Conversation with Robert Voas

Abstract

AddictionVolume 108, Issue 5 p. 865-873 JOURNAL INTERVIEWFree Access Conversation with Robert Voas First published: 11 December 2012 https://doi.org/10.1111/j.1360-0443.2012.04061.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In this occasional series, we record views and personal experience of people who have specially contributed to the evolution of ideas in the Journal's field of interest. Robert Voas’ contributions to alcohol research have won him international respect. Notably, his research has influenced the development of federal and state impaired-driving policies since the federal government became a funder of such research 40 years ago, with the founding of the US Department of Transportation's National Highway Traffic Safety Administration (NHTSA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Early Years Addiction (A) What kind of a home did you grow up in? What kind of expectations for life did that environment give you? Robert Voas (RV) I grew up in the Midwest in the upscale suburb of Winnetka on the north side of Chicago, a bedroom community where bars and even movie theaters were not allowed. My father was the school psychologist during the 1930s, when the then new concept of progressive education was in vogue. Despite having that introduction to the field that I went into and in which I eventually received my PhD, I grew up intending to follow a career in the State Department. Perhaps this was a romantic notion developed from seeing too many adventure movies set in foreign countries, but I had a special interest in Europe. As a child I followed events beginning with the Spanish Civil War running up to World War II. That interest in foreign travel may have had an influence in my joining the Peace Corps staff some years later. I think that the Great Depression had a strong influence on my determination to gain an advanced degree because of the problems experienced obtaining jobs by other members of my family with limited education. A Did any of your early experiences lead you to the choice of a research career? RV Not really. I always wanted to be a diplomat or pursue international law. I enrolled in a program to get into the Diplomatic Corps at the State Department, but when I finished my BA I was too young for the Corps. Then, I took some psychology courses. I found psychology intriguing, as it focused on the questions of ‘What is science?’ and ‘How do we apply science to human behavior?’. I graduated from the University of California in Los Angeles with a PhD in experimental psychology. ‘I always wanted to be a diplomat or pursue international law.’ Service in the Navy A Before you began your long career in alcohol and traffic safety you had several adventures, one could say several careers, in some other fascinating fields. First, the Navy. How did you get involved with the Navy, and what did psychologists do in the Navy? RV World War II ended about the time I received my PhD, but I still had a responsibility to serve in the military. If you had a student deferment, you were eligible for the draft until age 35. When the Korean War started, I accepted a commission in the Navy where I applied my psychological training to ergonomics, which includes human engineering, man–machine systems, and selection and training. These topics were of research interest to the US military. I was assigned to the Navy Research Center at Pensacola, Florida, which is the Flight Training Center for the Navy. The Center had a small psychology research laboratory that was studying the issues that arise in selecting naval aviators. A large issue was that half the candidates recruited into Navy air training failed to complete it. Thus, our job focused on pilot selection and training methods to reduce the failure rate because training was expensive. I also carried out some work on man–machine systems. Military technology was developing so fast and the equipment was becoming so complicated that it was difficult to keep it functioning in the field without highly trained technicians. Hence, there was a great need for simplifying maintenance systems and improving maintenance information systems. My research while in the military was like that of many psychologists employed by military and defense contractors during and following World War II. ‘I was assigned to the Navy Research Center at Pensacola, Florida, which is the Flight Training Center for the Navy.’ Assignment to the Space Program A Then, I understand, you got involved with the Mercury Space Program. How did that happen? RV It was serendipitous. I moved from the research center at Pensacola, Florida, to the Navy Medical Research Center in Washington, DC, to work for Captain Norman Lee Barr, who was conducting research on monitoring physiological responses in high-altitude balloon pilots, which could reach altitudes up to 100 000 feet where the pilots were potentially exposed to conditions similar to outer space. Captain Barr was responsible for the safety of the crew, which led to the development of technology to telemeter physiological data from the balloon pilots to the ground. When the National Aeronautics and Space Administration (NASA) first started, its staff had extensive high-tech engineering expertise from the flight and rocket test programs it had conducted for years, but they had little expertise in human factors and aviation medicine. NASA turned to the Navy, the Air Force and the Army for this medical expertise. Because of his balloon work, Barr was the Navy's leading expert in high-altitude medicine, and I was his principal assistant. Thus, I was transferred to NASA as a psychologist. My main assignment was to develop a program for selecting the astronauts and training them for space flight. A What were your duties