On a folder filled with legal documents, Andrew MacGillis has taped a meditation about a biblical passage, in which Jesus forgives a sinner.
“I come to you today with all my sins and failings and I lay them at your feet,” it says. “I know that you will heal me and save me.”
A former chef who lived with and cared for his parents in Pewaukee, MacGillis was sentenced to four years in prison followed by five years of extended supervision in 2011 for his seventh offense of drunken driving. But “this time, I’m confident, I’m willing, I’m able and I want the sobriety,” MacGillis said in a recent interview.
Rehabilitation, however, may prove elusive. MacGillis, 42, said he has not been offered treatment programs in prison. The court ordered him to get an alcohol and drug assessment, an interview used to identify alcohol dependence and determine required treatment, but he will not receive it until after he leaves Fox Lake Correctional Institution.
Others choose not to get assessments. In thousands of cases each year, drivers fail to comply with the assessment interview. Many continue to drive for months after their arrests without receiving any rehabilitation or facing legal penalties.
Even when alcohol programs are available, they may be underfunded and not last long enough to make a difference, experts say. For those who get treatment, accountability may be lacking, which is why seven Wisconsin counties are pursuing an innovative approach to stop repeat offenders and prevent relapse through advanced testing.
An intense illness
Addiction is a chronic disease that disrupts how the brain’s reward and motivation centers interact, leading people to “pathologically” pursue reward through substance use and other behaviors, according to the American Society of Addiction Medicine.
The group’s past president, Dr. Michael Miller, medical director of the Herrington Recovery Center at Rogers Memorial Hospital in Oconomowoc, said repeat offenders have a way of “rewriting history in their minds,” selectively recalling events to minimize the consequences of their actions.
“That shows how intense their illness is,” Miller said. These individuals “basically define reality the way it’s comfortable for them to see it rather than the way it actually is.”
Of the more than 29,000 assessments conducted in 2013 on persons convicted of operating while intoxicated (OWI) in Wisconsin, about 11,000 had nonclinical findings of alcohol or drug dependence, suspected dependence or dependence in remission, state records show.
In most of the research conducted in the United States and Canada, repeat drunken driving offenders tend to be white, male and, on average, in their mid-30s, said Thomas Nochajski, a professor of social work at the University at Buffalo in New York. They can also be socially anxious and use alcohol as a way to be part of a group, he said.
“In general, the initiation of drinking-driving begins with partying with friends. The ones who continue that partying atmosphere become our repeat offenders,” Nochajski said. He noted that many repeat offenders have mental health problems and some, especially women, have a history of trauma.
Alcoholics often start drinking in their early teens, which is why a drinking-prevention pilot program in Dane County in the mid-2000s targeted middle schools.
The program was part of a series of initiatives launched by former Dane County Executive Kathleen Falk, who faults the state’s culture of heavy drinking for encouraging binging and treating intoxication as a rite of passage.
“It is a medical disease,” Falk said. “Helping people find treatment just like we would for any other disease is just as important especially given that the behaviors of alcohol abuse hurt other people besides the person who suffers.”
Failing to assess
State law requires all persons convicted of OWI to get a court-ordered assessment that leads to treatment. Yet for each year in the past decade, more than 10,000 convicted offenders were found noncompliant with an assessment order, according to state data.
In 2013, the Wisconsin Department of Transportation suspended or revoked the licenses of 11,623 drivers for assessment noncompliance. That year, for comparison, about 25,000 people were convicted of OWI offenses.
“The vast majority of time, non-compliance is temporary for an offender,” said Dale Simon, a DOT supervisor who oversees the department’s alcohol review unit. He added that offenders could be “in non-compliance for days, weeks, months, years or indefinitely.”
Andrea Jacobson, former clinical area manager at Journey Mental Health, which does OWI assessments, said judges often do not hold drivers in contempt for breaking this part of their court order. Many drivers who have their licenses suspended or revoked for noncompliance continue to drive illegally, she said.
The assessment consists of an interview using a screening tool called the Wisconsin Assessment of the Impaired Driver. Assessors, who usually have training in substance abuse counseling, create a driver safety plan that recommends education or treatment.
Many other U.S. states and Canadian provinces use the Research Institute on Addictions Self-Inventory, a screening tool developed by Nochajski and others. The self-inventory identifies high-risk offenders through questions about family history, mental health problems, aggression and other factors.
In Wisconsin, fees for the assessments typically range between $200 to $300, which may pose a financial hurdle for some drivers when combined with other fees and fines and lead to noncompliance, said LeeAnn Cooper, who oversees the Wisconsin Intoxicated Driver Program at the Department of Health Services.
