Brief Report: Sex Differences in Substance Use, Mental Health, and Impaired Driving Among Rural DUI Offenders

Abstract

Background and Objectives:

Studies have documented sex differences among DUI offenders, but none have examined rural DUI offenders.

Methods:

Rural DUI offenders (83 male, 34 female) self-reported past year and lifetime substance use, mental health problems, and impaired driving history.

Results:

Substance use and impaired driving histories were similar, but significant disparities in mental health problems for female DUI offenders were found.

Conclusions and Scientific Significance:

This initial examination of sex differences among rural DUI offenders suggests additional research is needed to better understand their substance use and mental health problems and whether different treatment approaches are needed.

Introduction

Recent research has highlighted the increasing number of female drivers who are arrested for driving under the influence (DUI).¹ As a result, more studies have focused on understanding sex differences among DUI offenders to identify the unique characteristics and needs of female impaired drivers.² For example, female DUI offenders are more likely to use substances daily, ³ meet drug use disorder criteria,³ and have co-occurring mental health problems² compared to male DUI offenders.

Sex difference research, however, has largely ignored rural DUI offenders, which is important because increasing drug use and a higher prevalence of DUI have been found in rural communities.⁴ This omission is important given that the few existing studies of rural DUI offenders have suggested important differences between rural and urban offenders, including their substance use and problem severity. For example, in an examination of a statewide sample of female DUI offenders Webster and colleagues⁵ found that rurality was associated with being younger, having multiple DUI convictions, having a substance use disorder, and being less likely to be compliant with treatment requirements. Another study comparing first time and repeat rural DUI offenders concluded that there were fewer factors associated with recidivism than had previously been found in urban and national samples.⁶

Despite these studies showing differences between male and female DUI offenders and between rural and urban DUI offenders, a review of the literature failed to identify any studies focused specifically on sex differences among rural DUI offenders. Consequently, the current study examines sex differences in substance use, mental health, and impaired driving history in a sample of rural DUI offenders to determine the extent to which the sex differences in the existing literature extend to rural populations.

Method

Sample and Procedure

A purposive sample of 118 individuals convicted of driving under the influence was recruited from three rural counties in Kentucky. Study eligibility included (1) being at least 18 years old, (2) convicted of DUI within the past 12 months in one of the three counties, and (3) residing in the same county in which they were convicted. Ninety percent of participants were recruited from district court houses in person immediately following their DUI conviction, while the remaining 10% were recruited through flyers posted throughout the community. DUI conviction information was verified through court records for participants responding to flyers. Eligible and interested participants completed a one-time, 90-minute confidential research interview with a trained interviewer either in person (61%) or over the telephone (39%). Participants’ responses were protected by a federal Certificate of Confidentiality, and they received $25 for their participation. All study procedures were approved by the university Institutional Review Board.

Measures

Demographics.

Demographic information collected from participants included age, gender, race/ethnicity, level of education, and marital status.

Substance Use.

Sections of the Addiction Severity Index⁷ were used to collect participants’ substance use histories, including past year and lifetime use of alcohol, marijuana, powder and crack cocaine, amphetamines, methamphetamine, sedatives/tranquilizers, heroin, and prescription opioids. For the current study, an “any drug use” variable was also calculated for participants who reported using any of the aforementioned drugs in the past year or their lifetime. Participants’ injection drug use and substance use treatment histories were also recorded.

Mental Health.

The Addiction Severity Index was also used to assess mental health history. Participants reported on whether they had experienced significant periods (lasting at least 2 weeks) of depression, anxiety, or trouble remembering or concentrating in the past year or their lifetime. An “any mental health problem” variable was created for past year and lifetime based on whether participants reported having any of the three mental health problems assessed. Participants were also asked whether they had ever received mental health treatment.

Impaired Driving.

Participants self-reported their impaired driving histories, including age of first impaired driving episode, DUI arrest, and DUI conviction and their total number of lifetime DUI arrests and convictions. Participants also reported whether they had driven under the influence of alcohol, marijuana, powder and crack cocaine, amphetamines, methamphetamine, sedatives/tranquilizers, heroin, and prescription opioids during the past year or their lifetime. An “any drug” impaired driving variable was also created for past year and lifetime. Driving under the influence of drugs was recorded only for illicit, nonmedical drug use.

Analytic Plan

One participant was removed from the sample (N=117) due to missing data. Male (n=83) and female (n=34) DUI offenders were compared using a series of chi-square tests and t-tests to examine the differences in substance use, mental health, and impaired driving histories. Sex differences were considered statistically significant at p < 0.05.

Results

The majority of the sample was White (96.6%), male (70.9%), and had a high school education (70.9%). Participants had an average age of 35.1 years. Slightly more than half (52.1%) had a previous DUI conviction.

Sex differences in substance use included a higher percentage of females reporting past year illicit amphetamine (20.6% vs. 2.4%) and sedative (64.7% vs. 44.6%) use and a higher percentage of males reporting past year (81.9% vs. 70.6%) and lifetime (100.0% vs. 94.1%) alcohol use. Otherwise, the substance use profiles were similar (see Table 1). The analysis of mental health problems, on the other hand, revealed a more consistent pattern of sex differences. A significantly higher percentage of females reported experiencing past year and lifetime depression (67.6% vs. 39.5% and 82.4% vs. 58.0%, respectively) and anxiety (81.8% vs. 53.1% and 91.2% vs. 64.2%, respectively), as well as experiencing any mental health problem (91.2% vs. 69.1%) in their lifetime.

