Can alcohol abstinence orders reduce mortality? Insights from an individual-level analysis of 24/7 Sobriety

Background: Alcohol misuse can impose massive harms and a large share of these costs are attributable to justice-involved individuals. An increasing number of jurisdictions in the US and UK are using alcohol abstinence orders with frequent alcohol testing (twice daily breathalyzers and/or alcohol monitoring bracelets) to reduce alcohol consumption among those arrested/convicted for alcohol-involved crimes. In the US, 24/7 Sobriety programs combine frequent alcohol testing with swift, certain, and moderate sanctions for noncompliance (typically a night or two in jail). While county-level analyses of 24/7 Sobriety have found a negative association with mortality, ecological data do not allow for strong causal inference. This is the first paper to assess the relationship using individual-level data.

Methods: The analysis uses detailed criminal history and mortality information for the universe of individuals arrested for driving under the influence (DUI) of alcohol in South Dakota from 2004-2011 (N=55,981). The mortality data run through 12/2016, giving us at least 5 years of follow-up data for each individual. We examine 24/7 participation in our probit models and use county-level variation in the availability of 24/7 Sobriety as an instrument in our bivariate probit and instrumental variable survival analysis using G-estimation techniques.

Results: At the 1 year follow-up, probit models focused on all DUI arrestees suggest that 24/7 Sobriety participation is associated with a 47.6% lower risk of mortality (p<0.05). The magnitude declines with each additional year of follow-up, but the effect remains substantively and statistically significantly at the 5-year follow up (24.2%; p<0.01). Findings from the bivariate probit models suggest larger effect sizes and the IV survival models will be completed in Spring 2022.

Conclusion: Alcohol abstinence orders with swift/certain/moderate sanctions for noncompliance reduce mortality risk for justice-involved individuals in South Dakota. Additional research is needed to determine whether similar programs reduce mortality in other jurisdictions.