The article "Talk Therapy, Drugs Said Best Alcoholism Treatment" in the June 16 issue provided a useful summary of advances in the treatment of alcoholism including the role of naltrexone, nalmafene, and acamprosate. The article neglected to mention the potential role of a technological development that also shows promise of playing an important role in helping the alcoholic patient.

At another APA annual meeting presentation titled "DWI Prevention, Psychiatrist’s Role," the authors described the use of car-ignition interlock systems as mandated by several state legislatures and briefly reviewed a number of interlock outcome studies. Ignition interlock systems contain the following components: a breathalyzer typically set at a blood alcohol equivalent of 0.025 percent; an electronic system that links the breathalyzer to the vehicle’s ignition, headlights, and horn; a built-in program that requires a successful breathing routine with breath below the set point before the vehicle can be started; a programmed rolling retest requiring the driver to retest periodically to continue driving (failure to complete a timely retest satisfactorily results in flashing of headlights and repetitive honking of the horn); a system to store start-up data; and an arrangement to transfer the data monthly to a computer for distribution to the appropriate agency.

In early 1999 Coben and Larkin summarized seven outcome studies and concluded that five of the studies found that interlocks were "effective in reducing DWI recidivism while the interlock is installed in the car."

More recently Beck and colleagues reported the results of a prospective randomized trial and found that DWI recidivism dropped within the first year by 65 percent with these devices.

In addition, there are anecdotal data to suggest that the use of ignition interlocks may help reduce the role of denial and may favorably alter the overall pattern of alcohol consumption in alcohol-dependent individuals.

We predict that in the near future, NIH will launch outcome studies of the use of ignition interlocks as prescribed or recommended by physicians on a voluntary basis. We hope that psychiatrists and other physicians will become familiar with the utility of interlocks and begin to discuss with the alcohol-dependent patient and the patient’s family the voluntary installation of an ignition interlock before the patient experiences a DWI arrest or becomes responsible for some other more tragic outcome.

Bryce Templeton, M.D., M.Ed.

Philadelphia, Pa.

Richard Amar, M.D.

Atlanta, Ga.