Impact on families of DUI offenders by zhouwenjuan

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									                                    REPORT OF THE BOARD OF TRUSTEES

                                                                                 B of T Report 1 I-00

     Subject:        Prevention of Repeat Driving Under the Influence (DUI) Offenses: The Issues of
                     Diversion and Treatment, and Vehicle Incapacitation

     Presented by:   D. Ted Lewers, MD, Chair

            Reference Committee E
     Referred to:
            (C. Alvin Head, MD, Chair)
     ……………………………………………………………………………………………………….

 1   Resolution 9 (I-99) and Resolution 209 (A-00) introduced by the Michigan Delegation, were adopted by the
 2   AMA House of Delegates. Resolution 9 (I-99) calls for the AMA to “study diversion programs for
 3   impaired drivers with treatable conditions, including their impact on physician liability.” Resolution 209
 4   (A-00) calls for the AMA to “develop model legislation which could be used by any state which would
 5   result in the application of boots to the wheels of vehicles, or other means of physically incapacitating
 6   vehicles, of repeat offenders of alcohol-related driving offenses.” This report provides science policy
 7   information regarding these two resolutions.
 8
 9   Introduction
10   For the purposes of this report, “impaired drivers with treatable conditions” is defined as those drivers who
11   have been impaired by their use of alcohol or other drugs. Although many other conditions affect driving
12   abilities, driving under the influence (DUI; also commonly referred to as DWI – driving while intoxicated)
13   of alcohol has presented the greatest cost to society in terms of crash fatalities and injuries. Consequently,
14   major national, state and local efforts have focused on identifying effective means to prevent DUI and to
15   identify, apprehend, and intervene with those arrested and convicted for DUI offenses – and to prevent DUI
16   offenders from repeating their behaviors (i.e., prevent recidivism). All fifty states have also incorporated
17   language in their DUI statutes to address growing concerns with driving while under the influence of drugs.
18
19   The strategies to reduce crashes, injury and fatalities have included: passage of stricter state laws; making
20   programs aimed at deterrence and apprehension leading to conviction more active, credible, and consistent;
21   and extensive public information efforts discouraging drinking and driving by publicizing the health, legal
22   and emotional consequences of DUI, as well as the responsibilities of drivers. In recent years these efforts
23   have focused upon a gradual reduction of the legally permissible level of blood alcohol content (BAC) –
24   now under .08-.10 for adults and 0.00 – 0.20 for minors to provide consistent standards by which to judge
25   drivers’ risk to safety and public health.
26
27   Tremendous progress has been made in reducing the number of both adult and youth DUI fatalities from
28   23,646 in 1983 to 15,794 in 1999 – a drop of 33%. However, there has been broad national recognition,
29   shared by many other nations as well, that a major unaddressed problem is how to reduce recidivism rates
30   among DUI offenders.
31
32   It is further commonly agreed that a major cause of recidivism is the presence of alcoholism among DUI
33   offenders. Among drivers involved in DUI fatalities, a disproportionate number are found to have high
34   levels of BAC (i.e., the most intoxicated drivers) as well as previous records of DUI offenses. These are
35   referred to by a variety of terms – “Higher Risk” or “hardcore drinking” drivers, “repeat” or “recidivist” or
36   “persistent” offenders.
37
                                             B. of T. Rep. 1-I-00—page 2


