Stepwise Driving: A structured intervention for impaired driving: Exploring the views of facilitators and programme attendees

Abstract

This study explores the self-reported experiences of both facilitators and program attendees in the newly commissioned Stepwise Driving programme across the Probation Service. Stepwise Driving aims to reduce impaired driving through a psychoeducational approach. Qualitative interviews were conducted with 17 stakeholders to help understand the key enablers and obstacles to programme implementation. Preliminary findings highlighted inconsistencies in training, variations in delivery and ambiguity regarding the programme's objectives. Positive reflections included meaningful peer dialogues, collaborative learning experiences and the acquisition of knowledge. The study raised several questions. Firstly, how do we achieve an equilibrium between balancing professional innovation with a structured framework to preserve the fidelity of Stepwise Driving? Secondly, is the objective of Stepwise Driving to be purely educational or is there a need for psychological components to help aid attitudinal and behavioural change? And thirdly, how to disambiguate between inappropriate referrals and cohort tensions, particularly given the varied levels of social stigma associated with substance misuse? This study indicates the need for further refinement of Stepwise Driving to address the emergent implementation challenges to meet the needs of people convicted of driving under the influence of alcohol or drugs.

Keywords

Drugs alcohol impaired driving facilitators people on probation interventions

Current study

This study provides preliminary insights into the Stepwise Driving programme commissioned by the Probation Service in England and Wales for individuals convicted of drink and drug driving offences. The literature review summarises the societal challenge posed by drink and drug driving in England and Wales, the commonalities between drink and drug driving and an overview of the Stepwise Driving programme. Seventeen qualitative interviews were conducted to gain a deeper understanding of the experiences of both facilitators and programme attendees. The findings reveal five key themes in the implementation of Stepwise Driving. Key challenges include inconsistent staff training, issues in striking a balance between structure and innovation, difficulties in disambiguating between inappropriate referrals and cohort tensions, and a lack of clarity on the programmes' objectives. Promising practice included bespoke training initiatives, the merits of educational learning and the benefits of shared learning through peer discussions in mixed cohorts. This article contributes to the existing evidence base for interventions targeting low-risk people on probation and offers additional insights into impaired driving.

Literature review

In England and Wales, Section 5 of the Road Traffic Act (1988) criminalises driving or attempting to drive while impaired by alcohol or drugs, regardless of the legal status of these substances. Driving under the influence of alcohol and drug driving are distinct offences, yet both are prosecuted through evidential specimen analysis. Penalties for these offences can include driving bans, fines, and imprisonment. Research indicates that substance impairment can significantly damage cognitive functions, hinder co-ordination, and alter reaction times, thus escalating the risk of accidents (Armstrong et al., 2005). For instance, alcohol may induce overconfidence, leading to reckless behaviour, while opiates can cause drowsiness, impairing reaction speeds. Recent data from the Department for Transport (2024a, 2024b) indicate a troubling increase in road casualties involving illegal alcohol and drug levels in England and Wales. The upward trend in drink and drug driving cases coupled with an increase in fatalities, suggests that current prevention strategies, including the Department for Transport's THINK! Campaigns, are not effectively reaching the intended audience. Furthermore, findings from the Report of the Review of Drink and Drug Driving Law reveal a lack of public understanding regarding legal limits and the risks associated with impaired driving (North, 2010). Many individuals continue to drive under the influence, often believing themselves ‘fit to drive’ (Cromer et al., 2010) supporting the need for educational initiatives.

The commonality between drink and drug driving is that individually or together it impairs a driver's judgment and ability to drive safely resulting in road collisions and serious accidents. People convicted of driving under the influence of drink or drugs are likely to have done so before without being detected by the police (Beitel et al., 2000; Salas-Wright et al., 2021). Studies also found that people who drink more regularly are more likely to drink drive (Campos et al., 2013; Evans-Whipp et al., 2013). In addition, people who drink drive have higher impulsivity (Eensoo et al., 2005), risk-taking behaviour (Tokko et al., 2019) and are poorer planners (National Academies of Sciences, Engineering and Medicine, 2018). There has been limited research on the characteristics of drug-driving groups. However, there are several factors that increase risk (Hasan et al., 2022). Drug drivers are more likely to be young males, with past offending histories who are impulsive, and thrill seek (Hasan et al., 2022). However, it is important to note that there are substance-dependent differences in drug drivers. For example, people who drive under the influence of cannabis or cocaine tend to be younger than those driving under the influence of prescription drugs (Webster, 2021). There is now an emergent body of international evidence on drink drivers suggesting there is an association with drug use (Dols et al., 2010; Hammig et al., 2021). Multiple studies have found that people convicted of either drink or drug driving have detection avoidance and high impulsivity (Hasan et al., 2022). Social influences in both drink (Bingham et al., 2007) and drug driving (Hasan et al., 2022) are important factors for deterring or encouraging driving under the influence of substances. Similarly, people who drink and drug drive have diversity in substance use motives from occasional, recreational, self-medication to addiction. Overall, there does appear to be an overlap between drink and drug-driving populations with some shared risk factors between both groups.

Stepwise driving

Andrews et al. (1990) Risk, Need and Responsivity (RNR) model has undergone significant refinements over the years but remains the prominent approach in the Probation Service in England and Wales. To summarise, RNR suggests providing treatment services based on risk and need. Per se, people assessed as the higher risk would have high-intensity treatment services, and people assessed as the lower risk would have minimal treatment services (Bonta, 2023). Therefore, in 2021 the newly unified Probation Service in England and Wales developed a suite of structured interventions as part of a rehabilitation activity requirement (RAR). The target population for structured interventions are people on probation assessed as lower risk by the Offender Group Reconviction Scale (OGRS). OGRS is a risk assessment tool using static factors such as age, gender, and criminal history to estimate the likelihood of re-offending within a 12-month period and a 24-month period. Therefore, structured interventions were designed to be a short, low-intensity treatment option for people who have less intrenched attitudes and behaviours. In contrast, people on probation who are assessed as medium to high risk are referred to a more specific, intensive Accredited Programme. This aligned with the principles of the RNR model.

