Ignition Interlocks and Supporting Alcohol Control ... · (2) studies of interlock ability to...

Ignition Interlocks and Supporting

Alcohol Control Technologies

Paul R. Marques, PhD.

Senior Research Scientist, PIRE

Adjunct Professor, UMD-Sch. Public Health

[email protected]

Webinar Topics

◦ Basic Interlock Operation

◦ Interlock installation Rates over Time

◦ Recidivism During Interlock

◦ Recidivism After Interlock

◦ Can Interlocks Solve the DUI Problem?

◦ First Offenders - Interlock?

◦ USA Interlock Program Types

◦ Stories told by the BAC Test Log File

◦ Alcohol Biomarkers and Interlock

Interlock Basics

Basic Features of an Interlock

An alcohol sensor that detects BAC ≥

.02+ and prevents vehicle startups

A running retest feature that requires

periodic retesting while underway

A tamper detection installation that

detects efforts to alter the wiring

A data-recording function that logs all

activity: BAC results, stops, starts, refusals

Anti-circumvention protocols

Important Distinction

• Interlock Devices – the hardware

– Early devices were non-specific (Taguchi

semiconductors – their calibration would drift

and react to many hydrocarbons); today most

sensors are alcohol specific fuel-cell devices.

• Interlock Programs – the procedures

– Laws (court or licensing programs), sanctions,

regulations, reporting protocols, information

flow, treatment links, consequences; the ways in

which the devices are used.

Our (PIRE) interlock work (Marques, Voas,

Tippetts): 6 Themes, 25 years

(1) policy-relevant guidelines and research,

(2) studies of interlock ability to control DUI recidivism,

(3) the capabilities of the interlock BAC fail records to predict future DUI,

(4) impact of a motivational, or other adjunct treatment services to interlock programs,

(5) the relationship of interlock BAC data, and alcohol biomarker prediction of recidivism.

(6) the impact of State interlock laws on outcomes

Installation Rates

Interlock Installation Rates - USA

Dick Roth chart 2009 –

2013 NM is 60, KS CO 40, AZ 33

Interlocks per 10,000 residents by stateData from 9 of 10 providers; Plot by Richard Roth, PhD;August, 2009

0

5

10

15

20

25

30

35

40

45

New

Mexic

o

Ari

zo

na

Wash

ing

ton

Co

lora

do

Iow

a

Mary

lan

d

No

rth

Caro

lin

a

West

Vir

gin

ia

Texas

Kan

sas

Neb

raska

Ore

go

n

Vir

gin

ia

Ark

an

sas

Lo

uis

ian

a

Uta

h

Mis

so

uri

Ala

ska

Wyo

min

g

Okla

ho

ma

Flo

rid

a

Mic

hig

an

Illi

no

is

Massach

usett

s

Idah

o

Mo

nta

na

Pen

nsylv

an

ia

Oh

io

Geo

rgia

Nevad

a

Cali

forn

ia

Wis

co

nsin

Co

nn

ecti

cu

t

New

Yo

rk

Dela

ware

Ken

tucky

New

Jers

ey

So

uth

Dako

ta

New

Ham

psh

ire

Ind

ian

a

Ten

nessee

Mis

sis

sip

pi

Min

neso

ta

So

uth

Caro

lin

a

Rh

od

e I

sla

nd

Verm

on

t

No

rth

Dako

ta

Ala

bam

a

Haw

aii

DC

Main

e

Interlocks Projected to 2020 with

Est. DUI Convictions (green)

R² = 0.9967

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Nu

mb

er

of

Inte

rlo

ck

s

Year

Interlock Pros and Cons (briefly)