 1   Because there is a far larger population, in the aggregate, of moderate drinkers (typically those with lower
 2   BAC levels when apprehended), they produce the greatest number of non-fatal DUI incidents. Data from
 3   the 1993 Behavioral Risk Factor Surveillance System (BRFSS) showed that 2.5% of adults reported an
 4   estimated 123 million alcohol-impaired driving episodes in 1993 which corresponds to 655 episodes for
 5   each 1000 U.S. adults. The 1996 National Household Survey on Drug Abuse revealed that in the past year,
 6   23% of drivers age 16 or older drove within two hours of drinking and 4% after using both alcohol and other
 7   drugs. In 1998, estimates show that there were about 166 million drivers over age 16 in the US; 28 to 45
 8   million of them drove after consuming alcohol. Of this group, between 1.5 and 4 million drove with
 9   impairment levels of .08 BAC or higher.
10
11   Higher Risk Drivers with BACs of .15 or higher comprise only about 1% of drinking drivers. The National
12   Highway Traffic Safety Administration (NHTSA) estimates that 2-3% of all individuals involved in all
13   fatal crashes (both alcohol and non-alcohol related) were repeat DUI offenders. California data suggest that
14   the number of repeat offenders may be closer to 8%. Mothers Against Drunk Driving (MADD) identifies
15   higher risk drivers as including:
16   1) repeat offenders or individuals convicted of a drunk-driving offense within 5 years of a prior
17       conviction, i.e., a second offender
18   2) drivers with a BAC of .16 or higher
19   3) drivers convicted of driving with a suspended license where the suspension was the result of a
20       drunk-driving condition.
21
22   The high BAC group alone accounts for about 65% of all drinking driver fatalities. They are more than 300
23   times more likely to be involved in a fatal crash. Drivers with a DUI conviction are almost twice as likely
24   to be in a fatal crash and more than 4 times more likely to be intoxicated at the time of the crash. Typically,
25   these drivers are white, low-income males, ages 21 to 34, unmarried, not college educated, employed in non
26   white-collar occupations and meeting the criteria for alcohol abuse, alcoholism or substance abuse
27   problems. A Maryland assessment of DUI offenders found that 70% were alcohol or other drug dependent
28   while a New York study found that 43% of female DUI offenders were alcohol dependent, and 25% alcohol
29   abusers.
30
31   I. DIVERSION AND TREATMENT
32
33   Contextual Background: Common and Alternative Sanctions
34
35   The most common approach to reducing the incidence of DUI has been to apply the same measures used to
36   punish first-time offenders, but with additional and more severe consequences for repeat offenders. The
37   intent is to create a stronger deterrence effect while utilizing various means to interfere with the ability of
38   offenders to offend again. These include incarceration, actions against a driver’s license (ranging from
39   suspensions of varying duration to revocation), and fines (usually increasing with number of convictions).
40   Jail and license suspensions or revocations are intended to prevent the offender from driving at all.
41
42   Another group of strategies applies additional, alternative measures as an adjunct to incarceration, fines, or
43   licensure actions. These include interventions with the driver and removal of the vehicle from the
44   offender’s control. Measures targeting the driver include: educational programs; incarceration or home
45   arrest (via electronic monitoring); supervised probation and daily reporting to day centers; special stickers
46   on vehicle registration tags to indicate registration status; community service; victim restitution; and
47   programs to shock the offender with the consequences of DUI to victims (e.g., visits to local hospitals) and
48   shock incarceration or “boot camp” programs. Measures such as random breath testing and sobriety
49   checkpoints have also been used to identify and stop repeat offenders as well as other drinking drivers. A
50   final set of interventions focuses on disabling the vehicle so that the offender cannot drive it.
                                             B. of T. Rep. 1-I-00—page 3


