Original Voice

Indirect Consequences of DIRECT Surveillance: Drug and Alcohol Use Information From Remote and Continuous Testing1

Beau Kilmer, PhD, Co-Director, RAND Drug Policy Research Center

Introduction
This essay highlights some indirect consequences of using devices that enable DIRECT surveillance, where DIRECT stands for Drug and alcohol use Information from REmote and Continuous Testing. In short, those subject to DIRECT surveillance wear a monitoring device (e.g., an ankle bracelet) that detects the consumption of a particular substance. Information from the device is transmitted to a monitoring agency, thus allowing for continuous and remote testing.

These devices are commercially available for alcohol and are primarily used by criminal justice agencies to monitor alcohol consumption for those convicted of an alcohol-related crime, mainly DUI. Related devices intended to remotely and continuously monitor illicit drug consumption remain in the lab and it is unclear when (and if) they will become commercially available.

Determining whether existing devices help reduce alcohol consumption is an empirical question that largely depends on how this information is used (e.g., to create a credible deterrent threat, or identify those in need of treatment). Randomized controlled trials are greatly needed in this area—especially those which investigate the effectiveness of different sanction regimes as well as positive reinforcement.

When evaluating the impact of these devices it will be important to consider the possible indirect effects of their application. This essay highlights two possible indirect consequences: 1) The effect of continuous and remote alcohol monitoring on the use of other drugs, and 2) Whether making offenders pay for DIRECT surveillance influences consumption.

Does continuous and remote alcohol monitoring influence the use of other drugs?

If DIRECT surveillance influences the consumption of substances that can be detected by the technology, it may also influence the consumption of untested substances. While this question is not unique to this particular type of testing, it is especially relevant since DIRECT surveillance makes it much easier to continuously test for alcohol. The answer depends on whether the substances of interest are economic complements or substitutes. Two goods are considered substitutes if an increase in the price of good A leads to an increase in the demand for good B. They are considered complements if an increase in the price of good A leads to a decrease in the demand for goods A and B. A price increase can take the form of an increase in the money price or an increase in the expected sanction of using the substance.

Much of the research in this field suggests that alcohol and drugs are economic complements.2 That is, when the price of alcohol increases, the demand for alcohol and other drugs decreases. While some of the early research on alcohol and marijuana suggested they were substitutes,3 the vast majority of U.S.-based studies conducted over the past 12 years suggest that making alcohol consumption more expensive reduces both alcohol and marijuana use (i.e., they are economic complements).4

Based on these findings, it would be reasonable to hypothesize that policies and practices that reduce alcohol use may reduce other types of drug use; however, caution should be exerted when trying to project the effects for DIRECT surveillance. Many of these studies focus on the impact of marginal price changes on consumption by those in the household or student populations (e.g., how much would drug use decrease if the beer tax increased by 10 percent?). If DIRECT surveillance is used in a way that makes alcohol consumption prohibitively expensive for problem alcohol users (by creating a credible threat), this would not be a marginal change. The indirect effect of such a meaningful change may be to shift consumption to illegal and/or prescription drugs. Whether this happens is an important empirical question that should be incorporated into future studies of these technologies.

Does making offenders pay for DIRECT surveillance influence consumption?

It is common for courts and probation offices to make offenders pay for monitoring technologies. Monitoring technologies that enable house arrest or GPS tracking can cost offenders from $1-$20 day depending on the technology, location, vendor, and court policy on indigent offenders.5 This daily fee is in addition to set-up charges and any other fines or fees the individuals must pay to the court. In some cases individuals who cannot afford the technologies will remain incarcerated and in some cases there may be a sliding scale depending on income.

This offender pay system is common for devices that enable DIRECT surveillance of alcohol, typically with set up fees and daily fees ranging from $5 to $12 per day.6 In areas where it is believed that DIRECT surveillance is helping to reduce alcohol use, it is important to consider whether some of this is indirectly caused by an income effect.7 That is, could the fact that the offenders are forced to pay reduce the money available to spend on alcohol and/or on events that would have increased the probability that they would drink (e.g., attending sporting events)? There is also the possibility that forcing offenders to pay for the program increase their “buy in,” especially after they’ve already spent several hundred dollars in fees.

