Sobering Center Research

Research papers

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Examining the Utility of Sobering Centers: National Survey of Police Departments and Sobering Centers

Gabrielle Isaza, Robin S. Engel, and Jennifer Calnon Cherkauskas. National Policing Institute. December 2022

Description: The report details the patterns of policies and practices for police use of sobering centers as an alternative to arrest. How do police balance and overcome policy and legal inconsistencies guiding the transport to and use of sobering centers. As well as what the situational factors are that police use in practice to determine whether  or not to use sobering centers as an alternative to arrest.

Sobering Centers Offer Clients Pathway To Stable Lives: A conversation with Shannon Smith-Bernardin, PhD, RN, a national leader in the field

Bonar Menninger. California Health Care Foundation. September 20, 2021

Description: A conversation with Shannon Smith-Bernardin about the impact and importance of sobering centers, as well as her experience with the San Francisco Sobering Center.

Changing the Care Environment for Acute Intoxication: Providing Intoxicated Adults With an Alternative to the Emergency Department and Jail

Shannon Smith-Bernardin, Ph.D, R.N., C.N.L.  September 19, 2021

Description: A survey was developed and distributed from June to October 2019 to leadership of sobering centers in the United States that provided short-term (<24 hour) care to adults admitted for being intoxicated in public. The findings suggest that sobering centers play a principal role in stabilizing adults who are acutely intoxicated.

Sobering Centers Explained: An Environmental Scan in California

Shannon Smith-Bernardin, PhD, RN. California Health Care Foundation. September 2021

Description: This report describes the range of sobering center models in California and documents commonalities, differences, collective challenges, and best practices. The report is intended to provide background for health care leaders and policymakers in California when planning for, developing, and enhancing the use of sobering centers for acute intoxication.

Sobering Centers Explained: An Innovative Solution for Care of Acute Intoxication

California Health Care Foundation. July 2021

Description: Sobering centers present an intriguing, cost-effective alternative for providing care to persons with acute intoxication whose public alcohol or drug use puts themselves or others at risk. The paper includes insights gleaned from a field report on California sobering programs.

Sobering centers, emergency medical services, and emergency departments: A review of the literature

Brandon Marshall, Erin McGlynn, and Andrew King. The American Journal of Emergency Medicine. February 2021

Description: Literature around sobering centers reveals that sobering centers are a cost-effective alternative to emergency department visits for acute alcohol intoxication and further research is required to identify safe, effective protocols for EMS to triage patients to appropriate treatment destinations.

Lessons learned from a sobering center pilot for acute alcohol intoxication in South King County, Washington

Marlee Fischer, Michele Plorde, Hendrika Meischke, and Sofia Husain. Journal of Substance Abuse. September 10, 2019

Description: King County Emergency Medical Services (EMS) collected client utilization data, performed interviews, and conducted interviews to find areas for improvement and identify possible barriers. Results showed a need for culture change among the community and further integration of harm reduction services.

Cost impact of sobering centers on national health care spending in the United States

Claudia Scheuter, Danielle H. Rochlin, Chuan-Mei Lee, Arnold Milstein, and Robert M. Kaplan. Translational Behavioral Medicine. May 22, 2019

Description: The report estimated the impact on US health care spending if individuals with   uncomplicated, acute alcohol intoxication were treated in sobering centers instead of the emergency department. It was found that implementing sobering centers as a treatment alternative for individuals with uncomplicated acute alcohol intoxication could yield substantial savings for the US healthcare system.

Public Intoxication: Sobering Centers as an Alternative to Incarceration, Houston, 2010-2017

Suzanne V. Jarvis, Leonard Kincaid, Arlo F. Weltge, Mike Lee, and Scott F. Basinger. American Public Health Association. April 2019

Description: To address jail overcrowding, Houston created a jail diversion policy that allowed law enforcement to admit publicly intoxicated individuals into a new sobering center. By 2017, public intoxication jail admissions had decreased by 95%, freeing valuable resources. A promising public health intervention, sobering centers offer an alternative to incarceration and relieve overuse of emergency services while assisting individuals with substance use issues.

EMS Can Safely Transport Intoxicated Patients to a Sobering Center as an Alternate Destination

Shannon Smith-Bernadin, Megan Kennel, and Clement Yeh. Annals of Emergency Medicine. March 27, 2019

Description: Evaluation of sobering centers as an alternate destination for acute intoxication. A case review was performed on all visitors during 3 years who were secondarily transferred from the sobering center. Results show that the San Francisco Sobering Center is a safe EMS destination.

Permanent Supportive Housing for Homeless People – Reframing the Debate

Stefan G. Kertesz, Travis P. Baggett, James J. O’Connell, and David S. Buck. The New England Journal of Medicine. December 1, 2016

Description: The best way to serve homeless populations is not by focusing on costs. The popular recommendation that providing permanent supportive housing to chronically homeless people will deliver net savings by reducing the use of jails, shelters, and hospitals is not the best argument. The best thing to do is instead to consider the best way to meet the population’s needs.

