RESUMEN
OBJECTIVES: This study focuses on the predictive and comparative significance of ethyl glucuronide measured in head hair (hEtG) for estimating risks associated with alcohol-impaired driving offenders. Earlier work compared different alcohol biomarkers for estimating rates of failed blood alcohol concentration (BAC) tests logged during 8 months of interlock participation. These analyses evaluate the comparative performance of several alcohol markers including hEtG and other markers, past driver records, and psychometric assessment predictors for the detection of 4 criteria: new driving under the influence (DUI) recidivism, alcohol dependence, and interlock record variables including fail rates and maximal interlock BACs logged. METHODS: Drivers charged with alcohol impairment (DUI) in Alberta, Canada (n = 534; 64% first offenders, 36% multiple offenders) installed ignition interlock devices and consented to participate in research to evaluate blood-, hair-, and urine-derived alcohol biomarkers; sit for interviews; take psychometric assessments; and permit analyses of driving records and interlock log files. Subject variables included demographics, alcohol dependence at program entry, preprogram prior DUI convictions, postenrollment new DUI convictions, self-reported drinking assessments, morning and overall rates of failed interlock BAC tests, and maximal interlock BAC readings. Recidivism, dependence, high BAC, and combined fail rates were set as criteria; other variables were set as predictors. Area under the receiver operating characteristics (ROC) curve (A') estimates of sensitivity and specificity were calculated. Additional analyses were conducted on baseline hEtG levels. Driver performance and drinking indicators were evaluated against the standard hEtG cutoff for excessive drinking at (30 pg/mg) and a higher criterion of 50 pg/mg. HEtG splits were evaluated with the Mann-Whitney rank statistic. RESULTS: HEtG emerged as a top overall predictor for discriminating new recidivism events that occur after interlock installation, for entry alcohol dependence, and for the highest interlock BACs recorded. Together, hEtG and phosphatidylethanol (PEth) were the top predictors of all criterion measures. By contrast, the hair-derived alcohol biomarkers hEtG and hFAEE (fatty acid ethyl esters) were poorer than other alcohol biomarkers as detectors of interlock BAC test fail rates. CONCLUSIONS: This study showed that hEtG, an objective alternative to often unreliable self-reported past representation of drinking levels, yields crucial insight into driver alcohol-related risks early in an interlock program and is a top predictor of new recidivist events. Together with PEth, these markers would be excellent anchors in a panel for detecting alcohol consumption.
Asunto(s)
Alcoholismo/diagnóstico , Conducción de Automóvil/estadística & datos numéricos , Glucuronatos/análisis , Cabello/química , Detección de Abuso de Sustancias/métodos , Adulto , Alberta , Conducción de Automóvil/legislación & jurisprudencia , Biomarcadores/análisis , Etanol/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Equipos de Seguridad , Reproducibilidad de los Resultados , Medición de RiesgoRESUMEN
Widespread concern about illicit drugs as an aspect of workplace performance potentially diminishes attention on employee alcohol use. Alcohol is the dominant drug contributing to poor job performance; it also accounts for a third of the worldwide public health burden. Evidence from public roadways--a workplace for many--provides an example of work-related risk exposure and performance lapses. In most developed countries, alcohol is involved in 20-35% of fatal crashes; drugs other than alcohol are less prominently involved in fatalities. Alcohol biomarkers can improve detection by extending the timeframe for estimating problematic exposure levels and thereby provide better information for managers. But what levels and which markers are right for the workplace? In this paper, an established high-sensitivity proxy for alcohol-driving risk proclivity is used: an average eight months of failed blood alcohol concentration (BAC) breath tests from alcohol ignition interlock devices. Higher BAC test fail rates are known to presage higher rates of future impaired-driving convictions (driving under the influence; DUI). Drivers in alcohol interlock programmes log 5-7 daily BAC tests; in 12 months, this yields thousands of samples. Also, higher programme entry levels of alcohol biomarkers predict a higher likelihood of failed interlock BAC tests during subsequent months. This paper summarizes the potential of selected biomarkers for workplace screening. Markers include phosphatidylethanol (PEth), percent carbohydrate deficient transferrin (%CDT), gammaglutamyltransferase (GGT), gamma %CDT (γ%CDT), and ethylglucuronide (EtG) in hair. Clinical cut-off levels and median/mean levels of these markers in abstinent people, the general population, DUI drivers, and rehabilitation clinics are summarized for context.
