Horizon Treatment Services

Sobering Centers: A Humane Alternative to Jail

• Horizon Treatment Services • Season 1 • Episode 1

Share episode

Sobering centers provide a humane alternative to jail or emergency rooms for acutely intoxicated individuals, offering 4-12 hours of supervised care while saving public resources and respecting human dignity. Dr. Shannon Smith-Bernardin explains how these programs serve as a crucial intersection between law enforcement, healthcare, and substance use recovery.

• Sobering care focuses on short-term monitoring for people acutely intoxicated on alcohol or other substances
• Unlike detox programs, sobering centers aim to get individuals safely through intoxication, not remove all substances from the body
• Most clients are experiencing homelessness or cannot safely return home while intoxicated
• Law enforcement can complete drop-offs at sobering centers in under 10 minutes versus 45+ minutes for jail bookings
• Staff typically includes medical professionals (EMTs/nurses) and peer recovery specialists with lived experience
• Centers provide continuous monitoring for safety, particularly important with the rise of fentanyl in the drug supply
• One in three law enforcement encounters nationwide involve someone acutely intoxicated
• Funding comes from various sources including city/county funds, state programs, Medicaid reform, and criminal justice initiatives
• Success means treating people with dignity while reducing stigma and shame around substance use

For more information, visit the National Sobering Collaborative at nationalsobering.org or learn about our services at www.horizonservices.org.


Media - Podcasts (horizonservices.org)

Speaker 1:

Horizon Treatment Services, inspiring hope and healing since 1976.

Speaker 2:

The goal of Sobering Care is to take care of individuals who are acutely intoxicated on alcohol or other drugs. So it's that period of time about 4 to 12 hours when they are intoxicated, typically unable to care for themselves real well, and we're just monitoring, providing oversight etc. Making sure they get through that period of time.

Speaker 1:

Today we have a wonderful guest with us. She is the Director of Sobering Program Design here at Horizon Treatment Services. Dr Smith-Bernadin is a seasoned expert in the domain of sobering care and we are excited to delve into the world of sobering program operations with her guidance. I'll let her introduce herself.

Speaker 3:

Hey, shannon, it's good to see you Good to see you also, can you tell us a little about who you are?

Speaker 1:

to start.

Speaker 2:

My name is Shannon Smith-Hernadon. I am a registered nurse by trade and I've been a nurse for about 17 years now and pretty much that entire time I've spent working with individuals experiencing homelessness and in street medicine, street nursing, medical respite, recuperative care and sobering centers, which is what we're going to be chatting about today. I was with the San Francisco Sobering Center for about 10 years and since I left there in 2017, have been doing research on sobering centers, working with a number of programs across the country, either folks who run sobering centers and helping them enhance the programs and the services that they offer, and helping communities start sobering centers. I do research on, usually EMS collaborations, emergency medical system, and I run a nonprofit called the National Sobering Collaborative, which is a nonprofit that brings together sobering centers across the country so we can share best practices, chat about the work, et cetera, right here in the Bay Area. I'm in Oakland and I've been here for well about as long as I've been doing this work Right here in the Bay.

Speaker 3:

Area. I'm in Oakland. I've been here for well about as long as I've been doing this work. We have you right here in Oakland. That's amazing. So what? Just just for the folks who are listening what exact? What is a sobering center? What is that?

Speaker 2:

It's a great question because pretty much nobody knows Sobering centers or sobering care. The goal of sobering care is to take care of individuals who are acutely intoxicated on alcohol or other drugs. So it's that period of time, about four to 12 hours, when they are intoxicated, typically unable to care for themselves real well, and we're just monitoring, providing oversight, et cetera, making sure they get through that period of time. I think some of the most important distinctions between sobering and other services, in particular detox, is that sobering is short length of stay and the goal is to just get past the harmful effects of acute intoxication and not necessarily to remove all of the alcohol or drugs from the body. It's not treatment per se. It's just a short time to take care of an individual, basically in lieu of other services, instead of going to the emergency department, instead of going to jail.

