A criminal justice program that requires offenders convicted of alcohol-related offenses to stop drinking and submit to frequent alcohol testing with swift, certain, and modest sanctions for a violation was linked to a significant reduction in county-level mortality rates in South Dakota. These results came from a study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.
The 24/7 Sobriety program, launched in South Dakota in 2005, was associated with a 4.2 percent decrease in all-cause mortality over six years, with the largest reductions occurring among women and individuals over 40. Deaths from circulatory conditions, which include heart disease and stroke, declined significantly.
"The study suggests that effective programs for alcohol-involved offenders may have benefits, not only for the participants themselves, but for the community as a whole," said George F. Koob, Ph.D., NIAAA director. "If these results are replicated in future studies, it could advance our understanding of how interventions within the criminal justice system can be used to improve public health."
The analysis was conducted by Nancy Nicosia, Ph.D., Beau Kilmer, Ph.D., and Paul Heaton, Ph.D., of the RAND Corporation. Results appear online in The Lancet Psychiatry.
As part of the 24/7 Sobriety Program, people convicted of an alcohol-related offense must submit to twice-a-day breathalyzer tests or wear a continuous alcohol monitoring bracelet. Any violation is met with a swift, certain, and modest sanction; people who fail or skip tests immediately receive a short jail term, typically one to two days for a failed test. Nearly 3 percent of South Dakota's adult population (about 17,000 people) participated in 24/7 Sobriety between January 2005 and June 2011. Most people were placed in the program as a result of an arrest and conviction of driving under the influence of alcohol or other drugs.
Researchers analyzed county-level mortality data from 2000 to 2011, making statistical adjustments for several factors, such as county demographics, unemployment rates, snowfall, police per capita, and bars per capita. Researchers were aided by the fact that different counties implemented 24/7 Sobriety at different points in time.
The methods used in this study are stronger than simple cross-sectional studies that take data from a sample population at one point in time. Cross-sectional studies show correlation and cannot confirm any cause-and-effect relationship. In the present study, however, the researchers were able to compare within-county changes in mortality to within-county implementation of 24/7 Sobriety. This "differences-in-differences" statistical design provides substantial evidence of a causal relationship between the program and decreased mortality rates.
The study authors were surprised at the magnitude of the drop in mortality associated with 24/7 Sobriety and point to the need for additional research to understand the extent of the relationship and the possible underlying causes.
The researchers note that some of the reductions in mortality may reflect spillover effects onto nonparticipants, such as spouses, friends, and others who may be affected by changes in drinking behavior of those enrolled in the program. Previous studies have indicated that spouses sometimes reduce their drinking as a result of reductions in their partners' consumption.
24/7 Sobriety represents a promising alternate approach to preventing drunk driving. While other criminal justice interventions often focus on separating drinking and driving, 24/7 Sobriety attempts to manage the drinking itself. Technological advances such as remote alcohol monitoring in real time, coupled with the ability to transmit data electronically, are creating greater possibilities for these newer approaches.