24/7 Sobriety is Saving Lives in South Dakota: Why Not Everywhere Else?

Mark and I have a short piece in Newsweek praising an innovative anti-drunk driving program in South Dakota, which has reduced road deaths and may also be reducing the prison population. You can learn more about the program from the National Partnership on Alcohol Misuse and Crime; what I want to add here are the on-the-ground observations I made as I spent 3 days this week watching it in action.

For a criminal justice program, 24/7 Sobriety is remarkably respectful of offenders. I spent one morning at a breath test station and watched dozens of people convicted of DUI come in, get breathalyzed and then move along, each taking no more than a minute or two. The staff members were friendly, greeting each person by name and wishing each a good day. The building looked like a credit union. Because there were no uniformed officers, cell bars or guns visible, offenders with aversion to law enforcement would not have any instinctive ambivalence about coming in. The offenders also had some comaraderie among themselves, expressing pleasantries as they saw other offenders they knew in the testing station.

The atmosphere was, in short, completely different than what I had seen in many correctional programs I have visited over my career. Antagonistic interactions with and degradation of people who have been convicted of crimes are not uncommon in corrections. This is bad in itself, and also generates rage and oppositional attitudes in offenders that may be expressed destructively at the time or later when they are no longer under supervision. 24/7 Sobriety has a completely different tone, and that’s good for offenders and also for everyone else.

The visit also spurred some thoughts about the diffusion of innovation. Montana and North Dakota are launching their own 24/7 Sobriety pilots. London, England is interested also, and I will be visiting there soon to try to help. Each potential adopter will get the handbook of procedures, advice from the South Dakota experts, and the slick software that records all the tests and results, but what can’t be given to them if they don’t have it themselves are the intangible qualities that innovators bring to the table, and also the good fortune the South Dakota team had along the way that amplified the effects of their hard work. Those factors are part of the alchemy that determines whether a great local innovation goes to scale or stays a curiosity of a particular time and place.

Judge Larry Long, who created 24/7 Sobriety when he was the Bennett County Prosecutor, is a remarkable person, although he would be the last one to say so. He did not commit to a particular way of running the program and then try to ram it through as so many inventors do, regarding their innovation as a perfect child who deserves to be loved as is. Rather, as he described it to me, he started it on the assumption that it would encounter barriers (which it did) and he would simply keep changing it until it worked. And he supported the collection of data to see if it was effective, which too many people who create something new would never do.

The hand of fortune also dealt some good cards in South Dakota. Long had a good local context to start the program, namely some well-placed officials who were in recovery from alcoholism and understood what he was trying to do. Another benison that could not be guaranteed elsewhere is that Long was elected State Attorney General, which gave him a platform to endorse the program throughout South Dakota and not just in his own patch. But that still wouldn’t have made it happen if he didn’t have a skilled man on the ground. He got that in a police officer (and later Assistant Attorney General) named Bill Mickelson, who as far as I could see knows every single person in South Dakota, from state legislators to the guy who works the desk at the hotel in Sioux City to the waitress at Wall Drug. Spreading innovations requires a network, and in Bill Mickelson’s case it was a network established over decades that provided a basis to overcome inertia and skepticism. Not every program has both the high-level endorsement of political leaders (Long first, and now his successor AG Marty Jackely) and a skilled, hard working promoter to do all the legwork.

As I said, I am planning to help other sites attempt to launch 24/7, in collaboration with a loose confederation of colleagues around the country who think it could save thousands of lives and reduce incarceration levels at the same time. But for this to happen it will require manna from heaven in London and Montana and North Dakota in the form of unusually skilled local leadership, engaged politicians, and every break that Lady Luck can bestow.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College Lonon. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over ten thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

17 thoughts on “24/7 Sobriety is Saving Lives in South Dakota: Why Not Everywhere Else?”

  1. Keith – you've redeemed yourself! (j/k, it's all good)

    "Antagonistic interactions with and degradation of people who have been convicted of crimes are not uncommon in corrections. This is bad in itself, and also generates rage and oppositional attitudes in offenders that may be expressed destructively at the time or later when they are no longer under supervision."

