Preventton and Control of 'Drunk Driving:· Lessons for Social/Pork DAVID N. SAUNDERS
Vol. 4, No.4, November 1979 0360-7283/79/0404-0084 $0.50 ~ 1979 National Association of Social Workers, Inc.
HEALTH AND SOCIAL WORK,
This article examines efforts to prevent and control the widespread problem of "drunk driving" in the United States. Special emphasis is placed on one institutional mechanism—the Alcohol Safety Action Project—developed to deal with the behavior of problem drinkers.
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OST STATES define the legal limits for alcohol intoxication as 80 or 100 mg per 100 ml of blood. However, a person's ability to drive a motor vehicle can become impaired at lower levels. Despite many folk myths to the contrary, the effect of alcohol on a person's ability to drive is determined primarily by the amount of alcohol consumed, the amount of time elapsed since consumption, and the body weight of a person.' A considerable amount of alcohol must be consumed to reach the legal limit. For example, a 160-pound person has to consume five drinks of hard liquor within one hour to become legally intoxicated. Because high blood levels of alcohol are necessary to reach the legal limit and because most drivers arrested for driving while intoxicated (DWI) are well above that limit, it is not surprising that most either
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have a drinking problem or are well on their way toward developing one. Driessen and Bryk estimated that 7 percent of 137 million drivers in the United States have serious problems controlling their drinking. 2 In addition, roadside surveys and other studies revealed that, at any given time, between 10 and 20 percent of all the drivers on the highways have been drinking, although most of these drivers do not have a high blood level of alcohol. 3 However, between 2 and 4 percent of them have reached the legal limit of intoxication. The late hours on Friday and Saturday tend to be the periods of greatest danger. Alcohol is a contributing factor in 40 to 55 percent of the fatal automobile accidents that occur each year. 4 Moreover, a large proportion of all these accidents as well as injuries received from nonfatal ones involve pedestrians who have been drinking. 5 DWI has serious consequences for both drinking drivers and their victims. Property damage, high costs related to medical care, and personal suffering are some specific examples. Alcohol-related accidents represent the third largest economic cost associated with the misuse of alcohol in the United States. In 1974, costs for such accidents were estimated at $6.44 billion—$3.56 billion for fatal accidents, $2.38 billion for injuries received from accidents, and $.5 billion for property damage. 6 DWI AS A SOCIAL PROBLEM There is universa' disapproval of DWI. However, efforts to prevent and control this social problem have been ineffective. Although the reasons for this are difficult to analyze and beyond the scope of this article,
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a brief discussion is appropriate. The American Automobile Association, a national organization that is familiar with the problem, stated that the tragic consequences of drinking and driving .. . defies [sic] any single solution. Stricter law enforcement, stiffer fines, tougher driver's license suspensions or relocation measures are only partial solutions. 7 On one hand, society permits the limited consumption of alcohol, followed by a considerable delay in time before driving; on the other, it views heavy consumption, followed by immediate driving, as a serious social problem. Because of society's point of view, there is no simple way to separate appropriate and inappropriate drinking and driving. This means that the individuals involved must make a sophisticated judgment to determine the point at which an otherwise acceptable behavior becomes unacceptable. In contrast to other social problems, DWI is to a great extent culturally induced. Because alcohol consumption is viewed as a sign of adulthood and a symbol of enjoying life, pressures to consume alcoholic beverages pervade American society. Similarly, people view driving as a sign of adulthood. And cars are symbols of success, mobility, power, and masculinity. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that "attempts at prevention and control . . . of alcohol and driving in the past were characterized by stringent laws and scare slogans." 8 One reason for the failure of efforts to control and prevent drinking and driving is that the solutions are often viewed as more offensive than the problem itself. Bacon refers to the failure of such efforts as
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the second stage of a social problem (the first stage occurs when a behavior is considered improper, harmful, and unnecessary) 9 Efforts to control "drunk driving" are therefore seen as harmful for many reasons. First, it is assumed that most of those arrested are social rather than problem drinkers. Second, the enforcement of laws require considerable effort on the part of police, and police are reluctant to enforce laws that a large body of the population believes are unreasonable. Third, the legai penalties for DWI have traditionally been so severe that judges and juries are reluctant to apply them to otherwise law-abiding citizens. Fourth, the penalties appear to have little effect on the future behavior of persons arrested for DWI; suspension of licenses alone is ineffective. Finally, traditional sanctions do little to resolve the drinking problems that got the intoxicated driver into trouble in the first place. Like most social problems, DWI tends to occur among selected subgroups. These groups can be identified according to a series of demographic, driving, drinking-and-driving, and drinking patterns." Sex and age are clearly associated with .abusive drinking and driving. People who mix drinking and driving are overwhelmingly male, primarily because men, as compared with women, are more likely to be licensed drivers, drink more, and drive more at night. In addition, youths under age 25 are more likely to mix drinking and driving than are older drivers. Furthermore, teenagers who consume alcohol before driving are more likely to have traffic accidents than are people in other age groups. Zylman reported that although young adults aged 15 to 24 constitute only one-fifth of all drivers, they are involved in nearly one-third of all accidents.11 .
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ALCOHOL SAFETY ACTION PROJECT
A variety of drinking as well as driving variables are linked to abusive drinking and driving. According to Jones and Joscelyn, problem drinkers usually have a history of automobile accidents, serious driving violations, and license suspensions. 12 In addition, they are far more likely to be convicted of DWI than are other types of drinkers. However, Bacon reported that [until recently,] the means for attacking the alcoholaffected traffic accident, whether immediate or longrange in purpose, seemed comparatively apathetic, spasmodically emotional, chaotic and at times even contributory to the very phenomena being attacked. 13 One promising approach to the problem of DWI has been developed by the Department of Transportation (DOT). This approach, called the Alcohol Safety Action Project (ASAP), involves coordinated efforts on the part of agencies to prevent and control drunk driving. It contains five primary components: enforcement of laws on drunk driving, judicial discretion in handling the arrested, comprehensive treatment and rehabilitation programs, the dissemination of information on drunk driving to the public, and evaluation. The basic purposes of ASAP are to "identify problem drinking drivers, to develop procedures to ensure that they do not drink and drive, to reduce drinking problems, and to implement an action program to carry out these procedures." 14 Because ASAP was developed by an agency concerned with highway safety, the basic thrust of ASAP is to reduce drinking and driving rather than
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to focus on abstinence as a treatment goal. Furthermore, the procedures of ASAP are directed toward a wide range of drinking drivers. Many of these drivers are not abusive drinkers; for them, other goals rather than abstinence are preferable. To test the ASAP concept, DOT allocated funds for thirty-five pilot projects throughout the United States. 15 These projects stimulated the development of ASAPs in a number of states, including Virginia, Maryland, California, and Maine. Most projects follow similar procedures. For example, drivers apprehended for DWI by police are sent to the court for disposition. The court can dispose of the case in the traditional manner that involves some combination of fines, suspension or revocation of license, or incarceration; or it can refer the client to ASAP, which represents an alternative mechanism for handling the drunk driver. Court referrals to ASAP depend, in part, on drivers' past driving record, their history of previous drinking and driving offenses, their blood level of alcohol at the time of arrest, and their willingness to participate in the program. Case managers employed by ASAP are usually used as probation officers to monitor the client's behavior. Case managers are also responsible for classifying defendants on the basis of their drinking problem. A typical taxonomy is social drinker, preproblem drinker, and problem or chronic drinker. This classification, as well as other indications of alcohol-related problems, is used to assign clients to one or more rehabilitation programs operated by staff members of ASAP or by other cooperating agencies. Rehabilitation programs range from standard defensive driving courses and education on alcohol to various treatment programs. The treatment programs use individual, group, or family ap-
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proaches. Clients are often exposed to a combination of educational and treatment methods and usually participate under a court order. Their participation lasts from a few months to a year. The ASAP agency serves as an agent of the court and is administratively responsible for following up clients and reporting their progress to the court. Attempts have been made to determine the effectiveness of ASAP as a control system. As Jones and Joscelyn stated, evaluation of ASAP has suffered because the state of knowledge pertaining to fundamental hypotheses upon which most alcohol safety programs have been based . . . is totally inadequate for designing and operating effective programs."
