Table 1 presents data on sample demographic characteristics. The sample consists of 22,298 individuals who completed all components of the BOT by March 31, 2005. The clients completed their assessments beginning November 1, 1999. The majority of clients (about 96%) completed the follow-up within seven months of participating in their assigned 8-hour education or 16-hour treatment program. The sample was predominantly male (88%), average age 46 years, average 13 years of education, modal income $20,000–$49,999, 44.4% married and 35.8% single, and 72.1% employed. The mean scores on the RIASI-T, RIASI-R, ADS and DAST were 6.8, 3.3, 1.8, and 0.3 respectively. One quarter (25.8%) reported that they had a previous DWI offence. A total of 16,450 (73.8%) were assigned to the education program and 5,848 (26.2%) to the treatment program.

RIASI items loading on factors are shown in the Appendix. The proportion of variance explained by each factor corresponds to the eigenvalue and equals the sum of the squares of the factor loadings. The first component had the highest eigenvalue (5.70). The aim is to account for the maximum amount of variance with the smallest number of components. An 8-factor solution explained 31% of the total variance. The 8-factor solution retained showed substantial correspondence with the conceptually-defined items originally included by Nochajski et al. [19] (see Figure 1). The first factor included five items reflecting depressed mood, three reflecting anxiety, two reflecting hostility, and one reflecting sensation seeking. Since this factor seemed to reflect negative affect more generally, rather than depressed mood specifically, it was labeled Negative Affect. The second factor extracted loaded highly on items reflecting seeking or undertaking risky things for fun, or tendencies towards more impulsive behavior, therefore, labeled Sensation Seeking. The third factor items mainly reflected higher quantities of alcohol consumed on drinking occasions (largest number of drinks consumed in a 24-hour period, how many drinks usually consumed on a drinking occasion), other indicators of heavier drinking (more drinking days per week, money spent on alcohol per week), and one item suggesting higher tolerance for alcohol (how many drinks before feeling the effects). This factor was labeled Alcohol-Quantity. The fourth factor had four items; three came from a pilot lie scale [19], which identified behaviors that reflect a response pattern of endorsing the socially desirable response, even though it would be an unlikely response. For example, item 51 states, ‘I sometimes feel resentful when I don’t get my way.’ A response of ‘no’ on this item is considered to reflect a desire to provide a socially appropriate response, as opposed to an honest or accurate response. One item that was originally included to reflect hostility also loaded on this factor. This factor was labeled Social Conformity. The fifth factor items reflected criminal activities, high risk driving, and a history of being injured, which reflect a willingness to take risks or disregard societal rules, therefore labeled High Risk Lifestyle. The sixth factor labeled Alcohol Problems included items on symptoms of alcohol dependence or loss of control (e.g., I hardly ever drink more than I plan to), and acute and chronic consequences of excessive drinking (e.g., I was referred for a liver test, or a blood test for liver enzymes), and one item reflecting depression, which is often associated with excessive drinking. Higher scores on this factor reflected lower alcohol problem levels. The seventh factor labeled Interpersonal Competence appeared to reflect willingness and ability to act based on one’s own judgment. Items in this factor suggested assertiveness, internal locus of control, and an assertive attitude. The eighth factor extracted included items that reflected alcohol-related problems in family members, and was therefore labeled Family History. As with the Alcohol Problems factor, higher scores on the Family History factor reflected lower likelihood of being positive on family history measures.

Table 2 presents data on the association between the RIASI factors and measures of alcohol use and problems for the 90 days preceding the assessment. The Negative Affect, Alcohol-Quantity, Social Conformity, High Risk Lifestyle, and Alcohol Problems factors were associated with more days of drinking alcohol and more drinks per drinking occasion. Higher levels of Sensation Seeking and Family History were associated with more drinks per drinking occasion. Higher scores on the Interpersonal Competence factor predicted significantly fewer days using alcohol, as well as fewer drinks per occasion.

Higher levels of Negative Affect, Alcohol-Quantity, Social Conformity, High Risk Lifestyle, Alcohol Problems and Family History factors were associated with more DWI charges and convictions, and higher scores on the ADS and DAST. Higher levels of Sensation Seeking were found to be positively associated with the ADS and DAST, but associated with fewer previous DWI convictions. A higher score on the Interpersonal Competence factor was associated with fewer DWI charges and convictions, and lower scores on the ADS and DAST.