there? RV My main assignment was to develop a program for selecting the astronauts and training them for space flight. Additionally, we had to demonstrate that the project was safe and that NASA was ready to fly. The President did not want any flight to go forward until it was proved safe. The training exposed the seven astronauts to every imaginable experience they might encounter during space flight 1. Humans were the ultimate backup for all the electrical and mechanical systems. The astronauts’ performance in all simulated space conditions was therefore examined closely to determine flight readiness. Interlude in Politics A Then, as I understand it, you had a brush with politics. What happened there? RV During the Mercury Program I had become quite close to John Glenn 2, who was interested in politics and world affairs. John had become a national hero, and rightly so. By the end of the Mercury Program he was over 40, and he felt that his chances of getting another flight were limited, so he decided to leave NASA to run for the Senate in Ohio. I worked with him as his campaign manager for an unsuccessful race in 1964. Selecting Peace Corps Volunteers A After the Ohio campaign, you returned to Washington to work for the Peace Corps. RV Scott Carpenter, another astronaut, was on a plane with Sargent Shriver, the first director of the Peace Corps. Scott mentioned that I was looking for a job, as the campaign had not succeeded. Shriver brought me into the Peace Corps as the head of the field selection program—another interesting activity for a psychologist. Peace Corps volunteers had to learn the language and learn a skill that would be useful in their host community. The Field Selection Department, which I headed, employed other psychologists, who visited each training site and decided which trainees were qualified for assignment overseas. We had more than 100 of these ‘selection officers’, as they were called, who evaluated the trainees at 6 and 12 weeks during the training program. Sargent Shriver's rule was that you could only work for the Peace Corps for 4 years. He did not want the bureaucracy to stultify, so eventually I moved on. In 1967 the US Congress passed the Highway Safety Act, and in 1968 I joined the agency in charge of managing that program when it had only are relatively small staff. Work at NHTSA A What was NHTSA's interest in social science back then? RV Before Bill Haddon became the Administrator of NHTSA, he had been prominent in the research on alcohol and traffic safety. He was best known for the ‘Haddon matrix’, which was a conceptual method of organizing the work in traffic safety. The matrix had three factors—the driver, the vehicle and the environment—along one axis, and three stages of a crash—pre-crash, crash and post-crash—along the other. Together, those elements made a nine-cell matrix. Haddon organized this new agency around that matrix; that is, he created a department for each of those cells. I was assigned the pre-crash/driver cell. Potentially, all the research underway about drivers before a crash occurred came under my portfolio. A So any research on the human characteristics that might be predictive of a crash was your portfolio? RV Yes. The strong emphasis on alcohol and highway safety resulted from Congress calling on the Department of Transportation (DOT) to analyze its program on alcohol and highway safety. A report to Congress on ‘Alcohol and Highway Safety’, prepared by Haddon & Borkenstein 3, concluded that alcohol was the major factor in fatal crashes. Congress responded: ‘If alcohol is the biggest factor, what is NHTSA doing about it?’. Hence, one of my first assignments was to head a working group to develop a national community program to reduce drunk driving. We came up with the Alcohol Safety Action Program (ASAP) 4, a community grant program whereby US communities could apply for funding to address this problem. Accepted applications were funded for 3 years to conduct a community alcohol safety program based on the ASAP model. These local initiatives emphasized enforcement heavily, but funds could also be used to assist the work of prosecutors or the efforts of local treatment programs. There were two rounds of the program in 1969 and 1975, with 35 communities involved at a cost of about $83 million—by far the largest federal community highway safety prevention effort ever funded. “The ASAP project established the viability and the effectiveness of sobriety checkpoints.” A What did you learn from the ASAP program? RV Each ASAP site [4] was evaluated, from which we learned three things. First, it is important to create deterrence. Many communities did this by establishing sobriety checkpoints that were highly visible to the public and reduced the drinker's chances of evading detection. The ASAP project established the viability and the effectiveness of sobriety checkpoints. Communities with checkpoints demonstrated reductions in crashes. Secondly, the ASAP established a role for treatment and for education in the sanctions applied to offenders convicted of impaired driving. When ASAP started, few courts included treatment or education for impaired drivers. ASAP gave communities a chance to screen newly apprehended offenders for drinking problems. Generally, these screening programs found that about a third of the offenders exhibited some symptoms of alcohol abuse or dependence [5]. Addressing these underlying alcohol use disorders was recognized as essential to an overall impaired-driving strategy. Several clinical approaches to promote recovery were tested during the ASAP program, with varying success. For the other two-thirds of the offenders, the so-called ‘social drinkers’, the need was to provide educational information about alcohol and its impairing effects. Nowadays