Table 1.

Past Year and Lifetime Substance Use, Mental Health, and Impaired Driving Among Male and Female Rural DUI Offenders (N=117)

	Past Year		Lifetime
	Male (n=83)	Female (n=34)	Male (n=83)	Female (n=34)
Substance Use (%)
Alcohol	81.9*	70.6	100.0*	94.1
Marijuana	45.8	41.2	83.1	79.4
Powder Cocaine	9.6	8.8	50.6	50.0
Crack Cocaine	6.0	5.9	28.9	35.3
Amphetamines	2.4***	20.6	19.3	32.4
Methamphetamine	2.4	5.9	16.9	17.6
Sedatives	44.6*	64.7	56.6	67.6
Heroin	1.2	0.0	6.0	5.9
Prescription opioids	42.2	45.5	56.6	61.8
Any Drug Misuse	69.9	79.4	90.4	88.2
Injection Drug Use	---	---	10.8	21.2
Substance Use Treatment	---	---	41.0	50.0
Mental Health (%)
Depression	39.5**	67.6	58.0*	82.4
Anxiety	53.1**	81.8	64.2**	91.2
Trouble Concentrating	32.1	41.2	35.8	48.5
Any Mental Health Problem	61.7	79.4	69.1*	91.2
Mental Health Treatment	---	---	38.3	44.1
Impaired Driving History
Number of DUI arrests	1.1	1.1	3.0	2.6
Number of DUI convictions	1.1	1.0	2.6	2.1
DUI recidivist (%)	-	-	56.6	41.2
Age first drove impaired	-	-	18.6*	21.4
Age of first DUI arrest	-	-	26.6	29.8
Age of first DUI conviction	-	-	27.3	30.5
Driven Under the Influence of (%):
Alcohol1	62.7	52.9	89.0*	70.6
Marijuana1	32.5	32.4	72.8*	50.0
Powder Cocaine1	7.3	2.9	28.0	30.3
Crack Cocaine1	1.2	0.0	10.8	21.2
Amphetamines	1.2**	11.8	10.8*	29.4
Methamphetamine	0.0	2.9	7.2	5.9
Sedatives1	36.1	38.2	44.6	48.5
Heroin	1.2	0.0	2.4	2.9
Prescription opioids1	32.5	36.4	48.2	51.5
Any Drugs	57.8	64.7	79.5	67.6

Note:

¹N=116

^*p ≤ .05

^**p ≤ .01

^***p ≤ .001.

Participants’ impaired driving histories are displayed in Table 1. Females reported being significantly older than males (21.4 vs. 18.6) when they first drove impaired, but there were no differences in the age of first arrest or conviction. Females were also more likely to report having driven under the influence of amphetamines during the past year (11.8% vs. 1.2%) and in their lifetime (29.4% vs. 10.8%), whereas males were more likely to report having driven under the influence of alcohol (89.0% vs. 70.6%) and marijuana (72.8% vs. 50.0%) in their lifetime.

Discussion

The present study examined rural DUI offenders to determine whether they shared the sex differences identified in previous studies with urban and statewide samples. Overall, sex differences in mental health were consistent with previous, non-rural research, but substance use findings were less clear. Amphetamine and sedative use were the only substances that rural female DUI offenders were more likely to use than males. While some existing research has found higher rates of drug use among females,³ other studies have indicated similar substance use patterns between male and female repeat DUI offenders.⁸ The similar substance use histories in the present study may be attributable to the fact that about half of the sample (52%) were DUI recidivists.

While there were limited substance use differences, females in the current study were significantly more likely to report mental health problems, which is similar to findings from other studies of non-rural DUI offenders.² The rates in the current study are comparable to those found in previous research focused on other rural drug-using female offenders.⁹ The higher rate of sedative use among females in the sample could possibly represent a coping strategy for these elevated mental health problems, particularly given that less than half of the females reported ever receiving mental health treatment. Future research should continue to explore the relationship between substance use patterns and mental health among rural female DUI offenders.

The sex differences found in impaired driving histories among rural DUI offenders, particularly with respect to drug-impaired driving history, is a new contribution to the literature. Males were more likely to have driven under the influence of alcohol and marijuana, whereas females were more likely to have driven amphetamine-impaired. These differences were largely consistent with the differences in participants’ substance use patterns, which reflect findings from other studies of rural drug users.¹⁰ In addition to these sex differences, results highlight a broad range of substances involved in impaired driving episodes among rural DUI offenders, indicating a public health risk to rural communities and a challenge for local law enforcement.

Study limitations should be considered when interpreting results. First, participants were recruited from three rural counties in Kentucky. Although sample demographic characteristics largely reflect those of DUI offenders from the same region (96.3% White, 73.5% male, 37.2 years old),¹¹ the limited recruitment area, purposive sampling approach, and potential self-selection bias may reduce the generalizability of study findings to other rural areas. In addition, self-reported mental health symptoms rather than diagnostic interviews were used to measure mental health, likely resulting in higher rates of mental health problems in this study. Finally, the sample size was relatively small, and all data were self-reported, which may be subject to recall bias.

Conclusion

Despite these limitations, the present study adds to the literature on sex differences among DUI offenders by being the first to examine understudied rural DUI offenders. Study findings suggest few sex differences in substance use and impaired driving behavior may exist but that mental health problems disproportionately affect rural female DUI offenders, as found in other non-rural samples. Future research should continue to examine rural DUI offenders to better understand how substance use and mental health contribute to impaired driving as well as to determine whether different treatment approaches are needed for this population.