Suspending The Privilege to Drink

Husband, while opening a beer: “It’s every working man’s right to have a beer on the weekend!”

Wife: “It’s Wednesday and you’re unemployed.”

24/7 Sobriety is a program that mandates abstinence from alcohol for a number of months after a problem drinker is convicted of repeat drink driving or alcohol-related assault. Offenders’ alcohol use is regularly monitored, with any drinking being punished by a swift, certain but modest sanction (e.g., one night in jail). The program has been shown to reduce the rate of alcohol-involved vehicular deaths, drink driving arrests and domestic violence arrests.

You might think that no one could be against something that protects public safety while also helping people with drinking problems stay abstinent. But almost every time I give a talk about 24/7 Sobriety, a few people express upset that the “right to drink” of offenders is being compromised.

Sometimes it’s an ideological objection based on what I consider a overly literally interpretation of the harm reduction philosophy. For people with this viewpoint, state intervention in the use of a substance per se is always wrong. A second group of critics make an even balder criticism: “It’s every working man’s right to have a beer” — a senior male British politician used these very words when I was working with the U.K. Parliament on 24/7 Sobriety enabling legislation in 2012. (Not incidentally, the Parliamentary champions of the U.K. legislation were disproportionately female).

I have tried to persuade these critics to relent. For the first group of critics, I note that even though 24/7 Sobriety targets substance use per se it does a brilliant job of reducing harm. But this observation tends to inflame the opposition for the simple reason that it’s accurate (Nothing irritates an ideologue more than to have his or her philosophy empirically disconfirmed). For the second group of critics, I advance the argument that rights compete with each other, and the right of a man to drink could never trump the right of a woman not to have her nose broken by a drunken husband. Stony silence has been my usual reward for that argument.

I therefore am in debt to Beau Kilmer for providing a different framing of the issue that has on multiple occasions helped move the minority of critics towards consensus with the majority who are thrilled about the benefits of 24/7 sobriety. Beau noted that we don’t let some people drive or drink: Children and adolescents. When we become adults, we are granted these privileges but we all accept that if you prove to be a reckless driver, your driving privileges can be temporarily suspended. 24/7 sobriety is an extension of the same, widely-accepted concept: If you prove to be a reckless drinker your drinking privileges can also be temporarily suspended. That’s a perspective that everyone who cares about public health and public safety should be able to get behind.

New Mexico and Drink Driving: Right Impulse, Weak Approach

After trying ignition interlocks, policy makers in New Mexico have come to the right conclusion about repeat drink drivers: The focus should be on their alcohol use rather than just their driving. This approach has the twin virtues of allowing people to drive so that they can work and removing the vector of other public health and public safety threats (i.e., chronic drink drivers also commit other crimes under the influence).

However, New Mexico’s proposed approach of marking driver’s licences to indicate that someone may not purchase alcohol is pretty weak. People who are middle-aged and above almost never get carded. Your regular bar tender will never card you. A heavy drinker with a marked license could still easily get alcohol from family members and drinking buddies.

What’s tragic about this policy wheeze is that the solution is already known: Mandatory 24/7 sobriety with twice a day breath tests. In South Dakota, where the 24/7 approach was founded, over 99% of the more than 4 million conducted breath tests have been negative. Drink driving arrests, domestic violence arrests and rates of imprisonment have all fallen in the Mount Rushmore state, as have alcohol-involved vehicular homicides. Neighboring states are wisely copying the successful model of South Dakota.

New Mexico in this case *should* re-invent the wheel. Forget the licenses and go for 24/7 sobriety.

An Update on 24/7 Sobriety and Drink Driving Fatalities

Mark Kleiman and I have written extensively about intervention programs for substance-involved criminal offenders which combine regular drug/alcohol testing with swift, certain and mild consequences for use and non-use (see for example here and here).

One of the prototypes is 24/7 Sobriety, a South Dakota program that sentences repeat drink drivers to twice a day breathalyzation. The chart below uses the most recent National Highway Traffic Safety Administration data to show how the safety of the state’s roads has improved since the program began.