In addition, different outcome measures can be used to determine the effectiveness of ASAPs. If their effectiveness is measured in terms of whether they are a financial burden on local communities, ASAPs will be considered a success because most are self-supporting and do not require the use of local taxes. 17 However, other outcome *measures such as the number of alcohol-related accidents and the blood level of alcohol among drivers may yield different results. One study was undertaken to determine the effect of ASAP procedures on the behavior of problem and social drinkers." Data were obtained from thirty-five ASAP pilot projects on the number of nighttime fatal crashes and on the blood alcohol concentration of people stopped at roadside surveys. Differences were found between the behavior of problem and social drinkers.
For instante, there was a reduction in the number of nighttime fatal crashes and a lower concentration of alcohol in the blood among social drinkers, but not among
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problem drinkers. The study also revealed that most ASAPs had a limited impact on the future driving records of problem drinkers. However, the ASAP approach to drunk driving may be applied to traditional social work problems. Staff members in ASAP handle similar problems faced by social workers in health care and those in other fields of service. With this in mind, the author will address the following five issues: acceptance of problem, appropriateness of behavior, early identification, prevention, and demands for services. ACCEPTANCE OF PROBLEM
Acceptance of a problem is influenced both by the way the affected individuals view the problem and the manner in which the helping person handles it. Of ten those who need social services do not believe they have a problem, or they underestimate its severity. Examples of such people are the following: recently hospitalized stroke patients who minimize the extent of their impairment to avoid facing the possibility that they must be placed in a nursing home, obese diabetics who refuse to modify their eating or drinking habits, abusive parents who continue the excessive use of corporal punishment, and alcoholic employees who minimize the effect of drinking on their work performance. Persons arrested for DWI usually claim that they are social drinkers who had a few too many at a party and happened to get caught. Like most persons with drinking problems, they offer many excuses for their behavior. In addition, they tend to focus on their arrest rather than on their abuse of alcohol. Even when
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alcohol is the agent in causing child abuse, marital stress, domestic disturbances that involve law enforcement agencies, or poor job performance, problem drinkers resist the idea that the presenting problem is a symptom of an underlying disturbance. The social worker is often caught up in this dynamic and fails to recognize the underlying cause. Persons who deny or minimize the severity of their problems are reluctant to seek help. However, it is not unusual for clients who receive services to verbalize a desire to resolve their difficulties but be unwilling to make the effort necessary to do so. These may also be a gap between intellectual and emotional acceptance. Even when clients are able to come to grips with their problems on an intellectual level, emotional acceptance may be harder to obtain. In many social work agencies, the worker must spend valuable time helping clients first identify the problem and then accept the need for help. This is particularly critical in hospitals because advances in medical care and government review procedures have made it possible to curtail the length of stay for many patients. The acceptance of problem drinking by drivers in ASAPs is facilitated by several factors. These include the trauma associated with the individual's arrest, the definition of legal limits for intoxication, the danger that DWI poses to the individual and others, the power and control of those persons to whom the problem becomes evident, the ability of those in authority to apply punishment when problem drinkers do not manifest changes in their behavior, and the frequent use of group treatment, which limits the ability of participants to make excuses for their behavior. The arrest and court appearance cause concern
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among those stopped for DWI. In Virginia persons arrested for drunk driving are routinely handcuffed and brought before a magistrate for booking. Many spend a short time in a jail before bail can be posted. The handcuffs and jail are not quickly forgotten. This experience forces the client to come to grips with both the symptoms of alcohol dependence and reduces the opportunity for denial or rationalization. In addition, the power and control of persons who are responsible for dealing with drunk driving reflect the illegal nature of the offensive behavior. When judges inform a drunk driver that he or she has a drinking problem, they have a far greater impact than a friend, family member, or therapist. Moreover, the project's staff members expect a change in the behavior of problem drinkers. Differential definitions of success are unacceptable to the court, although actually determining whether the person's illegal behavior continues can present a problem. The role of peers with similar problems can also be critical in encouraging individuals to recognize the problem. Many ASAPs use group diagnosis and group treatment approaches that rely heavily on confrontation. The use of peers has proved highly effective in ASAPs. Such persons have greater credibility than a therapist because they are not identified as an agent of the court and are able to identify denial when it occurs. The legal process surrounding child abuse is analogous to that of ASAP. The client is faced with a series of requirements imposed by the court or some agent of the court such as a social worker. If the client does not conform to the requirements, certain personal and legal sanctions result. These may take the form of a fine, sentence, or locs of custody.
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". . . the ASAP approach to drank driving may be applied to traditional social work problems. Staff members in ASAP handle similar problems faced by social workers in health care and those [professionals] in other fields of service."