Stepwise Driving delivers a range of psycho-educational activities to address misunderstanding and misconceptions of drink and or drug driving behaviours. A psycho-educational programme seeks to improve the psychological and emotional understanding associated with a particular situation or challenge, rather than simply delivering information. It combines thoughts, emotions and coping strategies with educational methods aimed at improving knowledge. Road safety interventions predominantly use an educational approach with limited and contradictory evidence based on their effectiveness (Cutello et al., 2021). Educational interventions usually consist of presenting information to increase knowledge and awareness (Alvaro et al., 2018; Carcary, 2000). The specific risk factor being addressed in Stepwise Driving is ‘a lack of knowledge’ (Stepwise Driving Manual, 2020: 8). Multiple studies have indicated that creating changes in attitudes through credible factual messaging about impairments caused by alcohol and drugs can have an impact on safe driving behaviour (Elder et al., 2004; Greenberg et al., 2005). Stepwise Driving utilises a range of tools to enable and encourage program attendees to question the validity of their beliefs. This is an attempt to deepen the knowledge through open discussions, the exploration of skills and the search for solutions (Cutello et al., 2021). Psycho-educational work is best delivered in group settings offering open dialogue, social learning, and the potential for group reinforcement for a co-operative learning setting for positive change (Felder and Brent, 2001). However, psycho-educational interventions do have their disadvantages. Simply relying on educational content in an intervention may be considered less effective for behavioural change than multi-faceted approaches. In addition, it can be questioned whether pyscho-educational interventions are not necessarily targeting all of the important causes of dangerous driving reducing the reach and effectiveness of the intervention (McKenna, 2010). Albeit drivers may have the knowledge and awareness of risk but continue with unsafe driving behaviour. Consequently, this popular approach for improving road safety may not achieve the goal of reducing crashes, injuries and deaths (BMA, 2008).

Probation practitioners can refer people to structured interventions as part of RAR days. Specifically, Stepwise Driving is designed for programme attendees assessed by OGRS as low risk and have a drink or drug driving offence. The content Stepwise Driving is based on is the previously accredited programme Drink Impaired Drivers (DID). DID was designed for men and women convicted of multiple drink driving offences. The programme explored attitudes to alcohol, emotional management and road safety. Similarly, Stepwise Driving explores driving impairment but extends beyond alcohol to both drink and drugs. It focuses on the effects of alcohol and drug driving, safer driving, consequences of dangerous driving and coping with disqualification (Stepwise Driving Manual, 2020). The rationale behind this decision was due to the similar motivations and risk factors of impaired driving whilst under the influence of substances. Stigma is often dependent on the substance a person uses and the extent they use them (Kulesza et al., 2013). Perceived societal stigma can be internalised resulting in loss of self-respect, self-efficacy and decreased self-esteem (Luoma et al., 2013). The varied history of programme attendees may therefore be important in how they experience the group context. Stepwise Driving is delivered through group work or in a one-on-one setting to both male and female programme attendees. It is a ninety-minute, six-week course, facilitated by two trained facilitators using a variety of mediums to encourage engagement, consolidate learning and promote behavioural change. Group work includes video clips, generating group discussions and completing worksheets.

Methodology

This research was conducted as part of a wider evaluation framework to explore the implementation of a new suite of Structured Interventions targeting lower-risk people assessed by OGRS on probation. This article specifically focuses on interviews conducted with key stakeholders in Stepwise Driving. Approval for the study was provided by the National Research Committee at HMPPS and adherence to ethical guidelines was approved by the University of Twente. The researchers Woolford and Kahl developed the interview schedule and conducted all interviews, in addition to analysing the data and drafting the article content. Co-author Watson supervised the analysis and co-edited the article prior to submission. The lead author Woolford is internal to HMPPS but was not involved in the design or implementation of Stepwise Driving. All other authors were entirely independent of HMPPS. Facilitators who had delivered Stepwise Driving were invited to take part via email by Woolford. People on probation who had completed Stepwise Driving were invited to take part through their probation officer during their probation appointment. The interviews were conducted remotely via video conferencing or telephone between December 2022 and June 2023 to maximise the opportunity for participation.

Semi-structured interviews were used to gain a deeper understanding and richer insight into Stepwise Driving (Adeoye-Olatunde and Olenik, 2021). Participants were individually interviewed by Woolford and Kahl, which included an overview of the study, obtaining verbal consent, conducting an icebreaker exercise, following the interview schedule and providing a debrief. This was to improve the interview experience and foster rapport with participants (Vallano and Schreiber Compo, 2015). Adopting a participant-centred approach elicited a holistic understanding of their experiences and gain deeper and richer insights into Stepwise Driving (Adeoye-Olatunde and Olenik, 2021). Interviews were recorded using a Dictaphone and on average lasted 45.19 minutes with facilitator interviews on average equating to 56.25 and programme attendee interviews 32.32. Audio files were transcribed via AmberScript and Kahl reviewed the data to ensure accuracy. Thematic analysis (Braun and Clarke, 2022) was used to analyse transcripts to identify patterns of meaning and key features of the data. Researchers Woolford and Kahl re-read the transcripts to ensure greater familiarity with the data. Interesting concepts and experiences of the participants relating to the implementation of Stepwise Driving were then coded and formed the basis of the sub-themes. The progression of themes and sub-themes were regularly discussed during review meetings with Woolford, Kahl and Watson until a consensus was achieved to ensure credibility (Nowell et al., 2017). Following this, the themes were refined and defined to ensure that each was distinct and could be easily differentiated.