such educational programs for offenders are commonplace in most of the state courts, where a dual approach—treatment for drivers with alcohol use disorders and education programs for ‘social drinkers’—is typically applied. Thirdly, the ASAP demonstrated the usefulness of roadside surveys as a methodology for studying impaired driving. Although roadside surveys had not been used to evaluate the effects of prevention or enforcement campaigns. There is a tremendous advantage to using a roadside survey to assess program effects instead of relying on arrest data, as only a tiny fraction of impaired drivers are arrested. By now, roadside surveys have been used in a dozen large-scale community prevention studies to generate outcome data. Estimates of driver impairment gathered by nation-wide roadside surveys also began to be conducted in the wake of the ASAP experience. In succeeding decades, NHTSA has funded four waves of these nation-wide assessments, and a fifth is scheduled for 2013 6. These assessments are the nation's best means of monitoring the pulse of impaired driving. A The development of technological devices to improve traffic safety has always been an important part of your career. Weren't you involved in NHTSA's early work to develop the technology for breath testing? RV Yes. When I arrived at NHTSA, using blood alcohol concentration (BAC) in enforcement still had some important limitations. Although the Breathalyzer developed by Borkenstein provided a method of conducting breath tests at police stations, the device was too bulky to use for testing drivers at the roadside. The fuel cell sensor, a development from the space program, was being adapted as a hand-held tester, about the size of a cigarette case, by Lion Laboratories, a British firm. The fuel cell was highly accurate in measuring alcohol in the breath (it was not sensitive to false positives triggered by other substances). I first saw these devices in 1969 and brought them to NHTSA's laboratory for further development. These preliminary breath testers, which officers used to ensure that suspects were over the limit before transporting them to the police station, began to be used in NHTSA demonstration projects and have become standard equipment for officers enforcing driving-while-intoxicated (DWI) laws. Because of the Fourth Amendment, however, these devices can be used only if an officer has cause to suspect impairment. Conversely, in Australia, they are used more frequently and proactively 7. ‘The next stage of my work in devices for police use was in passive sensing of alcohol …’ A I suppose that one technology led to another. RV Yes. The next stage of my work in devices for police use was in passive sensing of alcohol. Because the preliminary breath tester I just described requires a mouthpiece, it is considered a search that is limited by the Fourth Amendment. An early issue I raised at NHTSA was whether we should develop a device that would measure alcohol in expired air outside the body. Such a device could not possibly be as accurate as the preliminary breath testers, but it could detect the presence of ethanol; so I argued that we should develop such a system. NHTSA studied the approach but decided not to pursue it. As a result, it was the Honda Motor Company in Japan rather than a US company that developed the first passive sensor, which was affixed to the steering wheel of some of their prototype safety cars. Later, a firm called Nippon Seiki developed a wand-like device similar to the wands that Japanese police officers use to direct traffic. RV Before leaving NHTSA in 1982, I obtained a set of those units from Japan, and we began to test them. The Insurance Institute for Highway Safety also became interested in passive sensing and, working together, we developed a sensor built into a flashlight. That is where passive sensors are now. Some passive sensors, produced by a company in Virginia, resemble a police officer's flashlight and have full flashlight functions. However, we have a science-to-practice problem: police officers resist using these devices because they tend to believe they do not need them to detect drunk drivers; but if they were used at checkpoints, arrests would increase by 50% 8. A I suppose the next stage of device development was the vehicle interlock, where the detector is attached to the car rather than in the police officer's hand? RV I was introduced to the first alcohol vehicle interlock in a General Motors car in 1969. However, in the following decade, NHTSA's research was focused on devices for the vehicle that measured human performance rather than sensing alcohol. These devices were designed to detect all kinds of impairment in addition to alcohol, such as impairment by drugs, sleepiness, or inattention. These tests were designed to detect slowed reaction times, inability to divide attention and other driving-related behaviors associated with crashes. Thus, the development of vehicle interlocks based on measuring alcohol in the breath was left to private industry. The chief problem was to make the interlock resistant to tampering, as the primary users would be DWI offenders who would be motivated to circumvent the devices. Most of these problems were taken care of in the 1980s, so interlocks became substantially tamperproof. Leaving NHTSA for the Pacific Institute in 1982 A Tell us about the transition from the government to the Pacific Institute. What changes were involved for you, and what new opportunities did this open up? RV The transition to a private not-for-profit research organization offered me the opportunity to pursue my own special interests in research and conduct my own research programs. Unlike the NIAAA, NHTSA did not sponsor an intramural research department. In addition, leaving government