ALCOHOL, IGNITION INTERLOCK (WORKING GROUP SESSION)

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1 ALCOHOL, IGNITION INTERLOCK (WORKING GROUP SESSION)

2 - 96 -

3 The Québec Alcohol Ignition Interlock Program: Impact on Recidivism and Crashes Vézina, L. Highway Safety Research and Strategy Société de l assurance automobile du Québec Keywords Alcohol, ignition interlock, conviction, recidivism, crashes Abstract The alcohol ignition interlock program began operating in Québec in December Someone convicted of driving while impaired (DWI) is allowed under the program to drive a vehicle on condition it be equipped with an ignition interlock, and the individual's voluntary participation allows for a shortening of the period of licence revocation. This evaluation seeks to measure the program s impact on both DWI recidivism and crashes. The methodology is a cohort study comparing a group comprised of individuals convicted of DWI who took part in the ignition interlock program, and a control group made up of drivers convicted during the same period who did not participate. The data concerning first-time DWI offenders and that pertaining to repeat offenders is presented separately. Participation in the interlock program resulted in a reduction in the repeat DWI rate by 80% during the first 12 months for first-time offenders and by 74% during the first 24 months among repeat offenders. Figures for night crashes involving no more than one vehicle, when compared to overall crash data, also tend to show the effectiveness of the program in lowering the incidence of impaired-driving mishaps. In both cases, however, the effect tends to disappear after removal of the interlock, which leads to the conclusion that it serves more as a restraining device than a tool for driver rehabilitation. This suggests that extending the period of interlock use should be considered, at least for drivers who are likely to become repeat DWI offenders. Introduction The alcohol ignition interlock program was implemented in Québec in December Other countermeasures were introduced simultaneously included administrative license suspension, vehicle impoundment for driving while disqualified and mandatory evaluation for DWI repeat offenders. Enrollment in the Québec ignition interlock program is on a voluntary basis, and allows a motorist sentenced for impaired driving to obtain a restricted licence with authorization to

4 operate a vehicle equipped with an interlock device. When the ignition interlock program was implemented, it was aimed at all drivers sentenced for DWI. In fact, it was aimed as much at drivers who had been sentenced for the first offence as those who had repeated the offence, since the main criteria for eligibility were having served the entire driving prohibition period as provided for under the Canadian Criminal Code (CCC) and not having other active driving suspensions on record. Originally, a driver could therefore, upon finishing the driving prohibition of a 3, 6 or 12-month period (either a first, second or third conviction within five years), obtain a restricted licence for the time remaining in the penalty period of a total duration of one, two or three years. However, because of amendments made to the CCC, the program was solely available to drivers who have been sentenced for an initial offence within the preceding five years during the period between July 1999 and December To date, studies carried out on the interlock device tend to show that this is an effective means for reducing DWI recidivism (Morse and Elliot, Beirness et al., Tippetts and Voas, Beck et al). Accordingly, the lower rates of repeat offences of this kind observed among the group of drivers using an interlock device, compared to a control group, vary from 60% to 75% during the period in which the device is installed. However, most of these studies also show that the effect seems to wane after the device is removed. In addition, the impact on crashes has not been well documented to date as few studies have broached the topic. A preliminary evaluation of the Québec program, based on first-year results, indicated a decrease in the rate of impaired driving offences as well as a decline in the rate of crashes involving bodily injuries further to the installation of an interlock device (Dussault and Gendreau). Although this initial evaluation has revealed encouraging findings, the preliminary assessment of the before-during-after period remains incomplete due to the recent time aspect of the data and due to the absence of a control group. The objective of this study is to evaluate the impact, after a three-year period, of the interlock device on repeat DWI offences by differentiating the effects among first-time offenders from repeat offenders. It also aims to shed a certain amount of light on the impact this program has on the entire range of motor vehicle crashes and more specifically on alcohol-related crashes. Methods The methodology is a cohort study comparing a group comprised of individuals convicted of DWI who took part in the ignition interlock program (study group), and a control group made up of drivers convicted during the same period who did not participate. The study group is comprised of drivers sentenced for impaired driving after December 1997 who enrolled in the ignition interlock program, whereas the control group is made up of drivers sentenced during the same period who did not participate in the program. For every individual meeting this criterion, the first sentencing as of that date was used as a benchmark penalty for calculating repeat impaired driving behaviour. The study group is composed of 42,563 drivers sentenced for impaired driving between December 1, 1997, and January 26, Of that number, 81% (34,405/42,563) had been sentenced for the first time in a five-year period and 19% were repeat offenders (8,158/42,563). The latter group comprised