I used to display these sort of data in the conventional metric of alcohol-involved auto-fatalities per million or hundred million vehicle miles traveled. That didn’t work well because neither policymakers nor the general public had a sense of what it really meant. Few people have a firm concept of how much driving a million vehicle miles is, or how many million miles Americans collectively drive per year.

The below chart adopts a different approach, namely expressing how dangerous it is to drive in South Dakota relative to the US as a whole. In the two years prior to the founding of 24/7, the risk of dying in an alcohol-involved auto accident per mile driven was almost twice as high in South Dakota as in the US as a whole. In the next two years, during which 24/7 began steadily expanding across the state, the risk dropped to about 1.7 times as great as the US as whole. Since the program went statewide in 2007, South Dakota is approaching being as safe as the national average.

Beyond ease of comprehension, another advantage of this way of breaking down the data is that it adjusts for the fact that the US as a whole has seen a drop in drink driving fatalities. Because the ratio between the state and national risk displayed in the chart is dropping, we can conclude that the welcome change in South Dakota is beating the secular national trend substantially rather than just being a local case of a broader trend.

Population-level relationships like this may not be replicated in individual data. Dr. Beau Kilmer of RAND Corporation is now doing more rigorous work on connecting individuals’ outcomes in 24/7 to traffic safety and crime impacts, and he will have a study of those issues out in a journal next week.

Note also that 24/7 sobriety is not the only effort South Dakota mounted against drink driving, so it could be that other policies (e.g. sobriety checkpoints) are causing the change evident in the chart. However, Montana, a similar nearby state with a serious drink driving problem tried all those policies as well and stayed extremely unsafe until 2010. In that year they began their own 24/7 sobriety program, and experienced a 40% decrease in the rate of alcohol-involved auto fatalities per mile driven. Most encouraging.

Innovations in Supervising Drug-Involved Criminal Offenders

The two most-commonly proposed policy solutions for drug-fueled crime are alike only in being wrong. The hard-edged approach, whether borne of anger, fear or frustration, is to bang up as many intoxicated offenders as possible. Politicians who adopt this stance rarely suffer at the ballot box, but in policy terms they’re on a hiding to nothing. The prison system is already financially costly and filled to capacity, and even were it expanded there is no evidence that the threat or even the actuality of a stint in prison causes many drug-involved offenders to change their behaviour.

The soft-hearted, equally misguided, policy alternative is to attack the problem by offering addiction treatment to all drug-using offenders. Addiction treatment is a critical part of the health care system and does indeed reduce criminal offences by those who seek it out. But few offenders present for treatment on a voluntary basis, and when magistrates order them to it en masse (as have unsuccessful programmes in the UK and in California) most offenders either don’t show up or nod gamely through a counselling session or two and then return to drug use.

That’s yours truly writing about ways to reduce crime by and incarceration of drug-involved criminal offenders, particularly when the drug of concern is alcohol. Full article text available for free in Crossbow, the magazine of the Bow Group think tank in London.

Concerning replication

I’m in London for meetings on criminal justice organized by the Centre for Justice Innovation (the UK arm of the Center for Court Innovation) and Policy Exchange. A small meeting that ran for two hours today tried to figure out whether the coerced-sobriety approach of the South Dakota 24/7 project (the alcohol version of HOPE) could be used in Scotland, with social problems, customs, and institutional arrangements quite unlike South Dakota’s. (In particular, Scotland has no such thing as a two-day term of confinement.)

The answer seems to be that you could try to do something based on similar principles and with similar aims, but you couldn’t really do the program in its trademark style, and even if you’re convinced 24/7 works on drunk drivers in Sioux Falls you can’t be sure that the alternative version would work on drunken wife-beaters in Glasgow.

That suggests a more general reflection. Heraclitus said that no one can step twice into the same river. By the same token, it isn’t really possible to do the same program in two different places.