opened up a broader field of work than I had as an office Director at the NHTSA. In addition to seeking out opportunities to conduct research of special interest to me, such as the application of vehicle interlocks to the management of DWI offenders, leaving NHTSA allowed me to begin working in the NIAAA extramural program where I could obtain grants to conduct research on topics beyond impaired driving, such as underage drinking and community prevention programs. “The transition to a private not-for-profit research organization offered me the opportunity to pursue my own special interests …” A After you moved on to the Pacific Institute, you continued to work on vehicle devices, didn't you? RV Yes, one of the remaining problems with devices was identifying who was blowing into the device. Thus, in the early 1990s when my associate Paul Marques and I received a contract from NHTSA to develop the federal standards for interlocks, there was no way to ensure that it was the DWI offender who was blowing into the device, so we had to include a requirement for repeating the test at random times about every 10–15 minutes after the car is moving. This blocks DWI offenders from being able to drive by having someone else start the car. The rolling re-test is still the key anticircumvention feature used today, but photographic identification systems will soon replace the rolling re-test. Overall, circumvention of the interlock is difficult without being caught. Extensive research has shown that interlocks lower offender recidivism by about two-thirds while on the vehicle, but have little carryover after removal 9. A Are there other devices that we should discuss? RV Currently, technological devices are beginning to be used to monitor the drinking of DWI offenders to maintain abstinence as a method of preventing impaired driving 10. One method is to detect the small amount of alcohol the body eliminates through the skin. One such transdermal measuring device—SCRAM® (Secure Continuous Remote Alcohol Monitor)—is attached near the ankle and continuously monitors an offender's drinking. There is also a wristwatch version of the transdermal sensor. Portable breath testers that verify the user photographically are just coming into use for monitoring DWI offenders. These units can be programmed to require tests at different times during the day to prevent drinking. As these devices are new, our knowledge of their effectiveness for reducing recidivism is limited. A In addition to evaluating impaired-driving devices, you have also evaluated impaired-driving policies during your career. Can you talk about your involvement there and what some of the findings have been? RV We evaluated a new law for administrative license revocation (ALR) that provides for immediate loss of the driver's license if over the BAC illegal limit. Also significant at that time was the minimum legal drinking age (MLDA) law. Both at NHTSA and afterwards, when I joined the Pacific Institute for Research and Evaluation, a non-profit research group, we evaluated several new impaired-driving laws 11. When the 0.08 illegal BAC limit and the ALR existed simultaneously, it was difficult to discern the independent impacts of the two laws. In one study, we measured states with and without ALR and with and without 0.08. We showed that each contributed independent risk-reduction effects 12. The extensive research supporting the effectiveness of the 0.08 law led to Congressional legislation requiring states to either enact a 0.08 law or lose part of their highway construction funds. Another special opportunity came my way. When Mothers Against Drunk Driving (MADD) was first formed in California, it was a relatively small state organization. In 1982, I was invited to serve on MADD's Board. Most of its members were businessmen, whose goal was to help raise and manage the organization's funds. My role was different. I was a scientific consultant. My job was to persuade MADD to support only those policies proven effective through research. The importance of MADD A Was it difficult to get MADD to adopt that point of view? RV Initially, it was difficult for them because MADD was founded and built on the suffering of victims. Thus, the pressure was strong to be tough on drunk drivers. MADD's first inclination was to push for increased penalties. I tried to help them see that other parts of the picture, like passing an underage drinking law, also had an important impact on drunk driving. MADD members ultimately became very strong supporters, and MADD was the principle organization responsible for the passage of minimum drinking age laws 13. MADD took on another interesting issue that caused much friction but was very effective for public safety. It developed a process called ‘Rating of the States’. I was the first chairman of that program. ‘… MADD was founded and built on the suffering of victims [and] had an important impact on drunk driving’. A This was a rating of policy approaches, right? RV MADD rated each of the 50 states on a set of underage drinking policies and then publicized the ratings. It created a great deal of heat, but it was a powerful motivator. This motivated some governors whose states were rated as lax on drunk driving to take some action, such as appointing a special commission to study the drunk-driving problem. Furthermore, it motivated state legislatures to adopt and enforce new laws 13. “… between 1969 and 1980, indicated that research demonstrated the effectiveness of many activities, such as sobriety checkpoints and lowering the BAC, but action to change policies was lacking.” A So, MADD was more successful when it stressed incorporating scientific findings into its activities? RV It was. If MADD had rated states based on ineffective laws, then its credibility