Table 3 presents data on the associations between the RIASI factors and measures obtained for the 90 days preceding the follow-up interview. Higher levels of Negative Affect are associated with significantly fewer drinking days at follow-up but not related to number of drinks per occasion. The Sensation Seeking factor was associated with significantly fewer drinking days but also was associated with more drinks per occasion. Higher scores on Alcohol-Quantity and on Social Conformity predicted more days using alcohol and more drinks per drinking occasion. Higher scores on the High Risk Lifestyle factor predicted more drinks per drinking occasion. More Alcohol Problems predicted fewer days using alcohol, while a greater Family History involvement predicted more drinks per drinking occasion. Finally, higher scores on the Social Competence factor predicted fewer drinks per drinking occasion.

The relationships between the RIASI factors and consequences of substance use from the follow-up ACSUS [25] are also presented in Table 3. Higher levels of Negative Affect and more Alcohol Problems predicted more adverse consequences in every area: health, memory, mood, relationships, aggression, school or work, legal and financial. Similar consistent relationships with all consequence measures except for school/work problems were observed for the Alcohol-Quantity factor. The Sensation Seeking factor was negatively related to school /work problems, indicating that higher scores on this factor were associated with fewer problems in this domain, but higher scores in all others.

The Social Conformity factors showed no significant relationship with memory, aggression, school/work, legal and financial problems, but a significant positive relationship with all others. More Family History of alcohol-related problems showed no significant association with relationship, aggression, and school/work problems, but it showed a significant association with all other problems. Finally, higher scores on the Interpersonal Competence factor predicted significantly fewer adverse consequences in all domains, with the exception of school or work problems.

Table 4 presents the associations between the RIASI factors and use of health services in the follow-up period. Higher levels of the Negative Affect factor predicted more use of all types of health services except for self-help programs for other than alcohol or drug problems. More Alcohol Problems similarly predicted higher use of all services. Higher levels of Sensation Seeking predicted more contact with Employee Assistance programs and self-help meetings for alcohol/drug problems. Higher scores on the Alcohol-Quantity factor predicted more contacts with drug/alcohol treatment facilities, Employee Assistance programs, private physicians, and self-help meetings for alcohol or drug problems. Respondents with higher Social Conformity scale scores had more contacts with drug/alcohol treatment facilities, outpatient mental health facilities, and self-help meetings for alcohol or drug problems. Higher scores on the High Risk Lifestyle factor predicted more contacts with self help programs for alcohol or drug problems. Greater Family History of alcohol problems was related to more contacts with drug/alcohol treatment facilities, self help for alcohol/drug problems and self-help for other problems. Higher scores on High Risk Lifestyle and lower scores on the Interpersonal Competence factors predicted more contacts with drug/alcohol treatment and self-help meetings for alcohol/drug problems. Scores on the Sensation Seeking factor were unrelated to any measures of service use at follow-up.

The observations on the Negative Affect factor are consistent with a growing body of literature on the importance of negative affect for understanding drinking drivers (e.g., [29]), and recently investigators have begun to consider the importance of this factor for remedial and rehabilitative efforts [28–31]. It is interesting to note here that this factor included items reflecting depressed mood, but also other states including anxiety, hostility and sensation seeking. Thus, we chose to describe this factor as Negative Affect, rather than depression, to reflect a more general negative state. Since the psychometric properties of instruments measuring depression are also complex [32], it would be interesting to determine how this state corresponded to more clinically-defined depression. One possibility is that Negative Affect observed here is importantly related to these individuals’ recent experiences with the legal system and with the social, economic and personal consequences of that experience. Thus the implications of this Negative Affect state may be different than the implications of clinical depression. Certainly the observation that higher levels of this state reflected more alcohol use prior to program entry, and less alcohol use at follow-up, suggests that this state should not be interpreted simply as in indicator of more serious problems and worse outcome. One interesting possibility is that because the main purpose of the BOT program is to reduce driving after drinking, elevated levels of the Negative Affect factor reflected a motivational state that somehow was conducive to achieving the specific goals of the program [29]. These results may be consistent with those of Wells-Parker and Williams [14], who observed that individuals high on the depression subscale of the Mortimer-Filkins measure were also more responsive to brief individual interventions to a program for convicted drinking drivers. Additionally, it appeared that higher levels of the Negative Affect factor also predicted more utilization of addictions and health care services at follow-up, which also might suggest that these individuals were more motivated to take additional steps to deal with personal problems. The results of this work provide important support for the potential value of understanding negative affect and its implications for convicted drinking drivers [29], and also points to the potential value of using subscores of the RIASI for program assignment purposes.