5 drivers who had been convicted for a first time but who were sentenced for more than one incident at the same time, giving rise to a penalty of two years or more. In that same period, 9,896 drivers obtained a restricted licence (8,846 first-time offenders and 1,050 repeat offenders) that allowed them to have an interlock device installed; this group accounted for 26% of the first-time offenders and 13% of repeat offenders. The percentage of repeat offenders with an interlock device is lower since that group was not eligible for the program during the period between July 1999 and December Drivers who display repeat behaviour by continuing to drink and drive are selected according to criminal sentencing or an immediate suspension of their licence, as related to an offence committed after the effective date of the benchmark penalty. Single-vehicle nighttime crashes (occurring between 9 p.m. and 6 a.m.) were used as a surrogate measure for alcohol-related crashes. The primary analysis technique used in this study is the survival analysis. This analysis allows us to take into account the length of time elapsed between the beginning of the penalty period and the occurrence of a first event (repeat offence or crash), compared to other analysis techniques that limit consideration of the rate of incidence. It also provides the advantage of being able to process censored data. Thus, the survival curves, according to the Kaplan-Meier method, are used to illustrate the probabilities of non-repeat behaviour in both groups at different times (t), based on the beginning of the penalty period and the Cox s model of proportionate rates allows us to introduce co-variables such as the characteristics of drivers belonging to either group. However, to ensure the validity of the Cox model, the impact of the factor we are seeking to measure must be constant over time. If that condition is not met, we must perform a stratified analysis over time, making the survival for each period conditional to the survival observed during the preceding period. In our case at hand, the effect of the interlock device program varies over time, so that stratification is necessary to ensure a certain degree of homogeneity. The stratification retained is different, depending on whether we consider first-time offenders or repeat offenders but the cutoff is rather clear in both cases: 12 months for the first group, and 24 months for the second. These periods closely correspond to the period with the interlock device (including the waiting period) and the post-interlock device period. Results - Demographic characteristics Drivers sentenced for impaired driving are mainly men (89 %) with an average age of 36.7 years. However, there are a few statistically significant differences between the interlock program participants and the drivers making up the control group. Among the group of first-time offenders, we find a greater proportion of men enrolled in the ignition interlock program and of a slightly older age, whereas among repeat offenders, those participating in the program are on average younger than the drivers without an interlock device

6 The tracking period of all drivers in the study lasted days on average. The length was greater for repeat offenders and drivers who had an interlock device. The average length of participation in the program was days for first-time offenders and for repeat offenders. - Impact on DWI recidivism First, the survival curves were traced for both groups according to the Kaplan-Meier method (figure 1). The differences observed between the group with interlock devices and the control group were statistically significant and indicate a lower recidivism rate for the group so equipped for the entire period covered. However, we noted changes to the appearance of the survival curves subsequent to 12 months of follow-up in the case of first-time offenders and after 24 months among repeat offenders, as the curves tend to come together beyond those two points. Incidentally, this confirms the stratified analysis according to the Cox model (table 1). Thus, among first-time offenders, the risk ratio of DWI recidivism for drivers with an interlock device as opposed to the control group was for the first 12 months, then climbing to 1.218; both results are statistically significant. Therefore, the risk of falling into repeat drunk-driving behaviour for drivers with an interlock device is significantly lower during the first 12 months, or during the period when the device can be installed and that, thereafter, it becomes significantly higher than that observed among drivers in the control group. Among the group of repeat offenders, the risk of recidivism (RR=0.260) for the first 24 months among drivers with an interlock device was significantly lower while after that period it was basically the same in both groups, even though the risk ratio is reported as Nonetheless, it is important to note that the gains observed at the outset of the period broadly offset the rises that occur afterward, resulting in significant gains for the entire period. This applies both to first-time offenders and repeat offenders. Table 1: Stratified analyses over time with the Cox model for DWI recidivism First-time offenders 12 months > 12 months Repeat offenders 24 months > 24 months Risk ratio* * adjusted for gender and age P-value < <

