The following articles have been reprinted from the September 2004 Frontlines, a publication by AcademyHealth and the National Institute on Alcohol Abuse and Alcoholism. For more information visit www.academyhealth.org .

Recidivism of DUI offenders poses a challenge for community corrections supervision. The three interventions described below provide examples of approaches that could reduce the likelihood of repeat DUI offenses.

Effectiveness of Court-Mandated Remedial Interventions for DUI Offenders
By Elizabeth Wells-Parker, Ph.D., Mississippi State University

Driving under the influence (DUI) offenses reflect a driving problem as well as an individual's alcohol or other drug use problem. Since these offenses concern both the traffic safety and alcohol treatment communities, the effectiveness of remedial interventions must be viewed from both perspectives.

Remedial interventions include various treat-ment modalities, educational modalities, probation, victim impact panels, self-help groups, and combination strategies. The effectiveness of individual interventions should be considered within the social, political, and economic environment of the individual and the community when formu-lating best practices and policy standards.

A recent review of the literature provides evidence for the effectiveness of remedial interventions for DUI offenders and also identifies areas where additional research could enhance the application of these interventions. 1

The review was based on an earlier comprehensive meta-analysis of the effectiveness of remedial interventions for DUI offenders and a review of subsequent relevant studies.

Do remedial interventions for DUI offenders work?

Reductions in DUI recidivism and crashes are the most commonly reported indicators of intervention success; measures of con-sumption and other indicators of alcohol problem severity are less commonly used and have proved problematic with DUI offenders. In general, remedial interven-tions reduce DUI recidivism compared to standard sanctions such as fines and jail time. The meta-analysis shows that, on
average, remedial interventions result in a 7 to 9 percent reduction in DUI recidivism rates and a similar reduction in alcohol-related crash rates.

How do the effects of remedial intervention compare to licensing actions?

Licensing actions such as revocation and suspension have proved more effective than remedial interventions in addressing traffic safety, however, they are less effective than remedial interventions in reducing alcohol-related driving events such as DUIs and alcohol-involved crashes. DUI remedial intervention targets alcohol-related driving rather than driving exposure in general. Therefore, combining licensing action and remedial intervention produces both a reduction in alcohol-related driving outcomes and a general traffic safety benefit. This combination is appropriate because research has suggested that many DUI offenders are high-risk drivers even when sober.

Which remedial strategies work best?

The most frequently evaluated remedial interventions include education, supervised contact, probation, and programs that com-bine one or more strategies (e.g., education, psychotherapy, and supportive follow-up).
Research has found combined strategies to be the most effective approach. Longer or more intense combined strategy programs did not differ significantly from shorter, less intense combined strategy programs for reducing recidivism, in spite of a relatively broad range of length and intensity of the multiple-strategy programs. The issue of length and intensity in terms of effective-ness needs further study.

The field urgently needs studies of the efficacy and effectiveness of specific treatment modalities for court-mandated DUI offenders. Several modalities, such as court-mandated Alcoholics Anonymous and victims' impact panels, failed to show a positive effect on DUI recidivism, with some evidence that those mandated to these treatments had higher recidivism rates. Although additional research is needed to evaluate these strategies, caution should be exercised with respect to mandatory assignment.

Is there good empirical evidence to match individual offenders to specific interventions and treatment regimens?

Few definitive matching studies have been conducted for DUI offenders. Studies have suggested that sociodemographic characteristics such as age, and co-occurring conditions such as depression, should be taken into account when determining intervention needs. However, these studies have addressed only a limited range of treatment options. Since most intervention assignment schema used for DUI offenders have not been adequately evaluated, the field needs additional matching studies that address DUI offenders as a distinct group.

What additional evidence is needed?

The expansion of well-evaluated treatment options for DUI offenders is critical. Promising alcohol treatment strategies should be evaluated specifically for DUI offenders in terms of their effectiveness for reducing alcohol problems and for reducing impaired driving and crash risk. The field needs to develop cost-effective, easily implementable programs that combine strategies and have components targeted at diverse sub-groups of drinking drivers. Future research also needs to focus on effective programs that can be delivered in areas with restricted resources such as personnel, time, and facilities.

