This article is excerpted from Beau Kilmer et al., “Combining Frequent Alcohol Testing with Swift-Certain-Fair Sanctions: Summary of the Peer-Reviewed Literature on 24/7 Sobriety and Ideas for Future Research,” Federal Sentencing Reporter, 36(4) (2024): 201–208.

Heavy alcohol consumption is a significant threat to public health and safety

After a decade of stability, the age-adjusted rate of alcohol-induced deaths in the U.S. started increasing after 2009, with a 26% increase from 2019 to 2020.1 Most people who consume alcohol do not encounter serious problems related to their use, but for those who do, the harms can be severe. Heavy alcohol use is associated with increased risk of acute injury, weakened immune system response, chronic illnesses affecting the heart, liver, and pancreas, and several forms of cancer.2 

The harms of alcohol use also extend to others, with intimate partner violence,3 firearm violence including suicide,4 youth homicide,5 among other manifestations.6 Of the 13,384 individuals killed in alcohol-involved traffic crashes in 2021, a quarter were individuals other than the intoxicated drivers.7

In the U.S., alcohol-related harms are disproportionately concentrated among persons involved in the criminal justice system.8 Estimates suggest the costs of alcohol-involved crime exceed $80 billion per year.9 Among current drinkers, persons arrested for driving under the influence of alcohol (DUI) and those who had alcohol-involved traffic crashes are more likely to have an alcohol use disorder (AUD).10 Approximately 30 percent of persons incarcerated in U.S. state and federal prisons reported drinking alcohol at the time of the offense.11 Persons under community supervision are also substantially more likely to have an AUD, and there is evidence that probationers with an AUD are more likely to experience violations than other clients.12 Thus, interventions that deter heavy alcohol use may help reduce criminal justice system involvement and its costs.

A new approach to reducing problematic drinking: 24/7 Sobriety

Individuals in the U.S. aged 21 and over can purchase and consume as much alcohol as they want. 13This raises an important question: When is it appropriate to suspend this “license to drink” because their use is leading them to threaten public safety repeatedly? Conditions of bail, probation, and parole may require individuals to abstain from alcohol, but those conditions are often difficult to enforce. For example, compared to other drugs, alcohol leaves the body quickly, so detection is unlikely without frequent testing. Furthermore, there may be resistance to punishing someone for their first substance use violation, which weakens the deterrent effect of the condition.

24/7 Sobriety programs may be a solution (hereinafter, 24/7). These programs focus on reducing alcohol consumption itself, imposing a consistent supervision structure and creating a credible deterrent threat.14 First implemented in 2005 as a pilot program in South Dakota, 24/7 requires those ordered to abstain from alcohol to be monitored via frequent testing (e.g., twice-daily breathalyzers, remote alcohol monitoring). Participants face swift, certain, and moderate sanctions for testing positive or missing a test (typically one or two nights in jail). Practitioners created the program to reduce alcohol-involved crime, and it is consistent with the evidence that swift and certain sanctions have a greater criminal deterrent effect than severe sanctions imposed arbitrarily.15 It has now spread from South Dakota to jurisdictions in other states, and a version of the program (“mandatory sobriety”) is operating in England and Wales.

How 24/7 Sobriety spread within and beyond South Dakota

The concept of 24/7 was introduced in response to South Dakota Governor Mike Rounds’s call for ideas to reduce the state’s reliance on incarceration.16 The state’s new attorney general, Larry Long, saw promise in enforcing abstinence orders for persons arrested for crimes where alcohol was a contributing factor. As a prosecutor, he observed that people who frequently went before the bench were often there because of an alcohol-related crime.17 He convinced the governor to implement a pilot program that combined abstinence orders with twice-a-day breathalyzer tests of arrestees with multiple DUI offenses. 