A parallel situation exists in industrial settings in which poor job performance is of ten a symptom of alcohol dependence or personal problems. In this case individuals are told that they should seek help and change their behavior. If they do not comply, they will lose their job. In health care, the acceptance of a problem can be aided by the referral process, especially when the referral emanates from an authority figure such as a physician whose judgment the patient accepts." The weakness in the medical analogy is that acceptance of the professional's judgment is voluntary on the part of the client, and professionals can exercise few punitive or personal sanctions other than discharge or personal criticism. Clients also have the option of finding another professional if they do not like the diagnosis, approach, or demands made on them. The drunk driver participating in ASAP does not have this option. Is it possible or feasible to build a system of problem recognition that relies on an ASAP-type approach, and, if so, is this approach practical or ethical? Such an approach is beginning to gain acceptance among those who treat child abusers. However, the next question is, Can the approach be extended to others such as suicidal individuals, juvenile delinquents, pregnant teenagers, obese diabetics, or smokers? Although it can be
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argued that drunk driving and child abuse represent special cases, standards used to make such judgments are not etched in brass but are influenced by changing cultural values. A decade ago an ASAP approach to drunk driving would not have been acceptable, yet today it receives considerable support. APPROPRIATENESS OF BEHAVIOR
Because of culturally prescribed patterns of acceptable behavior, individuals must make a decision about the appropriateness of their behavior. This decision is influenced by the following: (1) the nature of the behavior itself, (2) the individuals involved, and (3) the situation. The amount of liquor a driver can drink before driving, the number of times a child can be struck with a hairbrush, or the amount of sugar a diabetic can consume may vary considerably. A heavy person can consume more alcohol before driving than a light one, just as a physically strong child can withstand more punishment than a frail one. Because some behaviors are not considered wrong, exist along a continuum, and are situation- and person-specific, the decision about appropriateness is difficult. In addition, the behavior must be considered at several points in time. For instance, severe punishment of a child may be tolerated on a single occasion, although subsequent punishments of the same kind can be considered abusive. In addition, a diabetic may be able to exceed allowable sugar limits on an occasional basis without long-term consequences but cannot do it on a regular basis. ASAP responds to the issue of appropriate behavior by asking clients not to drive after drinking heavily. It does not ask that clients cease drinking entirely. The
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program's public information slogans—"Know your limits," "He who takes one for the road gets a trooper for a chaser," and "Friends don't let friends drive drunk"—clearly convey the message that drinking is acceptable provided it does not lead to drunk driving. Some of the program's preventive recommendations for persons in situations in which they may mix drinking and driving are these: getting a spouse or friend to drive home, hiding car keys, and sleeping over after a party. Although some of those entering the program may have to modify their drinking patterns drastically to avoid DWI, the program would be satisfied with continued heavy drinking as long as individuals would avoid drunk driving. This is possible, in part, because the rehabilitation of problem drinkers is one of a number of goals for which the umbrella ASAP agency is responsible. Professionals in other fields of service respond in a similar way to their clients' problems. For instante, those in Planned Parenthood agencies no Jonger expect teenagers to avoid having sexual relations. As a result, they stress that teenagers carefully consider their reasons for wanting to engage in sexual relations and that they use some method of birth control. As is the case with ASAP, the most effective interventions are those that use peer-based and group techniques. In the area of child abuse, the goal of treatment is not to avoid punishment totally but to help clients become better parents so they can make constructive and appropriate use of discipline. The cultural context in which the abusive behavior occurs can be critical. Another problem relates to obese blacks with diabetes mellitus. Only half the consequences of this condition can be controlled through medical interven-
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tion. The other half is a function of diet and life-style. It is not simply an issue of teaching the individual to control diet, for fond intake is closely linked to the way thinness or fatness is viewed by the individual's reference group and to patterns of buying, cooking, and eating. It is unrealistic to expect individuals from certain ethnic groups to change their eating patterns if such change runs contrary to normally expected behavior. Short of major modification in the individual's social environment, the heiping person must set realistic goals and stress how much improper eating can be tolerated in certain situations. This approach closely resembles that used in ASAP. In developing programs to aid clients in dealing with the appropriateness of their behavior, the social worker must understand the cultural milieu in which the behavior occurs, anticipate the situation in which clients will be under pressure to engage in potentially offensive behavior, and help clients develop mechanisms to cope with situations that trigger the behavior. In addition, the worker must help educate clients about the consequences of the behavior and use family networks and peer groups to reinforce positive actions.
EARLY IDENTIFICATION Individuals in need of help tend to wait until they experience high levels of discomfort or anxiety before seeking help. In most situations, social workers are in a passive position vis à vis the identification of problems. They do not and cannot engage in outreach efforts and must depend heavily on clients' identification of problems or referral from other professionals in agencies. However, in industrial settings, poor work per-
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formance brings the problem to the attention of a supervisor. And it is only then that the underlying difficulty—such as personal problems, stress, or problem drinking—can be identified. A unique feature of the ASAP approach is the built-in referral network that permits early identification. Many of those arrested are just beginning to have problems controlling their drinking. Historically, alcohol treatment programs have served people whose drinking problems are well advanced. The use of alcohol has already led to a severe disruption in the Jives of problem drinkers by the time they reach treatment agencies. The application of the ASAP approach to other social problems suggests that efforts should be made to identify symptoms of behavior that carry a high risk of some underlying disorder. Such efforts would determine what groups are especially vulnerable to offensive behavior and identify the warning signals emitted by individuals in these groups before the problem behavior becomes evident. PREVENTION Because problems of clients are usually already well advanced when they seek the assistance of social workers, the services are reactive and stress treatment. Services also tend to focus on the individuals rather than on their community. Other important social work functions such as education, consultation, and prevention are often neglected. The emphasis on treatment has unfortunate consequences. First, prevention tends to be either isolated or ignored in dealing with the problem. Bloom states that
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prevention is one of the great unexplored wildernesses in the province of health and effective social function. [This is not surprising because] prevention is directed toward some state of events that does not currently exist, among a population of persons in which the specific future victims are as yet unknown, using concepts borrowed from other disciplines."
