Alcohol Monitoring Technologies: Tools to Supervise Impaired Driving Offenders Erin Holmes Research Scientist Traffic Injury Research Foundation MADCP Annual Conference March 12 th, 2014, Lansing, MI

2 Overview > Alcohol monitoring technologies: » Alcohol interlocks » Continuous alcohol monitoring (CAM) » In-home monitoring » Remote breath testing > Effectiveness research: » Interlocks and CAM > Implementation: » Use in a DWI Court setting » Monitoring and treatment

3 Technologies

4 Alcohol interlocks > An alcohol interlock is a breath-testing device attached to a car’s starter. > It prevents the car from being started when a pre-set level of alcohol is detected in the breath sample presumably provided by the driver of the vehicle.

5 Goals of the device > Alcohol ignition interlocks are designed to protect the public by separating drinking from driving. > Alcohol interlocks are not designed to change drinking behavior. > To change drinking behavior, the device must be partnered with appropriate treatment. > If used appropriately, the alcohol interlock can support both a public safety and rehabilitative approach to drunk driving offenders.

6 How does it work?

7 BAC = 0 Ignition BAC <= 0.02Warn BAC > Interlock Running Retest

8 Sensor technology >There are two types of sensors that are be used in alcohol interlock devices: »semiconductor sensors »electrochemical sensors (fuel cells)

9 Electrochemical sensor >How does it work? »Most common technology used in modern alcohol interlocks. »Alcohol in breath sample undergoes a chemical oxidation reaction. »Current that is generated is converted into an alcohol reading that is compared to a baseline reading. »Change in the magnitude of the current is proportional to the alcohol concentration in the breath sample.

10 Electrochemical sensor >Advantages »Device is alcohol-specific and only generates a positive reading if ethyl alcohol is detected. »Is used in most modern breath testing devices including evidential tests due to the high level of accuracy. »Requires less frequent calibration. >Limitations »Electrochemical sensors while more advanced, are also more expensive than semiconductor sensors.

11 Environmental influences >Fuel cells operate at a high temperature; a brief warm-up period is needed prior to analysis of a breath sample. >Warm-up time typically spans a few minutes. In extreme cold environments, a longer period of 5-10 minutes may be required. >Technological advances have significantly reduced the warm-up period. These include: » detachable handset » wireless device

12 Accuracy >Alcohol interlocks with a fuel cell sensor are accurate in detecting alcohol consumption 99% of the time. >Detects beverage alcohol that is consumed, or alcohol in medications or other ingested products (e.g., cough syrup, mouth wash). >The NHTSA specifications state that the alcohol interlock device must prevent the driver from starting the vehicle (even in extreme heat or cold conditions) 98% of the time when the BrAC is.065% or greater.

13 Mouth alcohol >Mouth alcohol is residual alcohol present in the mouth or throat immediately following the consumption of food, drink, mouth spray, or medicine that contain alcohol. >Mouth alcohol can register on an interlock as an alcohol-positive breath sample and can prevent the engine of the vehicle from starting. >This is easily overcome by waiting a few minutes to allow residual alcohol to dissipate, similar to an evidential breath test.

14 Technical standards – U.S. >The goal of a technical standard is to ensure a uniform standard for devices, consistent quality, and efficacy in these devices. >NHTSA developed model specifications for alcohol interlock devices in »Document provides a guideline; not a requirement. >States have the authority to approve devices for use based on the NHTSA specifications. >Revised NHTSA specifications were released in May 2013.

15 Device features > Device features often set by the state: »language/visual display »BrAC threshold »lock-out time »stall protection time »pullover notice »recall notice »breath volume

16 Device features > There are several new features available on some devices that improve the ability of authorities to monitor interlocked offenders. These include: »camera; »GPS; »real-time reporting; »video streaming; »911 notification. > Cost vs. benefits

17 Anti-circumvention > Sealed wiring »Special tape or clips around all wiring and circuits to protect them; provide evidence of tampering. > Temperature and pressure gauges »Used to detect ‘non-human’, stored, or filtered breath samples. »Layers of testing for temperature, pressure, duration, moisture, and alcohol content of sample. > Multiple systems available to limit opportunities for non-drivers to provide a breath sample. »Camera, breath pulse, hum-tone, etc.

