The Mississippi Alcohol Safety Education Program (MASEP) is Mississippi’s highway safety education program for first offenders convicted or undergoing the non-adjudication process for driving under the influence (DUI) of alcohol or another drug that has impaired the individual’s ability to operate a motor vehicle [MS Code, Section 63-11-32(1)]. MASEP is administered through the Social Science Research Center (SSRC) at Mississippi State University. As of January 2017, MASEP operates 54 schools in 43 locations throughout the state. Each school conducts up to 10 classes a year depending upon enrollment needs at that location. The Mississippi Implied Consent Law requires the court to order first offenders and those undergoing the non-adjudication process to attend and successfully complete MASEP. DUI offenders are not eligible for driver’s license reinstatement until MASEP is completed [MS Code, Section 63-11-30(2)(a)].
History of MASEP: Development of the 1989 Edition
The original MASEP curriculum was developed in 1972 when most first-time DUI offenders were thought to be social drinkers who simply needed additional knowledge that would allow them to separate their drinking and driving behaviors. By the mid-1980’s, this conception of the DUI offender had been proven to be incorrect. Between 1975 and 1981 the SSRC conducted the Mississippi DUI Probation Follow-Up Project which examined over 5,000 DUI offenders. Results from this study indicated that over 57% of these offenders were classified as problem drinkers and that there was essentially no difference in recidivism rates of offenders assigned to MASEP and those assigned to a no-treatment control group (Landrum et al., 1982). Additional research demonstrated that lecture-oriented DUI schools were not effective in reducing DUI re-arrest rates and that there was great variation within the DUI population with regard to demographic characteristics, psychological characteristics, and drinking behaviors (Landrum et al., 1982; Donovan and Marlatt, 1982; Kunkel, 1983; Mann et al., 1983; Snow and Wells-Parker, 1986; Snow and Landrum, 1986; Miller and Hester, 1986). A review of DUI intervention studies concluded that “…the great majority of DUI offenders are not social drinkers but have deviant drinking behaviors” (Kunkel, 1983).
It became increasingly clear that the MASEP program needed to incorporate new strategies for dealing with the drinking drivers. The MASEP Program Development Project, funded by the Mississippi Governor’s Highway Safety Program in March 1987, addressed three major objectives: (1) to revise the MASEP curriculum and program format to reflect the most up-to-date knowledge and theory available with regard to first-offender DUI education and rehabilitation programs; (2) to develop a procedure to assess the drinking problems, driving problems, and other life problems experienced by MASEP participants; and (3) to develop a directory of treatment services to inform MASEP participants of the services that are available in their local areas.
The initial draft of the curriculum was pilot tested in several school sites during the fall of 1988. Training of the MASEP instructional staff on the utilization of the new curriculum and program format was conducted by the end of 1988 and the new curriculum was implemented statewide on January 2, 1989.
The 2000 Edition of MASEP
Further revisions to the MASEP curriculum were made based on ongoing research by the SSRC scientists between 1989 and 2000 (e.g., Wells-Parker et al., 1995). Research on the characteristics of DUI offenders who attend MASEP (Snow, 1996a), recidivism among MASEP participants (Snow, 1996b), and the effectiveness of procedures used by MASEP to identify offenders at high risk of recidivism (Anderson, Snow, and Wells-Parker, 2000) suggested the need for further changes in the curriculum.
The 2000 edition of the MASEP facilitators’ manual differed from the previous edition in several ways. The length of each session was expanded from 2½ to 3 hours, thereby extending the total length of the program from 10 to 12 hours. Group interaction techniques were used to process and reinforce awareness of how alcohol and other drugs were affecting their lives. Activities involving group discussions included more open-ended questions and discussion leaders were provided with probing questions to stimulate dialogue among participants. Homework assignments designed to help participants examine the effects of alcohol and/or other drugs on all aspects of their lives were added. Participants were also given resource materials on subjects such as the long-term health problems associated with heavy drinking and alcoholism. An assessment feedback activity was added to Session III that provided information on problem alcohol use and risk of future DUI behavior. Participants also completed the Alcohol Use Disorders Identification Test (AUDIT) to provide an additional measure of harmful alcohol use. More emphasis was placed on the development of a DUI avoidance plan. Finally, many of the revisions to the curriculum, such as individualized feedback, were designed to be consistent with Motivational Enhancement Therapy (MET; Miller et al., 1992).