In addition, Bloom notes that because functional and dysfunctional elements in social systems frequently exist side by side, prevention and intervention efforts tend to be mutually reinforcing. 2 ' Although child abuse, delinquency, abusive drinking, or premarital pregnancy may surf ace in a particular individual, they develop and are maintained in a social or familial context that requires a series of differential approaches. Klein, Alexander, and Parsons illustrated this with respect to delinquents and developed a pilot program that includes a system of parallel rehabilitative, interventive, and preventive services. 22 The tertiary or rehabilitative work deals with families of delinquents after the delinquent has participated in a corrective program; the treatment or interventive phase involves working directly with the delinquents; and primary prevention deals with services directed toward the siblings of the delinquents to keep the former out of the court system. ASAP is concerned with the community-wide reduction of drinking and driving, rather than simply the treatment of those arrested for DWI. Therefore, it is well suited to developing prevention efforts. Because it uses a systems approach to drinking and driving, treatment is only one of a variety of components and does not overwhelm other activities. This provides a better climate in which prevention efforts can be implemented. A second consequence of the emphasis on treatment
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is that there are no systematic mechanisms for dealing with other organizational elements, although these elements may impinge on the problem. In a family service agency, if resolution of a client's problem requires the cooperation of other agencies, this must be accomplished on a personal rather than an institutional basis, for no structural mechanisms exist to facilitate this cooperation. The organization of ASAPs institutionalizes coordination since it was set up to coordinate the enforcement, judicial, rehabilitation, and public information or education components. The use of case managers who are responsible for classifying, referring, and fol-
lowing up clients is particularly important. A case manager makes the system work for the client in a consistent and coherent manner, helps optimize the level of service by increasing the efficiency and effectiveness of services delivered, and provides additional control over clients' behavior that generates an "image of competence," which is particularly critical in court-related agencies. 23 DEMANDS FOR SERVICES Organizations dealing with social problems have difficulty accommodating the number of referrals or changes in the type of clients requesting or being referred for services. Although this occurs for a number of reasons, one critical variable is the limited control exercised by agencies over levels of funding that normally emanate from external sources. When faced with increased demands for services or sudden changes in the types of clients being seen, agencies respond by developing waiting lists, modifying the way in which services are delivered,
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or diverting potential clients to other agencies. This problem is particularly acute when appropriations are not increased or are cut back, since demands for services are determined by other unrelated forces. ASAP agencies have a rather unique financial and organizational structure that enables them to circumvent this problem. In Virginia and in other areas, the operating costs of most ASAPs are funded through fees paid directly by the client to the court. This fee, which can be considered a form of user tax, is in addition to any fines levied by the judge. Thus, ASAPs are insulated from the traditional types of budget allocation processes, although legislative bodies still retain responsibility for setting levels for fees and developing legislation. These fees also give the programs incentive to increase the number of clients being served. Few other agencies concerned with social problems are in this enviable position. The major criticism raised against ASAPs relates to their insulation from the political process, which reduces accountability. The auspice under which the ASAP operates is also important, and there is no standard way in which this is handled. ASAPs in Virginia have generally been administered through the courts rather than by mental health agencies or similar organizations. This has given the program considerable power and autonomy, and the court-based program has tended to possess considerable immunity from outside interference because of the independence of the judicial branch from the legislative and executive processes and the esteem in which judges, who set the policies and procedures of the program, are held. The reliance on case managers for following up clients further supports the independence of ASAP
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agencies and provides a relatively unbiased assessment of how all the various treatment and educational components are functioning. Case managers are less likely to become identified with a specific treatment orientation than are professionals involved in the direct provision of services. Because of referrals made by ASAP agencies, there
has been a large increase in both the number of persons seen by alcohol agencies and the type of clients who enter treatment. The increased number of referrals and the large number of persons with moderate as opposed to severe drinking problems have put considerable strain on traditional alcohol treatment agencies. Because abstinence-based approaches are not necessarily appropriate for many of those being referred, many of these agencies have been forced to change the way education and counseling on alcohol is conducted. Some ASAP agencies also have considerable control over alcohol and mental health services. In New Jersey the state ASAP agency located in the Department of Motor Vehicles refers over 6,000 arrested drunk drivers for treatment and education on alcohol. And because it is the largest user of alcohol services in that state, it is in a position to dictate the nature and type of services provided. This often occurs at the expense of state mental health or health agencies that have traditionally been responsible for structuring services. The tradition of long-term, abstinence-based approaches to alcohol has been challenged by the type and number of ASAP referrals. SUMMARY This article has attempted to show that the problem of DWI is similar to a number of dilemmas faced by social
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workers in health care and in other related settings. It has suggested that a systems approach used by ASAP to attack the problem of drunk driving can be applied to such social problems as alcoholism, child abuse, and juvenile delinquency. These problems all involve clients who have difficulty recognizing and accepting their problems and judging the extent to which their behavior is tolerable. All these individuals would benefit from early identification of problems, from prevention and better coordination between the various components in the ASAP system, and from the support and legitimization that would result from a stronger role of the judicial system.
About the Author David N. Saunders, Ph.D., is Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond. Between 1975 and 1977, the author conducted an evaluation of one of the pilot ASAPs in Fairfax, Virginia, that was part of a larger study sponsored by the National Highway Safety Administration. He wishes to thank Martin Bloom and Barent Landstreet for their comments and suggestions in the preparation of this article.
Notes and Refrences 1. National Institute on Alcohol Abuse and Alcoholism, Alcohol and Health, Second Report—New Knowledge
(Washington, D.C.: U.S. Department of Health, Education & Welfare, 1974).
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2. Gerald J. Driessen and Joseph A. Bryk, "Alcohol Countermeasures: Solid Rock and Shifting Sands," in M. W. Perrine, ed., Alcohol, Drugs and Driving (Washington, D.C.: National Highway Safety Administration, 1974). 3. National Institute on Alcohol Abuse and Alcoholism, op. cit., p. 98. 4. Ralph K. Jones and Kent B. Joscelyn, Alcohol and Highway Safety 1978: A Review of the State of Knowledge, Summary Volume (Washington, D.C.: U.S. Department
of Transportation, 1978); and Richard Zylman, "A Critical Evaluation of the Literature on 'Alcohol Involvement' in Highway Deaths," Accident Analysis and Prevention, 6 (Spring 1973). 5. National Institute on Alcohol Abuse and Alcoholism, op. cit. 6. Ibid. 7. DWI Counterattack (Washington, D.C.: American Automobile Association, 1972), p. 2. 8. National Institute on Alcohol Abuse and Alcoholism, op. cit., p. 108. 9. Sheldon D. Bacon, "Traffic Accidents Involving Alcohol in the U.S.A.; Second Stage Aspects of a Social Problem," Quarterly Journal of Studies on Alcohol, Supplement No. 4 (May 1968), pp. 11-34. 10. National Institute on Alcohol Abuse and Alcoholism, op. cit. 11. Richard Zylman, "Youth, Alcohol, and Collision Involvement," Journal of Safety Research, 5 (Fall 1973), pp. 58-72. 12. Jones and Joscelyn, op. cit. 13. Bacon, op. cit., p. 2. 14. Barent F. Landstreet, The Drinking Driver (Springfield, III.: Charles C Thomas, 1977), p. 8. 15. Alcohol Safety Action Projects, First Year Evaluation Preview (Washington, D.C.: U.S. Department of
Transportation, 1972).
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16. Jones and Joscelyn, op. cit., p. 91. 17. T. E. Hawkins et al., Summary of ASAP Results for Application to State and Local Programs: Vol. II, ASAP Costs (San Antonio, Tex.: Southwest Research Institute, 1976). 18. Paul Levy et al., "An Evaluation of the Department of Transportation's Alcohol Safety Action Projects," Journal of Safety Research, 10 (Winter 1978), pp. 42-176. 19. Talcott Parsons, The Social System (New York: Free Press, 1964). 20. Martin Bloom, "Explorations in Preventive Social Work," p. 2. Paper presented at the Fifth Biennial Professional Symposium, San Diego, Calif., November 1977. 21. Ibid. 22. Nancy C. Klein, James F. Alexander, and Bruce V. Parsons, "Impact of Family System Intervention on Recidivism and Sibling Delinquency: A Model of Primary Prevention and Program Evaluation," Journal of Consulting and Clinical Psychology, 45 (March 1977), pp. 469-474. 23. See Dennis F. Beatrice, Case Management: A Policy for Long-Term Care, University Health Policy Consortium (Waltham, Mass.: Brandeis University, 1979), P. 5 .