18

19 Anti-circumvention > Data recorder »Each interlock device contains a data recording device to record every vehicle event (e.g., start tests, re-tests, attempts to circumvent). »Backups of the data protect against loss even if there are power disruptions or tampering attempts. »Data collection enables authorities to monitor and respond to offender drinking and driving behavior.

20 Running re-test > The running re-test feature ensures that a driver remains sober while driving. > It requires random and repeated breath samples while the vehicle is in use. »The first re-test generally occurs within 5-15 minutes after the vehicle has been started. > A breath sample above the pre-set limit will result in a warning for the driver to pull over and stop driving. > The interlock will not shut off a running engine.

21 Running re-test > If a driver fails to provide a re-test or provides a breath sample above the pre-set limit, an auditory or visual warning will occur prior to an alarm being activated. > The alarm persists until the vehicle is turned off. > The driver will also have to report to a service center within a specified time frame. > Failure to report to the service center will result in a permanent lock-out of the vehicle.

22 Continuous alcohol monitoring > CAM allows courts to monitor offender compliance with abstinence orders. > CAM takes the form of an ankle bracelet that continuously monitors and measures alcohol consumption 24/7. > The device has a tamper and water-resistant strap. > Uses fuel cell sensor. > Wireless (i.e., no landline).

23 How does it work? > The device tests samples of vaporous perspiration (sweat) collected from the air above the skin at regular intervals. » Transdermal measurements are recorded twice each hour. > Test results are transmitted to a base station and then relayed to a secure central website. > Actions are taken in response to tampering or drinking events. > This is a valid way of determining whether an individual has consumed a small, moderate, or large amount of alcohol (Sakai et al. 2006).

24 Continuous alcohol monitoring

25 Anti-circumvention features > CAM devices have a number of anti- circumvention features. These include: » tamper clip or strap; » obstruction sensor – measures the reflective intensity of an infra red beam between the analog component of the device and the offender’s leg; » temperature sensor; and, » communication monitoring - ensures that the device is functioning normally and capturing and transmitting information related to the offender.

26 In-home alcohol monitoring > Portable breathalyzer devices used at home and plugged into standard outlet. > Allows for the monitoring of offenders through the provision of breath samples, at scheduled intervals. > Alternative to the interlock for offenders who do not have a vehicle; can also be used in combination. > Uses fuel cell sensor.

27 How does it work? > Operation is comparable to interlock. > Offenders are required to provide a breath sample during specified test windows. > The unit signifies to the offender that a test is required (visual/audio cues). > Tests must be completed during the window or a violation will register; failed breath tests also result in violations. > Real-time reporting (wireless).

28 Device features > In-home units have the same features as interlock devices (e.g., preset limit, data logger). > Anti-circumvention features such as temperature and pressure gauges are also found on these units. > Devices can also come equipped with cameras that take photos before and during breath tests. > GPS is also available (due to portable nature of device).

29 Remote breath testing > Handheld, wireless, portable breath alcohol device. > Added features may include: » facial recognition » GPS > Testing can be random, scheduled, or on- demand. > Real-time notification of test results. > Viable option for offenders assessed to be a lower risk.

30 Research

31 Effectiveness of interlocks > More than 10 significant evaluations of interlock programs have demonstrated reductions in recidivism ranging from 35-90% with an average reduction of 64% (Willis et al. 2005). > Research shows that device reduces recidivism among first-time and repeat offenders. > During interlock installation period users have lower total recidivism rates than non-users.

32 Effectiveness of interlocks > A recent study of NM’s interlock program (Marques et al. 2010) found that first offenders who participated had a 61% lower recidivism rate while the device was installed. »They also had a 39% lower recidivism rate following the removal of the interlock when compared to a control group. > In Washington, first offenders who installed an interlock had a 12% reduction in recidivism when compared to those who did not (McCartt et al. 2012).

33 Effectiveness of interlocks > Five studies of repeat DWI offenders revealed interlocks were effective in reducing recidivism while device was installed. > Offenders who participated in a 2-year administrative program in MD had a 36% reduction in DWI recidivism during the period of installation (Rauch et al. 2011). »Also 26% reduction in recidivism two years post-intervention.