Sensation seeking as a concept [33] involves a propensity to seek novel and intense sensations and experiences, including a willingness to take risks to attain those experiences. Sensation seeking is reflective of higher likelihood for risky driving, including impaired driving [34,35]. Higher levels of sensation seeking are associated with poorer outcomes in alcohol and drug treatment, including reduced likelihood of treatment completion [36]. At assessment, the Sensation Seeking factor showed an interesting pattern of associations with use of the various substances. The relationship with alcohol use measures was complex, with Sensation Seeking being associated with fewer drinking days, but more drinks per occasion. A strong pattern of association with consequences of alcohol use was seen. Sensation Seeking was positively associated with all the adverse consequences of substance use, with the exception of a negative relationship with school and work problems. Interestingly, Sensation Seeking predicted higher scores on the ADS and DAST, but fewer previous drinking driving charges or convictions. Individuals who scored higher on Sensation Seeking were less likely to report use of alcohol at follow-up. Interestingly, these relationships did not translate into increased health care utilization. This could reflect a tendency for individuals with higher levels of Sensation Seeking to avoid health care services.

Consistent with previous studies [10], we observed that higher scores on the Alcohol-Quantity factor predicted more use of alcohol, heavier drinking, and more DWI arrests and convictions at assessment and more adverse consequences of substance use and greater use of health services at follow-up. This suggests that elevated scores on the Alcohol-Quantity factor is a clear indicator of more problems at both assessment and follow-up. A large number of studies attest to the importance of quantity of alcohol consumed on a drinking occasion or over the course of a period of time, such as a day, week or month, as a major determinant of the risk of drinking driving, collisions, and other harms [37–39]. The Alcohol-Quantity factor appeared to be one of the most robust correlates and predictors of alcohol use, problems and negative outcomes among the factors derived. In view of the drinking driver population considered here, it may not be surprising that the Alcohol-Quantity factor appears to figure prominently as a problem indicator in these analyses.

Three of the four items that constitute the Social Conformity scale were originally included on the RIASI by Nochajski et al. [19] in an effort to measure purposeful efforts to distort results. The scores on the Social Conformity scale, in general, showed similar significant associations with the measures obtained at assessment, and with the measures obtained at follow-up, to most of the other scales. Higher levels of Social Conformity were significantly related to more drinks per drinking day, more days using alcohol, more previous DWI charges and convictions, and higher scores on the ADS and DAST at assessment. At follow-up, higher scores were associated with more use of alcohol, higher levels of negative consequences except for school/work problems, and more involvement with most health services. These results do indicate that scores on the Social Conformity scale are associated with and can predict alcohol and substance use and problems, even though their content is unrelated to these measures. This finding does validate the potential usefulness of this measure as an indicator of problems. However, additional work is needed to determine the particular value of this measure as a problem indicator when other factor scores are suggesting lower problem levels.

The High Risk Lifestyle factor consists of items reflecting commission of various crimes and experience of injury. These items are also related to the presence of Anti-Social Personality Disorder (ASPD), a condition which has been found to be more common in groups of convicted drinking drivers [31]. Previous studies have shown that individuals who have more criminal involvement, or are diagnosed with ASPD at assessment, also have higher levels of alcohol use and other problem indicators [10,40]. Our results are consistent with these previous findings. We observed that higher scores on this factor predicted more drinks per drinking day, more adverse consequences of substance use, and more contacts with most forms of health services at follow-up. Thus, higher scores on this factor appear to predict increased risk of adverse outcomes in this population.