Speaker 3:

Acutely intoxicated, so somebody who might be drunk in public or somebody who might be acting disorderly due to intoxication. So why don't they just go home?

Speaker 2:

Well, that's a great question. Individuals who use a sobering center or refer typically many individuals or folks who are intoxicated in public, who are without homes, so they're experiencing homelessness. They may or may not have an alcohol use disorder, but they're not indoors so they have to drink outside. Thus they're intoxicated outside and it's dangerous outside. You could be assaulted, you can be subject to the elements of rain, storms, et cetera. And especially if you're looking outside the Bay Area, there's sobering centers in Alaska, in Michigan, in Colorado, places that are a lot colder, where people can suffer from hypothermia, et cetera.

Speaker 2:

Then, full on San Francisco, we used to have people come over with in the Lyft or Ubers where friends would throw a friend into an Uber and be like take them home and the driver would feel very uncomfortable dropping them off, or the person couldn't unlock the door. Literally had people. The person who was driving the cab or Uber would put them back in the car and bring them to us. Is that a punishment? It's not a punishment. The goal is not to be a punishment. So let's go from the law enforcement aspect of it. So most sobering summers, including ones that we have here locally, in Alameda, of course, in Santa Clara County take directly from law enforcement police, sheriff's department, highway patrol, et cetera.

Speaker 2:

Now the officers do have the right, if they want to, to ticket someone with whatever they feel like. It could be public intoxication, keeping in mind that in many states, public intoxication is actually not illegal. But disturbing the peace may be, panhandling may be, aggressive behavior may be illegal, obviously. So you could be ticketed. The vast majority of people are not ticketed and so they wouldn't get a citation, they would not have to follow up in court. They don't have to spend the night in jail. It's really behaviorally based. So if you were, the police, for example, would bring one into a sobering center or, as you mentioned earlier, we call them recovery centers crisis receiving sobering upstations, et cetera. Officers would bring you in. As long as you're behaviorally appropriate and not being excessively violent, you'd be able to stay and the officers would leave after a couple of minutes and you'd be able to stay sober up there and never touch the criminal justice system other than that one referrer in with the police.

Speaker 3:

So if somebody is not going to jail, the officer doesn't have to do all the paperwork to book somebody, so they can just get back to the community.

Speaker 2:

One of the great things about sobering and this is sadly enough people have not published enough on this.

Speaker 2:

However, when I say people sobering programs across the country on average we're looking at first law enforcement to book someone into jail.

Speaker 2:

So they bring them in, they do all the paperwork, they book them in and they get back out to the world. At minimum I've heard it takes about 45 minutes. Many communities are looking at two hours to four hours just to have two officers stand there to book someone into jail for intoxication Sobering center. It's under 10 minutes. On average it's between four minutes to seven minutes to get someone into a sobering center before law enforcement is back out into the field dealing with all other public safety issues, ideally at that point. So it's very quick and also officers often will bring people to the emergency department when they think there might be something medically wrong with them. They can also go to the sobering center instead of the ED and if we determine in a sobering center that they have another medical need, we'll send them off to the emergency department. Either way law enforcement has a lot less time. They have to spend waiting, booking, handing off to health professionals in an emergency department versus the health professionals in a sobering center.

Speaker 3:

That sounds like it saves everybody a lot of time and a lot of money.

Speaker 2:

Yes, and mostly it's a cost, like you said, cost savings, a cost avoidance. Instead of having an expensive, just the whole process of going to jail, getting booked, then going to court, maybe showing up, maybe not dealing with probation all of that expense, all of that time, all that energy for somebody who may or may not have an alcohol use disorder, it's better to be in a situation where there's professionals, peer level staff that know what it's like to have a substance use disorder, what it's like to be in recovery and when I say recovery, it could be abstinence, it could just be a much healthier lifestyle than one used to have. And when you have someone go to a sobering care program where they've got all this going on, with peer professionals, with medical professionals monitoring and engagement around their substance use, versus jail, where you sit in a cell and then you get discharged the next day and now you're just dealing with paperwork Very big difference between both the cost of the system but also the cost of the individual, where one is much more helpful than the other.

