Direct Biomarkers as Tools to Detect and Monitor Alcohol and Substance Use in Repeat Intoxicated Drivers Using Novel Sample Matrices
Creators: name: Bean, Pamela
name: Brown, Guida
name: Hallinan, Patricia
name: Lewis, Douglas
name: Becerra, Sergio
Publisher: name: Taylor & Francis
Year: 2016
Subjects: subject: Medicine
subject: Pharmacology
subject: Biotechnology
subject: Sociology
subject: FOS: Sociology
subject: FOS: Sociology
subject: 111714 Mental Health
subject: FOS: Health sciences
subject: FOS: Health sciences
subject: 110309 Infectious Diseases

description: <b>Objectives</b>: This study reports the results of a pilot program in Kenosha county that used a combination of direct biomarkers extracted from blood spot and nails to monitor repeat intoxicated drivers for their use of alcohol and drugs with a detection window spanning from three weeks to several months. The objectives were to test whether the direct biomarkers phosphatidylethanol (PEth), ethylglucuronide (EtG) and five drug metabolites would: 1) help assessors obtain a more objective evaluation of repeat offenders during the assessment interview, 2) allow for timely identification of relapses and improve classification of drivers into risk categories and, 3) predict recidivism by identifying offenders most likely to obtain a subsequent Operating While Intoxicated (OWI) offense within four years of enrollment in the program. <b>Methods</b>: All (N = 261) repeat offenders were tested using PEth obtained from blood spots and EtG obtained from fingernails; 159 participants were also tested for a 5-drugs of abuse nail panel. Drivers were tested immediately after the assessment interview (baseline) and at 3,6,9 and 12-months after baseline. Based on biomarker results and self-reports of abstinence, offenders were classified into different risk categories and required to follow specific testing timelines based on the program's Decision Tree. <b>Results</b>: The baseline analysis shows that 60% of drivers tested positive for alcohol biomarkers (EtG, Peth or both) at the assessment interview with lower detection rates (0–11%) for the five drug metabolites. The comparison of biomarkers results to self-reports of abstinence identified 28% of all offenders as high-risk and assigned them to more frequent testing and more intense monitoring. The longitudinal analysis shows that 56% (Completers) of participants completed the program successfully and the remaining 44% (Non-compliant = NC) terminated prematurely. Two thirds (68%) of the Completers were able to reduce or control their drinking and one third relapsed at least one time during their mandated monitoring periods. After a brief intervention by the assessors, 79% of relapsers tested negative for biomarkers in their repeat tests. The rearrest analysis showed that offenders classified in the NC and Relapsers groups were seven times more likely to receive a new OWI four years after enrollment compared to drivers classified as Abstainers or Controllers. Refractory drivers were monitored the longest and reported no subsequent rearrests. <b>Conclusion</b>: These findings demonstrate the benefits of more individualized interventions with repeat OWI offenders and calls for further development of multimodal approaches in traffic medicine including those that use evidence based practices to reduce recidivism.