Objective: A common intervention to prevent alcohol -impaired driving are alcohol ignition interlock devices (IIDs), which prevent drivers with a blood alcohol concentration greater than .025% from starting the car. These devices force drivers to adapt their drinking to accommodate the device. Prior studies indicated a transfer of risk as some drivers with an IID may increase cannabis use as they decrease alcohol use. This study examines whether this increase in cannabis use persists after IID removal when alcohol use reverts to pre-IID levels. ' Method: The data are from the Managing Heavy Drinking (MHD) study of drivers in New York State. The MHD is a comprehensive three-wave study of drivers convicted of driving under the influence from 2015 to 2020. Participants (N = 189) completed all waves, and provided oral fluid/blood and hair samples to measure cannabis and alcohol use, respectively. Mixed between-within analysis of variance was conducted to assess cannabis use at IID installation (Time 1), removal (Time 2), and at 6-month follow-up (Time 3). Results: In aggregate, participants increased their cannabis use over the course of the study. Drivers who decreased their alcohol use while the IID was installed on their car sig-nificantly increased their cannabis use while the IID was in place and further increased cannabis use after the device's removal. Conclusions: IIDs are efficacious in preventing alcohol-impaired driving. However, in some cases, they may have the unintended effect of increasing other substance use. The current study outlines the need for supplemental treatment interventions while on IID to prevent a transfer of risk to other substances, or polysubstance use after the device is removed. (J. Stud. Alcohol Drugs, 83, 486-493, 2022)

As known cocaine-exposed cohorts of children aged, researchers were able to begin addressing questions about the effects of cocaine further along the developmental pathway. Developmental studies of gestational exposure are significantly more difficult to conduct because the possible consequent effects are not only subtle, but remote from the hypothetical cause by several years of time and postdevelopment experience. Many hospital staff use urine screening in an effort to document drug-use status of mother or infant at the time of delivery. This chapter reviews treatment related data to the extent that it relates to drug exposure measurements. It aims to characterize the meaningfulness of cocaine measured in the hair by referencing the results to other means of estimating cocaine. Another way to characterize the hair cocaine results is with behavioral change measures. Cocaine use is expected to decline as clients initiate programs of personal change.

Background: Some alcohol interventions have been found to have the adverse outcome of increasing non-alcohol-related substance use. It is unknown, however, how changes in alcohol use over the course of alcohol ignition interlocks - a common DUI intervention - may impact other substance use. Methods: Alcohol and cannabis use were measured using hair ethylglucuronide and Delta-9-Tetrahydrocannabinol concentrations in blood, respectively. Participants (N = 69) were measured at the interlock installation period and again 6-months later while the interlock was installed. A mixed ANOVA was conducted to examine changes in levels of ethanol and THC over time. Results: On measures of marijuana use, there was a significant interaction effect between the group that increased alcohol use and time F(2, 66) = 7.863, p =.001; partial eta(2) =.192; as well as a main effect for time F(2, 66) = 21.106, p eta(2) =.242. Conclusions: Installing interlocks may inadvertently increase cannabis use among those who decrease alcohol use. Crash risk associated with cannabis use is notably less than that of alcohol use, however, continued cannabis use may be problematic when the device is removed and alcohol use is expected to return to the higher pre-interlock levels.

BACKGROUND:Vehicle alcohol ignition interlocks reduce alcohol-impaired driving recidivism while installed, but recidivism reduction does not continue after removal. It has been suggested that integrating alcohol use disorder (AUD) treatment with interlock programs might extend the effectiveness of interlocks in reducing recidivism beyond their removal. This study evaluated the first implementation of a Florida policy mandating AUD treatment for driving under the influence (DUI) offenders on interlocks. Treatment was required when the offender accumulated 3 violations (defined as 2 "lockouts" within 4 hours; a lockout occurs when the device prevents a drinking driver from starting the vehicle). METHODS:Cox regression was used to compare alcohol-impaired driving recidivism during the 48 months following the interlock removal between 2 groups: (i) 640 multiple DUI offenders who received AUD treatment while interlocks were installed; and (ii) 806 matched offenders not mandated to treatment while interlocks were installed. RESULTS:The ignition interlock plus treatment group experienced 32% lower recidivism, 95% confidence interval [9, 49], following the removal of the interlock during the 12 to 48 months in which they were compared with the nontreatment group. We estimated that this decline in recidivism would have prevented 41 rearrests, 13 crashes, and almost 9 injuries in crashes involving the 640 treated offenders over the period following interlock removal. CONCLUSIONS:This study provides strong support for the inclusion of AUD treatment for offenders in interlock programs based on the number of times they are "locked out." The offenders required to attend treatment demonstrated a one-third lower DUI recidivism following their time on the interlock compared to similar untreated offenders.