Assessments are ordered upon conviction, which may be months after a person’s arrest. In 2012, more than half of the state’s 31,629 OWI convictions occurred more than 90 days after arrest, according to the DOT. On average, 141 days passed between arrest and conviction.
And some repeat offenders, like MacGillis, have to do their assessments after incarceration.
After his sixth drunken driving conviction, in 2007, MacGillis said he stayed sober for nearly four years. On May 16, 2011, he went to a Waukesha bar, thinking he could control his drinking. The last thing he remembers is ordering a beer.
He was pulled over later after hitting traffic barrels, police reports say, with a blood alcohol level more than three times the legal limit.
Since being convicted and sent to prison, MacGillis said he has not been offered any treatment and has tried to find his own programs for treatment by writing letters to addiction experts. He criticized the Department of Corrections for providing inmates with treatment at the end of their prison terms.
He believes from what he has read that treatment is more effective at the beginning of a sentence “because you use your rehabilitation throughout your incarceration.”
Records show MacGillis was offered treatment for his sixth offense and placed on a waiting list, but left prison before receiving it.
Now any program MacGillis might attend would require him to transfer to a different prison. DOC spokeswoman Joy Staab said the department closed Fox Lake’s alcohol and drug treatment program in July rather than fill staff vacancies. The agency decided to expand treatment programs at other prisons and transfer inmates requiring treatment.
MacGillis is planning to seek an assessment and treatment after his release in 2016, but is not sure how he would pay for it, a common complaint.
Lawrence Keller, currently serving time on his eighth OWI offense, considers treatment essential, given the difficulty chronic offenders have staying sober. He said he re-offended because of stress and pressures from unemployment.
“Above all, I have to want to stay sober,” Keller wrote in a letter to a reporter. “But with my situation, when my back is up against a wall, facing being homeless, hungry, without a job, I get that ‘I don’t care’ attitude and drink my troubles away.”
University of Wisconsin-Madison professor Dr. Richard Brown, a national expert on substance abuse screening and intervention, said programs for alcohol abuse have traditionally been underfunded. He cited a study showing that less than 10 percent of alcoholics receive medication that has proven effective, often because this is not covered by insurance or recommended by physicians.
Because of chronic underfunding, Brown added, many alcohol treatment programs “are stuck delivering counseling methods that are decades old and haven’t been able to keep up to date.”
Another issue is cost. Convicted drunken drivers in Wisconsin must pay a $435 surcharge, divided between the state and the county where the surcharge was imposed. The county’s portion goes toward funding treatment.
Todd Campbell, Dane County alcohol and drug abuse services manager, said a change made in the state’s last budget to the funding formula has led the county to project a 28 percent decrease in funds. What had been a roughly 60-40 split with the counties getting the larger share became a roughly 50-50 split.
“The thing that is most likely to reduce recidivism or habitual drunk driving is getting that person into treatment,” Campbell said. “If there’s less treatment available, it increases the likelihood that they’re going to drive drunk again because that problem hasn’t been solved.”
Cooper, who oversees the state’s intoxicated driver program, said most counties should not see a decline because the surcharge amount was raised, although they might see a slight decline because of a falling OWI conviction rate.
‘Making them aware’
Miller, medical director of the Herrington Recovery Center said historically, addiction has not been approached as a medical problem in the United States. He said treatment has tended to be “very intensive and acute,” like spending 28 days in rehab with no professional follow-up.
The trend is now toward treatment programs that follow the patient for longer periods, he added. A new program, known as the Biomarker Project, aims to accomplish that. The pilots are occurring in Taylor, Oneida, Forest, Vilas, Dane, Waukesha and Kenosha counties.
“We’re trying to provide better treatment and closer monitoring for repeat offenders enrolled in these pilots,” said Pamela Bean, project leader, adding that previous approaches focus more on increasing fees or penalties. The goal is to make high-risk offenders more aware and accountable.
The pilots involve alcohol biological markers, or alcohol biomarkers. Subjects are required to provide a blood sample, which can detect heavy alcohol consumption for three prior weeks, or fingernail clipping, which can detect it for three prior months.
Counties in the project test biomarkers several times at critical junctures. Bean said the tests, which cost $300 per driver per year, allow assessors to recommend further treatment for certain drivers.
MacGillis wrote Bean while in prison, seeking information about her program. He has also found an Alcoholics Anonymous sponsor, and, once leaving prison, hopes to be a recovery speaker. He asks forgiveness for his offenses, something he said he will never live down.
“I am truly, truly sorry for being an alcoholic. Please, please forgive me,” MacGillis wrote in a letter from prison. “Please, please give me one more chance at a sober life, a good life, a peaceful life.”