The sample

Seventeen people took part in this study representing both facilitators who had delivered Stepwise Driving N = 10 and programme attendees who had successfully completed the structured intervention N = 7. A third of potential programme completers participated in the interview process, and all facilitators from three regions who had delivered Stepwise Driving in a group context more than twice were included. Two interview schedules were designed, one for facilitators to share their professional opinions on delivering Stepwise Driving, and one for programme attendees to describe their personal experience of engaging and completing Stepwise Driving. The following description of participants' characteristics is deliberately generic to encourage honest responses and protect their anonymity (Knott et al., 2022). Facilitators possessed varying levels of experience delivering interventions in the probation service ranging from 2 to 30 years. Similarly, there was a mix of Accredited Programme (AcP) trained facilitators N = 6 and non-AcP trained facilitators N = 4. Of the six AcP trained facilitators, four had previous experience delivering the de-commissioned AcPs Drink Impaired Driving (DID) and/or Building Skills for Recovery (BSR). All programme attendees in the study were assessed by OGRS as low to medium risk, had a drink or drug driving offence, had RAR days to complete as part of their community order and had successfully completed Stepwise Driving. All seven programme attendees were male and therefore the study may not be generalised to women. All programme attendees had minimal prior convictions ranging from first time offence to three past convictions, their convictions were N = 3 drink driving, N = 2 drug driving and N = 2 both drink and drug driving. Three programme attendees had already completed a drink or drug-driving intervention outside of the probation service. There was an age range of 24–59 with a mean age of 33.7.

Facilitator training and self-reported competency

One of the first topics explored with facilitators was the central training offer. Several facilitators reported a long time-lag ranging from 6 to 12 months between attending training and delivering Stepwise Driving. This led to facilitators ‘partly forgetting the content and knowledge of Stepwise Driving’ (FO6). Consequently, some regions developed their own training package with a focus on a skills practice approach. This included professional discussions, role play and a walk through of the practitioner manual. However, this was on an ad-hoc basis dependent on the resources and time available to support facilitators in their role. The inconsistences from region to region were demonstrated with one facilitator reflecting ‘One of the treatment managers, is very good … actually spent time to invest in us … so the training was really well covered on our side’ (F07). In contrast, other facilitators were left to do their own ‘homework’ as one facilitator reflected ‘I didn't feel that I got much information or preparation from the training … I found that the training was very, very general … so I've had to research myself to, to gain a better idea’ (F05). This left a mix of self-reported confidence levels in delivering Stepwise Driving. Several facilitators recollected feelings of unease delivering Stepwise Driving as ‘nerve wracking’, ‘feeling vulnerable’ and ‘unprepared’.

I didn't feel fully prepared. I think Stepwise Driving is quite specialized, so it was completely new, and we had to jump in … I was thinking, Oh God, I don't know all the information when we are delivering the programme … I would have to google things, and it did come across that a few participants who had been banned several times knew a lot more than I did. (F01)

This was mirrored by facilitators who reflected on ‘learning together’ or ‘using phones and google’ to fact check the content of Stepwise Driving during the different sessions. Although this created a sense of unity between facilitator and programme attendees ‘I was learning along with the participants’ (F02). It could be questioned whether this was an appropriate treatment option for programme attendees if the facilitators were still learning the content whilst actively delivering Stepwise Driving. This may have blurred the professional competencies of the probation service in delivering programmes.

In contrast, several facilitators felt confident in delivering Stepwise Driving. This was often related to those facilitators who had delivered AcPs with specific reference to DID and/or BSR. These facilitators reflected on having a clear understanding of the needs of the target population and as a consequence felt ‘ready to deliver to participants’ (F07) with limited bespoke training on Stepwise Driving. This was echoed by some programme attendees who perceived the facilitators as ‘knowledgeable’, ‘experienced’, ‘approachable’ and ‘supportive’. As one programme attendee reflected ‘I didn't even realize it was a new course, to be honest. Yeah. They were really good, and they knew exactly what they were talking about’ (PA05). To alleviate concerns the model of delivery was to pair an experienced facilitator with an inexperienced facilitator. The rationale being ‘two heads are better than one…’ (F01) as facilitators have different experiences, backgrounds, delivery styles and strengths that would complement each other. However, this model was not always followed due to resource and capacity issues.

Balancing a structured format with professional innovation

The timeframe for the creation, development and implementation of Stepwise Driving was regarded as ‘fast paced’ (F02). Stepwise Driving was perceived to be a short intervention that would build knowledge rather than to assist behavioural change. Stepwise Driving was designed to follow a set format; video clip, discussion and worksheet to facilitate a consistent national roll out. This format was perceived by facilitators to be a ‘mixed bag’ of good and bad. Less experienced facilitators favoured a structured format as it was perceived to be ‘clear’, ‘easy to follow’ and ‘straightforward’. ‘It is not particularly difficult because the videos do the bulk of the work for you, and we are guided quite nicely into the questions’ (F07). This was mirrored by programme attendees who reflected on the format not just being told to ‘sit down and listen’ or being ‘talked at’. Programme attendees suggested that the format ‘Just broke it up a little bit, didn't it? Rather than being someone just talking at you all the time’ (PA05) and ‘we crack on with discussions and a couple of video clips and no one was getting left behind in the learning’ (PA02).