Speaker 3:

Huh, you said that the police officers can drop somebody off at the emergency department, but they also could drop them off at sobering, and then sobering is equipped to determine if they need to go to the emergency department, in which case we're again saving officers time. So who works at a sobering center.

Speaker 2:

So typical staff at a sobering center or a place that provides sobering care and I try to distinguish that slightly because many programs may be co-located with other services and sobering care is really what we're offering. So staff the vast majority of sobering centers in the United States have some level of medical staffing. The most common staffing model in sobering is EMT basics or some level of medical staffing. The most common staffing model in Sobering is EMT basics or some level of emergency medical technician and a peer level individual who has lived expertise. It could be health workers, it could be recovery support specialists, certified or registered drug and alcohol counselors. It could be individuals from the community, registered drug and alcohol counselors. It could be individuals from the community, and so basically the idea is that we have a mix of staff and obviously people who become EMTs and nurses, such as myself. We all come from our own backgrounds and histories of recovery and so many of us it's a whole overlap to who works there.

Speaker 2:

Some sobering centers are much more focused on the medical aspect in terms of taking directly from 911 ambulance and with 911 ambulances paramedics, typically across the US and definitely California. They have to drop off to an equivalent level of care or higher, so that would be an EMT, paramedic, lvn, licensed vocational nurse, registered nurse, go up the chain. So there are some centers that have these higher level of staffing. The nice thing with a sobering center is they get a 24 seven monitoring. People have eyeballs on all the time making sure they're looking okay, they're on recovery position on their side, they're breathing, and if something comes up we can usually figure it out very, very quickly, relatively speaking to being in a jail cell for a few hours before someone wanders by.

Speaker 3:

When we're talking about a sobering center or stabilization center, we're not necessarily just talking about alcohol. You mentioned opiates. When you talk about folks coming into the sobering center and being monitored, that's probably really critical, particularly for the opiate situation that we're in, because somebody's breathing too shallowly, they could die right, correct, and they're probably not going to be monitored in a jail cell or in a drug tank, so to speak.

Speaker 2:

Right, yeah, sobering came around kind of and helped to replace the drunk tank aspect of in jail, where people were dying or committing suicide, ie dying because they weren't being monitored while they're in the cell. And importantly just to mention too is that the opiate crisis is incredibly devastating right now. Sobering can take care of individuals with that. In addition, as you mentioned, fentanyl, carfentanil and the other versions, the drug supply in general is kind of infiltrated at this point. So folks who think they only use stimulants whether that's methamphetamines, cocaine could also be getting fentanyl or only be getting fentanyl.

Speaker 2:

And the nice thing is too, is we can also, in sobering, take individuals who maybe have had an overdose reversed with naloxone. They can come to the sobering center while they're still recovering. Ideally they haven't given them so much naloxone that they're in withdrawal, but we can monitor and just make sure, because fentanyl lasts on some if they've had enough and more, and as recently the fentanyl can last longer than the naloxone can. So the naloxone will reverse the overdose. Then naloxone wears out and the fentanyl will keep going and thus the respirations can start going down again, and so we can have the sobering center take care of individuals who have that going on.

Speaker 3:

Yes, that's amazing. Okay, naloxone is Narcan, right.

Speaker 2:

Yes, narcan, is that the same thing? It is the same thing. Naloxone is the generic name for it. Narcan is the brand name and the reason I don't say Narcan is because there are now generics that are available in the market, of which California has two different generics that are incredibly more economical for many organizations, incredibly less expensive.

Speaker 3:

Okay, good to know. So that's like when we say tissue, instead of saying tissue, we say Kleenex. Right, like we've learned that those are interchangeable. But it's actually say Kleenex right, like we've learned that those are interchangeable. But it's actually not Kleenex, it's tissue. So, naloxone is the tissue version of I got you Okay.