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Vol. 4, No.4, November 1979 0360-7283/79/0404-0084 $0.50 ~ 1979 National Association of Social Workers, Inc.
HEALTH AND SOCIAL WORK,
This article examines efforts to prevent and control the widespread problem of "drunk driving" in the United States. Special emphasis is placed on one institutional mechanism—the Alcohol Safety Action Project—developed to deal with the behavior of problem drinkers.
M
OST STATES define the legal limits for alcohol intoxication as 80 or 100 mg per 100 ml of blood. However, a person's ability to drive a motor vehicle can become impaired at lower levels. Despite many folk myths to the contrary, the effect of alcohol on a person's ability to drive is determined primarily by the amount of alcohol consumed, the amount of time elapsed since consumption, and the body weight of a person.' A considerable amount of alcohol must be consumed to reach the legal limit. For example, a 160-pound person has to consume five drinks of hard liquor within one hour to become legally intoxicated. Because high blood levels of alcohol are necessary to reach the legal limit and because most drivers arrested for driving while intoxicated (DWI) are well above that limit, it is not surprising that most either
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have a drinking problem or are well on their way toward developing one. Driessen and Bryk estimated that 7 percent of 137 million drivers in the United States have serious problems controlling their drinking. 2 In addition, roadside surveys and other studies revealed that, at any given time, between 10 and 20 percent of all the drivers on the highways have been drinking, although most of these drivers do not have a high blood level of alcohol. 3 However, between 2 and 4 percent of them have reached the legal limit of intoxication. The late hours on Friday and Saturday tend to be the periods of greatest danger. Alcohol is a contributing factor in 40 to 55 percent of the fatal automobile accidents that occur each year. 4 Moreover, a large proportion of all these accidents as well as injuries received from nonfatal ones involve pedestrians who have been drinking. 5 DWI has serious consequences for both drinking drivers and their victims. Property damage, high costs related to medical care, and personal suffering are some specific examples. Alcohol-related accidents represent the third largest economic cost associated with the misuse of alcohol in the United States. In 1974, costs for such accidents were estimated at $6.44 billion—$3.56 billion for fatal accidents, $2.38 billion for injuries received from accidents, and $.5 billion for property damage. 6 DWI AS A SOCIAL PROBLEM There is universa' disapproval of DWI. However, efforts to prevent and control this social problem have been ineffective. Although the reasons for this are difficult to analyze and beyond the scope of this article,
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a brief discussion is appropriate. The American Automobile Association, a national organization that is familiar with the problem, stated that the tragic consequences of drinking and driving .. . defies [sic] any single solution. Stricter law enforcement, stiffer fines, tougher driver's license suspensions or relocation measures are only partial solutions. 7 On one hand, society permits the limited consumption of alcohol, followed by a considerable delay in time before driving; on the other, it views heavy consumption, followed by immediate driving, as a serious social problem. Because of society's point of view, there is no simple way to separate appropriate and inappropriate drinking and driving. This means that the individuals involved must make a sophisticated judgment to determine the point at which an otherwise acceptable behavior becomes unacceptable. In contrast to other social problems, DWI is to a great extent culturally induced. Because alcohol consumption is viewed as a sign of adulthood and a symbol of enjoying life, pressures to consume alcoholic beverages pervade American society. Similarly, people view driving as a sign of adulthood. And cars are symbols of success, mobility, power, and masculinity. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that "attempts at prevention and control . . . of alcohol and driving in the past were characterized by stringent laws and scare slogans." 8 One reason for the failure of efforts to control and prevent drinking and driving is that the solutions are often viewed as more offensive than the problem itself. Bacon refers to the failure of such efforts as
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the second stage of a social problem (the first stage occurs when a behavior is considered improper, harmful, and unnecessary) 9 Efforts to control "drunk driving" are therefore seen as harmful for many reasons. First, it is assumed that most of those arrested are social rather than problem drinkers. Second, the enforcement of laws require considerable effort on the part of police, and police are reluctant to enforce laws that a large body of the population believes are unreasonable. Third, the legai penalties for DWI have traditionally been so severe that judges and juries are reluctant to apply them to otherwise law-abiding citizens. Fourth, the penalties appear to have little effect on the future behavior of persons arrested for DWI; suspension of licenses alone is ineffective. Finally, traditional sanctions do little to resolve the drinking problems that got the intoxicated driver into trouble in the first place. Like most social problems, DWI tends to occur among selected subgroups. These groups can be identified according to a series of demographic, driving, drinking-and-driving, and drinking patterns." Sex and age are clearly associated with .abusive drinking and driving. People who mix drinking and driving are overwhelmingly male, primarily because men, as compared with women, are more likely to be licensed drivers, drink more, and drive more at night. In addition, youths under age 25 are more likely to mix drinking and driving than are older drivers. Furthermore, teenagers who consume alcohol before driving are more likely to have traffic accidents than are people in other age groups. Zylman reported that although young adults aged 15 to 24 constitute only one-fifth of all drivers, they are involved in nearly one-third of all accidents.11 .
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ALCOHOL SAFETY ACTION PROJECT
A variety of drinking as well as driving variables are linked to abusive drinking and driving. According to Jones and Joscelyn, problem drinkers usually have a history of automobile accidents, serious driving violations, and license suspensions. 12 In addition, they are far more likely to be convicted of DWI than are other types of drinkers. However, Bacon reported that [until recently,] the means for attacking the alcoholaffected traffic accident, whether immediate or longrange in purpose, seemed comparatively apathetic, spasmodically emotional, chaotic and at times even contributory to the very phenomena being attacked. 13 One promising approach to the problem of DWI has been developed by the Department of Transportation (DOT). This approach, called the Alcohol Safety Action Project (ASAP), involves coordinated efforts on the part of agencies to prevent and control drunk driving. It contains five primary components: enforcement of laws on drunk driving, judicial discretion in handling the arrested, comprehensive treatment and rehabilitation programs, the dissemination of information on drunk driving to the public, and evaluation. The basic purposes of ASAP are to "identify problem drinking drivers, to develop procedures to ensure that they do not drink and drive, to reduce drinking problems, and to implement an action program to carry out these procedures." 14 Because ASAP was developed by an agency concerned with highway safety, the basic thrust of ASAP is to reduce drinking and driving rather than
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to focus on abstinence as a treatment goal. Furthermore, the procedures of ASAP are directed toward a wide range of drinking drivers. Many of these drivers are not abusive drinkers; for them, other goals rather than abstinence are preferable. To test the ASAP concept, DOT allocated funds for thirty-five pilot projects throughout the United States. 15 These projects stimulated the development of ASAPs in a number of states, including Virginia, Maryland, California, and Maine. Most projects follow similar procedures. For example, drivers apprehended for DWI by police are sent to the court for disposition. The court can dispose of the case in the traditional manner that involves some combination of fines, suspension or revocation of license, or incarceration; or it can refer the client to ASAP, which represents an alternative mechanism for handling the drunk driver. Court referrals to ASAP depend, in part, on drivers' past driving record, their history of previous drinking and driving offenses, their blood level of alcohol at the time of arrest, and their willingness to participate in the program. Case managers employed by ASAP are usually used as probation officers to monitor the client's behavior. Case managers are also responsible for classifying defendants on the basis of their drinking problem. A typical taxonomy is social drinker, preproblem drinker, and problem or chronic drinker. This classification, as well as other indications of alcohol-related problems, is used to assign clients to one or more rehabilitation programs operated by staff members of ASAP or by other cooperating agencies. Rehabilitation programs range from standard defensive driving courses and education on alcohol to various treatment programs. The treatment programs use individual, group, or family ap-
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proaches. Clients are often exposed to a combination of educational and treatment methods and usually participate under a court order. Their participation lasts from a few months to a year. The ASAP agency serves as an agent of the court and is administratively responsible for following up clients and reporting their progress to the court. Attempts have been made to determine the effectiveness of ASAP as a control system. As Jones and Joscelyn stated, evaluation of ASAP has suffered because the state of knowledge pertaining to fundamental hypotheses upon which most alcohol safety programs have been based . . . is totally inadequate for designing and operating effective programs."