However, less experienced facilitators relied on the content of the digital clips to aid the delivery of sessions due to a lack of knowledge on the subject area. ‘I would not have known the information. So, to be honest I relied on the video clips to deliver Stepwise Driving’ (F02). In addition, the repetitive nature of Stepwise Driving did run the risk of programme attendees pre-empting the format. This led to programme attendees not listening to the video clips, false engagement with discussions and completing the workbooks in advance. Facilitators reflected on the difficulties in getting ‘participants' full attention’.

You feel like a drone because it is very repetitive, and participants know the format of Stepwise Driving. For example, when I am talking or about to play the video clip participants are already completing the workbooks. This means you do not get people's full attention they are not focused … I think to make the programme more flexible in the delivery so we can keep participants interest and attention. It would not feel quite so monotonous. (F01)

Furthermore, whether a programme attendee had fully understood the area under discussion was questioned. As facilitator (F08) suggested it was difficult ‘to gauge whether the participants actually understand the discussion or whether they were just parroting from the clip’. Thus, a more flexible structure was conveyed to be helpful in terms of delivery, to keep programme attendees engaged, and information could be reduced or removed, to avoid repetition.

Many facilitators reflected on adapting the original design to create a more tailored programme to ‘fit the needs of participants’. Facilitators discussed adding and removing content, adapting materials and utilising different mediums in the delivery of Stepwise Driving. ‘As a more experienced facilitator you are able to use different mediums to deliver the content’ (F06). An example that was regularly discussed by facilitators was the adoption of oral discussions for programme attendees with low literacy levels to facilitate maximum participation in the learning outcomes. ‘So, what we have done, we have adapted it because we had some participants that struggled with reading and writing’ (F05). Considering neurodiverse needs a facilitator reflected ‘some people with ADHD struggle to watch the video clips so we just removed them’ (F02). However, a potential risk of adaptations lessens a consistent delivery through prioritising specific content or sessions. This was most notable among facilitators with the session that discussed drug driving especially in relation to the use of illegal drugs. Facilitators perceived that ‘everyone knows about illegal drugs and being over the driving limit’ (F06) and that in ‘terms of illegal drugs, that is not the majority of participants on the programme’ (F01). Therefore, facilitators tended to skip or give very brief emphasis on this session and focused more on prescription drugs as it was regarded as more ‘relevant’, ‘interesting’ and ‘useful’ to programme attendees. Henceforth, a careful balance is needed to deliver a consistent service with the intended outcomes of Stepwise Driving without inhibiting professional judgement to provide an equitable and inclusive delivery format.

Target population and inappropriate referrals

Stepwise Driving was designed for people on probation assessed as low risk by the probation service. The target population of low risk was defined as people on probation with a driving offence and an OGRS (offender group reconviction scale) score of 25–50 (Stepwise Driving Practitioner Manual, 2020). Firstly, facilitators reflected that most programme attendees were referred to Stepwise Driving towards the end of their probation order commenting that it was ‘too late’ with programme attendees already ‘off driving’. Thus, programme attendees had often already accomplished a lot of rehabilitative activities and picked up various skills and tools in their journey to desistance consequently regarding Stepwise Driving as unnecessary and irrelevant at that point in time.

A lot of participants were coming to the end of their order. This meant a lot of behavioural change work had been done. They had their licences back and had been off driving. So, we would get a dismissive response and false engagement with the programme … So, it would be more relevant for people in the earlier stages of their order. (F02)

In addition, in England and Wales there is a payable speed awareness course to reduce a person's sentence at court if they are eligible. Therefore, some of the programme attendees had already been on multiple driving courses prior to commencing Stepwise Driving. Reflections from programme attendees suggested that Stepwise Driving was repeating knowledge and information. As a programme attendee discussed ‘I did a course on zoom with leaflets before I did this Stepwise Driving programme … So, I knew quite a lot of it already … And I did notice a lot of similar questions (PA01). Furthermore, contradictions between courses or differences in calculation methods had the potential to cause confusion rather than empower programme attendees with knowledge.

I can't remember the exact numbers and figures … It was somewhere along the lines of what the legal limit is … It was worked out differently between the two courses if that makes sense. The calculation was different … I'm pretty switched on. I clicked on straight away. But I know other people won't, so that could be confusing. (PA02)

The main aim of Stepwise Driving is to challenge messages relating to a range of unsafe driving behaviours through psycho-educational activities (Stepwise Driving Practitioner Manual, 2020). However, inappropriate referrals were commonly reflected on by facilitators. As Facilitator (05) reflects Stepwise Driving ‘mainly focused on our driving abilities. Safer driving. Stopping and thinking’. It was not developed to be a recovery support programme for alcohol and drugs. As Facilitator (09) reiterated ‘What if someone's got a drug addiction? What if they are an alcoholic? That is not at all what this programme is targeting’. Facilitators reflected on difficulties in a group setting with programme attendees with treatment needs of ‘alcoholism’ and ‘addiction’. All facilitators shared concerns about suitable referrals to Stepwise Driving and reiterated that it was never designed to be a substance misuse treatment programme.

My reservation with Stepwise Driving is if participants are alcoholics or addicted to drugs, they can be very difficult to work with. The addiction needs to be treated before you can even look at anything else. Because in the group room, it is clearly not suitable as they would be impaired. (F04)

The referral process needs to be explored further so that the right people are being referred at the right time. The data collected from the interviewees suggest that the target population has been misinterpreted during the implementation process of Stepwise Driving.