7 Figure 1: Survival curves according to Kaplan-Meier for DWI recidivism First-Offender Grou Repeat-Offender Group 1 1 0,98 0,98 0,96 0,96 0,94 0,94 0,92 0,92 0, month 0, month interlock no-interlock interlock no-interlock - Impact on crashes The survival analysis on single-vehicle nighttime crashes conducted using the Kaplan-Meier model (Figure 2) gives rise to non-significant differences between the groups of drivers with or without interlock devices, both as regards first-time offenders and repeat offenders. After we stratify the results, however, certain differences come to light (see Table 2). Accordingly, we noted that the risk of crash is not significantly different during the first few months after the penalty period begins and that, thereafter, the risk among drivers with an interlock device becomes greater than that of drivers belonging to the control group. Risk ratios were also computed for all crashes and we observed that the risk of crashes among drivers with an interlock device is greater in all cases. Table 2: Stratified analyses over time with the Cox model for Single-vehicle nighttime crashes (and all crashes)* First-time offenders 12 months > 12 months Repeat offenders 24 months > 24 months Risk ratio** (3.557) (1.652) (2.160) (3.867) * Results for all crashes appear in parentheses ** Adjusted for gender and age P-value (<.0001) (<.0001) (<.0001) (<.0001)

8 Figure 2: Survival curves according to Kaplan-Meier for Single-vehicle nighttime crashes First-Offender Group Repeat-Offender Group 1 1 0,995 0,995 0,99 0,99 0,985 0,985 0, month interlock no-interlock 0, month interlock no-interlock Discussion The findings of this study have confirmed the effectiveness of the interlock program to reduce DWI recidivism while the device is in place. However, we noted that the rate of recidivism observed after the penalty period runs out is either significantly higher among first-time offenders, or the same among repeat offenders who had an interlock device, compared to the control group. These last results incidentally are similar to observations made by Tippetts and Voas who noted an increase in repeat behaviour of this type among first-time offenders and repeat offenders, after the removal of the device, and those of Beck et al. who found no significant differences among repeat offenders beyond the first 12 months. Therefore, at this stage, an interlock device appears to be more of an issue of contention than a means of rehabilitation since the gains seem to dissipate when the device is removed from the vehicle. However, it has been noted that the gains realized early in the period are sufficiently great to show that, despite all, a reduction in recidivism is observed over the entire period. In terms of the impact of the program on alcohol-related crashes, the findings reported as to single-vehicle nighttime crashes seem, at first glance, to be less conclusive since the risk ratios calculated during the first few months (1.053 among first-time offenders, and among repeat offenders) are not statistically significant. Nevertheless, these findings merit special attention since it is important to consider the fact that this indicator could be contaminated by the effect of crashes not related to alcohol and that it is also very sensitive to a difference in exposure between the two groups. Although nighttime crashes involving just one vehicle represent the best approximation available for crashes attributable to alcohol consumption, this measure is not perfect as it also takes into account a certain number of crashes not related to alcohol. That is why these results become more interesting when compared with the results obtained for all crashes combined