Speaker 2:

Exactly Right. So, because there is such an economical um, but there were um other forms of naloxone that had come out that were incredibly expensive, like $500 per dose versus we can't do that per dose, so it is, and that is definitely something. And also brain centers that have naloxone on site also. So, just in case somebody comes in and it's not obvious at the beginning, but then the respiration start going down, or they go into the bathroom and, yeah, we most, most, most organizations store their belongings to make sure they're not stolen. They make sure that, uh, they're not using anything while they're on site, because we're really trying to help people get to the point of being able to take care of themselves and not, uh, continue becoming intoxicated. So, having their belongings locked up, they might still have used something, go into an overdose 30 minutes an hour into their stay. So anticipated length of stay is around four to 12 hours. Average length of stay seems to be around seven to eight Individuals who come into Sobering Center who may be either more medically frail and just need longer to sleep or come in at 10 o'clock at night. We're not going to discharge them at four yet they will be able to spend the night. Hopefully they don't go into withdrawal at that point.

Speaker 2:

How do you deal with the atmosphere that that many individuals in the program? It's a lot easier than one would think, with a whole bunch of challenges that come with it With sobering. The whole goal is we're monitoring individuals, so you're keeping an eye on individuals. The goal is to keep people there. The goal is not to, as is often said in the emergency department, treat and street and as soon as they can wobble on their two feet, you kick them out. No, no, no. We want people to stay. Most important aspects treating individuals as individuals, being nice to them.

Speaker 2:

There is so much stigma. Actually, the World Health Organization had done a study many years ago and the number one stigmatized situation was being intoxicated on drugs and number two was alcohol. Like this is across the world what all the countries view as the most stigmatized conditions are being intoxicated in public. Essentially, the sobering center it's not a drop-in center. It's not an area where people wait in line to try to get a bed, so there is no interaction hanging out outside. This is not talking down drop-in centers and shelters, because they should be more prolific than they currently are in terms of having access for folks, but individuals. They're not waiting in line.

Speaker 2:

The goal is we're actually taking people off the streets who are outside already, who are having trouble, who are upset, who are intoxicated, and burning them inside. We're getting them out of the community. So this could be just a kid who's been drinking for the first couple of times who ends up in the program, to someone who's been homeless for 15 years and has had a longstanding alcohol use disorder from years and years and years of childhood trauma. So you've got two different areas and one case. With the younger individual we're helping, hopefully, prevent their substance use from getting worse. And now so we're going to prevent somebody from becoming homeless, from losing their job, from losing their family. To the individual who's been outside for a number of years, who cannot get the permanent housing because there's not enough, and that's a whole other topic this is really really rich, and there's just so much.

Speaker 3:

Who's paying for this? It's a variety.

Speaker 2:

So at look at California in particular in a study that came out in 2021. And sobering care is paid for by a variety of city, county funds, state funds, the Mental Health Services Act, according to lots of sobering centers. Now California in particular has Medicaid reform. It's called CalAIM. It's a massive Medicaid reform which is actually helping for reimbursement, and the managed care programs across the state are coordinating with their respective counties to see about creating sobering centers or enhancing the ones that exist.

Speaker 2:

There's different propositions, so maybe there's public safety propositions that came through elections and bonds. And then I think, lastly, there's lots of criminal justice funding for, from criminal justice reform to, again, public safety, relieving the prison system, the jail system. In the last 50 years and the number hasn't really changed one in three law enforcement encounters. So across the country, one in three law enforcement encounters involves someone who's acutely intoxicated. Could be alcohol, could be drugs One in three. And that has been the same since the 70s. And that's what law enforcement is working with on a day-to-day basis is, in addition to trying to work, public safety is sometimes getting individuals sometimes a lot. One in three have some level of intoxication.

Speaker 3:

What kind of training do they have?