would have evaporated. A As a scientist, you must have been glad to see that. RV Yes. My early experience, for example between 1969 and 1980, indicated that research demonstrated the effectiveness of many activities, such as sobriety checkpoints and lowering the BAC, but action to change policies was lacking. MADD created the public support the field had been missing. Ergo, the science that had been sitting on the shelf began to be implemented. In response, crash rates went down. Alcohol-related fatal crashes were reduced by 55%, saving about 300 000 lives over 15 years 14. It was a major change, and a welcome change from the days when little progress had been made. A Those reductions in crash rates have flattened out. Has the country's interest in using science to attack impaired driving peaked? RV I think public attention has been diverted by other problems, such as the war in Afghanistan. The public still believes that impaired driving is important, but the pressure on state legislatures has lessened. A Another area of your multi-faceted career has been your research on how to manage impaired-driving offenders. How have your views on that developed over the years? RV In my writing, I have suggested two primary goals for impaired-driving programs. The first is to prevent an offender from endangering others by getting them off the roads, suspending their licenses, and so forth. Secondly, you inherit a responsibility to assist offenders in recovering from an alcohol-use problem, which ultimately protects the public. All impaired-driving strategies need to accomplish these two goals. The system that has developed over the years involves both factors. Putting offenders in jail clearly keeps them off the road; however, for a couple of reasons incarceration as a punitive sanction has not proved effective for reducing the recidivism of DWI offenders. One is that it is expensive for the government. The other is that research suggests that this penalty is effective only while offenders are confined. When released, their recidivism level is similar to pre-confinement. Sanctions alone are ineffectual. Nevertheless, the public wants retribution when innocent victims are killed or injured. Although jail does not promote safety or recovery, it is the penalty demanded by the public. MADD's early approach emphasized this. It emphasized that drunk driving is not just a minor peccadillo—it is a crime. Putting an offender in jail clearly marked it as a crime. MADD even wanted to jail first offenders, but the jails were too crowded to hold so many people. That said, the threat of jail looming in the background is an important backstop to other sanctions. It may need to be available, but it should be used sparingly. Now, the big trend is to stop using jail and to try other methods. A What other methods are being looked at? RV Fines. Wagenaar and his colleagues have shown that states with higher fines for DWI offenses have fewer crashes, yet fines alone are not a strong sanction. Another method is license suspension, but there is an important caveat here. If an individual without a license drives carefully, the likelihood of attracting an officer's attention, and thus apprehension, is low. This encourages individuals with a suspended license to drive illicitly. McCartt 15 had private investigators track the driving of suspended DWI offenders and found that up to 80% drove illicitly. Interlocks A The present status of interlocks? RV When the courts started using interlocks, I naively assumed that offenders would welcome them because they could not drive otherwise; yet when offenders were given an option to install an interlock or to lose their license for a specified time, only about 10% chose the interlock. Several other factors also reduce the potential effectiveness of interlocks. At $2–3 a day interlocks are moderately expensive, and courts are reluctant to make low-income offenders pay. Offenders can avoid installing interlocks by denying they own a car (sometimes after transferring the title of their car to someone else). In some courts when a judge requires an interlock, overscheduled probation officers have difficulty monitoring compliance 16. A potentially promising alternative to relying on the courts to implement interlock programs is empowering state departments of motor vehicles (DMVs) to reinstate licenses contingent upon installing an interlock 17. This produces a high rate of compliance among those offenders who seek reinstatement; however, it delays the installation of an interlock until the offender qualifies for reinstatement, which could be a year or more following conviction. Studies indicate that as many as a third of the second offenders never reinstate their licenses 18. A In your most recent writings, you have explored a new direction that technology is making possible. This is the monitoring of drinking itself rather than just separating the drinking from the driving. Is this the future direction that traffic safety research is likely to take? RV This seems to be a trend. The concept of monitoring offenders’ drinking derived from the experience of drug courts, which have taken a different approach from the ASAP programs we discussed earlier. These courts have been established to deal with multiple DWI offenders who face incarceration. Offenders are given the option of agreeing to a 1- or 2-year program during which drinking and drug use and attendance at a treatment program are tightly monitored. Offenders come to court every month or two, where their information on progress in treatment and adherence to abstinence rules is reviewed. The judge uses that information either to reward good behavior by reducing the jail sentence or to penalize failure by imposing a short jail sentence when program requirements are not met