious problems with their drinking, but not with the alcohol levels found by the police on the streets.

One problem is tolerance to alcohol. Are people who can drink enormous quantities of alcohol without appearing drunk ~e drivers even if they are 'over the limit'? They would probably think that they were. The US Department of Transport, for example, warns that someone with a blood alcohol content of 0.15% and no apparent sign of drunkenness is likely to be a problem drinker. Stephan (1988) estimated that 14% of German men drink between 40 and 80 g of alcohol daily. and 5% exceed 80 g (their yearly consumption is 84 litres of pure alcohol). Almost one half of all drink-driving offences are committed by these regular, heavy drinkers. It has been estimated that these people live with

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262 Waldmann & Henderson

;;.··~~~~;~·bi~·~~~h~i·i·~~~i·~f·O:i8%·~·~~;;·~~:·~~~~di~~'~'fi;~~~ presented by Wieser (1973).

It is common for a course moderator to hear that the course participant was caught repeatedly because of bad luck, or because the police were out to get him. After a group discussion course participants usually agree that this does not make sense, and honest reflection leads to an acceptance that the nwnber of unrecorded cases must be very high indeed. This topic, and infonnation about accident risks, fonn the two statistical topics of the ten sessions dealing with information which can be presented in almost any order. There are two medical items: alcohol content in drinks, and the often misunderstood way in which the body rids itself of alcohol. The latter lesson provides information about how long it takes to get below the legal limit after drinking. There are also two lessons on the law relating to drinking and driving. The largest component is psychological: perception, motor responses, general psychological effect of drinking, and rules of drinking.

In Cologne, three-quarters of the duration of a course is spent in counselling, which, although it takes place in a group. is intended to concentrate on one person per session. Nothing that is said during this session will appear in offlcial files. and participants cannot fail the course, unless they do not attend or misbehave, as mentioned earlier. The expected result is a life-style analysis for each participant which focuses on drinking and driving. Other features of the participants' life. such as partnership, job, and social contacts are mentioned only if they are relevant to drinking and driving. Nobody is 'turned into a better person' according to the moderator'S definition during the 26 hours of the course. No personalities are changed. Instead. if the course is successful, drinking drivers become aware of how automatic some of their behaviours are, and learn to gain control over these behaviours. Much the same thing happens to every participant, in much the same sequence. during the course. This has helped the organisers to fonnalise aspects of the course, but to retain the flexibility that is needed to cater for the various participants' strengths and weaknesses. Course sheets exist not only for the teaching of factual material, but also for the construction of a focused life-style analysis.

Jensch and Lemm-Hackenberg (1981) considered the informative components not usually sufflcient to change the rigid perceptual schema of the course participants. The lesson on residual alcohol may be very interesting, but a bit of sleep. a shower and a cup of coffee will enable them to drive to work two hours later even though their blood alcohol level is still 0.13%. Only counselling of some kind or another, which enables people to compare themselves with their peers, allows for the information to sink in. The combination of the two seems to account for the success of rehabilitation courses for drinking drivers in Gennany.

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Rehabilitation of drinking driver. In Germany 263 ..........................................................................................................

ACKNOWLEDGEMENT

The authors are grateful for assistance and literature given 10 them by Dr. E. Spoerer of IRAK, Cologne, when they visited him as part of a project by Waldmann, Hale and Henderson for the Deparunent of the Environment for Northern heland in 1990.

REFERENCES

Buikhuisen, W. & van Weringh, J. (1968). Vorspeelen von recidivisme. Nederlands Tijdschrift voor Criminologie, 5, 223-240

Jensch, M. & Lemm-Hackenberg, R. (1981). Alkohol und Lebensstil (Vol. 31). Braunschweig: Rot Gelb GeOn Verlag, Faktor Mensch im Verkehr.

Stephan, E. (1988). Wirbamuit der Nachschulungskllrse bei erstmals alkoholauffiJlligen Kraftfahrern. Bericht lum Forschungsprojekt 8035 der Bundesanstalt rur StraBenwesen, Bergisch Gladbach.

Toffel-Nadolny, P. (1981). Zur alkoholischen Beeinflussung der Verkehrsteilnehmer in West-Berlin 1980. Blutalkohol, 18, 253-260.

Wieser, S. (1973). Das Trinkverhalten der Deutschen. Eine medizinisch­soziologische Untersuchung. Herford: Nicolai

Winkler, W., Jacobshagen, W. & Nickel, W. R. (1988). Wirksamkeit von Kursen fUr alkoholauffll.llige Kraftfahrer. Bundesminister fUr Verkehr (Ed.), Unfall und Sicherheits/orschung StraJ1enverkehr (No. 64). Bonn: Bundesminister fUr Verkehr. Bergisch Gladbach: Bundesaustalt fur Slrassenwesen.

W inkl er, W., Jacobshagen, W. & Nickel, W. R. (1991). RUckfll.1ligkeit von Teilnehmern an Kursen fUr wiederholt alkoholauffll.llige Kraftfahrer nach Fuenf Jahren. Bundesminister fUr Verkehr (Ed.), Un/all fmd Sicherheits/orschung StraJ1enllerkehr (No. 224). Bonn: Bundesminister fUr Verkehr. Bergisch Gladbach: Bundesaustalt fur Strassenwesen.

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