Asunto(s)
Consumo de Bebidas Alcohólicas , Trastornos Relacionados con Alcohol/diagnóstico , Conducción de Automóvil , Accidentes de Tránsito , Consumo de Bebidas Alcohólicas/sangre , Consumo de Bebidas Alcohólicas/epidemiología , Etanol/sangre , Glucuronatos , Glicerofosfolípidos , Humanos , Trastornos Relacionados con Sustancias/epidemiología , Transferrina/análogos & derivados , Estados Unidos/epidemiología , Lugar de Trabajo , gamma-GlutamiltransferasaRESUMEN
INTRODUCTION: The effectiveness of ignition interlocks at reducing drunk driving has been limited by the ability of driving-while-intoxicated (DWI) offenders to avoid court orders to install the devices. METHODS: In a pilot program in New Mexico, four Santa Fe County judges imposed home confinement (via electronic monitoring bracelets) on offenders who claimed to have no car or no intention to drive. Interlock installation rates for Santa Fe County were compared with all other counties in New Mexico over a 2-year program and 2-year post-program period. RESULTS: During the two program years, 70% of the drivers convicted of DWI in Santa Fe County installed interlocks, compared to only 17% in the other counties, but when the program was terminated, the Santa Fe installation rate fell by 18.8 percentage points. SUMMARY: Mandating the alternative sanction of house arrest led to the highest reported interlock installation rate for DWI offenders. IMPACT ON INDUSTRY: Impaired driving is a substantial expense to employers, particularly when it bars driving that interferes with employment. Interlocks provide a method of protecting the public while permitting the offender to drive sober. This study was directed at increasing interlock use by DWI offenders.
Asunto(s)
Intoxicación Alcohólica , Conducción de Automóvil/legislación & jurisprudencia , Motivación , Equipos de Seguridad , Control Social Formal/métodos , Accidentes de Tránsito/prevención & control , Humanos , New Mexico , Proyectos Piloto , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: Two types of transdermal electrochemical sensors that detect alcohol at the skin surface were evaluated. One, the AMS SCRAM device, is locked onto the ankle and is based on a fuel cell sensor; the other, a Giner WrisTAS device, worn on the wrist, is based on a proton exchange membrane. SCRAM is used by several court systems in the United States to monitor alcohol offenders, WrisTAS, a research prototype, is not commercially available. METHODS: The 2 devices were worn concurrently by 22 paid research subjects (15 men, 7 women), for a combined total of 96 weeks. Subjects participated in both laboratory-dosed drinking to a target of 0.08 g/dl blood alcohol concentration (BAC), and normal drinking on their own; all subjects were trained to use and carry a portable fuel-cell breath tester for BAC determinations. Overall 271 drinking episodes with BAC > or = 0.02 g/dl formed the signal for detection-60 from laboratory dosing, and 211 from self-dosed drinking, with BAC ranging from 0.02 to 0.230 g/dl (mean 0.077 g/dl). RESULTS: False negatives were defined as a transdermal alcohol concentration response equivalent <0.02 g/dl when BAC > or = 0.02 g/dl. The overall true-positive hit rate detected by WrisTAS was 24%. The low detection rate was due to erratic output and not recording during nearly 67% of all episodes; reportedly a chipset, not a sensor problem. SCRAM correctly detected 57% across all BAC events, with another 22% (total 79%) detected, but as <0.02 g/dl. When subjects dosed themselves to BAC > or = 0.08 g/dl, SCRAM correctly detected 88% of these events. SCRAM devices lost accuracy over time likely due to water accumulation in the sensor housing. Neither unit had false-positive problems when true BAC was <0.02 g/dl. CONCLUSIONS: Each device had peculiarities that reduced performance, but both types are able to detect alcohol at the skin surface. With product improvements, transdermal sensing may become a valuable way to monitor the alcohol consumption of those who should be abstaining.
Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Técnicas Electroquímicas/instrumentación , Técnicas Electroquímicas/métodos , Etanol/sangre , Adulto , Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Reacciones Falso Negativas , Femenino , Humanos , Jurisprudencia , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Fenómenos Fisiológicos de la PielRESUMEN
This study evaluated cocaine exposure and maternal characteristics as competing predictors of school-age cognitive, achievement, and language performance. One group of 47 exposed 9-year-old children were first studied in an earlier prenatal study. A non-exposed contrast group (n = 46) served as a reference. Maternal measures included: IQ, psychopathology, drugs, demographics, and environment. Child intelligence, language, and achievement scores were inversely related to maternal IQ and depression scores, with cocaine exposure significant secondary or tertiary predictors for many children. Verbal IQ scores of exposed children strongly reflected maternal depression (r = .54) but no such relationship was found among the non-exposed cohort (r = .00).
Asunto(s)
Trastornos Relacionados con Cocaína/epidemiología , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Madres/estadística & datos numéricos , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adulto , Niño , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Estudios de Cohortes , Trastorno Depresivo Mayor/diagnóstico , Femenino , Humanos , Masculino , Madres/psicología , Embarazo , Encuestas y Cuestionarios , Escalas de WechslerRESUMEN
OBJECTIVE: Cost-effectiveness analyses using preference-weighted health status as the measure of effectiveness allow for the direct comparison of cost-effectiveness ratios for physical and mental health interventions. However, these analyses are not commonly used for substance use-disorders interventions. We conducted a methodological evaluation of the relationship between preference-weighted health status and 6-month substance use-disorders treatment outcomes. METHOD: The design was an observational study of clients receiving substance use-disorders treatment. Fifteen high-volume treatment centers within a regional managed behavioral health care organization participated. There were 165 subjects (117 men, 48 women) diagnosed with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, substance dependence in the analysis. Baseline and 6-month data included substance-use quantity, frequency, and diagnostic criteria and preference-weighted Medical Outcomes Study Short Form-36 scores based on visual analog scale (VAS) and standard gamble (SG) conversion formulas. RESULTS: Controlling for sociodemographic variables, VAS change for early remission at 6 months was 0.107 (p = .0002) (reference category continued dependence). SG change for early remission at 6 months was 0.041 (p < .0004). Using heavy drinkers as the reference category, VAS preference-weighted change was 0.062 (p = .10) for abstinent and 0.112 (p = .01) for moderate drinkers. SG preference-weighted change was 0.027 (p = .08) for abstinent and 0.046 (p = .01) for moderate drinkers. CONCLUSIONS: These findings support the construct validity of preference-weighted health status in substance use-disorders treatment. Direct comparisons of the cost-effectiveness of substance use-disorders treatment with other mental or physical health interventions are critical during times of limited health care resources.
Asunto(s)
Conducta de Elección , Estado de Salud , Trastornos Relacionados con Sustancias/economía , Trastornos Relacionados con Sustancias/terapia , Adulto , Terapia Conductista , Análisis Costo-Beneficio , Demografía , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Sistemas Prepagos de Salud , Indicadores de Salud , Humanos , Masculino , Servicios de Salud Mental/economía , Servicios de Salud Mental/estadística & datos numéricos , Inducción de Remisión , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología , Templanza , Resultado del TratamientoRESUMEN
Drivers convicted of impaired driving are substantially overrepresented in alcohol-related fatal crashes. Because many such offenders continue to drive with suspended operators' licenses, monitoring their postconviction driving is a significant problem for the criminal justice system. Technology for tracking the location and drinking of such offenders is a rapidly developing field, which promises to provide methods for monitoring offenders on a 24/7 basis. The status of traditional monitoring methods is reviewed and contrasted with the new technologies that are being implemented. Although those technologies offer considerable promise, they have not yet been evaluated in programs for impaired driving offenders. Eight issues related to the probability of rapid implementation of the new technologies are discussed.
