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Forcing Sobriety, However Imperfectly

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May 6, 2008

Forcing Sobriety, However Imperfectly

Like most patients assigned to my substance abuse clinic these days, John, a stylish 22-year-old cosmetology student, did not arrive voluntarily.

After two drunken driving violations, one in which another motorist was injured, a judge ordered John to attend a weekly recovery group I conduct for young adults facing similar legal troubles. But that was hardly the biggest stick the judge had at his disposal.

“This Scram keeps me from even thinking about drinking,” John immediately told me as he raised a pant leg and pointed to a boxy plastic ankle bracelet that looked neither cool nor comfortable.

Scram, for Secure Continuous Remote Alcohol Monitor, records the wearer’s alcohol intake by measuring air and perspiration emissions from the skin every hour. It detects blood alcohol levels as low as 0.02 percent, which corresponds to one drink or less an hour, and can even tell when the alcohol was consumed.

Once a day, John has to be near a modem so it can transmit data from the last 24 hours to a monitoring agency and his probation officer.

Last year, American courts ordered Scram devices on thousands of defendants released on bond and awaiting trial for alcohol-related offenses, those sentenced to probation, and under-age drinkers. They pay a monitoring agency an average of $12 a day for the device, as well as installation and service fees.

Criminal justice professionals report high compliance rates, at least while these people remain in the court system. Last summer, the actress Lindsay Lohan wore one.

Yet the device is not perfect.

For one thing, it can lead to unexpected and embarrassing situations. When John was chosen by a favorite instructor to work on a fashion show at the airport, he worried how to inform her before his device was discovered by airport security. I urged him to be honest, and fortunately the teacher proved entirely supportive. She suggested letting the others in their group pass through security first and, a little later, explaining the situation to the inspectors. “It worked like a charm,” John told me the next week.

Defense lawyers say that despite widespread use, independent, peer-reviewed scientific data is lacking on the device’s reliability and the technology it uses to measure alcohol levels.

False positive readings are also a risk. Among other things, baked goods like raisin bread and sourdough English muffins can cause the body to produce its own alcohol. And like any computer-based device, the Scram can malfunction.

On the Web, bloggers recommend “scamming the Scram” by placing lunch meat, tape or paper between the ankle and the sensor or plunging the leg into an ice-cold bath to prevent perspiration.

Alcohol Monitoring Systems Inc., which manufactures the device, says such ploys do not work because they block the sensors, setting off a tamper alarm that is transmitted online to the monitoring agency and then to the court system.

John can testify that the notification is swift. One afternoon, he received a call from his probation officer about a tamper alarm recorded from 5 to 6 o’clock that morning. John convinced the officer that he was neither drinking nor scamming and provided evidence of reporting to work sober at 8 a.m.

Because his device had never registered alcohol consumption in all the time he had worn it, the officer gave him a second chance. The next morning, the same thing happened.

A stressful conference followed. “I’ve got to admit,” John recalled, “it was looking pretty bad.” Fortunately, the probation officer was in an experimental mood.

The culprit was a five-month buildup of sweat and dirt on the sensors. There have been no false alarms since the device was thoroughly cleaned.

John is beginning to understand the severity of his alcohol addiction and how it threatens his life and well-being. Over the past five months, I believe, he has remained sober and made significant progress.

But I have also treated enough substance abusers to be suitably impressed by the consuming grip of the disease. Active alcoholics do not often tell me the truth about their abuse. They lie, in essence, to protect the continued use of their most cherished commodity.

One could argue that Scram and the threat of jail bought those five months of sobriety and treatment for John.

As a physician, I remain uncomfortable aiding and abetting coercive methods like Scram.

But this concern is overshadowed by a far greater one surrounding his long-term health. Soon John will “graduate” from his court-supervised treatment. His real test of recovery begins the day his Scram device is removed from his ankle.

Howard Markel is a professor of pediatrics, psychiatry and the history of medicine at the University of Michigan.