Sobering center

A sobering center is a facility or setting providing short-term (4-12 hour) recovery, detoxification, and recuperation from the effects of acute alcohol or drug intoxication. Sobering centers, instead, are fully staffed facilities providing oversight and ongoing monitoring throughout the sobering process. Sobering centers include alternatives to jail and emergency departments, as well as drop-in centers”.[1] There are small numbers of sobering centers around the world. There are over 40 sobering centers in the United States, with dozens more in development.

In the US, sobering centers were created alongside medical and social detoxification programs with the passing of the Uniform Alcoholism and Intoxication Treatment Act in 1971. Distinct from historical "drunk tanks", which were typically unmonitored, locked cells where intoxicated individuals were left unattended until the individual was sober. People locked in these 'drunk tanks' sometimes experienced injuries, disabilities or even died from co-occurring medical or psychiatric conditions.

History

Prior to the development of sobering facilities, many municipalities internationally operated “drunk tanks”, which were unmonitored rooms or jail cells to hold persons intoxicated. Drunk tanks were found to be hazardous and inhumane, with clients at risk of suicide or other complications. Most to all traditional drunk tanks are no longer in existence.[2]

Sobering centers became established as a legitimate option within the United States with the Uniform Alcoholism and Intoxication Treatment Act of 1971.[3] These original programs in both the United States and Canada were called detoxication centers, and targeted adults during acute intoxication through early treatment;[4][5];.[6] With over 40 sobering centers in the United States, and more internationally, these current centers are increasingly seen as an important alternative to emergency department care.[7][8][9][10][11]

Sobering centers were historically funded by cities and counties, particularly those with county hospitals which saw large numbers of intoxicated patients in the emergency departments. After the Affordable Care Act, many of these patients previously uninsured became insured under expanded Medicaid. Recognizing the expense of caring for these patients in emergency departments, many states have now used Medicaid funding for development of sobering centers such as through Whole Person Care grants.

Critical differences between historical 'drunk tanks' and new modern sobering centers include more robust staffing, triage and assessment by staff at intake, ongoing and often visual monitoring of clients at all times, and assessments before discharge. Less acutely intoxicated clients may be treated by medical assistants and peer level non-medical staff, while more heavily or dangerously intoxicated clients may be helped by registered nurses and licensed social workers.

Models of sobering centers

Sobering centers have emerged largely as a grassroots movement across the United States and internationally. Most were designed specifically with regional needs in mind, and thus there are diverse models in operation.

A number of sobering centers collaborate primarily with the criminal justice system, accepting intoxicated adults from sheriff and police officers. Staffing may consist of nonmedical staff only, such as peer counselors, or provide basic medical oversight by emergency medical or psychiatric technicians. Care is largely observational to ensure there are no negative outcomes related to intoxication (aspiration, unintentional over-dose, self-harm, falls).

Sobering centers have been implemented to: reduce utilization of alternate services (including the emergency department and criminal justice system), provide a safe space for individuals to decrease alcohol related harms, and to offer a dedicated site specific to those acutely intoxicated on alcohol.[12][13][14][15]

All programs received clients from self-referral/walk-in, street patrol or homeless outreach vans, local agencies, and the police, while other programs additionally received clients from emergency departments, clinics, and ambulance paramedics. Many existing sobering facilities do not restrict the target client to those only intoxicated on alcohol, and are providing care for individuals with co-occurring drug intoxication.

Though the majority of sobering facilities are voluntary, some are legally permitted to hold involuntarily for acute intoxication[16]

Unlike drug treatment facilities, sobering centers are not intended to provide long-term substance use treatment. Rather sobering centers operate as an alternative to the jail or emergency department in the intoxication phase, with a stays less than a few hours as compared to the more traditional 14-90 day drug treatment programs. However, sobering centers can work as a hub to connect individuals with substance use disorders to appropriate treatment options.

Surge services

Emerging research has focused on a second manifestation for sobering care: a temporary facility established to provide surge services for peak emergency department hours or during large-scale sporting events or holidays associated with increased alcohol consumption.[17][18]