The 2005 Edition of MASEP
In 2002, the Mississippi Office of Highway Safety funded a project entitled: Improving the Effectiveness of Screening Procedures Used to Identify High Risk DUI Offenders in Mississippi (Snow, 2002). Data from this and other projects (Snow, 1996b; and Anderson, Snow, and Wells- Parker, 2000) were used to identify the strongest predictors of DUI recidivism among Mississippi DUI offenders. Results of these analyses provided the basis for the construction of a new procedure to predict risk of being rearrested for DUI. Using Blood Alcohol Concentration (BAC) at the time of arrest and data collected on the MASEP Registration/Intake Form during Session I, MASEP participants were provided with more information on their likelihood of being rearrested and their likelihood of having a drinking problem during Session III. This enhanced feedback procedure is the primary difference between the 2005 edition and previous editions.
The 2005 curriculum borrowed heavily from the Weekend Intervention Program (Siegal, 1985) and from Motivational Enhancement Therapy (Miller and Rollnick, 1991: Miller et al., 1992). Since the 2000 curriculum edition, research has shown the effectiveness of the motivational style in promoting behavioral change (Miller and Rollnick, 2002). In 2005, MASEP facilitators were trained in Motivational Interviewing strategies (Miller and Rollnick, 2002) that could be used with the 2000/2005 editions of the curriculum. Dr. Patricia Dill and Dr. Delwyn Catley (a certified trainer and researcher of Motivational Interviewing) developed a two day training workshop. Designed on the “train-the-trainer” model, six “master” facilitators were trained in this method. Training modules and handouts to supplement the 2000/2005 curriculum edition were developed to train all facilitators. During 2005 and 2006, master trainers conducted several regional meetings and one annual meeting to train all of the facilitators to use motivational strategies as they presented the curriculum to participants. Facilitators were instructed to incorporate several motivational additions to the dialogue with participants in three of the activities in the 2000/2005 model and were encouraged to use the motivational strategies elsewhere in the manual.
The 2008 Edition of MASEP
Research has shown that DUI recidivism is much higher among offenders who have drinking or drug problems than among those who do not. In 2007, a new assessment instrument was developed to better assess alcohol and other drug (AOD) use and related problems. The assessment was also designed to provide MASEP participants with more detailed feedback than has previously been provided. The new assessment contains the following validated measures: (1) Alcohol Use Disorders Identification Test (AUDIT) (Babor et al., 2001), (2) Research Institute on Addictions Self-Inventory (RIASI) (Nochajski and Wieczorek, 1998), (3) Short Inventory of Alcohol and Other Drug Consequences (InDUC) (Miller, Tonigan and Longabaugh, 1995), and the Center for Epidemiological Studies-Depression Scale (CES-D 10-item) (Andersen, Carter, Malmgren, & Patrick, 1994). In addition, there are measures that assess the frequency and amounts of alcohol consumption, binge drinking, other drug use and levels of psychiatric distress (including anxiety and other negative moods).
A pilot study on the feasibility of the new assessment was conducted September-November 2007 and findings were compared with those from the previous assessment instrument used in 2000/2005 editions of the program. The previous assessment used the Mortimer Filkins Questionnaire (MFQ) (Mortimer et al., 1971a; Mortimer et al., 1971b), a validated instrument that assesses problem use of alcohol (Anderson et al., 2000). The results of the pilot study showed that participants were able to understand and complete the new assessment instrument. In addition, the pilot study also demonstrated that the total RIASI score and the total Mortimer-Filkins score was strongly correlated (r=.557, p < .001). Measures from the RIASI could be used to predict DUI recidivism. Results from the pilot testing of the new assessment were used to improve the feedback process and to guide curriculum changes with the goal of motivating DUI offenders who have drinking and/or other drug problems to seek treatment.
Besides the need to improve the feedback process, changes in the MASEP populations over the past ten years and changing trends in society’s substance use preferences necessitated revisions to the MASEP program. In January 2008, the Mississippi Office of Highway Safety funded a project entitled MASEP Curriculum Revision. The 2000/2005 curriculum used video materials, in-class exercises, and homework assignments to encourage the participants to systematically examine every important aspect of their lives and to consider how the use of alcohol and other drugs negatively impacted various life domains. Many of the activities from the 2000/2005 program were retained, but some were modified to reflect the changing characteristics and needs of the Mississippi DUI population. First, to address the increase in non-English speaking Hispanic participants, Spanish-language materials from the curriculum were developed. Second, to address the increase in female MASEP participants, gender specific information for alcohol use, alcohol effects, and health outcomes was incorporated. Third, new program content was developed to address the use of marijuana and other drugs by MASEP participants. Fourth, to address the trend of increasing levels of psychological distress among program participants, a measure of depression was added to the assessment instrument, and feedback on psychological distress and the need for mental health services is now provided.