In 2005, South Dakota began its 24/7 pilot in its two most populous counties (Pennington and Minnehaha) and three rural counties (Bennett, McCook, and Tripp). Through word of mouth—among judges, prosecutors, and sheriff department officials—other counties began implementing the program. With this expansion came adaptations. Some jurisdictions added transdermal alcohol monitoring devices as an alternative to breathalyzer testing. Some also added urinalysis and sweat patch screening for illegal drug use. Some judges began assigning participants to 24/7 for offenses other than DUI (e.g., domestic violence cases where alcohol use was believed to be a contributing factor). 

In February 2007, the state legislature enacted House Bill 1072 to create a statewide 24/7 Program coordinator, formalize program rules, and provide resources to counties who wished to run the program. The state also created a schedule of fees paid by participants—$2 per day for breathalyzers and $6 per day for remote alcohol monitoring, plus fixed initiation fees—and apportioned these funds among the state and counties. These steps addressed some uncertainty surrounding implementation and mitigated the risk of financial loss to jurisdictions. The program spread quickly throughout the state. 

24/7 drew national attention, winning awards from the National Highway Traffic Safety Administration, the McGovern Foundation, and the Council of State Governments.18 Neighboring states also began replicating the program. In 2008, North Dakota started a large-scale pilot in 14 of the state’s 53 counties, making approximately 75 percent of the state population eligible. Montana followed suit, beginning a pilot in 2010 and authorizing the program in state law in 2011. Laws authorizing 24/7 programs were passed in states such as Idaho, Iowa, and Wyoming,19 and some jurisdictions in states such as Alaska, Nebraska, Utah, Washington, and Wisconsin have also implemented similar programs; however, program design and implementation choices vary by jurisdiction (e.g., the share of participants using breathalyzers vs. remote testing devices). 

Two notable efforts have been made to encourage 24/7’s expansion at the federal level.  The 2015 Fixing America’s Surface Transportation (FAST) Act allowed states to apply for funding to support the implementation of 24/7 programs over fiscal years 2016 to 2020. This was followed by the introduction of the Supporting Opportunities to Build Everyday Responsibility Act of 2022 (SOBER Act) in the U.S. House of Representatives. This bipartisan bill aimed to incentivize the nationwide implementation of 24/7 programs, with provisions for introducing new programs and expanding existing ones, as well as facilitating program evaluations.20

Review of the peer-reviewed literature on 24/7

We now have strong evidence suggesting that 24/7 participants largely abstain from heavy drinking during the program and that it may be an effective means to reduce alcohol-involved crime and other harms related to heavy drinking.

Heavy drinking

From 2005 through February 2017, more than 30,000 unique South Dakotans participated in 24/7. They accumulated more than five million days without a detected alcohol violation, missed test, or tampering event.21 Citing  South Dakota Attorney General data,22 Midgette and colleagues23 found that more than 99% of the breathalyzer tests were taken and passed. Additionally, more than 99% of the days participants wore alcohol monitoring bracelets did not lead to a detected violation (i.e., confirmed alcohol use or a tampering event).24  Midgette et al.25 calculated similar figures for 24/7 participants in North Dakota submitting to breathalyzer tests, observing rates for testing negative at 95.8% with an additional 2% excused. The results suggest that 24/7 participants largely abstained from heavy drinking during the program. 

Public health and safety

If heavy drinking is an underlying cause of participants’ risky behaviors, then high compliance rates with abstinence orders should be accompanied by lower levels of future alcohol-involved offending and negative health consequences. The peer-reviewed literature provides insight into 24/7’s effects on these outcomes. 