9 Furthermore, the factor of exposure can also allow us to qualify the findings obtained for crashes since the fact of being involved in a crash reflects of course the conduct of an individual but also reflects to a great extent the distance travelled by that individual. First, we can advance the hypothesis that drivers who chose an interlock device have a greater need for their vehicle and that they generally travel a higher number of kilometres. This was observed by Morse and Elliot in a previous study. Next comes the fact that the drivers subjected to a conventional penalty simply do not have the right to drive and, even though a substantial number continue to drive anyway, they tend to cover small distances. This would explain the decrease in the risk ratio of total crashes for first-time offenders with an interlock device once the penalty period is over, or when the drivers of the control group can regain their licence. Therefore, once distinctions have been made as to the limits of the indicator chosen and the measurement of exposure, the results obtained in terms of crashes involving just one vehicle at night also tend to show the effectiveness of the ignition interlock program over the period during which it is installed. The voluntary aspect of participation in the program also raises the question of a potential selfselection bias. Indeed, it is possible that the drivers taking part in an ignition interlock program are people more inclined to comply with set rules and that this would be the major reason for the relative decrease observed among that group. However, as pointed out by Tippetts and Voas, it is not very likely that the self-selection bias could alone account for the decrease, given the greater rate of recidivism observed after the device s removal. The fact that the risk ratios of DWI recidivism and crashes potentially attributed to alcohol of the participants in an interlock program are significantly higher following the removal of the device also raises a few questions, such as the absence of the rehabilitation effect. However, it is important to once again consider the question of relative exposure. When we compare the risks after a penalty period, our analysis presupposes that the exposure of the interlock group is relatively comparable to that of the control group, even though this might not be entirely the case. We do know that a high number of drivers opt not to regain their driver s licence after a penalty period, and we could suppose that this might affect the drivers in the control group to a greater extent, since the participants in the interlock program had expressed their desire to regain their licence beforehand. The proportion of non-reintegration is perhaps smaller in Québec due to the vehicle-seizing policy in effect for driving while disqualified, but could reach 50% according to Tippetts and Voas. A way in which to solve the problem would be to take into consideration solely those drivers who recovered their driver s licence at the end of their penalty period, and conduct a new study of this subgroup to ensure all analyses are conducted on the same basis of comparison. This would be a fairer way to gauge the level of rehabilitation attained by the device. Findings from this second assessment of the Québec ignition interlock program confirmed its effectiveness in reducing the recidivism in driving while impaired (DWI). The findings also suggest that the impact on alcohol-related crashes ought to be evaluated more accurately through

10 additional studies. However, in both cases we noted that the effects tend to diminish beyond the periods covered by the interlock device. Therefore, this infers we should extend the interlock device use period, at the very least, among drivers showing a major recidivism risk. References 1. Morse, B.J. and Elliot, D.S. Effects of Ignition Interlock Devices on DWI Recidivism: Findings From a Longitudinal Study in Hamilton County, Ohio. Crime & Delinquency, Vol. 38, No. 2; pp , Beirness, D., Marques, P.R., Voas, R.B. and Tippetts, S. Evaluation of the Alberta Ignition Interlock Program: Preliminary Results in C. Mercier-Guyon (Editor). Alcohol, Drugs and Traffic Safety T '97: Proceedings of the 14 th International Conference on Alcohol, Drugs and Traffic Safety. Annecy, France; pp , Tippetts, A.S. and Voas, R.B. The Effectiveness of the West Virginia Interlock Program. Journal of Traffic Medicine, Vol. 26 (1-2), pp , Beck, K.H., Rauch, W.J., Baker, E.A. and Williams, A.F. Effects of Ignition Interlock License Restrictions on Drivers With Multiple Alcohol Offences: A Randomized Trial in Maryland. American Journal of Public Health 89(11), pp , Dussault, C and Gendreau, M. Alcohol ignition interlock: One-year s experience in Québec. In Proceedings of the 15 th International Conference on Alcohol, Drugs and Traffic Safety, May 22-26, 2000, Stockholm, Sweden, 5 p,