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.

There has been a bounty of new and innovative developments in technology in the past 10 or more years that, if thoughtfully deployed, could support and extend efforts to reduce the alcohol road toll in the United States. Some of these technologies have been fully subjected to effectiveness–efficacy research, some partially evaluated, some exist as products in the marketplace but still await evaluation, and other promising approaches are still in development. In this report, six categories of technologies are discussed, and the evidence bearing on their adequacy and applications is described. Five of these categories represent alcohol-measuring technologies; one category of devices does not measure alcohol but plays a role in constraining the behavior of offenders convicted of driving under the influence of alcohol (DUI). With one exception, all products are directed toward the control of individual DUI offenders, or other types of problem drinkers. A few of the technologies could be configured to extend the monitoring and surveillance of excessive drinking to all drivers, perhaps at relicensing or other encounters. The author concludes that there appears to be two main paths that could reduce the alcohol road toll: to use more data-driven intensive monitoring and treatment services for the offenders who are captured and convicted, or to cast a wider net to facilitate detection of a higher proportion of alcohol-impaired drivers. Several of the technologies summarized could aid in achievement of either of those target objectives. The best results would probably come from a combination of both.

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.

Efforts are underway to encourage alcohol interlocks for all impaired driving offenders [driving under the influence (DUI)] in the USA. Interlocks require breath-alcohol concentration (BrAC) tests and prevent engine startups when BrAC is above preset levels. Interlock programs have grown rapidly; however, the devices are only effective while installed. Clearly, we need to strengthen effectiveness while installed, but also to improve monitoring and extend the installed duration when there is evidence of persistent excessive drinking. Perhaps most importantly, we need to improve the safety benefits achieved while installed for long after interlocks have been removed. Currently, 279,000 interlocks are in use, equaling about 20% of annual DUI arrests in the USA. Since 2006, installation has grown about 15% per year. The popularity of interlock laws is bolstered by 20 years of research studies showing offenders on interlocks have two-thirds lower recidivism rates than comparable controls 1. Policy initiatives by Mothers Against Drunk Driving seek to expand interlocks to all DUI offenders. This push is reflected in the recently passed 2012 U.S. Transportation Bill, which includes incentives for states to pass and enforce mandatory interlock laws. Unfortunately, receiving less attention than full enrollment is the return to control levels of impaired driving once the devices are removed 2, 3. Overcoming that problem may yield a greater safety benefit than adding additional interlock users. The average interlock sentence for first-time DUI offenders is less than one year, whereas the average drinking driver will be licensed for decades. Once the current wave of legislation to extend interlocks to first-time DUI offenders has run its course, extending the use of alcohol technologies to improve long-range alcohol safety will assume paramount importance. When given a choice to enroll in programs that substitute interlocks for some portion of the usual license suspension period, only 10–20% of DUI offenders select it. Presumably, many prefer the option of driving while unlicensed with its low probability of detection. Policymakers often believe that license suspension is the more severe sentence and most states retain it. As a result, a large portion of the time DUI offenders are subject to sanctions, they are suspended, rather than using interlocks, even though recidivism rates with an interlock are lower 4. As New Mexico successfully implemented in 2002, provisions of the 2012 Transportation Law create an incentive for states to remove most of the mandatory suspension required for interlock eligibility. This is important because recidivism risk is highest in the period immediately following the initial arrest 5. Some offenders successfully argue they have no access to a car so cannot enter an interlock program. But, studies show that when the court imposes a more burdensome alternative sanction, such as home confinement, offenders find cars and install interlocks, rather than face the more severe penalty 6. This goading of offenders into interlock programs, however, is rarely practised. Research from 1999 to 2010 showed a direct relationship between breath test lockout rates and subsequent re-arrest for DUI 7. Based on this research pedigree, a few states have provisions in their laws extending the interlock program, or additional monitoring, of offenders with repeated BrAC lockouts. Improved monitoring can take several forms. The basic interlock is a transparent low-level sanction system—blocking engine ignition—requiring no action other than periodic maintenance, data downloads, and action by the authority to discourage circumvention. Supplemental monitoring with targeted consequences can add a second level of supervision. A random assignment study in Maryland 8 evaluated regular postal letters that threaten sanctions, or applaud interlock offenders, based on program performance. This approach reduced recidivism for up to two years during the interlock program. States' monitoring can invoke a range of actions, including removal from the interlock program, extension of time on the interlock and a system of escalating supervision, as in Florida. New alcohol technologies provide monitoring alternatives. Two are transdermal alcohol detection and photo identification systems for interlocks. Transdermal units lock onto the ankle and yield nearly continuous readings of alcohol vapor at the skin. Positive photo identification of interlock test-takers makes it difficult for offenders to blame lockouts on other vehicle users. For those without cars, non-vehicle variants of such monitoring require BrAC tests several times during the day. Alcohol biomarkers—longer time horizon indicators of drinking—are widely used in Europe to monitor DUI offenders. Measurement of alcohol markers in blood, hair or urine sources can objectively improve our understanding of drinking status among DUI offenders. These advanced systems for monitoring drinking are now getting occasional use in the criminal justice system to reduce reliance on costly jail. As costs for monitoring drinking decline, someday this may replace interlocks as a method of controlling DUI offenders 9. We have no evidence on how offenders adjust their drinking and driving to accommodate the interlock. Clearly, offenders ‘learn’ to avoid lockouts while on the interlock 2, 3, 10, 11. This safety benefit occurs even while total driving is unchanged. Reduction in rates of failed BrAC tests led to initial enthusiasm that interlocks really might be reducing drinking. This inference was challenged by a 2010 study 10 in which six direct and indirect blood biomarkers were collected at both installation and interlock removal many months later. The pre- and post-comparison of biomarkers showed little to no change in alcohol consumption. Two approaches can counter the resumption of impaired driving upon interlock removal: active treatment during interlock or harm reduction strategies. An interlock program is not a therapeutic behavioral change program. DUI offenders may drink more strategically to avoid interlock lockouts, but they do not drink less. Accordingly, monitoring authorities that want abstinence could make better use of the interlock period, while drinking is held somewhat in check. A Texan study showed interlock participants under court order were amenable to a motivational intervention in which counselors use and discuss the interlock BrAC data 12. Harm reduction is also an option, preserving the behavioral accommodation to the interlock (reduced drinking and driving) without targeting drinking directly. What do interlock users do differently to avoid BrAC lockouts? Little is known about their coping methods but with drinking and driving both unchanged, offenders are making changes that avoid limiting either. A study of those adjustments might help us develop interventions. In sum, more interlocks are going on more offender cars, and there is growing recognition of the need to install soon after detection and arrest, rather than after long periods of license suspension. But, little effort is underway to actively monitor and mount supplemental interventions on higher risk interlock DUI offenders. Progress on the latter, and most difficult, element will be needed to break the cycle of catch and release. None.

