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

OBJECTIVE

This study examines models of sobering centers throughout the United States and identifies best practices and barriers to providing care to acutely intoxicated adults.

METHOD: 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.

RESULTS

The author screened 53 programs: 37 met inclusion criteria and 26 (70%) responded. The majority of centers operated 24 hours a day, 7 days a week, averaging 5,560 visits annually (Mdn = 4,680, range: 300-22,000). Most of the staff comprised medical personnel (80%) and substance use specialists (70%). The budgets ranged from $202,000 to $4.8 million annually (Mdn = $1,165,500) and were funded by city, county, state, law enforcement, hospital systems, and grants. In addition to alcohol, common intoxicants included opioids, marijuana, and stimulants. With 4.3% of clients requiring transfer to the emergency department and 4.3% to the police or psychiatric facility, the model appears appropriate for the populations served. Best practices included offering a compassionate environment with dedicated staff, providing outreach to community members, establishing inter-organizational communication, and establishing a continuum of care for clients. Primary barriers included dependency on grant and/or static funding, a lack of community resources available to clients, and an increase in the severity of comorbid mental illness.

CONCLUSIONS

These findings suggest that sobering centers play a principal role in stabilizing adults who are acutely intoxicated. Sobering center models vary, yet share a focus on harm reduction, community collaboration, and low-barrier access to care and coordination.