 1   Few states have a comprehensive system of laws covering DUI offender management. Section 164 of the
 2   new Federal Transportation Equity Act for the 21st Century (TEA-21) Restoration Act requires that states
 3   have certain repeat intoxicated driver laws in place by October 1, 2000. States without these laws will have
 4   a portion of their Federal-aid highway construction funds redirected into other state safety activities,
 5   beginning in Fiscal Year 2001. Section 164 includes a requirement that states conduct mandatory
 6   assessment of repeat intoxicated drivers’ degree of alcohol abuse and refer to treatment as appropriate.
 7
 8   Diversion and Treatment
 9
10   Nationally, treatment efforts have occurred within the context of the above approaches and ongoing efforts
11   to educate the public about the dangers of to bolster public norms against drinking and driving. Several
12   states allow some first-time DUI offenders to be diverted from criminal sanctions if they enter alcohol
13   education and/or treatment programs. In return, and upon successful completion of the designated
14   treatment program, they commonly have some aspect of the judicial process deferred (e.g., prosecution,
15   adjudication, sentencing). In some cases this can allow charge dismissal; in others it may prevent or delay
16   the DUI information from being placed in the offender’s driving record. A Century Council review of state
17   laws and opinion in this area (Combating Hardcore Drunk Driving, Century Council, 1997) found that
18   offenders seek diversion for the benefits it may provide them, depending on the specific state law: e.g.,
19   avoiding conviction and a criminal history, maintaining a valid driver’s license, avoiding insurance rate
20   increases, and maintaining licenses or certifications. Supporters of diversion laws argue that offenders (and
21   hence society) benefit from the treatment provided, that diversion reduces the strain on and costs to the
22   courts and jails, and precludes benefits to repeat offenders.
23
24   Critics of diversion laws point out that they can make it even more difficult to identify repeat offenders and
25   do not appear to reduce recidivism. The National Transportation Safety Board recommends that diversion
26   laws that allow dismissal be eliminated. Opponents also argue that diversion too often replaces effective
27   sanctions with less effective strategies. Others strongly argue against eliminating sanctions on social justice
28   grounds, stating that all individuals, regardless of personal problems, need to be held responsible for their
29   actions and compliance with the law. This position is even more persuasively argued when injuries or
30   fatalities result from the DUI offense.
31
32   Treatment of DUI offenders can be examined apart from the connection to diversion strategies, however. A
33   meta-analysis of 215 studies (Wells-Parker, E; Bangert-Drowns, R; McMillen, DL; Williams M. Final
34   results from a meta-analysis of remedial interventions with drink/drive offenders. Addiction. 1995; 90:
35   907-265) evaluated the effect of treatment programs on DUI offenders. It found a 7-9% reduction in
36   recidivism and alcohol-related crashes among participants in treatment, compared to those who did not
37   receive treatment. Those who received education alone, regardless of the severity of their alcohol
38   problems, did not show consistent behavior changes. High-risk offenders showed a smaller reduction in
39   drinking and driving than did moderate risk offenders; however, they tended to receive only treatments with
40   a narrower focus on abstinence, rather than broad-spectrum goals. Treatment programs combined with
41   licensing sanctions resulted in the greatest crash reduction. Strategies that combined treatment and
42   rehabilitation (e.g., especially combining psychotherapy/counseling, education and follow-up monitoring)
43   were the most effective of all in deterring later DUI behaviors.
44
45   Studies of specific programs have confirmed the benefits of ones that combine alcohol and other drug
46   treatment with educational presentations, counseling, after-care services, and monitored probation. A
47   Prince George’s County, Maryland, program found that offenders not sentenced to one of the treatment
48   options had four times the recidivism rate of those treated. First-time untreated offenders had a recidivism
49   rate almost six times higher than first-time offenders treated during the first year. Although inpatient
50   treatment, the monitoring program, and both combined all showed similar results, it is likely that offenders
51   sentenced to the combined program had more prior DUI offenses and more serious drinking problems than
                                             B. of T. Rep. 1-I-00—page 4