The first wave of peer-reviewed studies compared South Dakota counties with 24/7 programs with those without programs. 24/7 was associated with a 12% reduction in repeat DUI arrests,  a 9% reduction in domestic violence arrests,26 and a 4% reduction in mortality.27 Using the same analytic approach, a county-level study of North Dakota’s 24/7 found a 9% reduction in DUI arrests—a similar reduction to South Dakota’s.28

Consistent with the county-level studies, individual-level studies also point to a reduction in both re-arrest and deaths. The first individual-level study among repeat DUI arrestees demonstrated that 24/7 participants in South Dakota were substantially less likely to be re-arrested than non-participants: 49% lower risk during 1-year, 35% during 2-year, and 26% during 3-year follow-ups.29 Although based on data from a recently implemented program, findings from another analysis focused on Montana also point to beneficial effects on recidivism.30 Another North Dakota study also indicated improvements in citations and crashes among participants.31

An individual-level analysis focused on those arrested for DUI in South Dakota demonstrated that 24/7 participants were substantially less likely to die than non-participants during five-year follow-up, particularly in models that address selection into the program.32 The findings suggest that participants were about 50% less likely to die during follow-up than non-participants. 

Future directions for research on 24/7 Sobriety

Based on a decade’s worth of peer-reviewed evidence on 24/7 and the continued problems that heavy drinking poses for many under community supervision, it seems reasonable for other jurisdictions to conduct their own pilot programs and see if they work for them. Still, many questions remain about 24/7 and the causal mechanisms that may be driving the results. We highlight a few of these outstanding questions below.

How long should individuals stay in the program to produce a lasting effect? When 24/7 spread throughout South Dakota, the state did not mandate how long participants should stay in the program. That was left up to judges, who could also change the duration depending on how the participant was doing. Predictably, this generated a fair amount of variation. Because both judicial and participant behavior influence program duration, it would likely be misleading to simply correlate time in program with various outcomes while controlling for other factors. We hope program duration is rigorously evaluated in future studies.

Do certain types of alcohol testing lead to better 24/7 outcomes? While most 24/7 participants blow into a breathalyzer twice a day, a large number wear alcohol monitoring bracelets. Some jurisdictions have also used remote breath devices, which allow participants to test from anywhere, and there are other approaches to alcohol testing as well (e.g., kiosks). We know that different types of testing detect different patterns of alcohol use with varying levels of confidence (see Brobbin et al., [2023] for an overview of the literature), so this is a critical question to answer. 

What is the minimum level of sanction needed to produce a deterrent effect? Most jurisdictions with 24/7 require those testing positive or who have missed a test to spend a night or two in jail. But what if the sanction was only four hours in a holding cell or some type of house arrest? Would this generate the same deterrent effect? What about other types of sanctions that do not involve incapacitation?

Would combining sanctions with positive incentives for compliance improve outcomes? A tremendous amount of research supports the idea that small rewards (e.g., movie passes or gift certificates) for extended periods of abstinence can reduce substance use among those with alcohol and other substance use disorders. This is typically called “contingency management.”33 Because 24/7, as it has been implemented in most places, is largely focused on the “stick” of potential punishment, could better outcomes be achieved by incorporating some “carrots” into the model?34

Would combining 24/7 with treatment lead to better outcomes? While 24/7 doesn’t require individuals to participate in substance use disorder treatment, it does not forbid them from doing so. One could imagine an approach that combines 24/7 with outpatient or medication treatment.35 

How does 24/7 participation affect the family members and intimates of participants? The peer-reviewed research on the program has focused on secondary analyses of administrative data, primarily focusing on criminal recidivism or mortality at the county and individual levels. To assess the full costs and benefits of a program with the potential to reduce heavy drinking drastically, researchers should consider outcomes for those who live with participants and possibly other family members. 

Which intervention is most cost-effective at reducing alcohol-related harms? If one goal is to reduce the negative consequences of heavy alcohol consumption among those subject to community corrections, there are many options that could make a difference (e.g., 24/7, substance use disorder treatment, interlock devices). However, these approaches come with different costs, so what many decision-makers want to know is which intervention, or combination of interventions, produces the most “bang for the buck.” 