Asunto(s)
Consumo de Bebidas Alcohólicas , Conducción de Automóvil , Automóviles , Control Social Formal , Conducción de Automóvil/legislación & jurisprudencia , Automóviles/legislación & jurisprudencia , Humanos , Aplicación de la Ley , Política Pública , Castigo , Recurrencia , Asunción de Riesgos , Controles Informales de la Sociedad/métodos , Estados UnidosRESUMEN
This commentary reviews current and past vehicle interlock programs for impaired driving offenders with a focus on the challenges that courts and motor vehicle departments face in attempting to implement mandatory programs as required by current federal legislation. There are few offenders in interlock programs compared to the large number of impaired drivers arrested each year. This suggests that, to increase participation, courts will have to threaten more severe sanctions for those offenders who reject interlock programs. A combination of electronic house arrest with interlock programs is suggested as a method of maximizing interlock use.
Asunto(s)
Accidentes de Tránsito/legislación & jurisprudencia , Accidentes de Tránsito/prevención & control , Intoxicación Alcohólica/complicaciones , Conducción de Automóvil/legislación & jurisprudencia , Equipos de Seguridad , Humanos , Estados UnidosRESUMEN
This report summarizes evidence presented during the Third Annual Ignition Interlock Symposium at Vero Beach, Florida, 29 October 2002. The ignition interlock prevents a car from starting when blood alcohol concentration (BAC) is elevated. We review some of our prior work as well as introduce previously unpublished results to demonstrate the manner in which the data recorded by the alcohol ignition interlock device can serve as an advance predictor of future driving under the influence (DUI) of alcohol risks. Data used in this current report represent approximately 2,200 ignition interlock users from Alberta, Canada, and about 8,000 interlock users from Quebec, Canada; the Alberta data set contained 5.5 million breath tests and the Quebec data 18.8 million breath tests. All tests are time and date stamped and this information was used to characterize patterns of BAC and vehicle use, and the relationship between BAC elevations and DUI offenses that accumulated after the interlock was removed from the vehicles. Findings from Cox regression show that BAC elevations >.02-.04% are more potent predictors of repeat DUI (p<.0001) than even prior DUI (p<.006), usually found to be the strongest indicator of driver risk. Prior DUI obviously has no use for scaling the risk of first-time offenders. Drivers who are both multiple offenders and who have more than a few elevated interlock BAC tests are much more likely to repeat DUI. The timing and pattern of elevated BAC tests provided during the time drivers were required to use an alcohol ignition interlock device are remarkably similar on both a daily basis and an hourly basis when the interlock programs from the two provinces are compared directly. Both provinces had higher rates of elevated tests on Saturday and Sunday, and the fewest elevated tests on Tuesdays. The absolute rate of elevated tests is similar despite the two provinces adhering to different interlock lockout points (.02% Quebec;.04% Alberta). Charts tracking the Monday-Friday timing of elevated BAC tests by hour are nearly identical for both provinces. The most elevated BAC tests occurred between 7 and 9 A.M. Monday to Friday, even though most vehicle start attempts occurred much later in the day. This higher rate of elevated morning BAC likely represents drinking from the prior evening with alcohol not yet cleared from circulation; those with elevated BAC in the early morning were more likely to have a repeat offense even after accounting for prior DUI and the higher overall rate of elevated BAC tests. This is viewed as evidence of a drinking problem that will lead to impaired driving after the controlling function of the interlock is removed. Policy changes are discussed that might take better advantage of interlock information to improve the public response to drunk driving.