Psycho-educational approach

The overall aim of Stepwise Driving is to provide information and encourage skills to empower programme attendees to make informed driving decisions in the future. The content of the programme explored the effects of alcohol and drugs on driving, safer driving, consequences of dangerous driving and coping with disqualification (Stepwise Driving Practitioner Manual, 2022: 5). Therefore, leaning towards an educational approach through knowledge distribution and dispelling myths. Facilitators and programme attendees described Stepwise Driving as ‘informative’, ‘useful’ and ‘helpful’. Unanimously exploring facts and fictions towards intoxication and substance misuse was self-reported to be the most useful session with the Stepwise Driving programme. As programme attendees (05) reflected ‘the calculation for working out how the body breaks down alcohol per unit’. Mirroring the educational approach another programme attendee discussed:

I was shocked because I did not realize, sometimes it could take three days for it all fully to be out of your system … that stuck in my brain because like most people think, oh, if I go to sleep now, tonight, tomorrow morning, I'll be sober, it'll be okay. But no, it didn't work like that. (PA04)

Before I lost my licence, I was on tramadol and gabapentin. But you never realize the physical effects; the drowsiness you are feeling on prescription drugs. So that can impair your judgment to drive and the cognitive effects on safe driving … I have not been on painkillers, and I have not drunk since. So, it was a big eye opener for me to stop and a realization of why I have to stay off. (PA03)

In contrast, discussing and sharing common myths to dispel non-factual information were also regarded to be useful in the psycho-educational programme. It became clear that some driving myths get passed around people so much that it often becomes confused with fact. As Facilitator (08) reflected driving myths were prevalent among programme attendees ranging from ‘suck pennies’ to beat breathalysers or ‘eating a fatty breakfast, drink some water or have a shower’ and you will be fine to drive. Dispelling myths was also reflected by programme attendees’ interviews.

‘I was always told that when you drink, as long as you have a good night's sleep, you're fine the next morning, but you are not’ or ‘I always thought, oh, you know, you go to the toilet a couple of times, it's out your system. It's not. It's still in your system’. (PA03)

We worked out the calculations. And that stuck in my brain because most people think, Oh, if I go to sleep now, tonight, tomorrow morning, I'll be sober, it'll be okay. But no, it didn't work like that. (PA07)

Furthermore, the session that explored prescribed drugs was enthusiastically received by both facilitators and programme attendees. In England and Wales, it is illegal to drive with legal drugs in your body if it impairs your driving ability. The responsibility is therefore on the driver.

When we talk about intoxication, we generally lean towards people who have committed offences whilst under the influence of drink or drugs. But what was interesting was the topic of prescribed drugs and the legal limitations. So that awareness about dangerous driving includes prescribed legal drugs, not just illegal drugs. (F01)

All interviewees discussed this session with interest and enthusiasm as it was considered a subject area that was not commonly known. Descriptions such as ‘big eye opener for me to stop’ (PA03), ‘a big eye opener for a lot of participants’ (PA04) and ‘it opens up your eyes’ (PA01) and ‘the prescription drugs bit was an eye opener’ (PA02). Programme attendees reflected on not understanding the potential effects of prescription drugs or that it would be considered illegal to drive as it would impair cognition. Facilitators echoed these sentiments finding the session on prescription drugs having the most ‘impact’ and ‘usefulness’. As Facilitator (06) stated ‘the prescription or over-the-counter medication could also be illegal or not appropriate for driving shocked participants’. Increasing awareness and consequential thinking helped programme attendees to understand safe driving under both legal and illegal drugs.

However, having an educational approach for Stepwise Driving simply repeated the rules of the Highway Code which many programme attendees already understood. As Facilitator (03) conveyed ‘rather than lightbulb moments it re-inforced general safe driving details and knowledge’. Examples included breaking distances, reaction times, legal limits for both illegal and prescribed medications. As programme attendee (03) reflected on ‘if it's the third or fourth time someone has been arrested for drink driving why are we wasting time and money on them, they know the information’. Similarly, programme attendee (04) also commented ‘if you re-offend once or twice then have another go on the programme but if you keep on doing it there is an obvious issue’. Therefore, it could be assumed many programme attendees understood the ramifications from driving whilst under the influence of drink or drugs. This sometimes made the interventions appear as ‘we were teaching your grandmother to suck eggs’ (F01).

There are lots of people being referred to Stepwise Driving that might benefit from a problem solving or emotional management need. I think having a mix of educational and CBT was a better model. It met the needs of more people on probation. So, I think we are not meeting the needs of people. (F05)

Limited cognitive behavioural therapy (CBT) is used in Stepwise Driving. Therefore, facilitators questioned whether this would meet the needs of people who had been convicted more than once of a driving offence related to substance misuse. Programme attendee (07) reflected that although they enjoyed Stepwise Driving there were still concerns about potential future scenarios of drink driving. ‘I still find it difficult to say no to people, you know if there was peer pressure’. Therefore, programme attendees might need more than knowledge, to change their behaviours and attitudes in order to reduce the likelihood of re-offending in relation to drink or drug driving. Facilitators discussed skills such as increasing confidence, speaking with authority and strategies to handle peer pressure. A more skill or behaviour-focused intervention might be needed to meet the needs of a broader cohort, since knowledge alone might not be sufficient.