The point here is not to provide a comprehensive list of mechanisms about why paying for DIRECT surveillance could influence alcohol and drug use; rather the goal is to note that when DIRECT surveillance as well as other types of electronic monitoring are introduced, there may be a direct and indirect effects on behavior. The importance of the latter is an empirical question that could easily be answered by randomly assigning some individuals to different payment schedules.8

Conclusion
The invention of devices that collect drug and alcohol use information from remote and continuous testing create a host of interesting opportunities and new policy questions. The commercial viability of devices that enable DIRECT surveillance of alcohol suggests this type of testing is not only feasible, but in demand. Resources should be devoted to conducting experimental evaluations in criminal justice settings so we can learn how and for whom this technology can help influence behavior. Experiments that 1) randomly assign DIRECT surveillance, 2) randomly assign different levels of sanctions for positive tests, 3) randomly assign different payment schedules, and 4) closely monitor the use of illicit and prescription drugs will generate the most useful results.

References

Cameron, L., & Williams, J. (2001). Cannabis, alcohol and cigarettes: Substitutes
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Chaloupka, F., & Laixuthai, A. (1997). Do youths substitute alcohol and marijuana? Some econometric evidence. Eastern Economic Journal, 23, 253-276.

Chaloupka, F., & Pacula, R. (2000). Economics and antihealth beahavior: The
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DiNardo, J., & Lemieux, T. (1992). Alcohol, marijuana, and America youth: The unintended effects of government regulation. National Bureau of Economic Research Working Paper 4212.

Farrelly, M., Bray, J., Zarkin, G., Wendling, B., & Pacula, R. (1999). The effects of prices and policies on the demans for marijuana: Evidence from the National Household Surveys on Drug Abuse. National Bureau of Economic Research Working Paper 6940.

Gallet, C. (2007). The demand for alcohol: a meta-analysis of elasticities. Australian Journal of Agricultural and Resource Economics, 51, 121-135.

Kenkel, D., Mathios, A., & Pacula, R. (2001). Economics of youth drug use, addiction and gateway effects. Addiction, 96, 151-164.

Kilmer, B. (2008). The future of DIRECT surveillance: Drug and alcohol use Information from REmote and Continuous Testing. Journal of Drug Policy Analysis, 1. http://www.bepress.com/jdpa/vol1/iss1/art1

Kunkle, F., & Kravitz, D. (2009). Sweat becomes offenders’ new snitch. Washington Post, September 25, 2009.

Munger, E. (2009). Alcohol use monitoring planned for DWI cases. Daily Gazette (Schenectady NY), October 7.

Grossman, M., Chaloupka, F., & Shim, K. (2002). Illicit drug use and public
policy. Health Affairs, 21, 134-145.

Pacula, R. (1998b). Adolescent alcohol and marijuana consumption: Is there really a gateway effect. National Bureau of Economic Research Working Paper 6348.

Pacula, R. (1998b). Does increasing the beer tax reduce marijuana use? Journal of Health Economics, 17, 557-586.

Pacula, R., Grossman, F., Chaloupka, P., O’Malley, P., Johnston, L., & Farrelly, M. (2001). Marijuana and youth, in J. Gruber’s Risky behavior among youth: An economic analysis (pp. 271-326). Chicago, IL: University of Chicago Press.

Saffer, H.,& Chaloupka, F. (1999). The demand for illicit drugs. Economic
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Williams, J., Pacula, R., Chaloupka, F., & Wechsler, H. (2004). Alcohol and marijuana use among college students: Economic complements or substitutes? Health Economics, 13, 825-843.

End Notes

  1. Parts of this article are excerpted from Kilmer (2008).
  2. For reviews, see Chaloupka & Pacula, 2001; Kenkel, Mathios, & Pacula, 2001; Grossman, Chaloupka, & Shim, 2002.
  3. E.g., DiNardo and Lemieux, 1992; Chaloupka, and Laixuthai, 1997.
  4. Pacula, 1998a; 1998b; Farrelly et al., 1999; Saffer & Chaloupka, 1999; Pacula et al., 2001; Williams et al., 2004. It is important to note that the evidence based on Australian studies is mixed (Cameron & Williams, 2001; Williams & Mahmoudi, 2004).
  5. This large range is based on documents from two counties in California: Ventura (p. 21) http://portal.countyofventura.org/pls/portal/docs/PAGE/CEO/PUBLICATIONS/FY2009-10_COUNTY_RATES_AND_FEES_FINAL.PDF , and Stanislaus (p. 2) http://www.stancounty.com/bos/agenda/2009/20090127/B08.pdf.
  6. Kunkle and Kravitz, 2009; Munger 2009.
  7. For a review of the literature on the income elasticity for alcohol, see Gallet (2007).
  8. Conversely, everyone could be charged the same daily fee and discounted rates could be randomly assigned.