In addition, different outcome measures can be used to determine the effectiveness of ASAPs. If their effectiveness is measured in terms of whether they are a financial burden on local communities, ASAPs will be considered a success because most are self-supporting and do not require the use of local taxes. 17 However, other outcome *measures such as the number of alcohol-related accidents and the blood level of alcohol among drivers may yield different results. One study was undertaken to determine the effect of ASAP procedures on the behavior of problem and social drinkers." Data were obtained from thirty-five ASAP pilot projects on the number of nighttime fatal crashes and on the blood alcohol concentration of people stopped at roadside surveys. Differences were found between the behavior of problem and social drinkers.
For instante, there was a reduction in the number of nighttime fatal crashes and a lower concentration of alcohol in the blood among social drinkers, but not among
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problem drinkers. The study also revealed that most ASAPs had a limited impact on the future driving records of problem drinkers. However, the ASAP approach to drunk driving may be applied to traditional social work problems. Staff members in ASAP handle similar problems faced by social workers in health care and those in other fields of service. With this in mind, the author will address the following five issues: acceptance of problem, appropriateness of behavior, early identification, prevention, and demands for services. ACCEPTANCE OF PROBLEM
Acceptance of a problem is influenced both by the way the affected individuals view the problem and the manner in which the helping person handles it. Of ten those who need social services do not believe they have a problem, or they underestimate its severity. Examples of such people are the following: recently hospitalized stroke patients who minimize the extent of their impairment to avoid facing the possibility that they must be placed in a nursing home, obese diabetics who refuse to modify their eating or drinking habits, abusive parents who continue the excessive use of corporal punishment, and alcoholic employees who minimize the effect of drinking on their work performance. Persons arrested for DWI usually claim that they are social drinkers who had a few too many at a party and happened to get caught. Like most persons with drinking problems, they offer many excuses for their behavior. In addition, they tend to focus on their arrest rather than on their abuse of alcohol. Even when
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alcohol is the agent in causing child abuse, marital stress, domestic disturbances that involve law enforcement agencies, or poor job performance, problem drinkers resist the idea that the presenting problem is a symptom of an underlying disturbance. The social worker is often caught up in this dynamic and fails to recognize the underlying cause. Persons who deny or minimize the severity of their problems are reluctant to seek help. However, it is not unusual for clients who receive services to verbalize a desire to resolve their difficulties but be unwilling to make the effort necessary to do so. These may also be a gap between intellectual and emotional acceptance. Even when clients are able to come to grips with their problems on an intellectual level, emotional acceptance may be harder to obtain. In many social work agencies, the worker must spend valuable time helping clients first identify the problem and then accept the need for help. This is particularly critical in hospitals because advances in medical care and government review procedures have made it possible to curtail the length of stay for many patients. The acceptance of problem drinking by drivers in ASAPs is facilitated by several factors. These include the trauma associated with the individual's arrest, the definition of legal limits for intoxication, the danger that DWI poses to the individual and others, the power and control of those persons to whom the problem becomes evident, the ability of those in authority to apply punishment when problem drinkers do not manifest changes in their behavior, and the frequent use of group treatment, which limits the ability of participants to make excuses for their behavior. The arrest and court appearance cause concern
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among those stopped for DWI. In Virginia persons arrested for drunk driving are routinely handcuffed and brought before a magistrate for booking. Many spend a short time in a jail before bail can be posted. The handcuffs and jail are not quickly forgotten. This experience forces the client to come to grips with both the symptoms of alcohol dependence and reduces the opportunity for denial or rationalization. In addition, the power and control of persons who are responsible for dealing with drunk driving reflect the illegal nature of the offensive behavior. When judges inform a drunk driver that he or she has a drinking problem, they have a far greater impact than a friend, family member, or therapist. Moreover, the project's staff members expect a change in the behavior of problem drinkers. Differential definitions of success are unacceptable to the court, although actually determining whether the person's illegal behavior continues can present a problem. The role of peers with similar problems can also be critical in encouraging individuals to recognize the problem. Many ASAPs use group diagnosis and group treatment approaches that rely heavily on confrontation. The use of peers has proved highly effective in ASAPs. Such persons have greater credibility than a therapist because they are not identified as an agent of the court and are able to identify denial when it occurs. The legal process surrounding child abuse is analogous to that of ASAP. The client is faced with a series of requirements imposed by the court or some agent of the court such as a social worker. If the client does not conform to the requirements, certain personal and legal sanctions result. These may take the form of a fine, sentence, or locs of custody.
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". . . the ASAP approach to drank driving may be applied to traditional social work problems. Staff members in ASAP handle similar problems faced by social workers in health care and those [professionals] in other fields of service."