Mixing a drink and drug cohort

Mixing a drink and drug cohorts within one intervention is a relatively new initiative within the Probation Service. The rationale for mixing a drink and drug driving cohort was based upon ‘the principles of risk taking are the same, whether it is drink or drugs. The material was to help programme attendees think about risk management and potential choices they might have’ (F09). The cost–benefit ratio was carefully considered prior to developing Stepwise Driving. Facilitators were ‘cautious about creating a divide between participants’ (F08) or the potential to ‘label individuals’ (F04). Therefore, in-depth offence-related details were discussed during the one-to-one prior to the commencement of Stepwise Driving to alleviate any concerns from programme attendees and for facilitators to understand potential group dynamics. Facilitators also avoided discussing the offences of programme attendees in the group settings, to ensure a neutral and non-judgemental environment. The majority of interviewees did not experience any significant issues with mixing a drink and drug driving cohort. Facilitators described the mixed cohort as ‘workable’, ‘often entwined’ and ‘appropriate for the target population’. Similarly, programme attendees discussed all being on the programme ‘for the same or similar thing’ (PA07), ‘they are both sort of intertwined nowadays’ (PA02), ‘it was both sides for me’ (PA03) and ‘I was happy to have a mixture’ (AP04). Consequently, programme attendees were able to support and encourage each other in terms of sharing feelings and learning from other people's experiences.

What I feel good about the programme, it wasn’t specifically aimed at you. So, it wasn’t only a drink driving course, or a drug driving course or a dangerous driving cause. It was all smashed into one. So, you didn't feel singled out or whatever … So, you would learn other stuff, about other things, that you could then apply that to normal everyday life if you wanted. (PA01)

However, caution does need to be followed with this small-scale study as underlying tensions between drink and drug-driving cohorts may have been in hidden undertones. A potential stigma of ‘us versus them’ may have been apparent. This may be felt more strongly within group dynamics where there was a programme attendee with substance dependency as discussed in the section above with inappropriate referrals. Commonly used terms referring to people with substance addictions often reflect the misconception of drug or alcohol use and related behaviours as a choice rather than a compulsion. Terms such as ‘crackhead’, ‘junkie’ or ‘drunk’ provide negative labels. People with a drug or alcohol problem often see themselves in a way that reflects the prejudice and judgement of others. Sometimes this overrides any sense of self-worth or self-esteem. In addition, facilitators recognised a potential obstacle of mixing a drink and drug driving cohort with the ‘Definite stigma of drug taking which is not there for alcohol use’ (F08). Subtle undertones were apparent through the interviews with programme attendees. As programme attendee (PA05) stated ‘I was reassured by my probation officer that because it's an evening group, there would be people like myself, you know the people who work full time’. Another programme attendee suggested that ‘what I did was nowhere near as bad as what other people had done’ (PA07). Therefore, there is the potential for ‘conflict; which is worse, drink or drug driving?’ (F01). The challenge of mixing cohorts was evident when programme attendees described feelings of apprehension, nervousness, and isolation prior to commencing Stepwise Driving. Facilitators reflected upon being careful in encouraging discussions that might accidentally cause upset within group dynamics.

We need to be mindful and careful in encouraging discussions. If somebody in the group says ‘oh, well, I am not one of them crackheads’ and you have somebody in the room who has taken crack in the past it can be quite isolating for that individual. (F08)

Facilitators as discussed above needed to gain an understanding in the one-to-one session on the background of people in the group in order to carefully manage group dynamics and lead the discussion activities in a way that provided a safe and inclusive environment. On a positive note, mixing a cohort did provide some evidence that this has the potential to have enabling conversations to understand behaviour, take responsibility and develop a working alliance.

Discussion

The implementation of the structured interventions across the Probation Service has revealed significant disparities in training experiences among facilitators. While the central online training was established to standardise facilitator competencies, variations in additional training by different regions led to inconsistent skill levels. Further, those who only accessed the central training found themselves inadequately prepared, leading to a ‘postcode lottery’ in facilitator competency. This inconsistency not only affects the quality of delivery but also places greater pressure on experienced staff members, especially when paired with less experienced staff. Evidence suggests that well-trained staff are better positioned to implement evidence-based practices. For example, Bonta et al. (2011) demonstrated that training in the RNR model led to significant improvement in probation officer practice which in turn positively impacted people on probation. The concept of pairing novice facilitators with more experienced colleagues is beneficial yet highlights the ongoing challenges within the operational demands placed on probation staff. To address these issues, establishing a structured mentorship programme may provide a dual benefit: enhancing the skills of newer staff while recognising and utilising the expertise of experienced facilitators. Such a programme could promote professional development, improve overall competency in delivering structured interventions, and potentially improve staff retention within the Probation Service by fostering a supportive environment for growth and collaboration.

The findings from interviewees regarding the design and structure of Stepwise Driving reveal a dichotomy in perceptions. On one side, some facilitators appreciate the programme's fixed and repetitive structure, which offers a clear roadmap for implementation. They argue that adhering to the original design ensures consistent quality and reliability, facilitating easier replication and future assessments of Stepwise Driving's effectiveness (Andrews and Redmond, 2004). This perspective highlights the importance of programme fidelity to uphold Stepwise Driving's integrity and ensure reliable outcomes. Conversely, other facilitators advocated modifications and adaptations to the programme. They believe that personalised rehabilitative activities are essential to tailoring the intervention to meet the diverse needs of programme attendees. This has led to facilitators experimenting with re-ordering content, removing sections, changing delivery methods, and introducing new materials. Despite these calls for adaptation, it is crucial to exercise caution. There is a fine balance between fostering professional innovation and preserving the integrity of the programme's design, aims, and outcomes. Significant alterations could impact knowledge outcomes and potentially undermine intervention effectiveness (Platt et al., 2016). Therefore, an appropriate balance needs to be found between professional innovation and maintaining reliability and efficacy.

