Psychiatric Bulletin (2001) 25: 252-254. doi: 10.1192/pb.25.7.252
© 2001 The Royal College of Psychiatrists
Psychiatric Bulletin (2001) 25: 252-254
© 2001 The Royal College of Psychiatrists
Questionnaire survey of automobile driving among users of a substance misuse service
Tim Bradbeer, Specialist Registrar in Psychiatry and
Jim Ormsby, Specialist Registrar in Psychiatry
St James' Hospital, Locksway Road, Portsmouth PO4 8LD
Philip Fleming, Consultant Psychiatrist in Substance Misuse
Kingsway House, 130 Elm Grove, Portsmouth PO5 1LR
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Abstract
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AIMS AND METHOD
Users of a substance misuse service were asked to complete a questionnaire,
detailing information about driving habits as well as attitudes about
substance use and driving.
RESULTS
Of 120 subjects, 94 had ever driven, with only 36 currently driving.
Fifty-six subjects had been charged with a driving offence but only 18 stated
that they had been involved in an accident while intoxicated. The majority
would not use drugs before driving and remain within a safe level of alcohol
use. Most subjects stated that they were not informed of current legal issues
concerning driving and substance use.
CLINICAL IMPLICATIONS
Users of a substance misuse service were reasonably responsible in their
driving habits, however, it is still important for clinical staff working in
such services to make their patients aware of the danger of driving under the
influence of substances.
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Introduction
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The latest figures of road traffic accidents from the Department of
Environment and Transport
(1999) show 3423 fatalities and
39 122 serious injuries annually. The Road Traffic Act 1988 states that:
"A person who when driving or attempting to drive a motor vehicle on
a road or other public place and is unfit to drive through drink or drugs is
guilty of an offence."
The dangers of driving under the influence of alcohol have been well
recognised for many decades (Cohen et
al, 1958). There is increasing evidence that drug use,
particularly that of tranquillisers, stimulants and cannabis, not only affects
responses and judgements, but is also frequently (ranging from 7.4% to 40.9%)
being found in the blood of traffic accident victims
(AA Group Public Policy, 1998).
There have been few studies into the problems of driving and psychiatric
populations, particularly patients who misuse substances. A recently published
paper by Albery et al
(2000) demonstrated that in a
group of out-of-treatment users, 81.7% reported driving after consuming
illicit drugs, 53.3% of whom held a driving conviction, and 41.4% having been
involved in at least one road traffic accident.
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Objectives
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The aims of this study were twofold. The first objective was to establish
the driving habits of a cohort of patients of a substance misuse service, and
second, to establish the level of responsibility towards driving held by the
cohort.
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The study
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Substance misusers who presented to the in-patient detoxification unit or
medical out-patients during an 8-week period between November 1999 and January
2000 were asked to fill in the questionnaire. The questionnaire, amended after
an initial pilot, asked about current drug use (illicit and prescribed),
alcohol use and driving habits, particularly whether they had driven under the
influence of drugs or alcohol; been charged with a driving offence; or been
involved in an accident. Questions also asked about what they would consider a
safe level of drug or alcohol use before driving and if they had been given
information about legal issues concerned with substance use and driving. The
Leeds Dependence Questionnaire (Raistrick
et al, 1994), a 10-item instrument designed to determine
the level of dependence for a variety of substances, was also completed.
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Findings
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The population
One-hundred-and-twenty patients out of a total of 130 agreed to complete
the form. The majority of patients were male (a total of 70%), with 54.2%
being treated as in-patients. Of the sample, 44.2% were aged 40 and over, with
only 28.3% being under 29 years. Table
1 shows the distribution of primary substance in current use by
the sample. A total of 56 (47.7%) subjects were using more than one substance,
the range of substances used being 0-5, a mean of 1.8 substances per subject.
Primary alcohol use was defined as a total weekly consumption exceeding 40
units of alcohol; 16 subjects were drinking less than this and were not using
drugs. According to the response to the Leeds Dependence Questionnaire 40.3%
of patients scored 20 or over — the cut off for severe dependence.
Driving habits
Twenty-six people had never driven a car and only the remaining 94
completed the rest of the questionnaire. Of those that had driven, only 36
(38.3%) were current drivers. The majority (75%) of current drivers used their
vehicle on a daily basis Table
2 shows the response to the questions about driving habits. Of the
56 people who were charged with a driving offence, 50% had a drink-drive
charge. Only 18 (19.1%) of the subjects stated that they had been involved in
a road traffic accident while intoxicated, five while under the influence of
drugs, seven under the influence of alcohol and six influenced by drugs and
alcohol.