Objective: The rate of failed interlock blood alcohol content (BAC) tests is a strong predictor of recidivism post-interlock and a partial proxy for alcohol use. Alcohol biomarkers measured at the start of an interlock program are known to correlate well with rates of failed BAC tests over months of interlock use. This study evaluates 2 methods of measuring low blood levels of the biomarker phosphatidylethanol (PEth). PEth is a 100 percent alcohol-specific biomarker and strongly intercorrelated with several independent indicators of drinking driving risk, including 8 other biomarkers, 3 psychometric assessments, and the rate of failed interlock BAC tests during many months of interlock use. Does a more sensitive method of measuring PEth at program entry detect drinking even among those who subsequently log no failed interlock tests? Methods: In a sample of 281 driver blood samples, PEth was measured by both high-performance liquid chromatography (HPLC) and liquid chromatography tandem mass spectrometry (LCMSMS) in order to compare sensitivity and accuracy. The average rate of failed interlock BAC tests was the criterion measure for marker sensitivity. LCMSMS, calibrated to detect low levels of drinking as a possible measure of abstinence violation, was judged relative to the standard HPLC assay for PEth measured up to 4 μmol/L. Results: The 2 methods showed a good quantitative relationship (r2> .86). LCMSMS detected positive PEth levels in samples that were below the limit of detection of the HPLC method. PEth measured by LCMSMS was positive for a higher proportion of driving under the influence (DUI) offenders who logged zero failed interlock BAC tests than were detected by HPLC. Conclusion: Although HPLC is the widely used standard for measuring PEth in clinical alcoholism samples, the LCMSMS method, when calibrated to detect trace amounts of the major component of PEth, can detect abstinence levels of alcohol near zero intake and still correlate strongly with other indicators related to alcohol use and road safety.