Reference
1 Wells-Parker, E. et al. "Final results from a meta-analysis of remedial interventions with drink/drive offenders," Addiction, Vol. 90, Issue 7, July 1995, pp. 907-26.

Technological Developments Open New Opportunities to Reduce the Recidivism of Convicted Drinking Drivers
By Robert B. Voas, Ph.D., Pacific Institute for Research and Evaluation

America's progress toward reducing alcohol-related highway deaths has stalled during the last decade. Although several reasons explain this setback, the continuing failure to prevent future drunk driving by individuals apprehended driving under the influence(DUI) is an important factor. Approximately a third of DUI offenders will repeat the offense, and a driver with a DUI offense is4.5 times more likely than the average driver to be involved in an alcohol-related fatal crash. The criminal justice system needs to do a better job of controlling offenders' driving while their alcohol problem is being treated through court-mandated programs.

Jail terms for first offenders are too short to keep dangerous drivers off the road for a significant period. License suspension is more effective because it is generally imposed for a longer time-from three to 12 months for first offenders and up to two years for multiple offenders. On our crowded roads, however, the laws against unlicensed driving are difficult for the police to enforce, and approximately three of four DUI offenders drive while suspended. Three types of electronic monitoring systems are providing potentially more effective means for con-trolling the driving and/or the drinking of DUI offenders.

Alcohol Safety Interlocks

Alcohol Safety Interlocks are designed to limit impaired driving by requiring the driver to take a breath test to start the car. These devices are very difficult to circum-vent and have been shown to reduce recidivism by up to 80 to 90 percent.

Electronically Monitored Home Detention

This control system limits the nighttime and recreational driving of DUI offenders and has been shown to reduce recidivism. Recently, this type of location monitoring has been extended by devices that can be attached to the body and produce a record of the offender's location on a 24/7 basis. Such systems use two units: 1) a bracelet "locked" onto the ankle of the offender, which must be in constant radio contact with 2) a portable unit attached to the belt that contains a Global Positioning System (GPS)receiver, a computer, and a recording system.

Electronic BAC Monitoring

Electronic systems have been developed to monitor breath alcohol concentration(BAC). The earliest versions involved random breath tests that could be monitored over a phone line, but a recently developed transdermal sensor attached to the ankle can detect alcohol in sweat and transmit data to a recorder attached to the belt. Several courts have begun to use these trans-dermal sensors with DUI offenders as a method of monitoring abstinence.

The transdermal sensor, along with the electronic monitoring systems attached to home confinement and interlock systems, acquire a large amount of BAC data over an extended period. Data from interlock users (typically averaging about seven BAC tests per day) has been used effectively in spe-cially designed treatment programs to help offenders address their alcohol problems.

The interlock breath-test data has also been shown to track the offenders' progress in steering clear of impaired driving and is useful in predicting future recidivism once the interlock is removed.

Court-mandated alcohol treatment programs have been shown to produce a small (7 to 9 percent) but important reduction in DUI recidivism. In the past, treatment programs have operated independently of court-ordered sanctions programs. The court probation department has overseen both types of programs, yet treatment providers have had little access to information from providers that run impoundment, home confinement, interlock, or position monitoring systems. One important limitation on court-mandated treatment programs is their typically short length. Although they may make some progress in reducing the offender's dependence on alcohol, relapse is common, and much of the benefit may be lost without after-treatment follow up.

The recent growth in the number of DUI courts is extending the length and increasing the intensity of offender monitoring, there by allowing for expanded treatment programs. DUI courts follow the model developed for courts handling drug offenders. DUI courts require tight monitoring of offender alcohol consumption through surprise visits from court probation officers to conduct random alcohol breath tests. In addition, offenders must return to court regularly for an assessment of their treatment progress. DUI courts are very expensive to operate, in part because of the enforcement costs of alcohol monitoring programs. Electronic monitoring systems offer the possibility of more comprehensive and ultimately less expensive control of offender drinking by DUI courts.