Why interlocks are endorsed

0%

20%

40%

60%

80%

100%

120%

140%

1 OH 2 OR 3 NC 4 AB 5 WV 6 MD 7 AB 8 QC 9 IL 10 NM

During Interlock

Non-interlock control groups for each study set to 100%

10 studies 1990 - 2007

Why we are not satisfied

0%

20%

40%

60%

80%

100%

120%

140%

1 OH 2 OR 3 NC 4 AB 5 WV 6 MD 7 AB 8 QC 9 IL 10 NM

During Interlock After Interlock

Black line is non-interlock control groups for each study

The Details…

Bar pair # 7 – Alberta Interlock

Interlocks – what we know

These programs do reliably reduce recidivism while installed (≈ 65%)

They do not lead to much carry-over once licenses are reinstated

The most successful programs get only 50% enrollment (of all DUI convictions)

For these (and other) reasons they cannot be a total solution

What they do, they do well

There is reason to believe they will have a general deterrence effect

Alcohol Action and DUI Arrests

How select a club are DUIs?

200085 1100 1700300 600

(Values rounded)

Voas and Hause, 1987

250

Miller, Spicer, Levy, 1999

Borkenstein et al., 1974

Hingson et al. , 1995Self-reportStudy, Liu?

Beitel et al, 1975

What is the chance of arresting

an impaired driver? One in …

Let’s be conservative on this…

One in 300 impaired operators are

arrested (Voas and Hause)

undetected

detected

Estimated detection

rate of impaired

drivers with BAC ≥ .10

in a high enforcement

zone (Stockton, CA)*

Idealized BAC curves for Male2-7 hours expected time to alcohol clearance

after 1- 4 drinks in an average size male

BAC Equivalences

80 mg% =

80 mg/100 ml

.08 g/dL =

.8 g/L ≈

.08 % (near equiv.)

Is it fair to impose interlocks on

first offenders? It is true that first offenders are

somewhat less risky than multiple DUI offenders.

As we showed earlier – the chance of detecting any impaired driver is very remote – maybe 1 in 300 or more

How do arrest BAC’s differ?

How different are first offenders from NON-offenders?

What are States doing?

BAC distribution: Arrested Drunk

Drivers in NM – average is .14

Data from Dick Roth

First Offenders Pose Much Higher

Risk than Non-OffendersPercent Re-Arrested for DWI Within Three Years vs Priors

For Those Convicted of DWI in NM in 2003

0%

5%

10%

15%

20%

25%

None 1st 2nd 3rd 4th 5th+

Conviction Number in 2003

% R

e-a

rre

ste

d w

ith

in 3

Ye

ars

5x higher

0

10

20

30

40

50

60

0 1 2 3

Prior DUI

7x higher

New Mexico 2003 - 2006 (% new DUI)

based on 2003 status

Maryland (alcohol charges)

per 1000 drivers

DUI count in 2003

DU

I %

repeat

ed b

y 2006

Dick Roth et al., Impact DWI, NM Bill Rauch et al, Westat, MD

0 1 2 3 4 5

0 5%

1

0%

15%

2

0%

Interlock Programs around the US

Administrative Programs

Some ADVANTAGES

Centralized: authority, criteria, monitoring

Can be prompt installation after arrest

Allows some offenders to drive legally while monitored

Applicable to all arrested DWI offenders.

Some DISADVANTAGES

Large self-selection component

Avoided by those who need it most

More Administrative Appeal Hearings

Judicial ProgramsSome ADVANTAGES• Can be made mandatory (electronic

monitoring, jail are motivating alternatives)• It eliminates self-selection• It has the potential to get more interlocks

installed per DUI. (e.g., > 60% of those arrested in NM, > 62% of convictions in Hancock County, IN.)

Some DISADVANTAGES• Judges often do not apply their laws• Overburdened probation departments must

monitor, personnel spread too thin• Installation not immediately after arrest.• Your honor, I don’t own a car!• And I have no intention to drive!

The next six slides are from IIHS’

Eric Williams’ presentation in May

2013 at the Association of Ignition

Interlock Program Administrators

The IIHS (Insurance Institute for

Highway Safety) is a highly regarded

safety research center in Virginia.