34 Reductions in crashes > No conclusive research establishes a correlation between use of interlocks and reduction in alcohol-related crashes. > Alcohol-related crashes are “relative rare” in relation to total driving; low installation rate makes it difficult to measure (Fiedler et al. 2012). > Preliminary research in NM found that as interlock installation rates increased the frequency of alcohol- related crashes decreased (Marques et al. 2010).

35 Using device in sentencing > Use of interlocks has been historically low/ inconsistent, due in part to reluctance of judges to impose device as a sanction. > California study reported that following the passage of mandatory legislation requiring interlocks for offenders, an installation order was part of sentencing for less than ¼ of repeat DWI offenders. > More knowledge about devices and benefits can increase use.

36 Using the device in sentencing > Impediments to using alcohol interlock as a sanction include: »Perceptions of “too harsh vs. too lenient;” »Concern about cost to offenders; »Concern about technology and level of effort to monitor compliance; »Lack of knowledge about device effectiveness; and, »Lack of comprehensive, current informational materials.

37 Compliance with installation > Many studies estimate that between 25-75% of suspended or revoked drivers continue to drive. > Research suggests that offenders often fail to install the device. »Less than 20% of eligible offenders choose to install device over remaining under full license suspension (Voas et al. 1999). »Research suggests that repeat offenders are less likely than first offenders to install device. > Good follow-up and monitoring are essential.

38 Compliance with installation > Offenders are non-compliant because: »Device is inconvenient, an embarrassment. »Long delay between license suspension and eligibility for an interlock teaches them that they do not need a licence to drive. »Cost of device. > In order to increase compliance, incentives (e.g., reduced fines) and disincentives (e.g., vehicle impoundment, CAM) can be created.

39 Compliance post-installation > Inclusion of sophisticated anti- circumvention features greatly reduces the likelihood that offenders will successfully disable, bypass it in a way that is not detected. > As laws become stronger and the level of monitoring has increased, non-compliance has generally declined.

40 Offenders’ and family opinions > Offenders are supportive of the device; report it is effective and prevents them from driving after drinking (Beirness et al. 2007). > In UK study, offenders agreed device: »stopped them from driving drunk; »reduced their drinking; »invoked serious thought about drinking habits; »helped change drinking habits. > Research suggests families also supportive.

41 Removing the device > The interlock should remain installed until offenders are able to separate drinking from driving. > Offenders who are unable to control their drinking may require device as a long-term or permanent condition (DeYoung 2002; Raub et al. 2003). > While recidivism rates do increase once the interlock is removed, the overall reductions are greater in comparison to offenders who never installed the device.

42 Effectiveness of CAM > Many studies have established that consumed alcohol can be measured in perspiration through transdermal testing (Robertson et al. 2006). > A variety of experimental studies have shown this to be a valid method to determine whether an individual has consumed alcohol.

43 Effectiveness of CAM > A Michigan DOC study (Bock 2003) found that the device was able to: » Detect circumvention of alcohol test sampling; » Reliably ensure that test samples are from the intended test subjects; and, » Detect drinking episodes around the clock regardless of subject’s schedule or location. > Offenders reported that the device was “a fast- acting deterrent and a preferred method of testing because of the freedom to maintain work and family schedules.”

44 Effectiveness of CAM > The device is most effective with repeat offenders (e.g., 2+ DWI convictions). » Recidivism rate for any crime – 15.7% for CAM users compared to 28.6% for matched group. > The device is effective while it is worn. » Findings comparable to that of interlock; few offenders recidivate while in the program. > The device should be worn at least 90 days. » Offenders who wore the device for more than 90 days recidivated at half the rate of those who wore it for less than 90 days (10% vs. 20%) (Flango and Cheesman 2007).

45 Effectiveness of CAM > 24/7 Sobriety Program in SD uses CAM as well as twice-daily breath testing and urinalysis/drug test patches. > RAND evaluation results: » More than 17,000 offenders had participated (10% of male residents ages in some counties). » Reduced repeat DUI arrests at the county level by 12%. » Reduced arrests for domestic violence at the county level by 9%.

46 Effectiveness of CAM > Compliance statistics for CAM from Oct. 10 th, 2006 – March 1 st, 2014: » 6,269 participants; » 908,755 monitored days; » 704 confirmed drinking events; » 3,037 confirmed tampers; » Approximately 77% of participants never violate; » Per test compliance: 99.7% (SD Office of AG, 2014).