A parallel situation exists in industrial settings in which poor job performance is of ten a symptom of alcohol dependence or personal problems. In this case individuals are told that they should seek help and change their behavior. If they do not comply, they will lose their job. In health care, the acceptance of a problem can be aided by the referral process, especially when the referral emanates from an authority figure such as a physician whose judgment the patient accepts." The weakness in the medical analogy is that acceptance of the professional's judgment is voluntary on the part of the client, and professionals can exercise few punitive or personal sanctions other than discharge or personal criticism. Clients also have the option of finding another professional if they do not like the diagnosis, approach, or demands made on them. The drunk driver participating in ASAP does not have this option. Is it possible or feasible to build a system of problem recognition that relies on an ASAP-type approach, and, if so, is this approach practical or ethical? Such an approach is beginning to gain acceptance among those who treat child abusers. However, the next question is, Can the approach be extended to others such as suicidal individuals, juvenile delinquents, pregnant teenagers, obese diabetics, or smokers? Although it can be
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argued that drunk driving and child abuse represent special cases, standards used to make such judgments are not etched in brass but are influenced by changing cultural values. A decade ago an ASAP approach to drunk driving would not have been acceptable, yet today it receives considerable support. APPROPRIATENESS OF BEHAVIOR
Because of culturally prescribed patterns of acceptable behavior, individuals must make a decision about the appropriateness of their behavior. This decision is influenced by the following: (1) the nature of the behavior itself, (2) the individuals involved, and (3) the situation. The amount of liquor a driver can drink before driving, the number of times a child can be struck with a hairbrush, or the amount of sugar a diabetic can consume may vary considerably. A heavy person can consume more alcohol before driving than a light one, just as a physically strong child can withstand more punishment than a frail one. Because some behaviors are not considered wrong, exist along a continuum, and are situation- and person-specific, the decision about appropriateness is difficult. In addition, the behavior must be considered at several points in time. For instance, severe punishment of a child may be tolerated on a single occasion, although subsequent punishments of the same kind can be considered abusive. In addition, a diabetic may be able to exceed allowable sugar limits on an occasional basis without long-term consequences but cannot do it on a regular basis. ASAP responds to the issue of appropriate behavior by asking clients not to drive after drinking heavily. It does not ask that clients cease drinking entirely. The
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program's public information slogans—"Know your limits," "He who takes one for the road gets a trooper for a chaser," and "Friends don't let friends drive drunk"—clearly convey the message that drinking is acceptable provided it does not lead to drunk driving. Some of the program's preventive recommendations for persons in situations in which they may mix drinking and driving are these: getting a spouse or friend to drive home, hiding car keys, and sleeping over after a party. Although some of those entering the program may have to modify their drinking patterns drastically to avoid DWI, the program would be satisfied with continued heavy drinking as long as individuals would avoid drunk driving. This is possible, in part, because the rehabilitation of problem drinkers is one of a number of goals for which the umbrella ASAP agency is responsible. Professionals in other fields of service respond in a similar way to their clients' problems. For instante, those in Planned Parenthood agencies no Jonger expect teenagers to avoid having sexual relations. As a result, they stress that teenagers carefully consider their reasons for wanting to engage in sexual relations and that they use some method of birth control. As is the case with ASAP, the most effective interventions are those that use peer-based and group techniques. In the area of child abuse, the goal of treatment is not to avoid punishment totally but to help clients become better parents so they can make constructive and appropriate use of discipline. The cultural context in which the abusive behavior occurs can be critical. Another problem relates to obese blacks with diabetes mellitus. Only half the consequences of this condition can be controlled through medical interven-
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tion. The other half is a function of diet and life-style. It is not simply an issue of teaching the individual to control diet, for fond intake is closely linked to the way thinness or fatness is viewed by the individual's reference group and to patterns of buying, cooking, and eating. It is unrealistic to expect individuals from certain ethnic groups to change their eating patterns if such change runs contrary to normally expected behavior. Short of major modification in the individual's social environment, the heiping person must set realistic goals and stress how much improper eating can be tolerated in certain situations. This approach closely resembles that used in ASAP. In developing programs to aid clients in dealing with the appropriateness of their behavior, the social worker must understand the cultural milieu in which the behavior occurs, anticipate the situation in which clients will be under pressure to engage in potentially offensive behavior, and help clients develop mechanisms to cope with situations that trigger the behavior. In addition, the worker must help educate clients about the consequences of the behavior and use family networks and peer groups to reinforce positive actions.
EARLY IDENTIFICATION Individuals in need of help tend to wait until they experience high levels of discomfort or anxiety before seeking help. In most situations, social workers are in a passive position vis à vis the identification of problems. They do not and cannot engage in outreach efforts and must depend heavily on clients' identification of problems or referral from other professionals in agencies. However, in industrial settings, poor work per-
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formance brings the problem to the attention of a supervisor. And it is only then that the underlying difficulty—such as personal problems, stress, or problem drinking—can be identified. A unique feature of the ASAP approach is the built-in referral network that permits early identification. Many of those arrested are just beginning to have problems controlling their drinking. Historically, alcohol treatment programs have served people whose drinking problems are well advanced. The use of alcohol has already led to a severe disruption in the Jives of problem drinkers by the time they reach treatment agencies. The application of the ASAP approach to other social problems suggests that efforts should be made to identify symptoms of behavior that carry a high risk of some underlying disorder. Such efforts would determine what groups are especially vulnerable to offensive behavior and identify the warning signals emitted by individuals in these groups before the problem behavior becomes evident. PREVENTION Because problems of clients are usually already well advanced when they seek the assistance of social workers, the services are reactive and stress treatment. Services also tend to focus on the individuals rather than on their community. Other important social work functions such as education, consultation, and prevention are often neglected. The emphasis on treatment has unfortunate consequences. First, prevention tends to be either isolated or ignored in dealing with the problem. Bloom states that
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prevention is one of the great unexplored wildernesses in the province of health and effective social function. [This is not surprising because] prevention is directed toward some state of events that does not currently exist, among a population of persons in which the specific future victims are as yet unknown, using concepts borrowed from other disciplines."