 1   those who received one modality alone. Other programs (e.g., Turning Point; California’s DUI-related
 2   treatment program; New Jersey Alcohol Countermeasures Program) have also demonstrated the
 3   effectiveness of combining treatment, including incarceration or mandated inpatient services, with license
 4   or other sanctions.
 5
 6   A review of research on the effect of incarceration alone (Robert Voas, MADD’S Higher Risk Driver
 7   Program. Mothers Against Drunk Driving, Irving, Texas) found that,
 8          “[although] there is some question regarding the general deterrent effect of incarceration . . . jail
 9          appears to have little specific deterrent value in reducing DWI recidivism. Its use for DWI
10          offenders is limited by its cost and by jail over-crowding. A more viable alternative is incarceration
11          in a non-secure community facility where costs are lower, the offenders can be placed on work
12          release… and where they can be provided with an intensive treatment program. . . . Electronic
13          house arrest has the advantage that it is generally paid for by the offender and keeps [him or her] in
14          the home at high risk driving times. It has been shown to be effective in reducing DWI recidivism.”
15
16   A rapidly growing body of criminal justice literature does demonstrate the effectiveness of alcohol and
17   other drug treatment in criminal justice facilities for reducing recidivism and crime. This is especially
18   relevant in that the number of people in jail or on probation for DUI convictions almost doubled between
19   1986 and 1997, although DUI arrests dropped. In 1997, 454,500 DUI offenders were on probation, 41,100
20   in local jails and 17,600 in state prisons. The drop in arrests may reflect successes in reducing social drinker
21   DUI while the increase in imprisonments may show both a failure to effectively prevent recidivist offenses
22   and/or public demand for stricter penalties for recidivists.
23
24   There is no national consistency in the types or duration of treatment provided (in diversion programs or
25   combined with incarceration or sanctions), or in the variety of screening tools used. The use of screening
26   and treatment services appears to be increasing. There seems to be growing support for strategies that use
27   treatment in addition to, rather than as a replacement for, other sanctions.
28
29   A recent comprehensive review of the literature in the U.S. and other nations (Jones RJ, Lacey JH. Final
30   Report - State of Knowledge of Alcohol-Impaired Driving: Research on Repeat DWI Offenders. Prepared
31   by Mid-America Research Institute, Inc. of New England for the U.S. Department of Transportation,
32   National Highway Traffic Safety Administration, Washington, DC: February 2000) found that active
33   enforcement of existing sanctions “may be considered a punishment and deterrence for some drivers,” but
34   not as many as is desirable. Studies in Wisconsin (which mandates a jail sentence for repeat offenders) and
35   of a number of programs nationally that combine treatment with incarceration, home arrest, and strict
36   monitoring found that those who were treated had roughly half the recidivist rate of those who had not been
37   treated. A comparison of research on deterrent measures showed the following reductions in recidivist
38   rates:
39   License suspension with treatment: 10-50%
40   Treatment and rehabilitation: 0% - 50%
41   Alternative sanctions - Treatment and probation-oriented alternative sanctions: 33%-90%
42   Alternative sanctions - Vehicle-oriented sanctions: 15-80%.
43
44   The literature shows broad agreement on these important criteria for the provision of treatment:
45            It should be combined with “not replace” other sanctions.
46            Any sanctions applied should have a duration (generally six months to a year) that will allow
47            sufficient time to provide effective treatment and a high probability of recovery (which should be
48            monitored) and driving behavior change. Otherwise, treatment will not be effective, nor will
49            behaviors change.
                                             B. of T. Rep. 1-I-00—page 5