More research is required to better under-stand the long-term effects of electronic controls so that the courts and treatment professionals can use appropriate tools to help offenders and to keep the road safe.


A Five-Step Approach to Adjudicating the Repeat Drunk Driver
By Honorable Eric J. Bloch, Multnomah County Circuit Court, and Sandra Lapham, M.D., M.P.H., Behavioral Health Research Center of the Southwest

Repeat drunk-driving offenders pose a significant public health threat, often continuing to drink and drive even after their drivers' licenses have been revoked. They don't readily stop drinking and driving, even when faced with long jail terms. Interviews reveal that most are alcohol dependent, many are addicted to other
drugs, and a high proportion suffers from other mental health problems.

The DUI Intensive Supervision Program (DISP)was developed and implemented in 1998 by Judge Dorothy Baker in Multnomah County, Ore., and is currently directed by the Honorable Eric J. Bloch of the Multnomah County Circuit Court. The goals of the DISP are to affect thinking and life changes that will reduce recidivism, reduce risk to the community, and increase quality of life for the offender. The program includes sanctions, treatment, and close monitoring of offenders' compliance with
the program.

Originally limited to offenders with three or more DUIs, the program has expanded to include all repeat offenders. The DISP has an impressive record: At the end of May 2004, 357offenders had successfully completed the three-year program and stayed off probation an average of 406 days. Only 10 graduates (0.7 percent)have re-offended. Court statistics indicate that the overall recidivism rate, including those
who did not complete the program, is 12.5 per-cent-much lower than comparable groups.

The DISP has five key components:

1) Honesty. Sentences are "cast in stone" so offenders can give a complete report of their alcohol use and driving without fear of increased sanctions. False statements in court regarding alcohol, drugs, driving, or working will result in the offender being taken into custody. Short jail terms are imposed as negative consequences to discourage future probation violations.

2) Zero tolerance for alcohol and drugs. Offender-funded electronic monitoring (EM)with a bracelet and breath testing over telephone lines is required. A patch and/or urine drug tests are required for offenders who use illegal or controlled substances. Adults living with an offender must sign a notice agreeing that there will be no alcohol or drugs in residence. All offenders are required to undergo intensive monitoring with monthly in-person visits.

3) Zero tolerance for driving. Offenders are required to sell their vehicles on the open market and are encouraged to ride a bicycle or take public transportation. Adults living with offenders are required to sign a notice of possible criminal sanctions if their vehicles are made available to the offender.

4) Treatment. Within one month of release from custody, the court refers the client to out-patient treatment consisting of individual and group therapy for 90 days to one year or more. Offenders pay for treatment unless indigent. A state-sponsored program supplements fees for indigent clients, with additional provision for sliding scale fees. The therapists are licensed and the programs approved by the state mental health department.

5) Payment of monetary obligations. Offenders must obtain full-time employment. The court coordinator calculates the total payments (for EM, treatment, fines) for the offender and provides all information required to complete probation. The court system's accounting department notifies the judge if the offender does not pay fees, fines, and restitution as scheduled. As an incentive, the court waives the DUI fine upon successful completion of DISP.

Case Study
Ralph Pennington (not his real name) is a 54-year-old felon with six DUI (driving under the influence) offenses. When he was charged with a seventh offense, he was sure he would be spending a long time in jail. "My life was a mess," he said. "I'd been drinking for years-gambling, fighting, lying. I had a string of broken relationships. I'd even lost my girl-friend of many years." He was referred to a unique offender rehabilitation program, called the DUI Intensive Supervision Program (DISP).
When Ralph started the DISP, he had a job but no other life. He disliked the idea of outside social activity because he was tired after work, but he participated because it was a probation condition. He went to treatment and Alcoholics Anonymous meetings. He joined a gym, took dance and yoga classes, joined a golf team, and felt better than ever. He discovered he wasn't too old to have fun, and began to enjoy getting out of bed in the morning. He made the decision to remain sober, bought a house, and reunited with his girlfriend. Eventually he was allowed to drive again. Ralph cried tears of joy at his graduation from the DISP.