DUI offenders and CARS – Justice Speaks Podcast

In this episode, JSI Co-Founder David Wallace speaks with Erin Holmes of the Foundation for Advancing Alcohol Responsibility (FAAR).  Ms. Holmes is the Director of Traffic Safety Programs at FAAR. In our conversation, we discuss the Computerized Assessment and Referral System (CARS). CARS is a screening and assessment tool designed to help identify DUI (Driving Under the Influence) offenders who have both a substance use disorder and a mental health disorder.

Over the years, there have been significant advances in reducing impaired driving.  However, there is still a significant percentage of individuals who continue to repeat this deadly crime by drinking too much and then driving.  Unfortunately we have not addressed the underlying issues that push them to continue committing a DUI. One of the problems has been that many of the assessment tools were not validated with a DUI offender population; others  do not screen for mental health issues beyond an alcohol use disorder.  When such a person was evaluated, that tool would indicate the person is not a high risk offender since they usually had a job, family support of some sort and the person “just” had an alcohol disorder.  However, research has found that 45% of repeat impaired drivers have a major mental health disorder in addition to a substance use disorder.  This is known as a co-occurring disorder. Co-occurring disorders can be difficult to diagnose as the symptoms can be complex and the severity of the disorders can vary.  A tool was needed that evaluated for both.  CARS is that tool.

What is CARS?

Developed by a team of researchers from Cambridge Health Alliance, a teaching affiliate of Harvard Medical School and with initial grant funding from NIAAA and continued funding from FAAR, CARS is designed to:

• Ask about signs and symptoms of mental health issues both within the past year and/or a lifetime.
• Identify specific mental health and substance use disorders for which a client is at risk.
• Generate a report that informs the user about a client’s treatment needs and provides appropriate referrals.

The CARS tool is a completely electronic assessment tool that is available as free open source software.  There are three versions of CARS that can be used:

• Full Assessment
• Screener
• Self-Administered Screener

Once an assessment is completed, it  generates an individual diagnostic report that provides information about the mental health disorder for which the person qualifies or is at risk as well as a summary of bio-psycho-social risk factors.   Additionally a graphic is generated as part of the outcomes report that indicates where an individual is within a range of low to very high risk.

Finally, CARS can provide a list of individually targeted referrals at the end of each report based on the person’s issues and zip code.  (The referral list must be populated with treatment services that are available within the jurisdiction before CARS can be implemented.)

Implementation

The first implementation for CARS was as a randomized control trial done in two Massachusetts DUI programs.  That effort resulted in the development of the screening tool.  Since then, CARS was implemented in six pilot sites around the country and finally it was officially launched in June of 2017.  It is now available to any court, probation department, or program free of cost. 

Currently there is only an English version available; however, a Spanish version of CARS is being developed.  In addition, consideration is being given to developing a non-DUI specific version of CARS and to develop a web-based platform instead of utilizing software.  There is also an effort to partner with the Emergency Medicine Foundation to pilot CARS in several emergency departments/systems throughout the country.

Benefits of CARS

According to Ms. Holmes, the benefits of CARS are that it provides immediate diagnostic information for up to 20 major psychiatric disorders with a user-friendly report at the click of a button. It helps inform supervision and treatment personnel with vital information on a person’s mental state, and it can provide individually targeted referrals to appropriate treatment services.

For More Information

For more information about CARS, to obtain training to use it, or to download the software to use the tool, go to: www.carstrainingcenter.org