 1           Assessment and appropriate treatment by a state certified facility should be mandated. Repeat
 2           offenders and high BAC drivers are problem drinkers or alcoholics and usually do not admit or
 3           believe they have a problem. Thus, few will voluntarily enter or remain in treatment.
 4           Assessment should provide for personalized evaluations so that truthful and complete
 5           misinformation about drinking levels and related behaviors can be ascertained.
 6           Treatment plans must be individualized and based on an accurate assessment of each offender’s
 7           needs.
 8           Intensive supervision (during the treatment phase), further reassessment and follow-up supervision
 9           (such as probation or aftercare) after treatment is completed are often necessary to assure initial and
10           later compliance with court-ordered treatment and to prevent behavioral relapses.
11           Confinement should always be accompanied with assessment and treatment when appropriate.
12
13   Diversion and Physicians
14
15   Relevant AMA policies include:
16
17   “The AMA. . . (4) urges all states to pass legislation mandating all drivers convicted of first and multiple
18   DUI offenses be screened for alcoholism and provided with referral and treatment when indicated; (5)
19   further recommends the following measures be taken to reduce repeat DUI offenses: (a) Aggressive
20   measures be applied to first-time DUI offenders (e.g., license suspension and administrative license
21   revocation). Stronger penalties be leveled against repeat offenders, including second-time offenders. Such
22   legal sanctions must be linked, for all offenders, to substance abuse assessment and treatment services, to
23   prevent future deaths in alcohol-related crashes and multiple DUI offenses. . . . “ (Policy H30.945; AMA
24   Policy Database)
25
26   “The AMA (1) encourages hospital medical staffs to promote the performance of blood alcohol
27   concentration (BAC) tests and urine drug screens on hospitalized trauma patients and (2) urges physicians
28   responsible for the care of hospitalized trauma patients to implement appropriate evaluation and treatment
29   when there is a positive BAC, other positive drug screen result, or other source of suspicion of a potential
30   substance misuse disorder; and encourages relevant physician organizations to develop practice parameters
31   to assist physicians in the diagnosis and management of substance misuse disorders.” (Policy H-130.956)
32
33   “It is the policy of the AMA to . . . (3) seek to promote rehabilitation programs in addition to programs that
34   focus on penalties.” (Policy H-30.967)
35
36   Council on Ethical and Judicial Affairs (CEJA) Report 1 (I-99), strongly supports physician assessment of
37   impairment and of the relationship of such impairments to public safety. The report supports referral to
38   treatment where indicated and counseling for the individual and his/her family to reduce harm through safer
39   driving practices and avoiding risky situations. The report concludes, “In situations where clear evidence
40   of substantial driving impairment implies a strong threat to patient and public safety, and where the
41   physician’s advice to discontinue driving privileges is ignored, it is desirable and ethical to notify the
42   Department of Motor Vehicles” which should make the determination of the inability to drive safely. This
43   should be disclosed to the patient whose confidentiality should be protected by the physician providing only
44   the minimal amount of information. Physicians and their state medical societies should work to create
45   statutes that will “uphold the best interests of patients and community, and that safeguard physicians from
46   liability when reporting in good faith.” (Policy H-140.925)
47
48   Confidentiality and privacy play a critical role in the current practice of medicine in the United Sates.
49   “Confidentiality” is said to be present when one person discloses information to another, pledging not to
50   divulge the information to third parties without permission. In the context of a patient/physician
51   relationship, the physician gives such a “pledge” in order to provide appropriate patient care.
                                            B. of T. Rep. 1-I-00—page 6


 1
 2   The AMA’s Code of Medical Ethics maintains that “a physician shall… safeguard patient confidences
 3   within the constraints of the law.” This core value of medical ethics is reiterated in the Code’s Fundamental
 4   Elements of the Patient-Physician Relationship, which states that,
 5   “ . . . the patient has the right to confidentiality. The physician should not reveal confidential
 6   communications or information without the consent of the patient, unless provided for by law or by the need
 7   to protect the welfare of the individual or the public interest.”
 8
 9   While confidentiality is a fundamental tenet in the ethical and legal practice of medicine, confidentiality is
10   not absolute. In many instances, physicians must weigh respecting confidentiality against protecting the
11   interests of others. This conflict is recognized in CEJA Opinion 5.05, which states that “[t]he obligation to
12   safeguard patient confidences is subject to certain exceptions which are ethically and legally justified
13   because of overriding social considerations. When a patient threatens to inflict serious bodily harm…the
14   physician should take reasonable precautions for the protection of the intended victim.”
15
16   The courts have not tested whether reporting alcohol or drug impaired drivers to states’ Departments of
17   Motor Vehicles (DMV) or Departments of Public Safety (DPS) qualifies as an exception to physician
18   confidentiality. Only a handful of states presently require physicians to report patients with mental or
19   physical impairments, such as dementia or epilepsy. It is unclear whether this requirement would extend to
20   drug or alcohol impairment. Where the law requires physicians to report, physicians are not at risk of a
21   breach of confidentiality claim. Many states do not mandate reporting, but do provide physicians an
22   opportunity to notify the DMV or DPS, stating that such a report is not a breach of state patient
23   confidentiality laws.
24
25   In states without specific legislation on the issue or that permit a report, but do not provide corresponding
26   immunity, a physician could be at risk of a claim for a breach of confidentiality. On the other hand, a
27   physician who fails to report and knows or should know that a patient’s driving is impaired, may be held
28   liable for breach of duty to the driving public. (See, for example, Wilschinsky v. Medina, 775 P.2d 713
29   (1989)). A few states have resolved this “Catch-22” by enacting specific legislation. In Virginia, for
30   example, as long as a physician reports in good faith, he or she is protected against breach of state
31   confidentiality claims. (Va. Code Ann. Section 54.1-2966.1 (1999)).
32
33   II. Vehicle Incapacitation and Sanctions
34
35   A number of AMA policies support research into and use of devices to prevent use of motor vehicles by
36   intoxicated drivers and by repeat DUI offenders. (Policies 30.945, 30.969, 30.979, 30.986)
37
38   Vehicle sanctions for repeat DUI offenses exist in 36 states. Federal legislation (TEA 21) provides
39   incentives for states to adopt such laws and transfers a portion of highway funds to highway safety if they
40   do not. A variety of mechanisms have been developed to immobilize offenders’ vehicles or to eliminate the
41   ability of the offender to operate the vehicle. These include: impoundment or forfeiture of vehicles or
42   license plates; mechanical vehicle immobilization (e.g., wheel boots/locks); revocation of vehicle
43   registration; and interlock ignition devices to prevent vehicle operation by an intoxicated or convicted
44   driver.
45
46   Vehicle devices and sanctions are designed to protect the public. According to the National Highway and
47   Traffic Safety Administration (NHTSA), “A Guide to Sentencing DUI Offenders,” (NHTSA, U.S.
48   Department of Transportation, Washington, D.C.: March 1996. DOT HS 808 365.), “… vehicle
49   impoundment or forfeiture are not technically punitive or deterrent actions but derive from the remedial
50   purpose of protecting the general public from a potentially dangerous driver” and consequently overcome
                                             B. of T. Rep. 1-I-00—page 7


