1. Continuous Alcohol Monitoring and the SCRAM System Greater Littleton Youth Initiative September 11, 2009

2. Agenda  AMS Overview  SCRAM System Overview  Differentiating Consumed Alcohol from Interfering Substances  TAC to BAC Correlation  False Positives and False Negatives  How Can the Criminal Justice System Approach Alcohol Misuse and Crime  South Dakota 24/7 Program  Colorado Applications and Program Development Considerations  Questions and Answers

3. Alcohol – A Difficult Problem for the Criminal Justice System Colorado– Local Perspective  34% of all traffic fatalities are alcohol related (179)  18% of Insurance costs are due to impaired driving  $76 Per Day to Incarcerate Prisoner in Colorado  3,000 DOC offenders to be released in 2009  800 Offenders currently monitored on any given day in Colorado SCRAM Program National Recidivism  Alcohol is fueling the criminal behavior  36% of all crime/caseloads  75% of cases of domestic violence  33% of all DUI offenders will re-offend

4. The SCRAM System

5. SCRAM System Overview  The SCRAM System is Semi-Quantitative TAC results enable a technician to reliably determine whether a person consumed alcohol TAC results are highly correlated with, but not predictive of, BAC  SCRAM “flags” a drinking event when there are 3 or more consecutive readings of 0.020 TAC or greater Most people will require at least 2 standard drinks to achieve a 0.020 TAC  SCRAM is designed to be tamper resistant and also “flags” potential tampers. Security features include: Secured strap with tamper-evident securing clip Temperature sensor Obstruction sensors  All “flagged” events (both drinking and tamper) are reviewed by trained technicians in the AMS monitoring center prior to “confirmation.”

6. SCRAM System Overview  Example: TAC Curve vs. BAC Curve

7. TAC to BAC Correlation  Percent of events “flagged” for 60+ Self-Reported Community Drinking Events

8. False Positives & False Negatives  Results from Community Testing Consisting of 120 Self-Reported Drinking Events and 420 Days of Alcohol Abstinence Testing A “true negative” event is any 12 hour period where there was NO drinking and where a drinking event was NOT confirmed. Drinking episodes ranged from 2 standard-drinks to over 10 standard drinks Note that most Commercially Available Drug Kits have a False Positive Rate of 5.0% Actual Event PositiveNegative SCRAM System Result Positive True Positive 62 False Positive 1 Negative False Negative 58 True Negative 718

9. SCRAM System Overview  Example: Compliant Subject

10. Drinking Event on SCRAM Confirmable detections include at least two of the following three indicators: Presence of an absorption curve Presence of a burn-off curve Obstruction in place of the absorption curve Burn-off Curve Absorption Curve

11. SCRAM System Overview  Example: Non-Compliant Subject Absorption Rate = 0.011% Per Hour Elimination Rate = 0.010% Per Hour Subject consumed: 4 Tropical Margaritas in 2 hours From 4:15 PM – 6:15 PM

12. Tampers and Obstructions SCRAM detected an obstruction or an attempt to defeat the technology obstructions

13. Interfering Substances  Interfering substances are contaminants that may cause an elevated alcohol concentration reading in the SCRAM bracelet  AMS provides users with a list of interfering substances to avoid Users sign agreements promising to avoid these substances  Detecting interfering substances is relatively easy for trained technicians Consumed alcohol and the overwhelming majority of interfering substances produce distinctly different alcohol curves Technicians can distinguish consumed alcohol from interfering substances by examining absorption and elimination rates

14. Interfering Substances  Example: Band-Aide Anti-Itch Gel Results: Peak TAC = 0.229%Absorption Rate = 0.573% per hour Duration: > 31 HoursElimination Rate = 0.009% per hour Applied Band Aide anti itch gel @ 1:44 PM 8/29/06

15. Interfering Substances  Example: “Awesome” Floor Cleaner Followed by Drinking Episode Applied “Awesome” floor cleaner @ 3:30 PM on 2/8/05 Consumed alcohol beginning 7:00 PM on 2/8/05 Results: “Awesome” Floor CleanerDrinking Episode Absorption Rate 0.191 TAC per hour 0.022 TAC per hour Elimination Rate-0.030 TAC per hour-0.014 TAC per hour

16. Excuses and Excuses

17. OK! But does this thing work?

18. University of Colorado Study (2006)  Ethanol excreted in sufficient quantities to measure  Transdermal peak values are delayed 30 to 180 minutes behind breath peak values  No false positives occurred in test subjects

19. NHTSA Study (2007)  Performed by the Pacific Institute of Research and Evaluation  Combined laboratory and field trials – 96 total weeks of wear  Results No false positives “of any note” Tamper system performed well SCRAMNET system exceptionally innovative Moisture build-up can affect performance of older versions

20. Approaches to Alcohol Misuse  Judicial Focuses on the crime itself Addresses alcohol as an element of a charged offense Tries to treat everyone the same Favors punishment Bases decisions on statutes and precedent  Medical Focuses on the alcohol misuse problem Addresses alcohol as a cause or contributing cause of behavior Treats people as individuals Favors rehabilitation Bases decisions on scientific evidence

21. Which approach works best?

22. Why Do People Routinely Ask That Question? The solutions are NOT mutually exclusive……… In fact, comprehensive approaches are the MOST effective!

