Transcript Document

Alcohol Monitoring
Technologies:
Tools to Supervise
Impaired Driving
Offenders
Erin Holmes
Research Scientist
Traffic Injury Research Foundation
MADCP Annual Conference
March 12th, 2014, Lansing, MI
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
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Technologies
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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.
4
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.
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How does it work?
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How does it work?
BAC = 0
BAC <= 0.02
Ignition
Warn
Running
Retest
BAC >
0.025
Interlock
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Sensor technology
> There are two types of sensors that
are be used in alcohol interlock
devices:
» semiconductor
sensors
» electrochemical
sensors (fuel cells)
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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.
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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.
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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
11
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.
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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.
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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 1992.
» 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.
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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
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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
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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.
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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.
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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.
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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.
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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).
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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).
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Continuous alcohol monitoring
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Anti-circumvention features
> CAM devices have a number of anticircumvention 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.
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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.
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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).
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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).
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Remote breath testing
> Handheld, wireless, portable breath alcohol
device.
> Added features may include:
» facial recognition
» GPS
> Testing can be random, scheduled, or ondemand.
> Real-time notification of test results.
> Viable option for offenders assessed to be a
lower risk.
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Research
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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.
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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).
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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.
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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 alcoholrelated crashes
decreased
(Marques et al. 2010).
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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.
35
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.
36
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.
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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.
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Compliance post-installation
> Inclusion of sophisticated anticircumvention 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.
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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.
40
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.
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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.
42
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 fastacting deterrent and a preferred method of
testing because of the freedom to maintain work
and family schedules.”
43
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).
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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 18-40 in some counties).
» Reduced repeat DUI arrests at the county level by
12%.
» Reduced arrests for domestic violence at the
county level by 9%.
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Effectiveness of CAM
> Compliance statistics for CAM from Oct. 10th,
2006 – March 1st, 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).
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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:
www.nhtsa.gov/staticfiles/nti/pdf/811603.pdf).
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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:
www.nhtsa.gov/staticfiles/nti/pdf/811603.pdf).
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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.
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Implementation
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It is important to remember…
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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.
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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.
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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.
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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).
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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.
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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.
57
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.
58
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.
59
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
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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.
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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.
62
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.
63
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.
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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.
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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.
66
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).
67
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.
68
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
69
Indigency
> 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.
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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.
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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.
72
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.
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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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