Because low literacy has long been a problem, cartoon and other pictorial content were added to illustrate important concepts for participants who cannot read English or Spanish well. Most importantly, revisions to the MASEP program were based on recommendations from the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2008) and the Center for Substance Abuse Treatment (CSAT, 1999). Evidence-based substance abuse intervention practices (e.g., motivational components, movement through stages of change, reliable assessment of alcohol and drug problems, treatment recommendations and referrals as indicated by assessment) were adapted to fit the needs of the MASEP participants.
The theoretical basis of the 2008 curriculum is complementary to the 2000/2005 edition and is derived from theoretical concepts of change: (1) the IMB Model (Fisher, Fisher, and Harman, 2003), (2) Enhancing Motivation to Change (Miller and Rollnick, 2002), and (3) Transtheoretical Model of Change (Prochaska and Velicer, 1997).
The basic assumption of the IMB model is that when individuals are well informed, motivated to act, and have the behavioral skills necessary to enact change, they will change their behavior (Fisher, Fisher, and Harman, 2003). Although the information on the harmful effects of alcohol on health and driving ability has always been a part of the MASEP program, the 2008 curriculum adds information on the effects of other drugs on driving, as well as interactions with alcohol and/or other drugs on health and driving ability. Specifically, participants are informed about prescription painkillers, prescription sedatives, marijuana, cocaine, amphetamines/methamphetamine and MDMA/Ecstasy.
A new focus of the 2008 curriculum revision is that of teaching behavioral skills. The 2000 and 2005 editions emphasized the writing of a personal DUI Avoidance Plan. Many participants produced simplistic and unrealistic DUI Avoidance Plans. In order to improve MASEP participants’ ability to produce realistic DUI Avoidance Plans, participants will be taught problem solving and critical thinking skills so that they can create and evaluate a personal plan to prevent impaired driving. These skills can also be generalized to address other problems identified by participants.
Motivation is a key component of the IMB model and integral to theories of behavioral change. Enhancing motivation to change (Miller and Rollnick, 2002), as implemented in the 2008 curriculum, requires three key elements: (1) decrease participant resistance, (2) increase participant discussion of change, and (3) increase participant self-confidence that he or she can make the desired behavioral change (for the end result of no drinking/drug use and driving episodes). The changes in facilitator directions, added activities, and homework assignments incorporated motivational elements to prepare participants for change.
The Transtheoretical Model of Change (Prochaska and Velicer, 1997) asserts that there are five stages of change and that specific intervention or treatment strategies need to be matched to the stage of change that an individual is in. The 2008 curriculum teaches participants the stages of change. Participants assess the pros and cons of change, the importance of change, their level of confidence in their ability to change, and the social support for change that is available to them. Participants are also given information and advice on the change process.
The goal of MASEP has always been to reduce DUI recidivism by first-time DUI offenders in Mississippi and thereby enhance traffic safety. Revisions to the MASEP assessment process and to curriculum content were made with this goal in mind. Additionally, changes made to the curriculum were founded on the latest evidence-based practices for motivating alcohol and/or other drug abusers to change their substance use and driving behaviors.
The 2013 Edition of MASEP
An Advisory Committee was formed in 2012 to provide recommendations for facilitator training, improving the curriculum, and addressing operational issues. Fifteen MASEP Facilitators and Assistant Facilitators, representing all regions of the state, were selected based on their years of experience and their expressed interest in serving on the committee. Two issues regarding the curriculum were raised at the first meeting of Advisory Committee that ultimately led to program changes.
The first concern raised involved the presentation on the Stages of Change. The concepts and strategies of the Stages of Change model are based on the Transtheoretical Model of Change (Prochaska and Velicer, 1997) and the self-help book Changing for Good, a Revolutionary Six- Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward (Prochaska, Norcross, & DiClemente, 1994). Facilitators asserted that the 50-minute presentation delivered during the fourth and final session of the program was too didactic and not interactive enough, tried to convey too much information given the time constraints, and the terminology was difficult for low-educated, low-literacy participants to comprehend. Several of the Facilitators expressed frustration in their inability to facilitate understanding of the change process. Diane Allen and other Advisory Committee members offered suggestions for alternative ways of presenting the information, including graphical representations of the stages of change. Based on the input from the Advisory Committee, the material is now spread across three sessions. An introduction to the Stages of Changes with a focus on the Precontemplative and Contemplatives stages is presented in Session 2. The Preparation and Action stages are covered in Session 3, along with an explanation of the concept of triggers for relapse. The Maintenance stage and Relapse Prevention are presented in Session 4. A new measure of Readiness to Change was developed and is administered in Session 2. New homework assignments and in-class activities were also developed.