11 Illinois Ignition Interlock Evaluation Frank, J.F. 1, Raub, R. 1, Lucke, R.E. 2, Wark, R.I. 2 1 National Highway Traffic Safety Administration, Washington, DC 2 Northwestern University Center for Public Safety, Evanston, IL The Illinois ignition interlock law first went into effect in 1994 when the installation of ignition interlock devices was added to the package of sanctions for Driving Under the Influence (DUI) of Alcohol (625ILCS5/11-501(6)(i)). Previously, repeat offenders could petition the Secretary of State (SOS) for a restricted driving permit (RDP) after serving some period of license loss, and such permits generally were issued without other requirements. With the enacting of the ignition interlock legislation, those individuals would also need to install an interlock as an additional requirement for receiving the RDP. It was and still is an administrative program requiring the installation of an interlock as a condition of the RDP. Offenders had and have the option of not reinstating their licenses and not installing an interlock. Accordingly, the interlock users were and continue to be a group of people who are motivated to get their license back legitimately, and are, perhaps, more likely to succeed on the interlock than those who choose not to reinstate their license and install a device. The National Highway Traffic Safety Administration (NHTSA) agreed to provide some funding for an evaluation of the program in collaboration with the Illinois Secretary of State. This paper reports on the results of that evaluation. Procedures: The Comparisons The treatment group in this study consisted of all drivers who were eligible for and received an RDP, and accordingly also installed an interlock device on their car for one year during the period from July 1, 1994 through June 30, These were persons who met specific criteria set by state rules, but essentially were multiple offenders eligible for the RDP after a period of hard suspension. The comparison, or control group, consisted of a cohort of individuals who met the same criteria during the three-year period from July 1, 1991 through June 30, 1994, before the interlock law and program existed. It should be understood that during the period, individual drivers could elect not to seek an RDP and not have an interlock installed. Hence, the interlock group is, to some extent, self-selected and biased in favor of those who may have been more motivated to make the interlock work

12 Results As shown in Table 1, through December 2000, 938 drivers in the control group (68%) and 1,352 (87%) in the treatment group had not been rearrested for an alcohol- related violation 1. However, because those drivers in the control group had up to 9.5 years of driving (July 1991 through December 2000) compared to some in the treatment group having only 3.5 years (June 1997 through December 2000), including all arrests is useful only for showing possible trends in arrests. It does show that by the fourth year approximately the same percentage of persons in the treatment group as in the control group appear to be re-arrested for DUI. Table 1 Number and Percentage of Drivers Rearrested for DUI After Different Time Periods (through December 2000). Time to Arrest 1 Year 1 to 2 2 to 3 3 to 4 Total Total Group and Less Years Years Years Arrests in Group Control Percent 6,8% 7,7% 5,1% 3,4% 23,0% Treatment Percent 1,3% 3,1% 3,7% 2,9% 10,9% Table 2 displays the same data as Table 1, except that the period for comparison is limited to three years after the hearing. Within the first 3 years, 20% of the control group has been rearrested for an alcohol violation. Only 8% of the treatment group has had the same outcome. The differences are statistically significant at p < with a chi square of and 5 degrees of freedom (df). However, as both tables suggest, the differences between the two groups are beginning to disappear by the end of the third year. Those drivers in the control group who were re-arrested within three years averaged 515 days until the arrest with a standard deviation of 275 days. Those in the treatment group averaged 716 days to the arrest with a deviation of 262 days. These values are significantly different at the level based on a t-test of differences (t=5.28 with a F test showing no differences between the variances). 1 The arrests are for driving under the influence, but the conviction could have been for any alcohol related violations including failure to take a breath/blood test, DUI, or plead down to reckless driving

13 Table 2 First DUI Re-arrest: First Three Years After Receiving the RDP Time to Arrest No DUI 1 Year 1 to to 2 2 to to 3 All Total Group Arrest and Less Years Years Years Years Arrests in Group Control 1, ,384 Percent 80.3% 6.8% 4.4% 3.3% 3.2% 2.0% 19.7% Treatment 1, ,560 Percent 92.0% 1.3% 1.2% 1.9% 1.9% 1.7% 8.0% Chi square = 110.2, df=5, p<0.001 While interlock devices were installed for only one year, having three years of post-interlock data allows an examination of recidivism rates over a longer period of time than other studies have had the luxury of doing. It appears that the effects of the interlock did hold for some time after the interlock was removed, but this effect can only be characterized as a transient effect that disappeared by the end of three years. Only Weinrath (1997) has reported any sort of carryover effect after interlocks have been removed, and his n was relatively small and in need of confirmation. Logically, it makes sense that some offenders might have continued to be influenced by the yearlong experience of having had to use the interlock to get their car started. As in other studies (e.g., Beck, et al., 1999; Popkin, et al, 1992; as well as a review by Cobin and Larkin, 1999), these offenders appear to have relapsed when the interlock was not in place to prevent them from drinking and driving. Recidivism rates returning to pre-interlock levels support this explanation. Number of Arrests The Special Case of Offenders who fail, even on the Interlock This study also gave us an opportunity to examine a special group of offenders (n=152), persons in the interlock group who had their RPD rescinded for violations while they were on the interlock. This group is best characterized as the worst of the worst offenders examined in this study. This group of offenders was also followed to see whether they were subsequently rearrested for DUI, for Driving While Suspended (DWS), or were involved in a subsequent crash. Offenders showing up in any of these categories provide evidence that they were, in fact, continuing to drive. The data, presented in Table 3, are striking. In the three years following the initial hearing date, approximately 62% of drivers whose RDPs had been cancelled for an alcohol violation while they were on the BAIID and 55% of those cancelled for other reasons also while on the BAIID, had another driving action on their record. These offenders continued to be arrested for driving under the influence at a rate far in excess of the rate for the driving population in Illinois. Given a base of 11.4 million registered drivers and an average of 47,000 DUI arrests yields an annual rate of 4.2 DUI arrests per 1,000 drivers. The annual rate of arrests in the group whose BAIID was cancelled is 110 per 1,000 drivers (Etzkorn and Martin, 1997). Revoking the drivers license for those whose driving record makes them originally eligible for an RDP does not appear to deter driving, especially driving under the influence of alcohol. These data suggest that the public would have been safer had the interlocks remained on their cars, no matter what the violation rate had been. Perhaps other sanctions might be considered that would have an impact on the driver, without removing the interlock from the car, so the general driving