 1   defense attorney “motions to dismiss criminal charges in drinking and driving cases based on grounds of
 2   double jeopardy.”
 3
 4   Vehicle sanctions remove drink-and-drive decisions from the individual and transfer that decision to the
 5   state as far as a particular vehicle is concerned. These measures have been found necessary because, despite
 6   the general positive effect of license suspensions, an estimated 70% or more of suspended drivers have been
 7   found to operate their cars (often repeating DUI offenses) at least occasionally. These drivers have a low
 8   probability of apprehension, especially if driving at lower BAC levels, although sobriety checkpoints,
 9   random BAC checks, and even stings targeting DUI offenders may increase apprehension and help deter
10   these drivers. Overall, vehicle-oriented sanctions appear to reduce recidivism by 15% to as much as 80%
11   (see Jones and Lacey study cited above).
12
13   Ignition interlock devices connected to breath analyzers have been shown to have a positive effect, but the
14   results are not consistent. Some studies show positive but statistically insignificant effects. Thirty-seven
15   states allow discretionary (32 states) or mandatory use of such devices. Several studies showed reductions
16   in recidivism by 16-75% after one year. Data from 13 interlock programs showed low re-arrest rates (from
17   <.05% to .8% ) over time periods covering 9 to 30 months. A randomized study of interlocks used with 698
18   repeat offenders in Maryland showed a 65% reduction in alcohol traffic violations during the first year
19   (2.4% among participants vs. 6.7% in the control group). Effects as much as 75% reduction in repeat
20   offenses have been reported in other studies. Some studies show a continued positive effect even after the
21   device is removed. However, most of the literature indicates that the effect will be positive only as long as
22   the device is in place, properly installed and monitored, and remains in place long enough to allow alcohol
23   problem treatment and recovery of the offender.
24
25   Studies of vehicle impoundment and seizure are less numerous. Available studies demonstrate reductions in
26   repeat DUI offenses by as much as 80%, especially if impoundment occurs at the time of arrest. Some
27   studies show continued reductions even after the impoundment period ends. Impoundment will not,
28   however, prevent an offender from borrowing, renting, or stealing another vehicle. Most states only
29   impound overnight with longer periods for recidivists or drivers with suspended licenses.
30
31   Vehicle immobilizing devices other than ignition interlocks (e.g., a metal “club” placed on the steering
32   wheel, or metal “boot” placed on the tire) have been the least studied means of vehicle sanction. Usually
33   these devices are used for parking and other traffic violations and far less frequently for alcohol-related
34   infractions. A 1997 NHTSA report indicated that, since 1989, only Ohio, Michigan, New Mexico, and
35   Wisconsin have used steering wheel locks. Only Ohio uses wheel locks (boots) as part of state law although
36   there are likely to be additional states in the next few years. In some local jurisdictions a repeat offender’s
37   vehicle can be immobilized for a period of 30 days to 6 months. A study of vehicle immobilization and
38   impoundment in Ohio (up to 90 days for a second DUI and 180 days for a third) showed a 58% reduction in
39   recidivism in those sanctioned compared to vehicles which were unsanctioned. After the sanction was
40   removed there were still 35% fewer repeat DUI incidents after one year, although infractions increased after
41   device removal.
42
43   Given the relative effectiveness of interlock devices, there is certainly potential effectiveness of other
44   immobilizing devices which goes beyond simply denying currently intoxicated drivers access. As with
45   interlock devices, the effects are likely to be most positive only when the device is in place. Steering wheel
46   locks are inexpensive and easy to install but a car owner can remove the device by cutting the steering
47   wheel. Car boots are more expensive but far more difficult to remove. They offer the advantage that law
48   enforcement does not have to store the vehicle, which can remain in the owner’s possession. Because the
49   engine may still be run, the owners, at their own expense, can continue car upkeep and maintenance so that
50   it will still be operational after removal of the boot. Additional understanding of the advantages and
51   disadvantages of these devices will come through further studies.
                                             B. of T. Rep. 1-I-00—page 8