Can 24/7 generate the same results in more urban areas? After piloting a modified version of the program in a handful of places in England, including South London, the Alcohol Abstinence and Monitoring Requirements were rolled out in England and Wales. While there were some positive results from descriptive analyses of the South London pilot, we are unaware of any rigorous analysis of the pilots or of the more recent rollout. Logistical challenges related to transportation and testing volume mean that urban jurisdictions may have to rely more on remote monitoring or other forms of testing than in-person breathalyzers, which have been most common in the Great Plains. 

Concluding thoughts

24/7 programs primarily focus on reducing alcohol consumption among justice-involved individuals whose alcohol use has led them to threaten public safety repeatedly. Participants are ordered to abstain from alcohol use and subject to frequent alcohol testing (e.g., twice daily breathalyzers, remote alcohol monitoring); those testing positive face an immediate sanction—typically a night or two in jail. The empirical evidence on 24/7 programs suggests important benefits regarding reductions in heavy drinking, arrests, and mortality. Several questions remain about the design of these programs (e.g., optimal program length, potential benefits of incorporating positive incentives, efficacy of different alcohol testing technologies), many of which can best be answered in a randomized controlled trial.  Courts and community corrections agencies committed to evidence-based practices should consider helping build the evidence on 24/7 by implementing and rigorously evaluating their own pilot programs.