Optional alcohol ignition interlock lawsApril 2013

MD

DE

DC

MA

OR

RINJ

NH

ME

PA

WV

NC

SC

GA

FL

OH

MI

INIL

WI

IA

MO

LA

NM

CO

SD

ID

CA

WA

TN

VT

MS

MT ND

NV

AZ

UT

WY

NE

KS

OK

TX

AR

MN

AL

KY VA

NY

CT

AK

HI

Judicial discretion only

repeat offenders

high-BAC first offenders

all offenders

high-BAC first & repeat offenders

Data/slide from Insurance Institute for Highway Safety IIHS

April 2013

MD

DE

DC

MA

OR

RINJ

NH

ME

PA

WV

NC

SC

GA

FL

OH

MI

INIL

WI

IA

MO

LA

NM

CO

SD

ID

CA

WA

TN

VT

MS

MT ND

NV

AZ

UT

WY

NE

KS

OK

TX

AR

MN

AL

KY VA

NY

CT

AK

HI


repeat offenders


all offenders



Laws mandating alcohol ignition interlock orders

Laws mandating alcohol ignition interlock ordersApril 2013

MD

DE

DC

MA

OR

RINJ

NH

ME

PA

WV

NC

SC

GA

FL

OH

MI

INIL

WI

IA

MO

LA

NM

CO

SD

ID

CA

WA

TN

VT

MS

MT ND

NV

AZ

UT

WY

NE

KS

OK

TX

AR

MN

AL

KY VA

NY

CT

AK

HI


repeat offenders


all offenders



Mandate Interlocks? Think for a minute: what does that mean?

Mandate – meaning that unless the offender installs he has to sit out his suspension period with no driving?

Mandate – meaning without an interlock he will never drive legally in that state again?

Mandate meaning offender must obtain a car (even if he has none) and install before driving again?

Mandate – meaning he stays in jail unless he installs?

Also a law may “Mandate” but that does not mean it is enforced.

Interlock Log Files – the Data

Record

The Interlock Data Record

What is it?

◦ BAC levels: pass/fail, time/date stamp, failure to comply with requirements, engine on/off etc…

What can it tell us?

◦ Who warrants more watching? Who is using the interlock car and when?

How many BAC tests are in there?

◦ Average 7/day x 365 = 2550/year/driver

How can we use it to improve safety?

◦ Adjust interlock requirements or monitoring to reflect performance on interlock program.

First and Repeat Offenders give 6-8

BAC tests daily*

32.030.0

28.026.0

24.022.0

20.018.0

16.014.0

12.010.0

8.06.0

4.02.0

0.0

Quebec BAC Tests per day

Fre

qu

en

cy

1100

1000

900

800

700

600

500

400

300

200

100

0

Std. Dev = 4.63

Mean = 8.8

N = 9176.00

* About half are

start up tests

How many BAC tests are taken

over time? (each bar is 2 months)

Alberta data 2009

So about 5-6 tests

per day (half are starts)

BAC lockouts ≥ .04 (failure rate

decline) - 2 month intervals

Alberta data 2009

Interlocks: Fewer Fails, Less

Recidivism The preceding slide demonstrated that

the rate of failed BAC tests declines

sharply over the duration of the interlock

program.

This effect has been found in every one of

the 10 or so studies that examined it.

Combine this with evidence of reduced

recidivism during interlock.

Recipe for enthusiasm.