    This is an excellent point. Society has to get over the notion that there are "bad people". There are bad behaviors, and there are people who have a really hard time not doing them. But it is a moral imperative that we honor the dignity of every man, woman and child. Not only is this a moral issue, but as you point out, a utilitarian one as well. People do not respond well to humiliation. Most negative behaviors arise from dysfunctional feelings of low self-worth. They know right from wrong, but they choose the negative behavior because they lack the inner strength to choose otherwise. Doing the "right" thing seems unimportant because they don't feel valued enough to show they have integrity – why bother?.

    So what every "deviant" needs desperately is a sense that they are valued and that their behavior matters. In my classroom, my philosophy is that every kid is a "good" kid. There is nothing they can do to show me otherwise. There are rules, and consequences. But this is made clear, and then – most importantly – they are shown that *they will be loved* no matter what. As soon as a kid is on my side, the defiant behavior stops. They want to please me. They want to show me that they can do the right thing. Often times, this becomes one of the few places in their lives where they feel like they actually matter.

  2. Eli, what society needs to get over is the notion that people in the criminal justice system are somehow fundamentally different from us. I think you have it backwards though. I think society needs to accept the notion that there are bad people, because everyone is a naturally bad person by birth. What needs to be explained is not why good people do bad things, but why bad people (which includes us all) do good things. In other words, following in the tradition of the classical school of criminology (especially social control theory), it is the absence of crime that needs to be explained, not the presence of crime. You and I are fundamentally no different from the person behind bars, not in that we are all fundamentally inclined towards the good, but that we are all fundamentally inclined towards the bad. Anyone doubting the natural born moral depravity of all human beings need only spend time with young children.

    My favorite research demonstrating a natural (not learned) proclivity towards bad behavior is Nagin and Trembley's research on the peak age of aggression. It has been widely accepted in criminological research on the "age-crime curve" that the peak age of criminal and violent behavior is in the late teens to early twenties. But this age-crime curve is based on official or reported criminal justice interactions (arrests, reported crimes, etc.). Nagin and Trembley looked at aggression across age categories, regardless of criminal justice interaction or potential for arrest under the law. For example, they included aggressive behavior such as kicking, biting, pushing, etc. By this way of looking at it, aggressive behavior peaks at age 2 and goes downhill from there! Of course we don't arrest two year olds for biting or pushing but we do treat this behavior as aggressive behavior that we as parents work hard to undo. This behavior could not possibly be learned if it is peaking at age 2. It comes naturally and has to be un-learned.

    So yes, we need to get over this "us versus them" mentality, but not because we're all good….because we're all bad when it comes down to it.

  3. Bux, I disagree with your premise that it has to be either.* Humans, like any animal, operate within a set of behavioral limitations. Some of us are indeed quite biologically flawed, and some of us have developed in poor environments. The worst of us tend to have had both (likewise the best of us, the opposite). Yet humans also have an amazing capacity for socialization – essentially the structuring of our societies for particular behavioral outcomes. This explains most of why people do good things and why they do bad. Institutions like families, friends, schools, justice, government, trade, etc. all have extremely powerful effects on us.

    To extend the idea… this provides a key insight into the divide between conservatism and liberalism: liberalism emphasizes the role of social (and to a lesser extent biological) conditioning. Thus we are "soft on crime" and have no problem with progressive taxation on the rich – both were largely conditioned for their lot in life. Interestingly, I've always found an incoherence in the conservative emphasis on "values" that implies social conditioning, but the reluctance to see individual behavior as having been influenced by exactly this conditioning. So they believe in family and marriage because it's important for child development, yet when that institution breaks down and the child develops poorly, he's suddenly considered "evil", or at least a no-good punk who deserves no mercy.

    All of this is born out in the social data. And it is highly predictive. I don't see how conservatives can seriously look at any of it without experiencing large amounts of cognitive dissonance.