Asunto(s)
Accidentes de Tránsito/prevención & control , Intoxicación Alcohólica/complicaciones , Intoxicación Alcohólica/diagnóstico , Alcoholismo/complicaciones , Alcoholismo/diagnóstico , Equipos de Seguridad/estadística & datos numéricos , Humanos , Valor Predictivo de las Pruebas , Estados UnidosRESUMEN
OBJECTIVE: This work was conducted to find practical predictors that anticipate which driving under the influence (DUI) offenders will continue to drink and drive after a period of alcohol ignition interlock-controlled driving ends. The interlock prevents impaired driving by requiring a low blood alcohol concentration (BAC) breath sample before allowing an engine to start. Each breath test is recorded. The study evaluated the interlock record as a predictor of future DUI offenses relative to driver records and self-report items. METHOD: Subjects were 2,273 DUI offenders in Alberta, Canada, who used an interlock to gain full reinstatement of driving privileges; for 2,134, the installed periods ranged from 5 to 30 months. A median of 8.1 breath tests was logged for each installed day; 9.9 tests were taken on each day of vehicle use (4.3 starts plus 5.6 running retests). Predictors of postinterlock repeat DUI were compared by sensitivity and survival analyses. RESULTS: Although 69% of all interlock users had at least one BAC test > or = .04% (a "fail" test) within the first 5 months, only 9% were reconvicted up to 4 years after interlock removal. Failed interlock tests proportional to all BAC tests taken was the best predictor of driver recidivism risk during the years following interlock removal. CONCLUSION: The interlock record provides new information, particularly about drivers with no prior DUI offenses. Prior moving violations and driving while suspended convictions, although better predictors than questionnaire data, were poorer than interlock records and prior DUI offenses. The alcohol interlock, already recognized as a useful control device, warrants attention for DUI prediction as well.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Intoxicación Alcohólica/epidemiología , Conducción de Automóvil/estadística & datos numéricos , Registros/estadística & datos numéricos , Adulto , Canadá/epidemiología , Áreas de Influencia de Salud , Femenino , Humanos , Masculino , Estudios Prospectivos , Recurrencia , Encuestas y CuestionariosRESUMEN
AIMS: This report reviews breath test data captured by the alcohol ignition interlock, a device that prevents a car from starting when BAC (breath alcohol concentration) is elevated. DESIGN: The predictors were elevated BAC test rates from ignition interlock equipped cars of traffic offenders convicted of DUI (driving under the influence of alcohol) and who used interlocks for 6-18 months. Outcome data were future DUI convictions. SETTINGS: Québec and Alberta, Canada. PARTICIPANTS: Approximately 10000 interlock users from these two culturally distinctive English- and French-speaking Provinces. MEASUREMENT: Predictor patterns were analyzed from among 23 million breath tests. Repeat DUI convictions accumulated up to several years after interlock removal were studied as an outcome to be predicted by the rate of BAC tests > or = 20 mg/dl (0.02%) while the interlock was installed. Data were analyzed with sensitivity and survival methods. FINDINGS: A median of eight interlock breath tests per day per driver were logged (a rate of 3000 tests/year). Less than 1% of all tests were over 0.02%, but the rate of elevated BAC tests, particularly those taken at 7-9 a.m., strongly predicts repeat DUI offenses 2 years hence. The interlock record is an unobtrusive measure of drinking behavior and can be used to profile driver risk. CONCLUSIONS: With new legal mandates, North American use of these DUI control devices is increasing rapidly from the current 5% penetration rate. Interlock data may eventually come to serve as a useful adjunct for patient monitoring by alcohol counselors as well as by courts and motor vehicle authorities.