In addition, Bloom notes that because functional and dysfunctional elements in social systems frequently exist side by side, prevention and intervention efforts tend to be mutually reinforcing. 2 ' Although child abuse, delinquency, abusive drinking, or premarital pregnancy may surf ace in a particular individual, they develop and are maintained in a social or familial context that requires a series of differential approaches. Klein, Alexander, and Parsons illustrated this with respect to delinquents and developed a pilot program that includes a system of parallel rehabilitative, interventive, and preventive services. 22 The tertiary or rehabilitative work deals with families of delinquents after the delinquent has participated in a corrective program; the treatment or interventive phase involves working directly with the delinquents; and primary prevention deals with services directed toward the siblings of the delinquents to keep the former out of the court system. ASAP is concerned with the community-wide reduction of drinking and driving, rather than simply the treatment of those arrested for DWI. Therefore, it is well suited to developing prevention efforts. Because it uses a systems approach to drinking and driving, treatment is only one of a variety of components and does not overwhelm other activities. This provides a better climate in which prevention efforts can be implemented. A second consequence of the emphasis on treatment
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is that there are no systematic mechanisms for dealing with other organizational elements, although these elements may impinge on the problem. In a family service agency, if resolution of a client's problem requires the cooperation of other agencies, this must be accomplished on a personal rather than an institutional basis, for no structural mechanisms exist to facilitate this cooperation. The organization of ASAPs institutionalizes coordination since it was set up to coordinate the enforcement, judicial, rehabilitation, and public information or education components. The use of case managers who are responsible for classifying, referring, and fol-
lowing up clients is particularly important. A case manager makes the system work for the client in a consistent and coherent manner, helps optimize the level of service by increasing the efficiency and effectiveness of services delivered, and provides additional control over clients' behavior that generates an "image of competence," which is particularly critical in court-related agencies. 23 DEMANDS FOR SERVICES Organizations dealing with social problems have difficulty accommodating the number of referrals or changes in the type of clients requesting or being referred for services. Although this occurs for a number of reasons, one critical variable is the limited control exercised by agencies over levels of funding that normally emanate from external sources. When faced with increased demands for services or sudden changes in the types of clients being seen, agencies respond by developing waiting lists, modifying the way in which services are delivered,
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or diverting potential clients to other agencies. This problem is particularly acute when appropriations are not increased or are cut back, since demands for services are determined by other unrelated forces. ASAP agencies have a rather unique financial and organizational structure that enables them to circumvent this problem. In Virginia and in other areas, the operating costs of most ASAPs are funded through fees paid directly by the client to the court. This fee, which can be considered a form of user tax, is in addition to any fines levied by the judge. Thus, ASAPs are insulated from the traditional types of budget allocation processes, although legislative bodies still retain responsibility for setting levels for fees and developing legislation. These fees also give the programs incentive to increase the number of clients being served. Few other agencies concerned with social problems are in this enviable position. The major criticism raised against ASAPs relates to their insulation from the political process, which reduces accountability. The auspice under which the ASAP operates is also important, and there is no standard way in which this is handled. ASAPs in Virginia have generally been administered through the courts rather than by mental health agencies or similar organizations. This has given the program considerable power and autonomy, and the court-based program has tended to possess considerable immunity from outside interference because of the independence of the judicial branch from the legislative and executive processes and the esteem in which judges, who set the policies and procedures of the program, are held. The reliance on case managers for following up clients further supports the independence of ASAP
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agencies and provides a relatively unbiased assessment of how all the various treatment and educational components are functioning. Case managers are less likely to become identified with a specific treatment orientation than are professionals involved in the direct provision of services. Because of referrals made by ASAP agencies, there
has been a large increase in both the number of persons seen by alcohol agencies and the type of clients who enter treatment. The increased number of referrals and the large number of persons with moderate as opposed to severe drinking problems have put considerable strain on traditional alcohol treatment agencies. Because abstinence-based approaches are not necessarily appropriate for many of those being referred, many of these agencies have been forced to change the way education and counseling on alcohol is conducted. Some ASAP agencies also have considerable control over alcohol and mental health services. In New Jersey the state ASAP agency located in the Department of Motor Vehicles refers over 6,000 arrested drunk drivers for treatment and education on alcohol. And because it is the largest user of alcohol services in that state, it is in a position to dictate the nature and type of services provided. This often occurs at the expense of state mental health or health agencies that have traditionally been responsible for structuring services. The tradition of long-term, abstinence-based approaches to alcohol has been challenged by the type and number of ASAP referrals. SUMMARY This article has attempted to show that the problem of DWI is similar to a number of dilemmas faced by social
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workers in health care and in other related settings. It has suggested that a systems approach used by ASAP to attack the problem of drunk driving can be applied to such social problems as alcoholism, child abuse, and juvenile delinquency. These problems all involve clients who have difficulty recognizing and accepting their problems and judging the extent to which their behavior is tolerable. All these individuals would benefit from early identification of problems, from prevention and better coordination between the various components in the ASAP system, and from the support and legitimization that would result from a stronger role of the judicial system.
About the Author David N. Saunders, Ph.D., is Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond. Between 1975 and 1977, the author conducted an evaluation of one of the pilot ASAPs in Fairfax, Virginia, that was part of a larger study sponsored by the National Highway Safety Administration. He wishes to thank Martin Bloom and Barent Landstreet for their comments and suggestions in the preparation of this article.
Notes and Refrences 1. National Institute on Alcohol Abuse and Alcoholism, Alcohol and Health, Second Report—New Knowledge
(Washington, D.C.: U.S. Department of Health, Education & Welfare, 1974).
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2. Gerald J. Driessen and Joseph A. Bryk, "Alcohol Countermeasures: Solid Rock and Shifting Sands," in M. W. Perrine, ed., Alcohol, Drugs and Driving (Washington, D.C.: National Highway Safety Administration, 1974). 3. National Institute on Alcohol Abuse and Alcoholism, op. cit., p. 98. 4. Ralph K. Jones and Kent B. Joscelyn, Alcohol and Highway Safety 1978: A Review of the State of Knowledge, Summary Volume (Washington, D.C.: U.S. Department
of Transportation, 1978); and Richard Zylman, "A Critical Evaluation of the Literature on 'Alcohol Involvement' in Highway Deaths," Accident Analysis and Prevention, 6 (Spring 1973). 5. National Institute on Alcohol Abuse and Alcoholism, op. cit. 6. Ibid. 7. DWI Counterattack (Washington, D.C.: American Automobile Association, 1972), p. 2. 8. National Institute on Alcohol Abuse and Alcoholism, op. cit., p. 108. 9. Sheldon D. Bacon, "Traffic Accidents Involving Alcohol in the U.S.A.; Second Stage Aspects of a Social Problem," Quarterly Journal of Studies on Alcohol, Supplement No. 4 (May 1968), pp. 11-34. 10. National Institute on Alcohol Abuse and Alcoholism, op. cit. 11. Richard Zylman, "Youth, Alcohol, and Collision Involvement," Journal of Safety Research, 5 (Fall 1973), pp. 58-72. 12. Jones and Joscelyn, op. cit. 13. Bacon, op. cit., p. 2. 14. Barent F. Landstreet, The Drinking Driver (Springfield, III.: Charles C Thomas, 1977), p. 8. 15. Alcohol Safety Action Projects, First Year Evaluation Preview (Washington, D.C.: U.S. Department of
Transportation, 1972).
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16. Jones and Joscelyn, op. cit., p. 91. 17. T. E. Hawkins et al., Summary of ASAP Results for Application to State and Local Programs: Vol. II, ASAP Costs (San Antonio, Tex.: Southwest Research Institute, 1976). 18. Paul Levy et al., "An Evaluation of the Department of Transportation's Alcohol Safety Action Projects," Journal of Safety Research, 10 (Winter 1978), pp. 42-176. 19. Talcott Parsons, The Social System (New York: Free Press, 1964). 20. Martin Bloom, "Explorations in Preventive Social Work," p. 2. Paper presented at the Fifth Biennial Professional Symposium, San Diego, Calif., November 1977. 21. Ibid. 22. Nancy C. Klein, James F. Alexander, and Bruce V. Parsons, "Impact of Family System Intervention on Recidivism and Sibling Delinquency: A Model of Primary Prevention and Program Evaluation," Journal of Consulting and Clinical Psychology, 45 (March 1977), pp. 469-474. 23. See Dennis F. Beatrice, Case Management: A Policy for Long-Term Care, University Health Policy Consortium (Waltham, Mass.: Brandeis University, 1979), P. 5 .
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