    *To note, I should be clear that my use of "good" was in the colloquial sense (is there any other?). Good and bad are relative terms. As you point out, we are all capable of both. "Good" and "bad" simple means we behave in ways society has deemed "good" or "bad", generally based on positive or negative outcomes. Many animals would be considered evil psychopaths were we to hold them to human standards. Of course, many other animals would be considered saints. Interestingly, domestic animals have been bred and trained in a similar fashion to humanity.

  4. I'm reminded of an conversation I had in the mid-90s with Frank Gajewski, then chief of police in Jersey City. I was on a team evaluating their drug market intervention program. He pointed out two of his detectives, A and B. He said (I paraphrase), "You know Mike, both of them make lots of arrests. A grabs his guy around the neck, wrestles him to the ground, pulls his arms behind him, cuffs him and says, 'Buster, you're going to jail.'. B puts his arm around his guy's neck, walks with him and says, 'Look, I've got a job to do and you've got a job to do. Let's make it easy on ourselves and nobody gets hurt.' B gets a lot more information from his guys."

  5. Eli, can you clarify a bit please?

    > But it is a moral imperative that we honor the

    > dignity of every man, woman and child.

    "Dignity" is a term which, when combined with "human", always makes me uneasy. Double that when used in the same sentence as "moral imperative".

    To what human dignity do you refer? Reading your reference to humans as a type of animal in your response to Bux, or trying to interpret your statement strictly within the scope of your comment, hasn't been very helpful to me.

    Your use of the terms I quoted, combined with your statement that society needs to get over the idea that there are bad people, seems to go against what I thought I had learned about a significant percentage of us who _are_ fundamentally different. Sociopaths don't behave badly because of lack of self-worth but because they just don't care about others. Yes?

  6. I think we're miscommunicating Eli, because I don't see much incongruence with what you last wrote and what I'm saying. I too definitely recognize strong evidence for sociological factors affecting behavioral outcomes (good or bad). But what I'm saying is that humans are intrinsically, ontogenetically driven towards the bad (the brutish, the selfish, etc.). Those who are socialized in an environment that reinforces this proclivity towards the naughty, or in an environment that does not correct or control such behavior, will tend to act out on their tendencies towards the bad. This is why I think it's much harder to take a criminal offender and change his/her natural inclinations than it is to simply control those inclinations. Control can take many forms (e.g., formal control through the legal system, informal control through marriage, family, employment, etc.). But it's a lot easier to keep misbehaving people under control than it is to somehow reverse their born human nature. Of course the rest of us are largely already subjected to these controls (mostly informal), which is why we never got involved in criminal behavior in the first place. We have too much social capital to lose. We've been socialized within a set of collective group norms that are agreed upon as a sort of social contract. But don't get it twisted, I think we're ALL capable of the most horrible of crimes if completely left to our own device. When we realize this, we can't resort to what you label the conservative view of labeling a criminal offender a "no-good punk who deserves no mercy", because there but by the grace of God goes I.

    I think this view of human nature best explains why strategies such as HOPE and 24/7 Sobriety work. They assume a rational actor perspective (albeit "bounded rationality" in the case of impulsive offenders). But what is the end (or goal) of this rationality? It is one's own self-interest. If our primary goal motivating our behavior is self-interest, then we are naturally selfish individuals. Unless you view selfishness as a virtue, then selfishness is bad. Which means that we are naturally driven towards the bad (e.g., our own self-interest).

    I wasn't quite clear what you meant in the beginning of your last post, Eli, when you said you disagreed with my premise that it has to be either. That what has to be either? That human nature has to be naturally either good or bad? Are you saying that some people are born naturally good while others are born naturally bad, or are you saying that all are born with both good and bad tendencies with each to varying degrees? I see the first as a very dangerous viewpoint and the second as an illogical viewpoint. I think human nature has to have a tendency or proclivity towards one or the other.

  7. Bux: But what I’m saying is that humans are intrinsically, ontogenetically driven towards the bad (the brutish, the selfish, etc.).

