Frequent Alcohol Testing Combined with Swift, Certain and Modest Sanctions Is Associated with Drop in Mortality

For Release

February 9, 2016

An innovative program that requires alcohol-involved offenders to abstain from alcohol and submit to frequent alcohol tests may be associated with a reduction in deaths, according to a new RAND Corporation study.

Examining the 24/7 Sobriety Program in South Dakota, which started as a pilot in 2005, researchers found that county implementation of the program was associated with a 4 percent drop in deaths at the county level. The associations were most evident among causes of death associated with excessive alcohol use, such as circulatory conditions. The results are being published in the journal The Lancet Psychiatry.

Researchers say they were surprised by the magnitude of the negative association between program implementation and mortality, and emphasize that additional research is needed to better understand the size of this relationship and potential mechanisms. But if a negative association persists in future studies, the findings would represent a significant advance in our understanding of how criminal justice interventions may be used to improve public health.

“Our findings suggest that criminal justice interventions that reduce heavy alcohol consumption may, in turn, influence mortality,” said Nancy Nicosia, lead author of the study and a senior economist at RAND, a nonprofit research organization. “Further work is needed to better understand how programs like 24/7 Sobriety affect not only participants, but also those who are not direct participants such as their spouses, partners or peers.”

The South Dakota 24/7 Sobriety Program requires that individuals with an alcohol-involved offense undergo twice-a-day breathalyzer tests, typically once in the morning and once in the evening, or wear continuous alcohol monitoring bracelets. Individuals who fail or skip required tests are immediately subject to a short jail term, typically a day or two for a failed test.

Nearly 17,000 individuals — nearly 3 percent of the state's adult population — participated in the 24/7 program between January 2005 and June 2011. Nearly half of the participants were enrolled after a repeat DUI offense, while others were enrolled after a first-time DUI offence or being charged with assault or domestic violence.

A previous RAND study published in the American Journal of Public Health found that the 24/7 program reduced county-level repeat DUI arrests by 12 percent and domestic violence arrests by 9 percent. That study also documented that 24/7 Sobriety participants had generated more than 2 million days without a detected alcohol violation during the first five years of the program. The comparable figure through 2013 was more than 4.5 million days without a detected alcohol violation.

The program is now being implemented by other jurisdictions in the United States and the U.S. Department of Justice recently designated 24/7 Sobriety as “promising” in their evidenced-based practices portal, In addition, a modified version of the program was recently piloted by the Greater London Authority.

To examine whether the program was associated with changes in mortality, researchers analyzed county-level mortality data from January 2000 through June 2011, and took advantage of the fact that counties implemented the strategy at different points in time. The model included statistical adjustments for several factors that could influence the number of deaths, such as county demographics, snowfall and even the well-known Sturgis Motorcycle Festival that brings large number of motorcycle riders to the state every August.

The association was evident not only for total deaths, but also among conditions sensitive to alcohol use, including circulatory conditions.

The magnitude of the association was larger than anticipated, suggesting further research is needed not only to better understand the association among participants, but also among nonparticipants. For example, other researchers have found that when someone reduces their alcohol consumption, sometimes their spouse reduces their consumption as well.

“Our results are consistent with research suggesting that frequent testing with swift, certain and fair sanctions for violations can improve public health and public safety,” said Beau Kilmer, a study co-author and senior policy researcher at RAND. “It is time to conduct experimental evaluations comparing 24/7 Sobriety with other drunk driving interventions to determine which option is most cost-effective at reducing injury and death.”

Support for the study was provided by the National Institute on Alcohol Abuse and Alcoholism. Paul Heaton of the University of Pennsylvania co-authored the study.

Since 1989, the RAND Drug Policy Research Center has conducted research to help policymakers in the United States and throughout the world address issues involving alcohol and other drugs. In doing so, the center brings an objective and data-driven perspective to an often emotional and fractious policy arena.

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