BACKGROUND Apolipoprotein J (ApoJ) is a component of plasma high-density lipoproteins. Previous studies have shown progressive recovery of ApoJ sialic acid content with increased duration of alcohol abstinence. Therefore, the sialic acid index of plasma apolipoprotein J (SIJ) seems to be a promising alcohol biomarker. Phosphatidylethanol (PEth) is a direct ethanol metabolite and has recently attracted attention as a biomarker of prolonged intake of higher amounts of alcohol. The aim of the pilot study was to explore sensitivity, specificity, and normalization of SIJ and PEth in comparison with traditional and emerging biomarkers. METHODS Five male alcohol-dependent patients (International Classification of Diseases 10, F 10.25) were included (median: 40 years old; Alcohol Use Disorders Identification Test value, 30; alcohol consumption in the previous 7 days, 1,680 g). SIJ, PEth, urinary ethyl glucuronide (UEtG), urinary ethyl sulfate (UEtS), and gamma glutamyl-transpeptidase (GGT) were determined at days 1, 3, 7, 10, 14, 21, and 28. RESULTS At study entry, SIJ, PEth, UEtG, and UEtS were positive in all subjects, whereas GGT and mean corpuscular volume were positive in 3 of 5 (60%) of the subjects. Individual SIJ levels increased between day 1 and 28 between 13.7 and 44.3%, respectively. For SIJ and PEth, the ANOVA (p < 0.005) showed a significant trend with the average subject's SIJ and PEth changing 1.22 and 1.02, respectively, per week. CONCLUSIONS Our preliminary data suggest that SIJ and PEth might hold potential as markers of heavy ethanol intake.

This case report describes the police investigation of a road-traffic accident involving a collision at night (01.00 am) between a car and a truck in which a passenger in the car was killed. The driver of the truck was found responsible for the crash although a roadside breath-alcohol test was negative (<0.1 mg/L breath or 20 mg/100 mL blood). Because of injuries sustained in the crash, the female driver of the car was not breath-tested at the time but was transported to a local hospital for emergency treatment. After swabbing the skin with isopropanol an indwelling catheter was inserted at 01.40 am. A blood sample was taken at 02.10 am and the plasma portion contained 8 mmol/L ethanol according to analysis at the hospital clinical laboratory using a gas chromatographic method. Another blood sample was taken at 05.45 am for analysis of ethanol at a forensic toxicology laboratory, although the result was negative (<10 mg/100 mL). The police authorities wanted an explanation for the discrepancy between the clinical and forensic laboratory results and inquired whether the driver of the car was above the legal alcohol limit (>20 mg/100 mL) at the time of the crash. The scientific basis for converting a plasma-ethanol concentration into a blood-ethanol concentration and back extrapolation of the driver’s blood-alcohol concentration (BAC) is explained. The risk of contaminating a blood sample by swabbing the skin with isopropanol is discussed along with the use of alcohol biomarkers (ethyl glucuronide and ethyl sulphate) as evidence of recent drinking.

This Evaluation of the New Mexico Ignition Interlock Program begins by summarizing the development of alcohol ignition interlock devices, laws, and programs during the past 22 years. It then reviews the laws that were written in New Mexico from 1999 to 2005. It goes on to characterize current penetration of interlocks relative to alcohol-related risk indicators, followed by detailed methodological reports on eight studies undertaken to understand the effects of several aspects of the New Mexico laws. The eight studies include (1) an evaluation of recidivism among court-mandated offenders who were required to install interlocks but were not allowed to drive those cars; (2) an evaluation of recidivism differences of first-time offenders who installed interlocks relative to matched offenders who did not; (3) an evaluation of the effect of an interlock licensing law that allows revoked DWI offenders to install an interlock on an insured vehicle and drive that way during the remainder of their revocation period; (4) an evaluation of a strong mandate in Santa Fe County during a 2-year period in which electronically monitored house arrest was required for offenders who did not want to have an interlock or claimed no plan to drive; (5) an evaluation of the patterns of elevated blood alcohol content (BAC) tests by hour of the day and day of the week from among the more than 10 million New Mexico breath tests collected by interlock devices; (6) a comparative evaluation of predictors of recidivism including prior driving while intoxicated (DWI), measures of drinking from the interlock event record, age, and other predictors; (7) a report on an interview process that included key informants, such as judges, prosecutors, defense attorneys, and probation officers, who manage or administer the interlock program; and (8) a report on focus group findings with interlock-using DWI offenders. Each of the eight studies is reported with Methods, Results, and Comments sections. The conclusion summarizes key findings and places the New Mexico results in the larger context of the national effort to reduce impaired-driving-related injuries and deaths. This report begins with an executive summary that touches on all these topics, including key findings, lessons learned, and potential areas for improvement of the New Mexico program.

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.