The Stepwise Driving programme aimed to deliver a psycho-educational approach to address the knowledge gap regarding legal substances and driving behaviours (Alvaro et al., 2018). Interview feedback indicates that programme attendees recognised their limited understanding, highlighting the module's effectiveness in creating a positive learning atmosphere. According to Bolitho and Bruce (2017), such environments promote equity and mitigate against punitive dynamics among programme attendees. This is essential for fostering engagement and acceptance of the educational elements of Stepwise Driving. Nevertheless, there was a failure to fully explore the psychological model, and Stepwise Driving fell short in addressing deeper-rooted behavioural issues associated with repeated driving offences. The complexities of factors like thrill-seeking behaviours, peer influence, evasion of detection, and deficiencies in planning and consequential reasoning pose significant challenges that Stepwise Driving may not sufficiently tackle. As such, there is a critical need to review whether the Stepwise Driving programme should re-think its framework to be as defined in the Stepwise Driving Practitioner Manual (2020) as a psycho-educational programme. Incorporating additional tools, skills and strategies would more effectively meet a broader range of criminogenic needs within Stepwise Driving. These could include targeted rehabilitative activities that address specific behavioural patterns and attitudes; thereby supporting programme attendees to understand the risks associated with impaired driving and also in changing risk-taking behaviours.

A diverse group addressing both alcohol and drug-related driving offences demonstrates the potential in promoting a respectful and safe environment. Exchanging experiences enables collective learning among programme attendees. For example, peer success stories can be motivational for people seeking rehabilitation. Therefore, widening programme attendees understanding of impaired driving and encouraging self-responsibility may contribute to reductions in recidivism (Bandura, 1977). Nevertheless, it is important to exercise caution, as the study indicates a potential tension stemming from the stigma linked to substance misuse, which fosters an ‘us’ versus ‘them’ mentality. Consequently, facilitator training is important for the effective management of group dynamics and conflict resolution when working with a mixed cohort of drink and drug-related offences. Furthermore, concerns were raised regarding inappropriate referrals, especially from programme attendees with substance addictions. This highlights the need for consistency between programme attendee's demographics and programme objectives. Since these inappropriate referrals were also those most likely to have the greatest stigma, it is difficult to disambiguate between potential tensions involving people on probation with different offending histories and those who are inappropriately referred to a low-risk driving programme. As such, there is a critical need to review the referral process and criteria for Stepwise Driving, as well as to establish standardised protocols for managing tensions and or conflicts within a group setting, especially when addressing stigmatised populations (Fierro, 2016; Shamekhi et al., 2018).

Conclusion

In England and Wales, addressing drink and drug-impaired driving has remained a societal issue fuelled by legal reforms and public education efforts. The prevalence of substance-related road casualties persists as a major concern. This study enabled the opportunity for facilitators and programme attendees to share their thoughts and experiences on a substance-impaired driving programme, Stepwise Driving. To summarise, implementation was marred by inconsistencies in staff training, variations in delivery, inappropriate referrals and a lack of clarity of the programme's objectives. Positive reflections from implementation included valuable peer discussions, shared learning and attainment of knowledge specifically relating to the subject area of impairment through prescription drugs. Further development would be necessary to adopt a psycho-educational approach that leant towards more cognitive skills and may better equip programme attendees with effective strategies for decision-making and resistance to peer pressure. In addition, there is a need to disambiguate between inappropriate referrals of programme attendees and the subtle undertone of stigmatisation, which necessitates further investigation to gain a deeper understanding of how group dynamics influence programme experience and outcomes. To conclude, our preliminary qualitative study indicates that substantial revisions may be beneficial for Stepwise Driving to better achieve its intended outcomes and address the needs of people convicted of driving under the influence of alcohol or drugs.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Rebecca Jayne Woolford

Katharina Kahl

Dr Steven James Watson

References

Adeoye-Olatunde

Olenik

(2021) Research and scholarly methods: semi-structured interviews. Journal of the American College of Clinical Pharmacy 4(10): 1358–1367.

Alvaro

Burnett

Kennedy

, et al. (2018) Driver education: enhancing knowledge of sleep, fatigue and risky behaviour to improve decision making in young drivers. Accident Analysis & Prevention 112: 77–83.

Andrews

Zinger

Hoge

, et al. (1990) Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Criminology; An Interdisciplinary Journal 28: 369–404.

Andrews

Redmond

(2004) A review of clinical guidelines. British Journal of Surgery 91(8): 956–964.

Armstrong

Wills

Watson

(2005) Psychological influences on drug driving in young Australian drivers. Wellington: Road Safety Research, Policing and Education Conference.

Bandura

(1977) Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.

Beitel

Sharp

Glauz

(2000) Probability of arrest while driving under the influence of alcohol. Injury Prevention 6(2): 158–161.

Bingham

Elliott

Shope

(2007) Social and behavioral characteristics of young adult drink/drivers adjusted for level of alcohol use. Alcoholism, Clinical and Experimental Research 31(4): 655–664.

BMA Science and Education department and the Board of Science (2008) Alcohol misuse: tackling the UK epidemic. London: British Medical Association. Available From: https://www.drugsandalcohol.ie/11945/1/BMA_Alcohol_misuse_tcm41-147192.pdf Accessed 10 December 2024.

10.

Bolitho

Bruce

(2017) Science, art and alchemy: best practice in facilitating restorative justice. Contemporary Justice Review 20(3): 336–362.

11.

Bonta

(2023) Training community supervision officers in the risk-need-responsivity model of offender rehabilitation: a review and implications. Journal of Offender Rehabilitation 62(1): 39–58.

12.

Bonta

Bourgon

Rugge

, et al. (2011) An experimental demonstration of training probation officers in evidence-based community supervision. Criminal Justice and Behavior 38(11): 1127–1148.

