Medical-psychological assessment (Germany)
In Germany, a medical-psychological assessment (MPA) is used by the authorities in deciding whether to revoke or reissue a driving licence. Medical-psychological assessment has been shown to be highly effective in reducing the number of repetitions of driving under the influence. 
The first standards mandating the MPA for certain prospective drivers were legally adopted in 1955. Its stated purpose was to improve traffic safety and reduce the number of accidents by identifying unfit dangerous drivers and removing them from traffic until fitness to drive was restored.
The MPA has an interdisciplinary basic approach. Although it is considered a punishment by many offenders, it offers them the chance to rehabilitate themselves. German medical-psychological institutes issue about 100,000 MPAs a year. Many of their clients have to take the MPA twice because more than 50% fail to get a positive opinion on their first try.
The prerequisites for operating a motor vehicle are only met once the level of alcohol consumption has changed appropriately. The change in drinking behaviour must be stabilised and motivationally consolidated. Passing the MPA is not easy: Drunk drivers with a blood alcohol level of 0.16% or more may in some instances be required to establish that they have been completely abstinent for at least one year; test administrators corroborate drivers' certifications (formal statements) as to their abstinence by measuring their liver function levels and conducting random urine screenings.
A conviction for driving while impaired by alcohol and/or drugs is not the only scenario in which the MPA can be imposed. Many test subjects who have ridden[clarification needed] a motorcycle under the influence or who regularly use drugs must present a favorable MPA opinion to the license-issuing agency by a certain deadline (usually several weeks after an incident) or face suspension of their driver's licenses. This justification for requiring an MPA opinion enables the government to suspend the licenses of many alcoholics who were not apprehended while driving drunk.
Also, in addition to justification, an MPA (which is much more often passed than alcohol-related MPAs) is necessary if someone wants a dispensation from the minimum driving age.
If possible, the MPA gives a clear recommendation to the offender to attend a specific course to re-establish his fitness to drive. These courses are well adapted to the specific problems of the offenders: Alcohol, drugs, or other traffic safety violations.
In Russia, all professional drivers must pass a similar test at 2-year intervals.
- Medical screening and medical-psychological assessment as prerequisites for regranting of licences; Alcohol & Alcoholism Vol. 31, No. 6, pp. 605-607, 1996
- Müller & Laub 2006. The Medical Psychological Assessment: An Opportunity for the Individual, Safety for the General Public
- Krohn 2006. Courses for the re-establishment of fitness to drive with legal consequences