The Alcohol Problems factor reflects health and social consequences of drinking and a drinking style suggesting loss of control. Experience of problems in association with loss of control over drinking are two major defining characteristics of alcohol dependence, and thus this scale may be reflecting this. Alcohol dependence is considered to be a more serious and advanced form of problem, and includes the development of health-related problems such as alcohol-related liver disease [38]. The Alcohol Problems factor was associated with more days of drinking and more drinks per drinking day, more DWI charges and convictions, and higher scores on the ADS and DAST at assessment. At follow-up, more Alcohol Problems were associated with higher levels of all adverse consequences, and more contacts with all health services. These findings are consistent with this factor being a strong indicator of increased problems and risk. On the other hand, higher scores on this factor were associated with fewer days of alcohol use, but were not predictive of number of drinks per occasion at follow-up. This pattern is the same as that observed for the Negative Affect factor, and at first glance seems counter-intuitive. However, these results may also be suggesting that high scores on this factor could reflect the individual’s recognition of their own alcohol problems, and possibly indicates a desire to address these problems. Thus, scores on this factor reflecting more alcohol problems could be reflecting both a need and a desire for more help in dealing with these alcohol problems. In interpreting this factor it is important to keep in mind that high scores on the factor reflect lower problem levels, and thus it may be worth considering reverse-scoring this factor in any practical applications.

The Interpersonal Competence factor included items that reflect self-confidence, assertiveness, and a perceived ability to make and follow plans. Higher scores on this factor were associated with fewer days of alcohol use, fewer drinks per occasion, fewer previous DWI charges and convictions and lower ADS and DAST scores at assessment. Higher scores predicted better outcomes at follow-up, including lower levels of alcohol, fewer adverse consequences of use, and fewer contacts with addiction treatment and self-help resources. Thus, this factor appears to have important value as a positive prognostic indicator. Previous studies have demonstrated the importance of concepts and factors that are related to the Interpersonal Competence factor identified here, including self-efficacy, self-confidence and assertiveness. These factors have been linked, in the context of addictions, to more positive outcomes and better responsiveness to treatment interventions [29,31,41]. The results observed here with the Interpersonal Competence factor confirm these observations and also support the validity of this factor as differentiated from other factors seen in the RIASI.

Individuals with a family history of alcohol problems are themselves more likely to develop alcohol problems, to develop them at a younger age, and be more likely to experience emotional problems, hyperactivity, and conduct problems [42]. These risks may be related to both environmental influences and to genetic factors [43,44]. The association between the Family History factor and measures obtained at assessment confirmed expectations that individuals with a family history of alcohol problems would demonstrate more drinks per occasion (but interestingly, not with number of drinking days), more DWI charges and convictions, and higher scores on the ADS and DAST. More extensive family involvement with alcohol also predicted more problems at follow-up, including more drinks per occasion, more negative consequences (with the exception of problems with relationships, aggression and with school/work), and more contacts with addictions services and self-help groups. This is consistent with a large body of research (e.g., [42,43]), and points to the validity of this factor in the RIASI and its potential utility as a marker for adverse outcomes. As with the Alcohol Problems factor, it is important to keep in mind that high scores reflect lower family involvement in alcohol problems, and that reverse scoring might be considered in any practical applications of this analysis.

Several limitations must be kept in mind when considering these results. One limitation of these results is that they are based on self-report measures which may be subject to a variety of factors that may affect their validity. Additionally, while participants are not required to attend BOT by courts, attendance is necessary if they want their driver’s license reinstated. Thus, there may be demand characteristics in the program that may act to influence participants’ self-reports. The available evidence indicates that self-report measures of alcohol and drug use are generally reliably and valid (e.g., [45,46]). Nevertheless, under-reporting of drug use and previous legal problems in this population has been noted in the literature [47]. An additional limitation of these results is that they may be specific to the time period covered in this research, or may have been affected by factors that occurred during the time when these data were collected, although we are not aware of any policy changes or similar factors that would have affected the nature of the convicted drinking driver population over this period. Thus, while of substantial interest, these results need to be replicated and extended in further research.

Another limitation of these observations is that they do not consider relationships of the factor scores with traffic safety consequences, a key concern underlying the creation of remedial programs, and a key goal of programs for participants is to reduce drinking driving recidivism and collisions. However, it is clear that a necessary precursor to impaired driving is excessive alcohol use, and thus the measures considered here are of substantial importance to understanding how to prevent impaired driving. Nevertheless, it will be important to examine the traffic safety correlates of RIASI factor scores in future studies.