    If I may, your version imputes some measure of malice ("brutish") as inherent, whereas Eli's doesn't.

  8. Bux, I had a feeling that might not have been clear. I just meant that I don't think humans are naturally "bad". There is no real natural state for humans, so the experiment is impossible. I think we can make some pretty good assumptions about what might happen in certain circumstances, but "human" as we know it requires a a great deal of socialization. It would make no more sense to ponder the "nature" of any other social animal.

    That said, there are certainly negative impulses. Your example with children is apt. There are behaviors that arise naturally that must be unlearned (delayed gratification, kindness). Yet much of this is also just as much of a learning process. Despite actually not having developed brain capacity to do the sort of emotional geometry that empathy requires, their access to knowledge about the world informs this capacity as well (other cultures, behaviors, protocols, etc.). Children usually act according to their level of biological and social development, their knowledge both of self and the world. They can grow up to be worse than they were before, or much better.

    Answering Steve, I certainly do believe there are psychopaths. But as I mentioned before they are generally a combination of poor biology *and* environment. And they are relatively rare. The vast majority of criminals were not born that way at all. Sure, some may have cognitive weaknesses, such as learning disabilities, etc. But most are products of their environment.

    And as for the moral imperative of treating them with dignity. Well, why not? In fact, the sickest of individuals ought to receive the most compassion and understanding. The key is in the word *sick*. These are the people where it is most obvious that their is simply something wrong with their wiring, no different than any other disability. It just happens to turn them into monsters.

    In the end, if one is a materialist, and views humans as operating within the same fundamental forces as the rest of the universe, then there is no reason to think of good or bad behavior isn't essentially the outcome of human development. You get what goes in. Some people's minds are broken and want to rape children. Why should I begrudge them for the way they were created? I think this is a universal spiritual truth that humanity has discovered a long time ago, and finds expression in our most sage texts. But it is *so* hard to do.

    For instance if anyone did something to my daughter I'm sure I'd feel the most horrible emotions imaginable. But that doesn't change the reality that the person who did it was created that way, and then went on to create really bad things. My emotions can't change that reality. It would be no different than if a rabid dog had done the same. Or a plane crash. It is simply a series of events. I could probably turn my children into deranged killers if I really wanted to. We know how to do that. But they are lucky enough to be born to a father who is (tries to be) a good person. And I was created that way by my biology and environment. As were my two loving parents who went to college. As were their parents,and their parents who were able-bodied and had the self-efficacy and agency to settle in California a hundred years ago.

    So then I'm thinking about Native Americans and blacks.. and you get into privilege and cultural legacy, etc. Bottom line, yeah, to me I should be bowing down before the worst among us and praising that poor soul who's had to live in that rotten consciousness, while I've been blessed with the riches I have been. It isn't fair at all and as Bux writes "there but for the grace of God go I". Although as an atheist I can't even take comfort in the idea there there might be some purpose to any of it.

  9. Bux, I can't see why either "humans are naturally rotten" or "humans are naturally nice" should be true to the exclusion of the other. We know that people have inborn selfish and aggressive traits, and inborn tendencies toward cooperation, whatever St. Paul, St. Augustine, and John Calvin might have thought, and in the face of the claim that each human being is the "image and likeness" of God.

    What's more to the point is how we treat one another, and especially how the officials charged with enforcing laws treat those who have broken them. As David Kennedy points out, respectful treatment is far more likely to lead to good results that nasty and contemptuous treatment. Every cop who refers to an incident as "NHI" (for "no humans involved") is doing his bit to make the crime problem worse.


  10. Mark, how does that kind of "both-and" thinking not violate the law of noncontradiction? I propose that humans are naturally inclined towards the bad. According to the dictionary definition of "inclination", an inclination is "an attitude of the mind that favors one alternative over another". The key in that definition is the word "alternative". The law of noncontradiction tells us that it is impossible that the same thing belong and not belong to the same thing at the same time and in the same respect. One's natural pull cannot simultaneously be towards good and non-good. Or are you suggesting that there is no such thing as a natural pull, only a situational response (which would mean that one can be good at one time or in one sense but bad at another time and in another sense)? That view would not violate the law of noncontradiction, but it would also deny that there is such a thing as human nature.