14 public would continue to be protected from this individual drinking and driving, at least in his own vehicle. There is a clear need to get this offender s attention, either by impounding his car and/or increasing the intensity of supervision and/or treatment. Just taking the offenders license away again does not appear to have the desired effect, or protect the general driving public from them. Table 3 Further Driving Actions for Cancelled Treatment Group Time to First Action No Time to Action Cancellation Reason Other 1 Year 1 to to 2 2 to to 3 Total Total and Next Action Actions and Less Years Years Years Years Actions in Group Alcohol Percent 38.5% 19.2% 7.7% 0.0% 19.2% 15.4% 61.5% 2nd DUI* Crash Invalid License Other Percent 45.2% 13.5% 11.1% 15.9% 8.7% 5.6% 54.8% 1st DUI Crash Invalid License * An additional 6 drivers had DUI arrest after 3 years. Conclusions During the one-year period that the breath alcohol ignition interlocks (BAIID) were installed on their vehicles, fewer drivers were arrested for DUI than a similar group without the interlocks. This finding is in agreement with what has been found by most other researchers. Even though the control group employed in this study was from a different population than that used for the treatment group, the differences between those groups were probably not large enough to offset the significant differences found in driving behavior between these two groups of offenders. These findings support the assertion that simply providing a Restricted Drivers Permit, as well as the rules and restrictions under which the license is offered, is not sufficient to prevent persons from continuing to drive after drinking. Adding a device that prevents the vehicle from starting when alcohol is detected is a critical component. Those few drivers who were arrested for DUI while the device was installed in their vehicle probably had tampered with the device, were driving another vehicle, or not yet had the device installed. The BAIID does not appear to promote a long-term change in driving behavior. By the end of three years, those who had the device installed had arrest rates roughly similar to those who had never been exposed to the BAIID. This finding is also in agreement with other research that, in general, has found even shorter carry-over affects. The finding that long-term behavior is not likely to change also implies the need to determine if the continued use of the BAIID may need to be a permanent requirement for some drivers. Currently, only in a few cases has the Illinois Secretary of State continued requiring the use of the device for more than one year. The Secretary of State may need to establish guidelines for requiring continued (long term) use of the BAIID