Tuesday low

New

Mexico11 million

tests

2004-2008

Stories in the Data File – day of the week

Interlock BAC Tests ≥.02 g/dL

More on Tuesday

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

SUN Mon Tues Wed Thurs Fri SAT

Hifail >.08%

Fail .04-.079%

Warn.02-.039%

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

1.00%

DIMANCHE Lundi Mardi Mercredi Jeudi Vendredi SAMEDHI

Hi fail >.08%

Mid Fail .04-.079%

Low Fail .02-.039%

Québec

Alberta

5.5 million tests

18.8 million tests

USA 2007: Fatal Crashes with Driver

BAC ≥.08 by day of week; N=9884

Tuesday low

Interlock Fails

Workday (Monday-Friday)

HOUR of Day

2220181614noon1086420

Co

un

t

500

400

300

200

100

0

gm/dl

.080+

.040-.079

Interlock Fails

Weekend (Saturday-Sunday)

HOUR of Day

2220181614noon1086420

Co

un

t

300

200

100

0

gm/dl

.008+

.040-.079

More stories in the Data File – hr of day

Alberta 1994-98 (fail > .04%)

X axis = 24 Hours of the Day

7-8 am high10-12 high

Monday - Friday Saturday - Sunday

New Mexico, BAC ≥ .02% by hr of day -

based on ≈ 11million tests

7-8 am high 10-12 high

Morning high BAC most common:

AB, QC, NM, TX

0.00

0.20

0.40

0.60

0.80

1.00

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Hour of Day

Quebec All TestsQuebec Tests>=.02%Alberta All TestsAlberta Tests >=.02Texas All TestsTX tests>.02%

Based on ≈ 40 million

BAC tests

7-8 am high

Predicting Driver Risk:

Combining Data File and Future

Recidivism

Predicting new DUI by the rate of

failed BAC tests during interlock

DURING INTERLOCK BAC Rate ≥ .02%

24 M

o.

AF

TE

R IN

TE

RLO

CK

N=720 Offenders in Each Bar

Data from

Marques, Voas, Tippetts

(2003) Addiction,

Quebec Prediction Study

Support from NIAAA

7200

DUIs,

18.8

million

BAC

tests

Quebec

Same data showing a third (time) axis

– months after interlock

What the data say…

BAC tests average 6-8 per day or > 2500/yr.

Failed BAC tests, as a percent of total tests taken, decline over time in the program.

People with the highest fail rates during interlock have the highest recidivism after the interlock.

Failed BAC test occur most often in the workday morning hours 7-9AM, weekend hours 10-12.

This morning failed test effect is believed due to prior night high consumption levels (and a potential treatment need indicator).

About 20% of a cohort of interlock DUI drivers is likely to be high risk based on fail rates.

Alcohol Biomarkers with Interlock

and Recidivism

Defined: Interlock BAC Fail Groups by Total Fail Rate (BAC ≥ .04 g/dL)

Three BAC risk groups

instead of ten

20.5%

52.8%

26.8%

Alberta

2004-09

Alcohol Biomarkers

Markers of alcohol exposure that extend

the duration of evidence long after Blood

Alcohol Concentration (BAC) has fallen

to zero.

Different types and found in different

sources: blood, serum, urine, hair,

fingernails.

Used widely in European nations to

document drinking levels.

Alcohol markers to be discussed

• 2 general categories of markers

– indirect (chronic exposure)

• Due to organ damage or biological adjustment after repeated alcohol exposure

• examples: ALT, AST, MCV (poorer), GGT, %CDT (better)

– direct (recent exposure if in blood or urine, long exposure if in hair)

• directly reflect consumption via minor metabolic pathways, or are only formed in presence of alcohol

• examples: ethanol, PEth, EtG, EtS, FAEE (all good)

Marker levels with solid lines reference left axis;

marker levels with dashed lines reference right axis

Mean, Median: 5 biomarkers,

6 categories of consumers.

