The Sixth Judicial District SBIRT Informed Consent
Clinician-Administered AUDIT Form

Participant Name:
E-mail Address:   

The Sixth Judicial District and its partners invite you to take part in the SBIRT program for DWI Offenders. This program seeks to reduce the recidivism rates of first-time offenders and enhance public safety. Participation is voluntary. Non-participation will not impact the legal outcomes of your case.

A large proportion of offenders in the criminal justice system have alcohol-related problems. Therefore it makes sense to implement alcohol screening and brief intervention programs for people in this setting, particularly for impaired driving offenders. Although most states mandate screening for impaired drivers, not much effort has been put forth to determine how the screening process could be improved and expanded to the entire criminal justice population. To address this, the Sixth Judicial District and its partners developed and implemented a program for screening DWI offenders.

A groundbreaking study by the Institute of Medicine (IOM) on unintentional injuries associated with alcohol use concluded that the public health community should focus on those with mild-to-moderate alcohol problems in order to significantly reduce unintentional injuries.

Done primarily in the healthcare setting, this program aims to successfully implement SBIRT into additional community settings. Normative drinkers are believed to account for a higher proportion of total harmful events because they are more numerous than the high-risk group. This process assumes that there are physical, social, and financial benefits to reducing the likelihood of harm as soon as risky behavior has been demonstrated; waiting to address an issue may result in more costly outcomes as well.

You are being offered this opportunity because you have been charged with a fourth-degree DWI or an underage drink and drive. If you agree to participate in this program, your involvement will consist of a brief screening with an appropriate intervention recommendation and a follow up contact within the next few months. In the future the court system may review your record to see if there have been any further drinking-related offenses. Completely independent of this process, you will be required to comply with the Court and probation requirements.

By clicking the 'I Agree' button below, you agree to participate in the program.