15 In the short-term, the interlock appears effective for those who use it. However, this group represents only a fraction of the potentially eligible drivers. No additional investigation was made of the large group (approximately 70% of the total) who may have met the conditions for use of the BAIID but did not apply for the RDP. More information concerning the likelihood that these drivers will continue to drive without a valid license is clearly needed. The literature has indicated that the large number of those with revoked licenses continues to drive. If this were confirmed as the case with Illinois drivers with multiple alcohol offences, it would call into question the strategy of employing revocation as a sanction for those drivers presenting the greatest potential danger on the road. The failure of revocation as a tool to control driving clearly was evident with the small group of drivers who had applied for the BAIID, but for multiple reasons were returned to revoked status. In the three-year period following the return to revoked status, 60% were either arrested for a driving infraction including DUI or involved in a crash; both events clearly indicating they were continuing to drive. It appears that what is needed is to increase the incentives for using BAIID while at the same time increasing the disincentives for driving while in a revoked status. In summary, BAIID appears to be a valuable tool that helps reduce driving under the influence of alcohol by those who previously were likely to continue to drink and drive. However, especially given the economic disincentives such as the costs of installation, monitoring and increased insurance premiums, many potential users will not be motivated to obtain a Restricted Driving Permit when the interlock device is required. Moreover, there is not sufficient disincentive for persons to continue driving even though their license has been suspended or revoked. Finally, for those who tamper with the BAIID, fail to report for monitoring, or do not have it installed, simply a return to revoked status is not an effective option. An approach needs to be found that will effectively prevent driving while impaired or in more severe cases, driving at all. References Beck, Kenneth H., William J. Rauch, and Elizabeth A. & Williams Alan F. Baker. Effects Of Ignition Interlock License Restrictions on Drivers With Multiple Alcohol Offenses: A Randomized Trial in Maryland. American Journal of Public Health 89, no. 11 (1999): Coben, Jeffrey H., and Gregory I. Larkin. Effectiveness of Ignition Interlock Devices in Reducing Drunk Driving Recidivism. American Journal of Preventive Medicine 16, no. 1S (1999): Etzkorn, Larry D. and Jim Martin. A Preliminary Report on the Effectiveness of the Illinois Secretary of State s Breath Alcohol Ignition Interlock Device (BAIID) Pilot Program. Paper presented at the 76 th Annual Transportation Research Board, Washington, DC: January Popkin, C. L., J. R. Stewart, C. Martell, and J. D. Brickmayer. An Evaluation of the Effectiveness of the Interlock in Preventing Recidivism in a Population of Multiple DWI Offenders. Chapel Hill: University of North Carolina Highway Safety Research Center, Weinrath, Michael. The Ignition Interlock Program for Drunk Drivers: a Multivariate Test. Crime and Delinquency 43, no. 1 (1997):

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17 A Preliminary Evaluation of the Swedish Ignition Interlock Programme and Recommended Further Steps Bjerre, B. Traffic Medicine Advisory Board, Swedish National Road Administration, S Borlänge, Sweden Abstract The Swedish alcohol ignition interlock programme for DWI offenders started as a pilot project in It is a volunteer programme, but differs in some respects from other programmes. It covers a period of two years, and includes very strict medical regulations entailing regular check-ups by a physician. Records from the five years prior to the DWI offence showed that the DWI offenders are generally in a high-risk category long before their offence. During the programme, alcohol consumption is monitored through the use of self-esteem questionnaires (AUDIT) and five different biological markers. Our preliminary data shows a noticeable reduction in alcohol consumption amongst the participants, as determined through falling AUDIT scores and significantly decreased levels in the biological markers. It must, however, be noted that the number of participants is still very small (285 individuals) compared to other programmes. Up until now, no case of recidivism has been found during the programme, but it is still too early to draw any conclusions concerning the rate of recidivism after completion of the programme, as data is not yet available for analysis. Nevertheless, the preliminary results are so promising that the programme will be expanded to cover all of Sweden, as well as include all driving licence categories. Introduction From February 1999, DWI offenders in three of Sweden s twenty-one counties were able to volunteer for a two-year alcohol ignition interlock pilot programme. In this programme, the interlock memory was checked every other month and medical check-ups using biological alcohol markers were conducted every third month. Participants had to verify a sober lifestyle during the second year to be permitted to continue. Objectives The aim of the pilot programme was to examine driver behaviour in connection with the alcohol ignition interlock and to study its effect from a recidivism and rehabilitation perspective. A further aim was to assess the potential of the interlock for reducing relapse frequency, and thereby benefit road safety. Moreover, a study was to be made of the specific effect of the alcohol ignition interlock compared to that achieved through driving licence revocation. Additionally, the rehabilitation potential through long-term follow-ups was to be examined

