title: From the brain to bad behaviour and back again: neurocognitive and psychobiological mechanisms of driving while impaired by alcohol.
abstract: OBJECTIVE
  Driving while impaired by alcohol (DWI) is responsible for substantial mortality and injury. Significant gaps in our understanding of DWI re-offending, or recidivism, reduce our ability to practically assess recidivism probability and to match interventions to individual risk profiles. These shortcomings reflect the baffling heterogeneity in the DWI population and the limited focus of much existing DWI recidivism research to psychosocial, psychological and substance use correlates.
  
  
  METHODS
  This narrative review summarises the evidence for the contribution of neurocognitive and psychobiological mechanisms to DWI behaviour and recidivism. Given the nascent nature of this literature, insight into the putative contribution of these mechanisms to DWI is also drawn from other experimental literatures, particularly those on alcohol use disorders and cognitive and behavioural neuroscience.
  
  
  RESULTS
  Alcohol-related neurotoxicity and dysregulation of hypothalamic-pituitary-adrenal axis and serotonergic systems may underlie certain offender characteristics consistently correlated with heightened DWI risk, persistence and intervention resistance. Their markers are less vulnerable to sources of bias than subjective psychosocial indices and are more far-reaching than alcohol abuse in explaining DWI behaviour and recidivism. Implications. The investigation of neurocognitive and psychobiological mechanisms in DWI research is a promising avenue for discerning clinically meaningful subgroups within the DWI population. This can lead to research and development in alternative assessment and more targeted intervention technologies.
  
  
  CONCLUSIONS
  Multidimensional research in DWI and recidivism offers novel avenues for increasing road safety.
authors: Douglas Hospital Research Centre, Montreal, Quebec, Canada. thomas.brown@mcgill.ca
authors: Thomas G
authors: TG
authors: Brown
authors: Marie Claude
authors: MC
authors: Ouimet
authors: Louise
authors: L
authors: Nadeau
authors: Christina
authors: C
authors: Gianoulakis
authors: Martin
authors: M
authors: Lepage
authors: Jacques
authors: J
authors: Tremblay
authors: Maurice
authors: M
authors: Dongier
mesh_terms: D000428:Alcohol Drinking / Q000503:physiopathology*; D000435:Alcoholic Intoxication / Q000503:physiopathology*; D000437:Alcoholism / Q000503:physiopathology; D001334:Automobile Driving / Q000331:legislation & jurisprudence / Q000523:psychology*; D003071:Cognition / Q000187:drug effects; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D020258:Neurotoxicity Syndromes / Q000209:etiology; D010913:Pituitary-Adrenal System / Q000187:drug effects; D012008:Recurrence; D012701:Serotonin / Q000378:metabolism
chemical_list: D012701:Serotonin