The other issue raised by the Advisory Committee involved the Research Institute on Addictions Self-Inventory (RIASI). The RIASI was added to the assessment measures in 2008. We selected the RIASI to replace the Mortimer-Filkins Questionnaire (Mortimer et al., 1971) because the RIASI was developed specifically for the assessment of problem drinking and DUI recidivism among DUI offenders. Furthermore, the RIASI is used by several impaired driving intervention programs in the United States and Canada. We adopted the cut scores as recommended in the RISAI Manual (Nochajski, 2006) for problem drinking and recidivism risk, which were determined based on research conducted on participants of the New York State Drinking Driving Programs. Studies of the psychometric properties and predictive validity of the RIASI with Mississippi DUI offenders by MASEP Research and Development found that other assessment measures performed equally or better than the RIASI in identifying alcohol problems, and that the RIASI recidivism subscale did not predict recidivists. Several new measures were pilot tested in February and March 2013, and the results were used to design a new assessment form and personalized feedback reports. The changes to the assessment form and feedback process necessitated revisions to Sessions 1 and 3 of manual.
The 2017 Edition of MASEP
Curriculum revisions for the 2017 Edition of MASEP were informed by facilitator responses to a questionnaire administered during the 2016 annual training. Facilitators were asked to rate the helpfulness of program components and make recommendations for program improvement. Input on proposed changes to the curriculum was also sought from the Advisory Committee. A number of concerns were voiced that led to program revisions.
First, facilitators noted that the concept of triggers for substance misuse (e.g., people, places, emotions) were covered multiple times. They expressed that this material was redundant and not a good use of valuable class time. Based upon this feedback, the triggers sections has been reconfigured to be more concise and impactful. A discussion of personal triggers is presented in Session 3, along with homework. The exercise is more straightforward than before, only inquiring about participants’ basic triggers falling under 4 broad categories. Triggers are again briefly discussed in Session 4 as they are directly related to relapse and relapse prevention.
The facilitators also reported concerns regarding the Feelings Chart and Stages of Change. Facilitators generally noted that the Feelings Chart was not presented in a way that participants easily understand due to the nature of the bar graph being too scientific and technical. Images of emoticons were added to the graph to depict the emotion corresponding with each peak and valley displayed on the graph. The Stages of Change were rated low by facilitators who remarked that the terminology and concepts continue to be problematic for participants with lower literacy. As a result, the Stages of Change are presented with simple phrases to describe each phase. In addition, graphical representations have been added to depict each stage for enhanced understanding. The Stages of Change have been linked with activities and homework in each session which follows along with the stages learned in each session.
Participant feedback reports in Session 3 is another area which was rated low by facilitators. Facilitators shared that the existing feedback was too difficult for them to understand in order to adequately relay the information to participants. Participant feedback was ultimately altered based on our own research regarding predictors and risks of recidivism. The feedback was also updated to reflect the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) revised diagnostic criteria for Substance Use Disorders (SUD). The feedback portion of Session 3 includes an activity in which participants can track their risk of having an Alcohol Use Disorder. In the first session when the assessment is completed, participants may not be honest about their alcohol and drug use due to unfamiliarity with other classmates, the facilitators, and the program. Participants can compare the results of the diagnostic criteria activity in Session 3 to their feedback on the number of diagnostic criteria met based on the assessment from Session 1.
The content on alcohol and other drug use (AOD) and health was moved from Session 4 to Session 2. Both the IMB model and Transtheoretical models of behavioral change assert that enhanced information and motivation lead to behavioral changes (Fisher, Fisher, and Harman, 2003, Prochaska and Velicer, 1997). Including information on long-term health effects of alcohol and other drugs sooner in the program is intended to increase participants’ motivation to make changes in their lives. Information on illegal drugs including cocaine, amphetamines/methamphetamines, and MDMA/ecstasy has been removed from the curriculum because studies of participants’ substance use on the day of arrest and in the 30 days prior to program enrollment showing that few participants (less than 3%) admit to using these drugs. The AOD and Health activity focuses on substances used by either the majority of participants (i.e., alcohol), and a substantial proportion of participants (i.e., marijuana, and prescription painkillers and sedatives). The revisions to the informational session also focuses on health effects of mixing alcohol with other drugs as well as the effects of alcohol and drugs on driving ability.
Session 4 has been updated to include activities on coping and life stressors to raise participant awareness about their own lives. These activities encourage participants to think critically about how alcohol and drugs are negatively impacting their lives and ways they are harmfully involved with alcohol and drugs. In addition, information and insight gained from the coping and life stressors activity provide additional resources for participants to draw upon to create quality DUI Avoidance Plans and more successfully avoid relapse to heavy drinking/drug use.