Is 24/7 sobriety a good goal for repeat driving under the influence (DUI) offenders?

Driving under the influence (DUI) of alcohol and/or illegal drugs is an important problem by any measure. On average, associated crashes kill someone in the United States every 40 minutes [1]. Various control strategies have been tried, including punitive sanctions; in the United States, DUI accounts for 1.4 million arrests annually [2], 40 000 inmates in jail [3] and another 32 000 in prison [Eric Sevigny, personal communication]. Another approach tries to prevent offenders from driving by suspending or revoking licenses, impounding cars or requiring breath alcohol ignition interlock devices [4]. A recent emphasis lowers permissible blood alcohol content. While these strategies work, to some degree, DUI continues to generate enormous harms, implying that existing interventions are not entirely satisfactory. South Dakota, a state in the northern plains of the United States, has adopted a different approach. Its ‘24/7 Sobriety’ program attempts to prevent repeat DUI offenders from drinking through frequent testing. The program has teeth; the punishment for a failed test is immediate and automatic incarceration. However, incarceration is so brief (24 hours), and compliance rates so high, that total sanctioning may actually have declined [5]. South Dakota’s fundamental innovation is to require offenders to stop drinking, rather than stop driving. Simple trend data suggest stunning success. Traffic fatalities involving alcohol impairment dropped from 71 in 2004 to 34 in 2008 [6], and some have suggested that there are favorable effects on other alcohol-associated crimes (e.g. domestic violence). The initiative has not been evaluated scientifically, but if a formal study produced outcomes approaching those suggested by the descriptive statistics, it might spark some rethinking about approaches to dealing with harms related to substance abuse.