Responsibility
Six subjects, 16.6% of those currently driving, did not hold a current
driving licence. Table 3
details the response to the questions of safety and substance use. For the
presentation of results, the amount of alcohol use was divided into three
categories: none; fewer than 5 units; and 5 units or more — which is
most likely to lead to a blood alcohol level over 80 mg, the current legal cut
off. There are no such legal measures for drugs, so responses were divided
into none; a level less than or equal to the individual's current use; and a
level that was more than the current use.
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Discussion
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Relatively few (7.7%) declined to answer the questionnaire, so we achieved
a good representation of those accessing the service. The population was
unremarkable as a substance misuse group in contact with services, 40% being
severely dependent, the majority being male and over the age of 30. There was
a wide spread of substance use — opioids and alcohol most frequent
— reflecting the emphasis of treatment within a clinical service. The
first issue, of driving habits, shows that few were currently driving, which
may be for financial or legal reasons as opposed to actual choice. Most had
driven while influenced by either drugs or alcohol and had charges for driving
offences, often drink—driving. This would suggest that most would feel
safe combining substance use with driving even though legally many are being
challenged. The low reporting of the traffic accidents suggests either a
fairly high level of driving competence or an underestimation of
accidents.
The second aim was to establish the degree of responsibility. Contrary to
the above, responses suggest a high level of awareness of safe levels of
substance use before driving, with only a small proportion seeing excess drug
or alcohol use as safe. Despite this, substance misusers continue to drive
following usage, possibly minimising the perceived risks attached to driving
while intoxicated. One explanation of this, as proposed by Albery et
al (2000), is that:
"Actual experience of driving after taking drugs could create
realistic knowledge and hence a more accurate perception or judgement of the
different impairing effects of various illicit drugs."
It is standard local practice at the first interview to run through driving
issues with each user and so it is surprising that most people reported not
being given information about legal matters. This could be explained by the
regularly demonstrated poor retention of information following clinical
interviews. The Driver and Vehicle Licensing Agency
(1999) widely distribute
information regarding fitness to drive — group one licence holders
(motor car and motor cycles) who persistently use cannabis, ecstasy and other
hallucinogens will have their licence revoked for 6 months. This period
increases to 1 year in use of amphetamines, heroin, benzodiazepines, cocaine
and methadone (except supervised oral methadone users, who are subject to
annual reviews). This must be crucial information to impart to such a
population.
Comparing the results to those of Albery et al
(2000), the two studies show
very similar proportions of subjects that held driving licences, had used
drugs prior to driving and had driving convictions, although they found a much
higher rate of substance related accidents.
This study begins to look at how substance users may assess risks and
responsibilities with regard to driving. With increasing prevalence of
substance misuse the danger of driving while under the influence of substances
merits further investigation. Clinicians have a responsibility to alert their
patients to the risks.
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References
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AA GROUP PUBLIC POLICY (1998) Drugs and
Driving: A Discussion Paper. Basingstoke: AA Policy.
ALBERY, J. P., STRANG, J., GOSSOP, M., et al
(2000) Illicit drugs and driving: prevalence, beliefs and
accident involvement among a cohort of current out-of-treatment drug users.
Drug and Alcohol Dependence,
58,
197-204.[CrossRef][Medline]
COHEN, J., DEARNALEY, E. J. & HANSEL, C. E. M.
(1958) The risk taken in driving under the influence of alcohol.
British Medical Journal,
2, 1438.[Medline]
DEPARTMENT OF ENVIRONMENT AND TRANSPORT (1999)
Road Accidents — Great Britain: 1999 The Casualty
Report. London: HMSO.
DRIVER AND VEHICLE LICENSING AGENCY (1999)
At a Glance Guide to the Medical Aspects of Fitness to
Drive. Swansea: Driver and Vehicle Licensing Agency.
RAISTRICK, O., BRADSHAW, J., TOBER, G., et al
(1994) Development of the Leeds Dependence Questionnaire (LDQ): a
questionnaire to measure alcohol and opiate dependence in the context of a
treatment evaluation package. Addiction,
89,
563-572.[CrossRef][Medline]
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Abstract
Introduction