    One minor point too, selfishness and aggressiveness are clearly naughty but I don't think that "cooperation" can be categorically defined as a nice. The question becomes "cooperation towards what end?". I can cooperate with someone else temporarily to get what I want. That doesn't mean I've set out to do a good thing. My driving purpose is my own self-interest. What other naturally nice tendencies do you view as being inborn?

    I whole-heartedly agree with you about the way that we are to treat one another (respectful, kind, etc.). To put my cards on the table, I come from a Christian worldview (the worldview of the people you named- St. Paul, St. Augustine, John Calvin, etc.). My worldview teaches that human nature is bad because our representative parents (Adam and Eve) chose the bad over the good. This does not diminish (and is completely compatible with) the fact that we were originally created in the "image and likeness" of God, however. We live in a "paradise lost" because of the choices of our federal parents. But this should never take away the fact that every single person has deep intrinsic personal worth, not because they earned it but because they were "endowed with it" by their creator. Our worth and dignity comes from a higher power. Therefore, when I disrespect my fellow man or treat him unfairly, I am not simply disrespecting that individual but I am also disrespecting God. What possible higher view of human beings could there be? Indeed, I would propose that there can be no such thing as intrinsic human worth apart from a loving creator but that takes us down a whole other line of discussion.

  11. Bux, would you design river engineering (dams, levees, etc) differently if you believed the river embodied a demon who just liked to flood farmland and drown people than if you believed its ruling god was benevolent and kindly? I bet not: I bet you would observe its response (and that of similar rivers) to this and that kind of intervention, and build what would most likely lead to the best behavior in the future. If people wanted to throw a cow or a chicken into it every spring, while your bulldozers were at work, or rain curses on it from the shore,fine. The argument about the moral nature of people who might or might not drive drunk seems to me useless, even if interesting for its own sake, in the face of data about what kind of treatment makes them do so (and, of course, offend otherwise, if it matters) less.

  12. Michael, yes I do think one's view of moral nature is profoundly useful here. As I like to say, data never simply speaks for itself. Or as Mark Kleiman once pointed out, if you hear data speaking to you then seek professional help (http://www.samefacts.com/2010/06/uncategorized/what-the-numbers-dont-say/). We all interpret data through a lens (a worldview, a unifying theory, etc.). This is what allows two people to come to vastly different conclusions when viewing the same data. So the data on 24/7 Sobriety can tell us that something works in producing an effect, but it can't tell us why it works in producing that effect. My interpretation of why programs like 24/7 work is that they are not seeking to transform people to their core, but instead or trying to get people to behaviorally comply. Counseling and treatment programming has a much harder job in this respect, if my view of moral human nature is correct. If people naturally misbehave, then what we're trying to do through treatment programming goes against and requires changing human behavior. This seems to me to be a much more daunting task than simply enforcing behavioral compliance. Hence, for example, the finding that the best sorts of in-prison treatment programming typically only report single digit reductions in post-release recidivism rates. But again, I don't think it's enough to take a strict positivist view that the only job of the social scientist is to be a mechanical observer of outcome data. This is why there is such a thing as "process evaluation". Outcome data can never explain the "why". I was always taught in my theory class in grad school that the first step in evaluating a theory is to lay out its underlying assumptions (for example its assumptions about human nature). Of course you may have a totally different view of human nature and we can still agree that, for example, a program like Sobriety 24/7 works.

  13. North Dakota and Montana are racially homogeneous states. I very much approve of this program. But I can see opposition along racial lines if it were to be implemented in, say, Baltimore, where most of the African-American residents are lower-income or jobless, and where the city's Whites view them with suspicion. I have a feeling many White Baltimoreans would want something more punitive. I would be glad to be wrong, of course.

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