Relationship of Victimization, Self-Esteem, Alcohol Expectancies, and Alcohol Problems to Psychiatric Distress in Impaired Drivers

Background/Purpose: Impaired driving remains a pervasive problem in America. High rates of both first and repeat offenses have prompted the scrutiny of existing DWI treatment programs. Several recent reports call for the revision of existing intervention paradigms to include treatment for underlying mental health and substance use problems, as these concerns are common among both first time and repeat offenders.

Parallel lines of inquiry have suggested that people with substance abuse problems have high rates of childhood trauma; however, this variable has not yet been examined in the impaired driving population. If childhood victimization is found to have an effect on other variables known to be associated with impaired driving, it may provide valuable insights pertaining to the pathways between childhood trauma and adult psychopathology, thus offering helpful information for revising treatment programs. Consequently, this study examined the relationship of victimization, self-esteem, alcohol expectancies to alcohol problems and psychiatric problems.  

Methods: Data for this analysis were taken from a larger study of impaired drivers (n=650) in western New York State. Information on self-esteem, psychiatric distress, alcohol problems, alcohol expectancy (that alcohol can be used to manage mood), and type of childhood victimization were collected.

Results:  55% of the sample had experienced at least one form of victimization. The average self-esteem score was 31.13 (SD = 5.44; range: 12-90). The average belief score that alcohol can be used to manage mood was 3.66 (SD = 2.50; range: 0-8). The average number of alcohol problems was 11.39 (SD = 27.86; range: 0 -297). Multivariate path analysis indicated that psychiatric distress is a function of alcohol problems and self-esteem. Victimization and alcohol expectancies have significant indirect effects on psychiatric distress through self-esteem and alcohol problems. Self-esteem has significant indirect effects on psychiatric distress through alcohol problems and alcohol expectancies. Model fit indices exceeded accepted standards (Χ²=2.15, p=n.s.; CFI=.998; TLI=.978). All paths were significant (p’s < .001).

Conclusions and Implications: Taken together, the results suggest that a variety of factors contribute to the maintenance of alcohol problems and psychiatric distress in impaired drivers. Additionally, these findings bolster reports that suggest that impaired driving is precipitated by a constellation of problems in one’s life. Consequently, treatment programs may be more effective if they focus on psychiatric distress as well as alcohol problems.

Efforts to reform treatment paradigms may be more successful if policy makers understand the harmful effects of childhood trauma. Social workers may be especially well-positioned to agitate for such changes, given their systems view of problems.

Finally, these findings suggest that impaired drivers are analogous to other substance abusing populations who experience childhood trauma. It precipitates challenges experienced throughout the life course. Our research extends this literature by suggesting that self-esteem is an important mediator in the pathway between childhood trauma and adult mental health problems.