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Ignition Interlocks and Supporting
Alcohol Control Technologies
Paul R. Marques, PhD.
Senior Research Scientist, PIRE
Adjunct Professor, UMD-Sch. Public Health
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
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
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
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
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
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
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
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
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
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
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