 1
 2   Impact on families of DUI offenders
 3   A disadvantage of vehicle impoundment and tire or steering wheel lock devices is that they deny use of the
 4   vehicle to, and thus punish, an offender’s family. This has led to the reluctance of some judges to use these
 5   options. In this respect, other mechanical or electronic devices may , therefore, be superior tools. For
 6   example, interlock devices installed on an offenders’ vehicle will prevent anyone with a predetermined
 7   BAC level from operating the vehicle. This offers the advantage of preventing an offender’s use of the
 8   vehicle when intoxicated, while allowing sober family members to drive. In some cases, the device can also
 9   be set to require regular BAC breath tests while the vehicle is in operation, shutting it down if alcohol use is
10   then detected. This can prevent someone else from starting the car and turning it over to a drinking driver or
11   disable the car if a sober driver begins to drink. Electronic home monitoring devices placed on a DUI
12   offender can allow monitoring of movement beyond the home or other permitted location while not
13   affecting other family members’ vehicle use. The state of Oregon has used special stickers placed on the
14   license plates of convicted DUI offenders as a way to readily identify an offenders’ vehicle. This provides
15   the police with probable cause to check the drivers’ license without removing vehicle access to family
16   members who are legally driving. Although other means to provide transportation of an offenders’ family
17   members could be considered, this does not appear to be an option that has been discussed in the literature.
18
19   Conclusions:
20
21   No single tool demonstrates an overwhelming advantage in deterring DUI recidivism. Many strategies
22   provide incremental reductions. The size of change related to each tool is difficult to determine due to wide
23   variations in research study size, sampling and methodology. It is clear at this time that, as is the case in
24   DUI prevention, reductions in DUI recidivism requires use of a combination of strategies to deter future
25   DUI incidents and to remediate the problems which give rise to them. The most effective combination will
26   address individual offender characteristics (especially alcohol or other drug use and problems), access to
27   vehicles (their tool of destruction), family member needs, and public safety measures with the result of
28   assuring effective and rapid detection, credible enforcement, effective sanctioning for infractions, and
29   education to maximize deterrence effects. Active and consistent enforcement of DUI laws, no matter what
30   tools those laws provide, is necessary for their success. Recent experiences with zero tolerance laws for
31   minors who drink and drive, usually resulting in loss of a drivers license and other strong penalties, have
32   proved that although such laws can be effective, a lack of commitment to their enforcement can reduce their
33   effectiveness.
34
35   It is clear that screening and appropriate treatment for alcohol and drug problems is necessary to more fully
36   diminish DUI recidivism – especially among frequent offenders and those found with higher BAC levels.
37   As research into the U.S. and European experiences with treatment as a counter DUI tool grows, we are
38   likely to learn more about what kinds of treatment under what conditions are most likely to be effective –
39   and what the limit of that effectiveness is. However, it is clear that early alcohol and other drug abuse
40   intervention, even with first time offenders, is crucial. Treatment as an alternative to other sanctions
41   appears to have very limited among researchers, highway safety and anti drunk driving advocates and
42   government bodies. Incarceration as the sole sanction also seems to be ineffective. However, there is wide
43   support for combining treatment with a variety of sanctions, including incarceration (or close monitoring,
44   supervision or house arrest), education, removal of access to vehicles during that time, and other penalties
45   which communities may find appropriate. These sanctions are important to assure treatment compliance,
46   until recovery and behavior change are clearly likely. Sanctions also appear to address the desire in much
47   of the public for punishment of the offender for the criminal threat they pose to the public and the harm they
48   have caused their victims. Vehicle incapacitation appears to be an effective and inexpensive means to help
49   promote compliance with treatment, to support behavior change, and to provide a credible deterrent and
50   sanction for offenders. Treatment supports the effectiveness of these sanctions, making them believable and
51   effective in the mind of the offender. Whatever combination of strategies is used, ongoing individual
                                           B. of T. Rep. 1-I-00—page 9