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  1. Centers for Disease Control and Prevention, “Alcohol-induced Death Rates in the United States, 2019–2020,” Centers for Disease Control and Prevention, November 2022. ↩︎
  2. Samir Zakhari, “Overview: How Is Alcohol Metabolized by the Body?” Alcohol Research & Health, 29(4) (2006): 245. ↩︎
  3. Keith C. Klostermann and William Fals-Stewart, “Intimate Partner Violence and Alcohol Use: Exploring the Role of Drinking in Partner Violence and its Implications for Intervention,” Aggression and Violent Behavior 11.6 (2006): 587-597. ↩︎
  4. Charles C. Branas et al., “Alcohol Use and Firearm Violence.” Epidemiologic Reviews 38.1 (2016): 32-45. ↩︎
  5. Robert N. Parker et al., “Alcohol Availability and Youth Homicide in the 91 Largest US Cities, 1984–2006.” Drug and Alcohol Review 30(5) (2011): 505-514. ↩︎
  6. Aaron A. Duke et al., “Alcohol, Drugs, and Violence: A Meta-Meta-Analysis.” Psychology of Violence 8(2) (2018): 238. ↩︎
  7. Timothy Stewart, “Overview of Motor Vehicle Traffic Crashes in 2021,” United States Department of Transportation, April 2023. ↩︎
  8. Lawrence A. Greenfeld, “Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime.” Bureau of Justice Statistics 168632 (1998). Michael R. Rand et al. “Alcohol and Crime: Data from 2002 to 2008.” Bureau of Justice Statistics 231685 (2010). ↩︎
  9. Ted R. Miller et al., “Costs of Alcohol and Drug-involved Crime.” Prevention Science 7(4) (2006). ↩︎
  10. Jie Yao et al., “Drivers with Alcohol Use Disorders and Their Risks of Crash Involvement.” Drug and Alcohol Dependence 183 (2018): 210-216. ↩︎
  11. Laura M. Maruschak et al., “Alcohol and Drug Use and Treatment Reported by Prisoners: Survey of Prison Inmates.” Bureau of Justice Statistics 252641 (2021). ↩︎
  12. Miranda A. Galvin et al., “Substance Involvement and Probation Outcomes: Evidence from a Cohort Study.” Journal of Drug Issues 52(3) (2022): 329-348. ↩︎
  13. Beau Kilmer and Keith Humphreys, “Losing Your ‘License to Drink’: The Radical South Dakota Approach to Heavy Drinkers Who Threaten Public Safety.” The Brown Journal of World Affairs 20(1) (2013): 267-279. ↩︎
  14. Robert L. DuPont and Keith Humphreys, “A New Paradigm for Long-Term Recovery.” Substance Abuse 32(1) (2011): 1-6. ↩︎
  15. Robert L. DuPont and Keith Humphreys, “A New Paradigm for Long-Term Recovery.” Substance Abuse 32(1) (2011): 1-6. ↩︎
  16. Robert L. DuPont and Keith Humphreys, “A New Paradigm for Long-Term Recovery.” Substance Abuse 32(1) (2011): 1-6. ↩︎
  17. Larry Long, “The 24/7 Sobriety Project.” Public Lawyer 17(2) (2009): 2-5. ↩︎
  18. ↩︎
  19. Lawsuits filed against 24/7 programs, including challenges about constitutionality of a) making individuals pay for their alcohol tests even though they had not yet been convicted of a crime (Montana), and b) daily warrantless searches for those not convicted (Wyoming). Respectively, Montana Supreme Court ruled against the plaintiff (Baumann, 2015) and a federal judge dismissed the case in Wyoming (Sanchez et al v. Hill et al., 2022). ↩︎
  20. On November 1, 2022, the House Committee on the Judiciary referred the bill to the Subcommittee on Crime, Terrorism, and Homeland Security. It did not receive a vote. ↩︎
  21. Beau Kilmer and Greg Midgette, “Deterring Crime: Insights from an Individual-Level Analysis of 24/7 Sobriety.” Journal of Policy Analysis and Management (2020): 2. ↩︎
  22. South Dakota Attorney General, “24/7 Program Statistics,” 2019. ↩︎
  23. Greg Midgette et al., “The Impact of Ambiguity-Induced Error in Offender Decision-making: Evidence from the Field.”  Journal of Research in Crime and Delinquency (2021). ↩︎
  24. Ibid., 651. ↩︎
  25. Ibid. ↩︎
  26. Beau Kilmer et al., “Efficacy of Frequent Monitoring with Swift, Certain, and Modest Sanctions for Violations: Insights from South Dakota’s 24/7 Sobriety Project.” American Journal of Public Health 103(1) (2013). ↩︎
  27. Nancy Nicosia et al., “Can a Criminal Justice Alcohol Abstention Programme with Swift, Certain, and Modest Sanctions (24/7 Sobriety) Reduce Population Mortality? A Retrospective Observational Study.” The Lancet Psychiatry 3(3) (2016). ↩︎
  28.  Greg Midgette et al., “A Natural Experiment to Test the Effect of Sanction Certainty and Celerity on Substance-Impaired Driving: North Dakota’s 24/7 Sobriety Program.” Journal of Quantitative Criminology (2020). ↩︎
  29. Kilmer and Midgette Deterring Crime. ↩︎
  30. Greg Midgette and Beau Kilmer, “Can Novel ‘Swift-Certain-Fair’ Programs Work Outside of Pioneering Jurisdictions? An Analysis of 24/7 Sobriety in Montana, USA.” Addiction (2021). ↩︎
  31. Kimberly Vachal and Andrew Kubas, “Does the 24/7 Sobriety Program positively influence driver behaviors in North Dakota?” Traffic Injury Prevention 19(sup2) (2018): S188-S189. ↩︎
  32. Nancy Nicosia et al., “Association of an Alcohol Abstinence Program With Mortality in Individuals Arrested for Driving While Alcohol Impaired.” JAMA Psychiatry 80(5) (2023): 520-522. ↩︎
  33. Nancy M. Petry et al., “Give Them Prizes and They Will Come: Contingency Management for Treatment of Alcohol Dependence.” Journal of Consulting and Clinical Psychology 68(2) (2000). ↩︎
  34. Keith Humphreys and Beau Kilmer, “Still HOPEful: Reconsidering a ‘Failed’ Replication of a Swift, Certain, and Fair Approach to Reducing Substance Use Among Individuals Under Criminal Justice Supervision.” Addiction 115(10) (2020). ↩︎
  35. Angela Hawken, “Behavioral Triage: A New Model for Identifying and Treating Substance-Abusing Offenders.” Journal of Drug Policy Analysis 3(1) (2010). ↩︎