18 Methods The process evaluation involved a longitudinal monitoring of participants, with the main focus on any changes in life-style and drinking behaviour. This was determined through interviews, self-esteem questionnaires (AUDIT) and through the use of biological markers (the three liver enzymes GGT, ASAT and ALAT, the mean volume of the red blood corpuscles (MCV) and the carbohydrate-deficient transferrin (CDT)). Two control groups were used, one comprising DWI offenders who had abstained from participating in the programme and who therefore had had their driving licence revoked (K2), and the other consisting of matching individuals from counties not taking part in the programme (K1). The outcome evaluation involved a study of official accident statistics, the number of DWI offences, hospital discharge registers and sick leave registers. Data covering the five years prior to the DWI offence and onwards was collected. Results During the programme period under evaluation, 285 people had volunteered for the ignition interlock programme (as of December 2001). Eleven percent of these were women. Among the participants, 50% had been diagnosed as alcohol dependent and 10% as alcohol abusers. The remaining 40% had no diagnosis. The mean BAC level at the time of the DWI offence was 0.20% in the interlock group compared to 0.18% and 0.17% in the two control groups. In all, only 11% of the eligible DWI offenders in the three counties took part. Three percent of the applicants were rejected, the usual reason being simultaneous abuse of other drugs. Twenty percent were subsequently denied permission to continue, primarily because a sober lifestyle could not be verified during the second year of the programme, or due to repeated attempts to start their car while under the influence of alcohol. There were also some participants who decided to quit the programme of their own accord. In all, 60 people have now successfully completed the entire programme. Records from the five years prior to the DWI offence showed that the accident rate (road accidents involving injury reported by the police) for the participants in the interlock and control groups was 4-5 times higher than for the average driver. Their records also showed a times higher frequency of DWI offences. Ill-health statistics were also studied, whereby significant differences were found between the DWI offenders and the average Swede in the same age category: the DWI offenders, interlock participants as well as members of the control groups received hospital care (irrespective of medical diagnosis) much more frequently than the average Swede. A specific analysis of the statistics from the past five years on hospital care due to a road accident revealed that DWI offenders had been patients 3-4 times more often than the average Swede and that they were hospitalised a significantly greater number of days (Figure 1). They also reported in sick to work about twice as many days per year as compared to the average Swede

19 Figure 1: Hospital care due to road accidents during the five years prior to the DWI offence. Number of occasions and number of days at hospital per person and year in the interlock group, in the control group (K1) and in Sweden as a whole 0,09 0,08 Number per person and year 0,07 0,06 0,05 0,04 0,03 0,02 0,01 0 Interlock Control (K1) Whole Sweden Occasions of hospital care Number of days at hospital During the programme a noticeable change in alcohol habits among the participants was found, measured both through improved results from biological alcohol markers as well as through better results on the AUDIT questionnaire. The latter showed an impressive reduction in alcohol problems during the 2-year programme. Among men, the mean AUDIT score fell from 11 to 2. While 64% of the male interlock participants had an initial score of 8 or more (indicating potentially dangerous of harmful alcohol habits), only 6% had such a high score at the end of the programme (Figure 2). As a more objective measure of the alcohol consumption, five different biological markers were monitored during the two years of the programme. A noticeable change was observed through steadily diminishing values, which confirms the reduced alcohol consumption suggested by the AUDIT reports. Thus the mean level of the liver enzyme GT - having a specificity of around 75% regarding alcohol abuse was reduced by about 40% during the programme (Figure 3). CDT, with the highest alcohol specificity (about 95%) was elevated for 17% of the participants at the start of the programme and for about 6% by the end (Figure 4). Any elevated CDT-levels during the second year of the programme indicated a relapse into alcohol abuse, which in turn meant being denied permission to continue in the programme

20 Figure 2: Percent of the participants in the interlock programme having risky or harmful alcohol habits according to AUDIT (> 8 scores) at each of the eight medical check-ups Percent Months Males Females Figure 3: The mean values of the liver enzyme GT for the participants in the interlock programme at each of the eight medical check-ups (every third month from start). The GT-values are presented as a percent of the upper reference level 120% 100% 80% 60% 40% 20% 0%

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