1. Biomarker Project – OWI Enhancement Grant
The Human Service Center of Forest, Oneida, and Vilas Counties

2. What is a biomarker?
A biomarker is a biological indicator which varies with the amount of alcohol consumed.

3. Traffic Medicine - Europe
Alcohol biomarkers used in at least 7 European countries to assess and monitor intoxicated drivers
Sweden / Norway / Netherlands
Italy / Switzerland / Germany / England
If biomarker is elevated driver must prolong monitoring period before regaining DL

4. Advisory Committee Intoxicated Drivers Program (IDP)
In Wisconsin:
“The use of these tests is permissible under intoxicated driver program rules (HFS 62.03) and in treatment-oriented driver safety plan programs”
WI State IDP Advisory Committee – August 2005

5. Motivation to Use Biomarkers in Forest, Oneida and Vilas Counties
In 2010 there were 621 OWI related convictions in Forest, Oneida and Vilas Counties.
44% were for second or subsequent OWI offense.
24% for a third offense and >70% had a BAC above 0.08
This data clearly demonstrates that the Forest, Oneida, and Vilas county region has a significant population that meet the definition of “hard core drunk drivers.”

6. Direct Biomarkers Phosphatidyl-Ethanol – PEth
Metabolite of alcohol that incorporates into red cells and remains there until the cell dies
Found in blood – obtained by finger stick
Remains present for 2-3 weeks

7. Direct Biomarkers Ethyl Glucuronide – EtG
Metabolite formed by the body in the presence of alcohol
Found in urine, nails, and hair
Remains present for 3 months in nails

8. Inclusion Criteria
Second or third OWI offenders with a BAC>0.15 at the time of arrest who did not volunteer for OWI court
Fourth offender or more with BAC>0.15 at the time of arrest

9. Standard Procedure Client comes for assessment interview
If client fits Inclusion Criteria, he/she enrolls in a 1-year Drivers Safety Plan
Biomarker testing is part of the DSP
Each client is tested at least 3 times:
Assessment (baseline)
End of treatment
End of Drivers Safety Plan

11. Counties Using Biomarkers
Waukesha = 250 drivers
Dane County = 500
Kenosha = 300
Oneida/Forest/Vilas = 300
Taylor = 100
TOTAL = 1,500 DRIVERS

12. Demographics: N=280 Age = 39.7 average Male = 76%
Single/ widowed/ divorced = 80%
American Indian=30%
Employed full or part-time = 62%
Years of education = 12 average
Diagnosed with AD or SAD = 80%
BAC at last arrest = 0.20 average
Oneida=51% - Vilas=35% - Forest= 14%

13. Identifying High Risk Drivers
Baseline analysis
N (%)
Total Drivers (all 3 counties)
276 (100%)
Biomarker positive (either or both)
138 (50%)
50% of the repeat offenders enrolled in this pilot continues to drink heavily after their last OWI arrest
57% of the 138 drivers who tested biomarker + denied drinking any alcohol for at least one week before the assess

14. Monitoring Drivers – Case Studies
Collection Date
Timeline
Nail
(20pg/mg)
Blood
(20ng/ml)
Classification
Case study #1
4/11/2013
Baseline
Completed successfully / abstained
9/6/2013
End of Tx
4/7/2014
End DSP
Case study #2
3/28/2013 77
78.32
Drinking all along / extend DSP
11/8/2013 48
56.51
2/10/2014 49
30.11
6/17/2014
Ext. DSP ?
Case study #3
10/9/2012
397
228
Active heavy drinking
12/18/2012 nd
168
2/22/2013
paid test
291
61.46
Active HD - recent drinking reduced
5/21/2013
Recent (3 wks) drinking stopped
9/17/2013
No dangerous drinking in last 3m or 3wks

15. Program Completion (N=123)N %
Re-arrests
Successful 89
72%
Unsuccessful 34
28% 6
TOTAL
123
100%
Six drivers in the unsuccessful group have been rearrested with a new OWI since program inception (last 2 years) to render a 2.1% recidivism rate (6/282)

16. Exit Interview (N=76) % 86% 92% 97%
Do you have a support system now?
86%
Have you reduced your use of alcohol?
92%
No Additional Legal Problems
97%
Was the Biomarker program helpful?
The biomarker program was helpful to stay sober and to provide proof of sobriety

17. Feedback from Clients Some responses from them in exit interview are,
“I feel I am getting my money’s worth.”
“I think this will be a helpful process for me to stay sober for one year to see if I can really do it.”
“I thought I could trick the process by figuring out when I would be seeing you next…but it didn’t work.”
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18. DUI pilot Benefits – Short term
Provide a better assessment of the driver:
identify hard-core drivers who continue to drink heavily after their arrest
Objectively identify drivers in denial
Allows for better treatment decisions
Provide better monitoring:
Identify relapses during monitoring,
conduct timely Brief Intervention

19. Long-term Outcomes Reduction in the rate of OWI re-arrests And /Or
Increase the period of time between arrests

20. Recidivism – Waukesha and Dane (N=54)
Drivers non-compliant with monitoring (n=12) get re-arrested in 430 days after assessment.
Drivers who went through monitoring (n=42) got rearrested 684 days after assessment.
For every additional day of monitoring the time to re-arrest increases by one day.

21. Costs of testing Cost of biomarker testing = Jail costs =
$50-100/test x 3-5 tests/year
$150-$500/year /driver = approx $1 per day
Jail costs =
$90 / day x 1 year = $32K/ year /driver

22. Next Steps - Legislation
WE NEED YOUR SUPPORT TO MAKE TESTING SUSTAINABLE