Speaker 2:

It really depends. Across the country there has been an increase in the crisis intervention training CIT training. They'll get like an hour of sobering center training acute intoxication, maybe a few more hours of mental health, but training around alcohol and substance use disorders and everything that comes with it. How they started, like what is someone dealing with? They usually have incredible amounts of trauma and so there's just a lot of things that they're dealing with in that and so it's tough, and that's why one of the reasons why I've been working and trying to promote sobering centers so dramatically is we're offering a better alternative than the criminal justice system, a faster alternative for law enforcement itself to be able to drop in, get back out to what you're doing and we will help take care of it and providing something that is very, very focused on.

Speaker 2:

Sobering is focused on people with harmful use Don't have to have a diagnosable disorder. You just have to have some level of harmful use that caused you to be intoxicated in a manner that third parties were involved to bring you to a sobering care center. A successful sobering stay is someone comes in with acute intoxication, recovers from that, maybe they get a shower, maybe they get a snack. They have conversations with the staff regarding how they got themselves into that situation and what happened everything from offered services, what their needs are, and then they leave. They stay for five or six or eight hours and then they go. That is success, because they didn't go to jail, they didn't go to the emergency department.

Speaker 2:

The bigger picture of what we're doing is, especially with individuals who have had longer term use and or have a lot of social inequities, really rebuilding relationships, helping them feel less alone, because individuals who have severe substance use conditions often are at the stage by this point especially when we're seeing them they burn many, many bridges. They may likely don't have employment anymore, they may have lost their family connections, they may be homeless, and so their social network and support network is gone, and so we're helping them basically realize that they are okay. They're faced with so much stigma and shame and so much of that's internalized Work with thousands of individuals over the last 17 years. They've internalized this stigma and the shame and they are unable to really see themselves as a good individual, and I think where a lot of our work comes in is really getting someone to realize that we can help you when you're ready for that. So I think that's some of the bigger picture.

Speaker 2:

Will an alcohol use disorder that has been present for 30 years, since someone was 12 years old, go away because they have one? Visit the sobering center. No, no, there's so much that goes into it, but can we start making inroads to that, figuring what they need? Sobering Center can help identify needs that the populations have that are not present in the county. So we as a Sobering Center can say, hey, we've had this number of individuals coming in with these particular needs. Let's work with the community to see if we can have something that we can refer it to.

Speaker 2:

I mean, there's been research out there of cost. If every urban environment in the United States had one sobering center just to take from the emergency department, even if they only used it a little bit, it would still save millions of dollars across the US just for the health care system. And there is a lot of interest in rural environments where the sobering fitting in as a hub. The success would be engaging with a population that is often very either ignored or not taken care of. So now we're engaging with a population that we can spend a little bit more time with, and so there's just a lot of benefits that can be translated into cost benefit. It really depends on the community and what the resources are. Sobering provides a space where people can come together and take care of an individual, and so I find it works really well, and some of those benefits are going to not be easily translatable into cost benefit, and that they're there.

Speaker 3:

So is there anything else? You want to leave us with Shannon before we go? That we didn't talk about that. You think we just really need to say out loud on the topic of sobering centers?

Speaker 2:

I think the only thing I would say is that if you haven't heard of it prior to this conversation or came in, there's so much to learn. We have a lot to share, both Jen and I, about this topic. It is a really fabulous opportunity for the clients that we serve and the communities that we're in as Sobering Care, yeah, and the National Sobering Collaborative is something Horizon is a founding member of.

Speaker 3:

I know that you're involved with them as well, and so we've kind of crossed paths in many directions prior to meeting, as we have through Horizon. So that's a wonderful place also where folks can learn more and sort of get involved if they're interested and want to advocate for these centers. So your perspective on this is very much appreciated and I appreciate your time today and we'll do it again.

Speaker 2:

So yeah, and as you mentioned, check it out. National Sobering Collaborative nationalsoberingorg. Check us out.

Speaker 3:

Awesome. Thank you so much. We'll talk soon. Please visit our website to learn more and to connect with us on social media. Our website is wwwhorizonservicesorg.

Speaker 1:

Horizon Treatment Services, inspiring hope and healing since 1976.