13.

Braun

Clarke

(2022) Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher. International Journal of Transgender Health 24(1): 1–6.

14.

Campos

, et al. (2013) The effect of the new traffic law on drinking and driving in São Paulo, Brazil. Accident Analysis & Prevention 50: 622–627.

15.

Carcary

(2000) Changing driving beliefs, attitudes and self-reported driving behaviour amongst young drivers through classroom-based pre and post driving test interventions.

16.

Cromer

Maruff

, et al. (2010) Perception of alcohol intoxication shows acute tolerance while executive functions remain impaired. Exp Clin Psychopharm 18: 329–339.

17.

Cutello

Walsh

Hanoch

, et al. (2021) Reducing optimism bias in the driver’s seat: comparing two interventions. Transportation Research Part F: Traffic Psychology and Behaviour 78: 207–217.

18.

Department for Transport (2024a) Accredited official statistics: Reported road casualties in Great Britain involving illegal alcohol levels: 2022. Available From: Reported road casualties in Great Britain involving illegal alcohol levels: 2022 - GOV.UK (Accessed 12th January 2025).

19.

Department for Transport (2024b) Official Statistics: Drugs in reported road fatalities in Great Britain, data to 2022. Available From: Drugs in reported road fatalities in Great Britain, data to 2022 - GOV.UK (Accessed 12^th January 2025).

20.

Dols

Gonzalez

Aleixandre

, et al. (2010) Predictors of driving after alcohol and drug use among adolescents in Valencia (Spain). Accident Analysis and Prevention 42(6): 2024–2029.

21.

Eensoo

Paaver

Harro

, et al. (2005) Predicting drunk driving: contribution of alcohol use and related problems, traffic behaviour, personality and platelet monoamine oxidase (MAO) activity. Alcohol and Alcoholism 40(2): 140–146.

22.

Elder

Shults

Sleet

, et al. (2004) Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: a systematic review. American Journal of Preventive Medicine 27: 57–65.

23.

Evans-Whipp

, et al. (2013) Adolescent exposure to drink driving as a predictor of young adults’ drink driving. Accident Analysis and Prevention 51(1): 185–191.

24.

Felder

Brent

(2001) Effective strategies for cooperative learning. Cooperation and Collaboration in College Teaching 10: 69–75.

25.

Fierro

(2016) Enhancing facilitation skills: dancing with dynamic tensions. New Directions F0r Evaluation 2016(149): 31–42.

26.

Greenberg

Morral

Jain

(2005) Drink-driving and DUI recidivists’ attitudes and beliefs: a longitudinal analysis. Journal of Studies on Alcohol 66(5): 640–647.

27.

Hammig

Davis

Jones

(2021) Driving after marijuana use among U.S. adolescents: prevalence profiles and related behaviors. Traffic Injury Prevention 22(5): 361–365.

28.

Hasan

Watson

Haworth

, et al. (2022) A systematic review of factors associated with illegal drug driving. Accident Analysis & Prevention 168: 106574.

29.

Knott

Rao

Summers

, et al. (2022) Interviews in the social sciences. Nature Reviews Methods Primers 2(1): 1–15.

30.

Kulesza

Larimer

Rao

(2013) Substance use related stigma: what we know and the way forward. Journal of Addictive Behaviors, Therapy & Rehabilitation 2(2): 782.

31.

Luoma

Nobles

Drake

, et al. (2013) Self-Stigma in substance abuse: development of a new measure. Journal of Psychopathology and Behavioral Assessment 35(2): 223–234.

32.

McKenna

(2010) Education in road safety – are we getting it right? London: RAC Foundation. Available From: https://www.racfoundation.org/wp-content/uploads/2017/11/education-in-road-safety-mckenna-080910-report.pdf. Accessed on 7th Dec 2024.

33.

National Academies of Sciences, Engineering, and Medicine (2018) Getting to zero alcohol-impaired driving fatalities: a comprehensive approach to a persistent problem. Washington, DC: The National Academies Press.

34.

North

(2010) Report of the Review of Drink and Drug Driving Law. Available From: NorthReview-Report.pdf (ias.org.uk). Accessed 10th December 2024.

35.

Nowell

Norris

White

and Moules NJ (2017) Thematic analysis: striving to meet the trustworthiness criteria. International Journal of Qualitative Methods 16: 1–13. https://doi.org/10.1177/1609406917733847.

36.

Platt

Melendez-Torres

O'Donnell

, et al. (2016) How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis. BMJ Open 6(8): e011473.

37.

Salas-Wright

Cano

Hodges

, et al. (2021) Driving while under the influence of hallucinogens: prevalence, correlates, and risk profiles. Drug and Alcohol Dependence 228: Article 109055.

38.

Shamekhi

Liao

Wang

, et al. (2018) Face value? Exploring the effects of embodiment for a group facilitation agent. Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, 1-13. https://doi.org/10.1145/3173574.3173965

39.

Stepwise Driving Manual (2020) Stepwise driving practitioner manual. HMPPS.

40.

Tokko

Eensoo

Vaht

, et al. (2019) Relapse of drunk driving and association with traffic accidents, alcohol-related problems and biomarkers of impulsivity. Acta Neuropsychiatrica 31(2): 84–92.

41.

Vallano

Schreiber Compo

(2015) Rapport-building with cooperative witnesses and criminal suspects: a theoretical and empirical review. Psychology, Public Policy, and Law 21(1): 85–99.

42.

Webster

(2021) Drink driving – the tip of an iceberg? A report from PACTS. Available from: PACTS-Drug-Driving-The-tip-of-an-iceberg-3.0.pdf (Accessed 12/12/2024).