Identification and Practice Patterns of Sobering Centers in the United States

Otis Warren, Shannon Smith-Bernardin, Katherine Jamieson, Nickolas Zaller, and Aisha Liferidge. Journal of Health Care for the Poor and Underserved. November 2016

Description: The study is a cross-sectional analysis and survey of sobering centers with a review of current practices. Twenty-seven potential sobering centers were identified, where nine centers met the definition of a sobering center. The sobering centers had a wide range of missions and medical oversight. Significant heterogeneity was found in regards to size, practice patterns, and funding mechanisms.

Intoxicated, Homeless, And In Need Of A Place To Land

Otis Warren. Health Affairs Volume 35, Issue 11: Culture of Health. November 2016

Description: The story of a patient with alcoholism and how he cycles in and out of an emergency department. His providers grapple with an outdated system of care that, instead of helping him, hurts the patient.

Setting Up An Alcohol Treatment Centre

James Brewster-Liddle, Wayne Parsons, and Simon Moore. Journal of Emergency Nursing. July 29, 2013

Description: The article describes the solution that the emergency unit at University Hospital Wales, Cardiff, created when they were running out of the clinical space available for patients. The staff launched a three-month pilot project which revealed that diverting intoxicated patients with low to moderate risk improved the clinical care in the unit.

Ambulance Triage and Treatment Zones at Major Rugby Events in Wellington, New Zealand: A Sobering Experience

Andrew H. Swain, Amanda Weaver, Alasdair J. Gray, Mark Bailey, and Stephen G. Palmer. New Zealand Medical Journal. April 5, 2013

Description: An analysis of the workload of prehospital triage and treatment facilities established in Wellington for the 2011 and 2023 International Rugby Sevens, and the Rugby World Cup 2011. Results show that with minimal supervision, event medics and paramedics can safely care for the majority of patients attending large rugby events in New Zealand, easing the pressure on ambulances and the ED.

Patient Characteristics and Patterns of Intoxication: One-Time and Repeated Use of Emergency Ambulance Services

Barbara M. Holzer, Christoph E. Minder, Nina Rosset, Gabriela Schaetti, and Edouard Battegay. Journal of Studies on Alcohol and Drugs.

Description: Investigation of the utilization of ambulance services that resulted from alcohol and drug intoxication over a period of 1 year in a metropolitan. Results showed that sobering centers might relieve hospital emergency departments of patients not requiring acute emergency care and, in addition, could provide intervention services to prevent relapses. 

EMS Triage and Transport of Intoxicated Individuals to a Detoxification Facility Instead of an Emergency Department

Davis W. Ross, John R. Schullek, and Mark B. Homan. Annals of Emergency Medicine. November 7, 2012

Description: Evaluation of the effectiveness and safety of emergency medical services (EMS) provider use of a checklist to triage alcohol-inebriated patients directly to a detoxification facility, instead of an emergency department (ED). The results show that field triage criteria can be used effectively to safely divert patients to detoxification facilities. *Correction about ethanol concentration

A Pilot Study of Emergency Medical Technicians’ Field Assessment of Intoxicated Patients’ Need for ED Care

Alexandra H. Cornwall, Nickolas Zaller, Otis Warren, Kenneth Williams, Nina Karlsen-Ayala, and Brian Zink. The American Journal of Emergency Medicine

Description: The pilot study examined intermediate-level emergency medical technician (EMT) ability to identify intoxicated individuals who may be eligible for diversion to an alternative sobering facility. The results showed that intermediate-level EMTs may  be able to play an important role in facilitating triage of intoxicated patients to alternate sobering facilities.

Safe Sobering: San Francisco’s Approach to Chronic Public Inebriation

Shannon Smith-Bernardin and Michelle Schneidermann. Journal of Health Care for the Poor and Underserved. August 2012

Description: The San Francisco Sobering Center cares for intoxicated clients historically treated via emergency services. At the time this was written, the Sobering Center has had 29,000 encounters and 8,100 unduplicated clients. The Sobering Center safely and efficiently provides sobering and health care services to some of the City’s most vulnerable people.

Validation of Triage Criteria for Deciding Which Apparently Inebriated Persons Require Emergency Department Care

Keith Flower, Anneke Post, Jeremy Sussman, Niels Tangherlini, John Mendelson, and Mark J. Pletcher. Emergency Medicine Journal. 2011

Description: Investigation of the sensitivity and specificity of consensus triage criteria for identifying which inebriated patients could be triaged to care in a sobering center. The results showed that most inebriated individuals in the study did not require ED care, but the prospective identification of these persons was difficult.

Serial Inebriate Programs: What to do About Homeless Alcoholics in the Emergency Department

Jan Greene. Annals News and Perspective. May 2007

Description: San Diego’s Serial Inebriate Program officials were getting frequent visits from all over the country, viewing it as a long-term solution to chronic homeless populations. Emergency Departments should be used as a last resort in order to ensure that people get the best care they can for their specific needs.

Impact of the San Diego Serial Inebriate Program on Use of Emergency Medical Resources

James V. Dunford, Edward M. Castillo, Theodore C. Chan, Gary M. Vilke, Peter Jenson, and Suzanne P. Lindsay. Annals of Emergency Medicine. January 2006

Description: The study determined the impact of the San Diego Serial Inebriate Program. The results show that the community-supported treatment strategy reduced the use of EMS, ED, and inpatient resources by individuals repeatedly intoxicated in public.