Sobering Centers are facilities that provide a safe, supportive, environment for mostly uninsured, homeless or marginally housed publicly intoxicated individuals to become sober. Sobering centers provide services for alcohol-dependent individuals that may have secondary problems such as drug abuse/dependence, mental illness and/or medical issues. Stated goals for sobering centers include:

• Provide better care for homeless alcohol-dependent persons and improve health outcomes
• Decrease the number of inappropriate ambulance trips to the emergency department (ED) for homeless alcohol-dependent individuals
• Decrease the number of inappropriate ED visits for homeless alcohol-dependent individuals
• Create an alternative to booking individuals arrested for public inebriation

Sobering Centers are located in cities across the country that are supported by local, state and charitable organization funding and provide 7 days/week services, some operate 24 hours a day. A table providing a listing of the known sobering centers with detailed site specific information about capacity, client encounters, staffing, length of stay, and regulatory agency involvement to name a few. This table was developed via a survey conducted in 2013, and may exclude centers who did not respond to the survey. The table was developed by Shannon Smith-Bernardin, MSN, RN, CNL; Otis Warren, MD; Katherine Jamieson, BA; Nickolas Zaller, PhD; and Aisha Liferidge, MD, FACEP, and posted with permission. Criteria for admission and support services available at the centers vary. The centers focus on non-violent public intoxication offenders. The minimum age requirement is 18 with a length of stay from 3 to 14 hours per visit depending on the program and the program policy. Centers do not require a commitment to abstinence to receive services although referrals for additional services are available. Transportation to the centers is most often by ambulance, sobering center operated vans, or law enforcement. Vans operated by sobering centers are frequently staffed by EMTs trained to work with this population. Center staff may include medical staff members to screen clients for medical and behavioral health issues.

Sobering Center Literature Review

• Evidence-based resources regarding sobering centers are limited. Most reports are anecdotal, with some annual operating reports, and media investigations.
• Most of the literature cites the large burden of alcohol on emergency department (ED) visits, with anywhere from 1-5% of ED visits being alcohol related.

Best Practices Shared by Respondents

When members of the Public Health and Injury Prevention Committee (PHIPC) surveyed a number of sobering centers the respondents shared the following best practices:

• Motivational interviewing
• Housing first philosophy
• Case management
• Inter-organizational communication
• Peer support
• Harm-reduction centered

Conclusions

• Most sobering centers are local government funded and operated entities.
• Most report minimal objective and validated use of standardized guidelines.
• One Web site reports use of the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) Treatment Improvement Protocols (TIPs) and another uses state guidelines from the Bureau of Substance Abuse Services.
• Data is lacking, particularly related to outcomes.
• External validation of sobering centers is needed.

While there is little research available, there is a relatively significant amount of interest in and support for the development of sobering centers.

Created by members of the ACEP Public Health & Injury Prevention Committee Subcommittee on Sobering Centers

• Robert A. De Lorenzo, MD, FACEP, Chair
• Aisha Liferidge, MD, MPH, FACEP, Subcommittee Chair
• Timothy Ruttan, MD
• Stephen Y. Liang MD
• Jennifer N. Thompson MD, FACEP
• Heather S. Owen MD, FACEP
• Margaret Montgomery, RN, MSN, Staff Liaison

Resources

1. Downtown Emergency Service Center. Nicole Macri, director. Seattle, WA. info@desc.org.
2. Top 12 of 2012: Law enforcement Sobering Centers. December 7, 2012. Sobering Up. (Houston)
3. Sobering Station/CHIERS. Central City Concern. Last accessed September, 2013. (Portland)
4. San Francisco Sobering Center. Hospital Council of Northern & Central California. Last accessed September 2013. (San Francisco, CA).
5. Ross DW, Schullek JR, Homan MB. EMS triage and transport of intoxicated individuals to a detoxification facility instead of an emergency department. Ann Emerg Med. 2013;61(2):175-184.
6. Sobering Center Program. Pierce County, WA. Accessed September 2013.
7. The Center for Health Care Services. San Antonio, TX. Accessed September 2013.
8. Community Awareness & Treatment Services, Inc. Medical Respite and Sobering Center Program. San Francisco, CA.
9. Andrews M and Kaiser Health News. ER Visits After Drinking May Not Be Covered. PBS Newshour. April 30, 2012.
10. King County, Department of Community and Human Services. Community Services Division. Implementation Plan. Veterans and Human Services Levy, Activity 2.1.B Sobering Center and Emergency Services Patrol. Seattle, WA.
11. Larimer ME, Malone DK, Garner MD, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009;301(13):1349-1357.
12. Sobering Center 3rd Quarter Data Report. Reporting Period January 1, 2010-March 31, 2010. Emergency Department. Yukon-Kuskokwim Health Corporation. 2010.
13. Special Senate Commission to Study Emergency Department Diversion: Findings and Recommendations. Rhode Island State Senate. Senators Paul V. Jabour and Joshua Miller, Co-chairs. Feb 16, 2012.