Asunto(s)
Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Conducción de Automóvil/legislación & jurisprudencia , Pruebas Respiratorias/métodos , Accidentes de Tránsito/prevención & control , Consumo de Bebidas Alcohólicas/psicología , Humanos , Aplicación de la Ley/métodosRESUMEN
This report summarizes evidence presented during the Third Annual Ignition Interlock Symposium at Vero Beach, Florida, 29 October 2002. The ignition interlock prevents a car from starting when blood alcohol concentration (BAC) is elevated. We review some of our prior work as well as introduce previously unpublished results to demonstrate the manner in which the data recorded by the alcohol ignition interlock device can serve as an advance predictor of future driving under the influence (DUI) of alcohol risks. Data used in this current report represent approximately 2,200 ignition interlock users from Alberta, Canada, and about 8,000 interlock users from Quebec, Canada; the Alberta data set contained 5.5 million breath tests and the Quebec data 18.8 million breath tests. All tests are time and date stamped and this information was used to characterize patterns of BAC and vehicle use, and the relationship between BAC elevations and DUI offenses that accumulated after the interlock was removed from the vehicles. Findings from Cox regression (Marques et al., 2003) show that BAC elevations > .02-.04% are more potent predictors of repeat DUI (p < .0001) than even prior DUI (p < .006), usually found to be the strongest indicator of driver risk. Prior DUI obviously has no use for scaling the risk of first-time offenders. Drivers who are both multiple offenders and who have more than a few elevated interlock BAC tests are much more likely to repeat DUI. The timing and pattern of elevated BAC tests provided during the time drivers were required to use an alcohol ignition interlock device are remarkably similar on both a daily basis and an hourly basis when the interlock programs from the two provinces are compared directly. Both provinces had higher rates of elevated tests on Saturday and Sunday, and the fewest elevated tests on Tuesdays. The absolute rate of elevated tests is similar despite the two provinces adhering to different interlock lockout points (.02% Quebec; .04% Alberta). Charts tracking the Monday-Friday timing of elevated BAC tests by hour are nearly identical for both provinces. The most elevated BAC tests occurred between 7 and 9 A.M. Monday to Friday, even though most vehicle start attempts occurred much later in the day. This higher rate of elevated morning BAC likely represents drinking from the prior evening with alcohol not yet cleared from circulation; those with elevated BAC in the early morning were more likely to have a repeat offense even after accounting for prior DUI and the higher overall rate of elevated BAC tests. This is viewed as evidence of a drinking problem that will lead to impaired driving after the controlling function of the interlock is removed. Policy changes are discussed that might take better advantage of interlock information to improve the public response to drunk driving.
Asunto(s)
Accidentes de Tránsito/prevención & control , Intoxicación Alcohólica/diagnóstico , Equipos de Seguridad/estadística & datos numéricos , Alberta , Intoxicación Alcohólica/sangre , Conducción de Automóvil , Automóviles , Pruebas Respiratorias/instrumentación , Depresores del Sistema Nervioso Central/análisis , Congresos como Asunto , Etanol/análisis , Humanos , Modelos de Riesgos Proporcionales , Quebec , Factores de Tiempo , Estados UnidosRESUMEN
This commentary reviews current and past vehicle interlock programs for impaired driving offenders with a focus on the challenges that courts and motor vehicle departments face in attempting to implement mandatory programs as required by current federal legislation. There are few offenders in interlock programs compared to the large number of impaired drivers arrested each year. This suggests that, to increase participation, courts will have to threaten more severe sanctions for those offenders who reject interlock programs. A combination of electronic house arrest with interlock programs is suggested as a method of maximizing interlock use.
Asunto(s)
Accidentes de Tránsito/prevención & control , Intoxicación Alcohólica/diagnóstico , Conducción de Automóvil/legislación & jurisprudencia , Programas Obligatorios/legislación & jurisprudencia , Equipos de Seguridad/estadística & datos numéricos , Automóviles , Pruebas Respiratorias/instrumentación , Humanos , Castigo , Estados UnidosRESUMEN
Approximately 30,000 alcohol ignition interlocks, which are designed to prevent the operation of a vehicle if the driver has been drinking, are in use in the US and Canada. Ignition interlock programs are also being initiated in Sweden and Australia. The best-controlled studies that are currently available suggest that ignition interlocks are effective in reducing impaired driving recidivism while on the vehicle. However, in the US, the practical effectiveness of these devices is limited because only a small number of offenders are willing to install them in order to drive legally. This paper reports on a study of a court policy that created a strong incentive for impaired driving offenders to install interlocks by making traditional penalties, such as jail or electronically monitored house arrest, the alternative to participation in an interlock program. Comparison of the recidivism rates of offenders subject to this policy with offenders in similar, nearby courts, not using interlocks, indicated that the policy was producing substantial reductions in DUI recidivism.