Alcohol Consumption Monitoring with Sanctions for People Arrested for Alcohol-Related Crimes Associated with Reduced Mortality

In 2005, South Dakota implemented a program that combined frequent alcohol consumption monitoring with swift and certain sanctions for people who have committed alcohol-related crimes, like driving under the influence. Participants undergo twice-daily breathalyzer testing or wear a continuous alcohol monitor. A positive or skipped test results in an immediate jail term of 1–2 days. Researchers conducted a study of the program to determine its impact on monthly county-level mortality 2005–2011. Analyses controlled for county-level characteristics, including unemployment, snowfall, college attendance, and demographic rates.

• Over 16,000 people (3% of the population) participated in the program 2005–2011.
• Implementation of the program was associated with a 4.2% reduction in all-cause mortality.
• Women in particular seemed to benefit with an 8% reduction in all-cause mortality.

Comments:

A program that combines frequent alcohol monitoring with swift and certain sanctions may reduce mortality beyond the individuals enrolled directly in the program. Studies in other settings, those that include individual-level longitudinal outcomes, and those that incorporate randomization could confirm these findings and advance understanding of the mechanisms by which such a program may reduce mortality. The role of alcohol treatment in the context of a program of negative reinforcement for people at high risk for alcohol use disorder-related consequences warrants consideration and study.

Alexander Y. Walley, MD, MSc

Reference:

Nicosia N, Kilmer B, Heaton P. Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study. Lancet Psychiatry. 2016;3(3):226–232.