47 Effectiveness of CAM > NHTSA case studies examined programs that utilize transdermal alcohol monitoring devices in CO, MO, NE, NY, ND, and WI (McKnight, Fell, and Auld-Owens 2012; available online:

48 Effectiveness of CAM > NHTSA case studies examined programs that utilize transdermal alcohol monitoring devices in CO, MO, NE, NY, ND, and WI (McKnight, Fell, and Auld-Owens 2012; available online:

49 Effectiveness of CAM > Key study findings (McKnight et al. 2012): » Transdermal monitoring is generally effective in deterring offenders from drinking alcohol. » Information collected is generally accurate. » Non-compliant offenders are likely to be identified; violations are reported in a timely-fashion to the appropriate authority. » Transdermal monitoring helps enforce abstinence. » Continuous transdermal monitoring is more effective for monitoring drinking than periodic/random testing. » Practitioners find technology easy to use. » Alternative to incarceration; reduces number of visits to case managers and testing appointments.

50 Implementation

51 It is important to remember…

52 Contexts for technology use >Alcohol monitoring technologies can be utilized in a variety of contexts: » Pre-trial programs; » Probation supervision programs; » Speciality court programs; » Treatment programs; » Re-entry or parole programs.

53 There is no single model >The breadth of available technologies affords practitioners choice. >Several factors can be taken into consideration when determining which device offenders should be required to use: » What is their risk level? » Do they have abstinence requirements? » Do they own/have access to a vehicle? » Are they indigent? » What services are available? >Offenders can be required to use a combination of technologies.

54 Data as risk management >Alcohol monitoring technologies provide information about offenders’ drinking behavior. » Determines compliance to abstinence orders. » Provides assessment of progress in treatment. » Helps to identify offenders who are high-risk and in need of additional intervention. >Provides an opportunity to hold offenders who are non-compliant accountable for their actions. >Identifies treatment opportunities.

55 Data as risk management > For example, alcohol interlock devices are a reliable predictor of drunk driving recidivism. > Offenders who have more DWIs and more interlock warnings/failures logged during the first 5 months of interlock usage predict more than 60% of repeat DWI violations (Marques et al. 2001).

56 Data as risk management >In order for data to be useful, practitioners must know what information should be reported. >Practitioners must also learn how to interpret data and identify patterns in the data. » For example, how to distinguish between a drinking event and mouth alcohol. >Reporting of data brings responsibility: »Data must be acted upon. »Failure to act creates liability.

57 Importance of monitoring >Monitoring offenders on devices is the linchpin to an effective application and pivotal to deterring future offending. >Offenders need to be aware that consequences will be imposed in order to create deterrence. >Non-compliance can be used as teachable moments. » Can help offenders recognize their drinking problem; understand the impact it is having on their life. >Strategies are needed to ensure offenders are appropriately supervised, particularly during initial use of technology.

58 Monitoring challenges >Often monitoring is inconsistent or non-existent for a variety of reasons including: » poor communication between agencies regarding roles and responsibilities; » variations and confusion in reporting paperwork and practices; » a lack of training and education among practitioners regarding the interpretation of reports; » inadequate knowledge regarding what actions can or should be taken in response to events; and » insufficient staff and resources to review reports and follow-up with offenders.

59 Streamlining monitoring >There are several ways that monitoring can be streamlined. These include: »designating responsibility for monitoring offenders to one agency; »establishing a good reporting system (filtering data; »understanding reports; »taking action in response to violations; »allocating adequate staff; and, »facilitating monitoring through the use of DWI/drug courts.

60 Responses to behavior > Responses to data reported are needed. > Use of graduated sanctions: »increase frequency of reporting »use of early recall feature »camera feature »treatment requirement »random testing/home alcohol testing »extension of period of device use »incarceration »combination of technologies

61 Responses to behavior > Basic deterrence theory should guide approach to supervision and violation response. > Sanctions must be: » Swift » Certain » Meaningful » Proportionate > Creates specific deterrence through offender accountability.