23. A Lack of National Standards  With the exception of Drug and DWI Courts, there are no national standards for: Identifying offenders with alcohol misuse issues (no standards for screening, assessment and evaluation) Providing necessary and adequate treatment for offenders Appropriately sanctioning offenders, particularly with regard to relapse We can’t expect different results if we keep relying on the same strategies

24. What’s been missing for alcohol offenders? Source: NADCP

25. Key Components of Drug Courts (NADCP and OJP 1997) Key Component #5: Abstinence is monitored by frequent alcohol and other drug testing And it all starts with monitoring...

26. Saving Lives: The Award-Winning South Dakota 24/7 Sobriety Program

27. State of South Dakota – 24/7 Sobriety The Situation  DUI-related offenses resulted in 20% of all felony convictions in the state between 2001 and 2005  12.5 % of state prison population for DUI felonies  Current methods of supervision were not working −24/7 project was created utilizing N.H.T.S.A. Impaired Driving Program Funds Scram Program Results  SCRAM an integral component of 24/7 Program  1,600 clients completed or currently under SCRAM supervision  Total monitored days – 199,097  Average monitoring period – 124 days  Confirmed drinking events – 141 clients had 193 drinking events (12%)  Confirmed obstructions or tampers 295 clients had 571 tampers (18%)

28. Alcohol-Impaired MV Fatalities and 24/7 Participation

29. What is the South Dakota 24/7 Sobriety Program? A statewide program that provides unprecedented levels of supervision  Twice-daily breath testing  Continuous alcohol monitoring (SCRAM) to monitor sobriety  Random urine testing to monitor drug use

30. Violation Comparison - DUI Offenders

31. Violation Comparison - Drug/DUI Court

32. Violation Comparison - 24/7 Program

33. Violation Comparison

34. So What Does The Data Tell Us?  Continuous Alcohol Monitoring is an Effective Deterrent Most of the offenders that are being monitored have spent years consuming alcohol on a daily basis At least 85% of the offenders being monitored for 120 to 180 days have gone 4 to 6 months without any alcohol  Swift and certain court imposed consequences for any violation improve the outcomes Specialty courts have fewer people that violate and those that do violate less frequently The 24/7 model also yields improved outcomes

35. SCRAM in Colorado

36. City & County of Denver – Direct Agency  The Situation Jail overcrowding led major metropolitan city to seek alternative monitoring methods SCRAM Program provides intense supervision Emphasis on treatment and letting offenders maintain employment Program self-sustaining to City and County Offenders pay full cost of monitoring SCRAM is most secure form of supervision other than jail  Scram Program Results SCRAM used in DUI, domestic violence, and other misdemeanor cases 3,298 clients supervised by SCRAM Average monitoring period –64 days Fully compliant offenders – 2,484 (80%) Confirmed drinking events –264 clients (9%) Confirmed tampers – 492 clients (16%) Overall non-compliance – 20%

37. Greeley, CO – Underage Drinking Problem  The Situation College town with substantial underage drinking problem Entire community impacted by students’ drinking  SCRAM Program Results Municipal Court worked with university to develop underage alcohol program that includes SCRAM Program targets 18-21 year-olds Minimum monitoring period – 2 weeks Students pay for own SCRAM monitoring Less than 3% of students commit repeat drinking offenses 70% reduction in student transports to either the hospital or detox Significant reduction in citations for minor possession of alcohol

38. SCRAM Usage in the Criminal Justice System DUI Offenses Domestic Violence Family Court / Human Services

39. SCRAM Program Objectives  Ensure participants maintain sobriety  Increase accountability of participants through continuous monitoring  Provide alternatives to court system  Reduce recidivism by addressing root cause of the problem and modifying behavior  Decrease impact of alcohol related cases on the system  Provide evidence-based program statistics

40. SCRAM Program Development  Develop a systems approach that defines primary goals and agency sponsor  Define target population  Indentify funding streams and start up costs  Establish implementation timelines  Launch program / collect data  Review program objectives and goals

41. SCRAM Program Development Offender Pay Model Agency Direct vs. Service Provider Model  Agency Direct enables broad system wide support and specific program criteria development  Agency can offset initial startup costs via offender pay model  Service Provider transfers responsibility to private companies  SCRAM program responsibilities transferred to service provider Modeled successfully across the country Average cost across the country $10-12/day Daily fee is cheaper than drinking 85% of participants pay with no collection issues

42. Questions and Answers