 1   monitoring of offenders and public measures to apprehend and deter recidivism (e.g., through random
 2   breath tests and sobriety checkpoints) are indicated.
 3
 4   The physician’s role in assessing and treating substance abuse problems and dependence is an important
 5   one. It can play a major role in helping prevent recidivism. State laws can protect them from charges of
 6   breaching confidentiality or professional duty when physicians report cases in which impairment poses a
 7   threat to the patient or the public’s safety.
 8
 9   RECOMMENDATIONS:
10
11   Based on this study, the Board of Trustees recommends that the following be adopted and that the
12   remainder of this report be filed:
13
14           1.      The AMA encourages passage of state traffic safety legislation that mandates screening for
15                   alcohol and other drug problems and dependence for all driving under the influence (DUI)
16                   offenders. Those who are identified with alcohol or other drug problems or dependence
17                   should be strongly encouraged and assisted in obtaining treatment through state and
18                   medically certified facilities. (New HoD Policy)
19
20           2.      Treatment of all convicted DUI offenders, when medically indicated, should be mandated
21                   and provided but in the case of first-time DUI convictions should not replace other
22                   sanctions which courts may levy in such a way as to remove from record the occurrence of
23                   that offense. (New HoD Policy)
24
25           3.      Treatment of repeat DUI offenders, when medically indicated, should be mandated and
26                   provided but should not replace other sanctions which courts may levy. In all cases where
27                   treatment is provided to a DUI offender, it is also recommended that similar services
28                   should be provided to or encouraged among the family members actively involved in the
29                   offender’s life. (New HoD Policy)
30
31           4.      The AMA encourages continued research and testing of devices which may incapacitate
32                   vehicles owned or operated by DUI offenders without needlessly penalizing the offenders’
33                   family members. (New HoD Policy)
34
35           5.      That policies 140.925, 30.945, 30.969, 30.979, and 30.986 be reaffirmed.
36                   (Reaffirm existing HoD Policy)
37
38           6.      That AMA encourage physicians and their state medical societies to work to create statutes
39                   that will uphold the best interests of patients and community, and that safeguard physicians
40                   from liability when, in good faith, they report alcohol or other drug driving impairment in
41                   their patients as permitted or mandated by state law. (Directive for Action)
42
43           7.      That AMA encourage further research into and professional discussion about the issues of
44                   reporting medical information for the purpose of punishment or criminal prosecution.
45                   (Directive for Action)
46
47           8.      That AMA encourage state medical societies to seek passage of legislation which allows
48                   for the use of devices that can incapacitate vehicles as part of a comprehensive strategy to
49                   reduce repeat DUI offenses. (Directive for Action)

								
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