62 Responses to behavior > The use of positive reinforcements can be just as important as the use of sanctions. > These actions do not need to be substantial to be effective (Robertson et al. 2007). Some examples include: »giving verbal praise during regular meetings; »decreasing the frequency of monitoring/reporting; »providing a certificate to recognize compliance; »reducing the period of supervision. > Encourages compliance and builds self-esteem.

63 NCDC Interlock Guidelines >NADCP supports the use of interlocks for DWI and Drug Court participants. >NCDC established Ignition Interlock Guidelines for DWI Courts. >Some of these guidelines include: » DWI Court team members need to understand the devices available in their state as well as the use of data loggers/early recall feature. » Devices can be used to help monitor alcohol use. » Use devices with photo identification. » Incentives and sanctions are important.

64 Treatment > To reduce the likelihood of recidivism, there is a need to incorporate technologies into a more comprehensive treatment intervention. > Treatment has the ability to do what devices cannot - i.e., address the underlying drinking issue that leads to offending. > Devices have the potential to complement and facilitate behavior change by: » Providing an independent assessment of compliance with, and progress in, treatment; » Creating opportunities to confirm instances of compliance and use positive reinforcement; and, » Identifying instances of non-compliance.

65 Treatment > Treatment for alcohol issues can be a long process that may include relapse. > The interlock provides a safety net to protect the public in the event of relapse. > Treatment provider should have access to technology data to begin dialogue and facilitate change. » Practitioners use data to show offenders their alcohol consumption. » Can help offenders overcome denial and move towards readiness for change.

66 Treatment > Not all offenders will require or benefit from a treatment intervention. > Eligible offenders should be screened. > Partnerships between courts, probation, treatment professionals, and service providers can enhance the benefits of alcohol monitoring technologies. > Challenges with including treatment: »resource allocation; »patient confidentiality; and, »education of treatment providers.

67 Performance-based measures > Programs are beginning to adopt policies that are based upon offender performance. > Fewer violations can result in a shorter period of supervision whereas more violations can result in an extended period of supervision or program participation. > Offenders who demonstrate consistent non-compliance require intensive supervision. » Likely candidates for CAM in addition to other technologies (interlock/in-home).

68 Cost concerns > Devices rely on offender-pay schemes. > Cumulative costs place large financial burden on offenders (e.g., fines, fees). > Concerns about the potential for a two-tier system resulting in inequality. > Research has shown that judges are concerned about the costs associated with devices such as interlocks. > Indigent offenders are an issue that can be addressed.

69 Device costs > Interlocks average approximately US $70.00 for installation; $70.00 monthly for monitoring. »Costs may be higher in rural jurisdictions. > The cost of the alcohol interlock device is about $3-4 per day; the cost of a drink. > The cost of other alcohol monitoring technologies varies: » CAM – $7-12/day » In-home – $4-5/day » Remote breath testing - $5-6/day

70 > Challenges defining indigency. » Different meanings in different communities of practice. » Indigency vs. “unaffordability.” > Need to identify clear eligibility criteria. > The creation of a form is recommended. > Reduced fines/fees or indigent funds can cover partial or complete cost of interventions. Indigency

71 Overcoming barriers > Some strategies to overcome technology implementation issues include: » Identify the most appropriate device(s) for each DWI/drug court participant. » Provide practitioners with information about the devices that are available. » Provide practitioners with information about device technology and research on effectiveness. » Train practitioners to interpret data. » Establish monitoring protocol; graduated responses. » Establish objective indigency/unaffordability criteria. » Provide ongoing education.

72 Comprehensive approach > Use of technology in conjunction with: » supervision/monitoring; » treatment to address underlying substance use issues; and, » offender accountability. > Importance of swift, certain, and meaningful sanctions. > The DWI/drug court model incorporates each of these elements.

73 Conclusions > A range of alcohol monitoring technologies are available. > These devices are reliable, accurate, and have multiple anti-circumvention features. > Research has demonstrated that both alcohol interlocks and continuous alcohol monitoring are effective interventions. > There is no one-size-fits-all approach; use of technology should depend on individual offender.

74 Conclusions > Devices provide data that can be used to manage offender risk. > Technologies are a viable sentencing option to use as part of a larger supervision plan. > In order to create long-term behavior change, technologies must be paired with supervision and treatment interventions. > Specialty courts are uniquely positioned to take advantage of the benefits associated with alcohol monitoring technologies.

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