References
  1. Warren, O., Smith-Bernardin, S., Jamieson K, Zaller N, Liferidge A. (2016) Identification and Practice Patterns of Sobering Centers in the United States. J Healthc Poor Underserved, 27(3)
  2. Drunk tank
  3. Vestal, A. D., Day, R. E., Kulp, H. G., Marsh, J., Needham, T., & McClenahan, D. J. (1971). Uniform Alcoholism and Intoxication Treatment Act, 1–41.
  4. Annis, H. M. (1979). The detoxication alternative to the handling of public inebriates; the Ontario experience. J Stud Alcohol Drugs, 40(03), 1–15. Retrieved from http://www.jsad.com/jsad/downloadarticle/The_Detoxication_Alternative_to_the_Handling_of_Public_Inebriates_the_Onta/2991.pdf
  5. Finn, P. (1985). Decriminalization of public drunkenness: response of the health care system. J Stud Alcohol, 46(1), 7–23. http://doi.org/10.15288/jsa.1985.46.7
  6. Segal, B. (1989a). Homelessness and Drinking: A Study of a Street Population. Drugs & Society, 5(3), 67–109. http://doi.org/10.1300/J023v05n03_04
  7. Cornwall, A. H., Zaller, N., Warren, O., Williams, K., Karlsen-Ayala, N., & Zink, B. (2012). A pilot study of emergency medical technicians“ field assessment of intoxicated patients” need for ED care. The American Journal of Emergency Medicine, 30(7), 1224–1228. doi:10.1016/j.ajem.2011.06.004
  8. Flower, K., Post, A., Sussman, J., Tangherlini, N., Mendelson, J., & Pletcher, M. J. (2011). Validation of triage criteria for deciding which apparently inebriated persons require emergency department care. Emergency Medicine Journal : EMJ, 28(7), 579–584. doi:10.1136/emj.2009.089763
  9. Ross, D. W., Schullek, J. R., & Homan, M. B. (2013). EMS Triage and Transport of Intoxicated Individuals to a Detoxification Facility Instead of an Emergency Department. Ann Emerg Med, 61(2), 175–184. doi:10.1016/j.annemergmed.2012.09.004
  10. Swain, A. H., Weaver, A., Gray, A. J., Bailey, M., & Palmer, S. G. (2013). Ambulance triage and treatment zones at major rugby events in Wellington, New Zealand: a sobering experience. The New Zealand Medical Journal, 126(1372), 12–24.
  11. Smith-Bernardin, S., Kennel, M., & Yeh, C. (2019). EMS Can Safely Transport Patients to a Sobering Center as an Alternate Destination. Ann Emerg Med, DOI: https://doi.org/10.1016/j.annemergmed.2019.02.004
  12. Brady, M., Nicholls, R., Henderson, G., & Byrne, J. (2006). The role of a rural sobering-up centre in managing alcohol-related harm to Aboriginal people in South Australia. Drug Alcohol Rev, 25(3), 201–206. http://doi.org/10.1080/09595230600644657
  13. Segal, B. (1989b). Homelessness and Drinking: A Study of a Street Population. Drugs & Society, 5(3), 1–8. http://doi.org/10.1300/J023v05n03_01
  14. Smith-Bernardin, S., & Schneidermann, M. (2012). Safe sobering: San Francisco's approach to chronic public inebriation. Journal of Health Care for the Poor and Underserved, 23(3 Suppl), 265–270. http://doi.org/10.1353/hpu.2012.0144
  15. Warren, O., Smith-Bernardin, S., Jamieson K, Zaller N, Liferidge A. (2016) Identification and Practice Patterns of Sobering Centers in the United States. J Healthc Poor Underserved, 27(3).
  16. Warren, O., Smith-Bernardin, S., Jamieson K, Zaller N, Liferidge A. (2016) Identification and Practice Patterns of Sobering Centers in the United States. J Healthc Poor Underserved, 27(3).
  17. Brewster-Liddle, J., Parsons, W., & Moore, S. (2013). Setting up an alcohol treatment centre. Emergency Nurse : the Journal of the RCN Accident and Emergency Nursing Association, 21(6), 14–18. http://doi.org/10.7748/en2013.10.21.6.14.s17
  18. Swain, A. H., Weaver, A., Gray, A. J., Bailey, M., & Palmer, S. G. (2013). Ambulance triage and treatment zones at major rugby events in Wellington, New Zealand: a sobering experience. The New Zealand Medical Journal, 126(1372), 12–24.

Further reading
  • Dunford, J., Castillo, E. M., Chan, T. C., Vilke, G. M., Jenson, P., & Lindsay, S. P. (2006). Impact of the San Diego Serial Inebriate Program on use of emergency medical resources. Ann Emerg Med, 47(4), 328–336. doi:10.1016/j.annemergmed.2005.11.017
  • Greene, J. (2007). Serial inebriate programs: what to do about homeless alcoholics in the emergency department. Ann Emerg Med, 49(6), 791–793. doi:10.1016/j.annemergmed.2007.04.011
  • Smith-Bernardin, S., Kennel, M., & Yeh, C. (2019). EMS Can Safely Transport Patients to a Sobering Center as an Alternate Destination. Ann Emerg Med, DOI: https://doi.org/10.1016/j.annemergmed.2019.02.004
  • Smith-Bernardin, S., Carrico, A., Max, W. & Chapman, S. (2017). Utilization of a Sobering Center for Acute Alcohol Intoxication. Academic Emergency Medicine, published online May 2017. doi: 10.1111/acem.13219
  • Warren, O. (2016). Intoxicated, Homeless, and In Need Of A Place to Land. Health Affairs, 35(11): 2138-2141. doi: 10.1377/hlthaff.2016.0888
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