In many communities, there are few options available when local police pick a person up for public intoxication: they can go to jail or to the emergency room (ER). But these approaches take a toll on police resources due to the time required for transporting, booking, and, in the case of a visit to the ER, waiting until the person is admitted.
The Uniform Alcoholism and Treatment Act of 1971 created an alternative: sobering centers. For 50 years, sobering centers have offered a low-barrier space for intoxicated people to stay safe and access substance use disorder (SUD) and other social services. A sobering center is a community-based facility that can be an alternative to jail or a hospital for people who are under the influence of alcohol or drugs. There are now close to 40 sobering centers across the country that provide a bed or recliner, frequent monitoring to ensure the individual is recovering safely from the acute effects of alcohol and/or drugs, and a range of other benefits to people recovering from acute intoxication.
The Need: A Safe Space to Sober Up
Public intoxication laws vary by state and are primarily focused on reducing disturbances and risks to the community and individual. Sobering centers help address these issues and keep intoxicated individuals safe and provide the opportunity to connect people to services if they need and want them. Sobering centers are found in at least 13 states in locations ranging from major metropolitan areas (e.g., Austin, Texas; San Francisco, California) to remote communities (Bethel, Alaska). The National Sobering Collaborative maintains a directory of sobering care programs in the United States.
Sobering centers can be freestanding or co-located with or nearby a related organization, such as a homeless shelter, medical respite, detoxification center, or rehabilitation center. It all depends on the need. “The location and the services are largely based on community need,” says Shannon Smith-Bernardin, PhD, RN, CNL, president and co-founder of the National Sobering Collaborative. “In a community with a large population experiencing homelessness, the sobering center might be located next to a medical respite or shelter. In a city with a lot of ‘revelers,’ or non-resident party- or conference-goers, it might be located in an easily accessible location downtown. It’s all about what works best for that community.”
The Basics: Short-Term, Low-Barrier Access
Any person over the age of 18 who is intoxicated in public can use a sobering center. Typically, people are brought to a center by the police, ambulance, or street or homeless outreach teams. But they may also be dropped off by community groups, ride-share drivers, or friends, or they may even walk in the door on their own. As long as a person is not violent or acutely ill or injured, a sobering center will accept them. However, a person needs to want to go to the sobering center; it is a voluntary alternative to jail or hospital.
While the offerings vary widely, all sobering centers provide a place to rest, peer-level experienced staff, and services to monitor for intoxication-related harms, such as underlying medical conditions or overdose. After a very brief intake, which usually involves simply learning the person’s name and, if possible, what substance they used, individuals are given a bed.
Most programs staff medical professionals, such as an emergency medical technician or nurse, who watch the person’s vitals for a few hours while they sleep. For programs without licensed medical providers, staff follows monitoring and oversight guidelines aimed at identifying any emerging needs to activate an emergency response rapidly. “An important factor of a sobering center is that either the medical staff can sit where they can see every single person in the room, or they will do continuous bedside monitoring every 5 or 10 minutes. Often, it’s both,” says Smith-Bernardin. “This ensures the individual’s safety and well-being in a way that being held in jail, and sometimes an ER does not.”
Within 2 to 4 hours, most people are awake and able to engage with the sobering center workers. All sobering centers employ peers, along with a variety of other recovery, behavioral health, and clinical personnel. From here, people may be connected to any number of services, or, if they wish, they may just go home or back to their hotel, shelter, or other housing. Many sobering centers offer bus passes or a van ride. Most people stay for about half a day but depending on need, a sobering center may allow a person to stay onsite for a day or even longer.
The Details: A Community Hub
Beyond providing a safe space to “sober up,” sobering centers can function as a hub for connection to community resources and an important step for people who are ready to address their substance use. Staff and services are usually customized to the needs of their community. For instance, some sobering centers may employ prescriber-level clinicians, care coordinators, or other specialized professionals.
Once a person is able to participate in a conversation, staff use various methods to assess their needs and their interest in other services. “Sobering centers use a variety of methods like motivational interviewing, substance use assessment, and peer engagement to see where people are at with their substance use and how staff can help them if they want help,” says Smith-Bernardin.
Suppose a person expresses interest in addressing their substance use. If so, sobering centers have connections throughout their communities, usually including inpatient and residential treatment programs, community-based services, and connection to medication-assisted treatment (MAT). The main goal is for a person to have someplace to go when they leave the center (e.g., a medical detox program or an appointment with a prescriber) if the individual is looking to change their substance use or get help for related needs (e.g., housing or shelter, primary care).
If not, that’s okay too. “We meet people where they are,” says Smith Bernardin. “Many sobering centers have onsite social workers and case managers who might follow a person for 3 to 18 months to help them. Whatever they need, we aim to help.”
The Bottom Line: Funding and Financial Benefits
Sobering centers do not require payment or insurance information. They are a free, 24-hour per day community service. “A sobering center is a cost-avoidance model,” says Smith-Bernardin. “They reduce the financial burden of public intoxication for police and hospitals, but they are not money-makers on their own.”
Sobering centers are nonprofit organizations with funding from a variety of resources. In some states, like California, they are or will soon be part of Medicaid reform, so funding comes directly from the government. In other areas, they are funded through public and private grants and fundraising. Some sobering centers are able to get state funding through mental health services-type grants.
How to Start a Sobering Center
Dr. Smith-Bernardin offers the following key steps to setting up a sobering center.
- Conduct a community needs assessment. This process enables you to identify community characteristics around public intoxication and available services to customize your sobering center to your community’s unique needs. Work with the police, ERs, and other information sources to find out how many people get picked up for public intoxication and where they are coming from (e.g., populations experiencing homelessness, local bars and restaurants).
- Think about how to enhance or support existing community resources. Find out what services exist in your area and how you might partner with them to meet your community’s unique needs. For instance, could you co-locate next to a detox center, near the hospital, or a shelter?
- Find a champion. A champion can help you move forward to establish a location and obtain funding. This might be a medical or justice leader in your town or city. An influential and excited partner can help you gain community support.
- Reach out to the National Sobering Collaborative. They can provide best practices and policies, education, and operational and service guidance to anyone interested in starting a sobering center. Visit the National Sobering Collaborative’s website or @NationalSober on Twitter to learn more.
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