摘要：Objectives. We examined the public health impact of South Dakota’s 24/7 Sobriety Project, an innovative program requiring individuals arrested for or convicted of alcohol-involved offenses to submit to breathalyzer tests twice per day or wear a continuous alcohol monitoring bracelet. Those testing positive are subject to swift, certain, and modest sanctions. Methods. We conducted differences-in-differences analyses comparing changes in arrests for driving while under the influence of alcohol (DUI), arrests for domestic violence, and traffic crashes in counties to the program with counties without the program. Results. Between 2005 and 2010, more than 17 000 residents of South Dakota—including more than 10% of men aged 18 to 40 years in some counties—had participated in the 24/7 program. At the county level, we documented a 12% reduction in repeat DUI arrests ( P = .023) and a 9% reduction in domestic violence arrests ( P = .035) following adoption of the program. Evidence for traffic crashes was mixed. Conclusions. In community supervision settings, frequent alcohol testing with swift, certain, and modest sanctions for violations can reduce problem drinking and improve public health outcomes. Alcohol consumption can impose enormous health and safety costs on individuals and society. 1,2 Problem drinkers account for a disproportionate share of these costs. 2,3 Although millions of problem drinkers pass through the criminal justice system each year, 4,5 reducing their alcohol consumption has proven difficult. Those arrested for or convicted of an alcohol-involved offense are sometimes ordered not to drink or frequent bars, but abstinence is difficult to enforce because alcohol passes through the system more quickly than other substances. For example, a 160-pound man who exceeds the legal drinking limit for driving after consuming 5 drinks in 2 hours will likely register a 0.00 in a breathalyzer test 8 hours after drinking. 6–8 In traditional community corrections settings (e.g., probation and parole), sanctions often occur only after major violations or after a series of minor violations, and they may not be imposed until weeks or months after the offense. However, a growing body of evidence from neurobiology, psychology, and economics suggests that punishment certainty is a stronger deterrent to criminal activity than punishment severity. 9–13 Research also suggests that individuals value immediate rewards more strongly than delayed rewards, 14,15 a tendency particularly pronounced among alcohol-abusing populations. 16,17 In 2004, South Dakota Attorney General Larry Long proposed an innovative pilot project called the 24/7 Sobriety Project (hereinafter, 24/7) that made twice-a-day breathalyzer tests (i.e., once in the morning and once in the evening) a condition of bail for those who had been rearrested for driving while under the influence of alcohol (DUI). Individuals who failed or skipped tests were immediately subject to a short jail term, typically 1 or 2 days. The 5-county pilot project quickly expanded to incorporate additional counties, individuals arrested or convicted for other offenses (e.g., assault), and additional monitoring technologies. By the end of 2010, more than 17 000 of the roughly 825 000 residents of South Dakota—including more than 10% of men aged 18 to 40 years in some counties—had participated in the program. Our analysis of data from the South Dakota Attorney General’s Office revealed that program participants were ordered to take approximately 3.7 million breathalyzer tests from 2005 to 2010 and that the pass rate exceeded 99% (99.3% of the tests were clean, 0.36% dirty, and 0.34% no shows). With inclusion of the results from continuous alcohol monitoring bracelets (worn by roughly 15% of participants), there were approximately 2.25 million days without a detected alcohol violation. These patterns suggest that the program may have been effective in reducing problem drinking among the target population. If 24/7 successfully reduces alcohol use among problem drinkers, we might expect improvements in alcohol-related public health outcomes following the establishment of the program. Although 24/7 has won national awards and is being implemented in other states, evidence to date of its effectiveness has been largely anecdotal and descriptive. 18–20 We provide the first rigorous empirical evaluation of 24/7 across a range of public health outcomes by using a differences-in-differences research design that leverages the program’s phased implementation across counties using a 10-year county-month panel (January 2001–December 2010).