Driver Fitness Criteria Abroad –

Biomarkers as Decision Aids

Sweden – GGT, CDT, MCV, ALT, AST – levels above 97.5% Percentile of normal

Netherlands – GGT, CDT

Belgium – CDT, GGT, AST, ALT, MCV

France – GGT, CDT, MCV

Germany – newly added EtG urine, EtG hair

◦ Comparative detection: urine 2.1%, hair 12.7%

Norway, Finland – marker panels

Likely many others in Europe

Australia, Canada – studying evidence

USA – still MIA

Interlock data plus biomarker data

20.5%

52.8%

26.8%

Ten biomarkers by 3 interlock risk

groups in Z (standard) scores******************ns

*

******

***

P<.0005

Biomarker evidence …

Not much change in drinking over the

course of an interlock program

But:

◦ This is not yet replicated by others

◦ This was documented in one jurisdiction

◦ Not enough statistical power to tease out

different types of drivers (other than priors)

If confirmed by others it means interlocks

are only a temporary preventative

Over 8 months of interlock - no

change in %CDT or GGT

%CDT Mean +/- 2SE

baseline to end

GGT Mean +/- 2SE

baseline to end

Blue baseline

Green 8 months

No change over 8 months on

interlock in PEth or γ%CDT

PEth Mean +/- 2SE

baseline to end

γ-CDT Mean +/- 2SE

baseline to end

Blue baseline

Green 8 months

Sadly…

This means that while the interlock

reduces recidivism and the rate of failed

BAC tests, it does not appear to reduce

drinking per se.

Participants seem to drink more

strategically but not less alcohol.

This likely explains why recidivism rates

return to control levels once interlocks

are removed and licenses reinstated.

A’ (AUC) Recidivism Prediction

0.45

0.5

0.55

0.6

0.65

0.7

0.75

A' ROC

biomarkers Dui and self-report

Hair EtG

A’ (AUC) BAC Fail Rate Prediction

2 methods PEth

biomarkers Dui and self-report

γ%CDT

Hair ethylglucuronide (hEtG)

Highest sensitivity (Høiseth et al., 2009)

Most accurate detection of heavy drinking (Pirro et al., 2011)

Best choice for assessing fitness in drinking drivers (Liniger et al., 2010)

Detected 12.7% positives relative to 2.1% positives (in urine EtG) among German DUI drivers at relicensing (Dufaux et al., 2012)

30 pg/mg hEtG is cutoff for alcohol abuse (Soc. Hair Testing 2010)

Compare with current DUI sample: ◦ median 22 pg/mg, mean 51pg/mg. One third are over

50 pg/mg, two thirds over 30 pg/mg

Phosphatidylethanol (PEth)

Formed only in presence of ethanol, so only ethanol can alter levels (Varga et al., 1998)

Half life about 4 days, detectable in blood for 4 weeks after sobriety (Hansson et al., 1997)

Highest specificity and highest sensitivity alcohol marker (Wurst et al., 2010)

Significantly correlated with 9 other alcohol biomarkers, 16 psychometric scales, and rates of failed interlock BAC tests (Marques et al., 2010)

Threshold ethanol intake to raise PEth in blood estimated at 50 g/day for 3 weeks (Viel, 2012)

Conclude from Biomarker data

Hair EtG is strongest contender for predicting recidivism, dependence, and patterns of heavy drinking over extended time base.

PEth seems the solid best predictor of failed BAC tests on interlock (and therefore drink-driving proclivity).

The interlock record and biomarker data should be used to help triage certain drivers (maybe 20-30%) toward alcohol treatment services.

Interlocks with Biomarkers

Interlock is still a very good intervention that reduces recidivism while installed but it will not change drinking for the average person required to use one

Supplemental evaluation with monitoring is warranted using objective biological methods to assess drinking levels

It will be necessary to include competent expert treatment services to attain real behavior change

There is no better time to do that than when someone is under interlock restriction

Some closing thoughts

Annual interlock growth at about 10% continues apace – much legislative support from MADD.

Interlock is effective intervention for many

Focusing only on arrested, convicted DUI offenders is unlikely to make the roadways safe from impaired drivers.

Also, alcohol is just one drug, new designer drugs are available daily – each often need guidelines.

Medicines – taken legally (opiates, benzos) are another large source of driver error.

Impaired driver solutions may need to await autonomous cars – to get rid of the driver

Ignition Interlocks and Supporting Alcohol Control ... · (2) studies of interlock ability to...

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