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

Published:November 17, 2020DOI:



      Acute alcohol intoxication accounts for a large proportion of potentially unnecessary emergency department visits and expenditure. Sobering centers are a cheaper alternative treatment option for alcohol intoxication and can provide an opportunity to treat the psychosocial aspects of alcohol use disorder.

      Objective of the review

      The objective of this review is to analyze the existing literature regarding the use of sobering centers, EMS and their role in transporting to sobering centers, and the appropriate triage of the intoxicated patient.


      Excessive alcohol consumption accounts for an estimated $24.6 billion in healthcare costs and patients are often referred to the emergency department for expensive care. Current literature suggests sobering centers are an alternative to acute hospitalization and are safe, relatively inexpensive, and may facilitate more aggressive connection to resources such as longitudinal rehabilitation programs for the acutely intoxicated patient. EMS plays a pivotal role in triage and transportation of intoxicated individuals, but demonstration of outcomes in lacking.


      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.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mandelberg J.H.
        • Kuhn R.E.
        • Kohn M.A.
        Epidemiologic analysis of an urban, public emergency department’s frequent users.
        Acad Emerg Med. 2000; 7: 637-646
        • Bouchery E.E.
        • Harwood H.J.
        • Sacks J.J.
        • Simon C.J.
        • Brewer R.D.
        Economic costs of excessive alcohol consumption in the U.S., 2006 [published correction appears in Am J Prev Med. 2013 Feb;44(2):198].
        Am J Prev Med. 2011; 41: 516-524
        • Hawk K.
        • D’Onofrio G.
        Emergency department screening and interventions for substance use disorders.
        Addict Sci Clin Pract. 2018; 13 (18. Published 2018 Aug 6)
        • Smith-Bernardin S.
        • Carrico A.
        • Max W.
        • Chapman S.
        Utilization of a sobering center for acute alcohol intoxication.
        Acad Emerg Med. 2017; 24: 1060-1071
        • Mullins P.M.
        • Mazer-Amirshahi M.
        • Pines J.M.
        Alcohol-related visits to US emergency departments, 2001–2011.
        Alcohol Alcohol. 2017; 52: 119-125
        • Fuda K.K.
        • Immekus R.
        Frequent users of Massachusetts emergency departments: a statewide analysis.
        Ann Emerg Med. 2006; 48: 9-16
        • Klein L.R.
        • Martel M.L.
        • Driver B.E.
        • Reing M.
        • Cole J.B.
        Emergency department frequent users for acute alcohol intoxication.
        West J Emerg Med. 2018; 19: 398-402
        • Van Dillen C.
        • Kim S.H.
        Unnecessary emergency medical services transport associated with alcohol intoxication.
        J Int Med Res. 2018; 46: 33-43
        • Rönz K.
        • Hirschi T.
        • Becker S.
        • et al.
        Predictors of high resource consumption in alcohol intoxicated patients in the emergency department.
        Int J Environ Res Public Health. 2020; 17: 4122
        • Hamilton B.H.
        • Sheth A.
        • McCormack R.T.
        • McCormack R.P.
        Imaging of frequent emergency department users with alcohol use disorders.
        J Emerg Med. 2014; 46: 582-587
        • Verelst S.
        • Moonen P.J.
        • Desruelles D.
        • Gillet J.B.
        Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room.
        Alcohol Alcohol. 2012; 47: 433-438
        • Dunford J.V.
        • Castillo E.M.
        • Chan T.C.
        • Vilke G.M.
        • Jenson P.
        • Lindsay S.P.
        Impact of the San Diego Serial Inebriate Program on use of emergency medical resources.
        Ann Emerg Med. 2006; 47: 328-336
        • Kim J.S.
        • Bae H.J.
        • Sohn C.H.
        • et al.
        Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest.
        Crit Care. 2020; 24 (305. Published 2020 Jun 6)
        • McKenna P.
        • Heslin S.M.
        • Viccellio P.
        • Mallon W.K.
        • Hernandez C.
        • Morley E.J.
        Emergency department and hospital crowding: causes, consequences, and cures.
        Clin Exp Emerg Med. 2019; 6: 189-195
        • Bernstein S.L.
        • Aronsky D.
        • Duseja R.
        • et al.
        The effect of emergency department crowding on clinically oriented outcomes.
        Acad Emerg Med. 2009; 16: 1-10
        • Klein L.R.
        • Driver B.E.
        • Miner J.R.
        • Martel M.L.
        • Cole J.B.
        Emergency department length of stay for ethanol intoxication encounters.
        Am J Emerg Med. 2018; 36: 1209-1214
        • Vardy J.
        • Mansbridge C.
        • Ireland A.
        Are emergency department staffs’ perceptions about the inappropriate use of ambulances, alcohol intoxication, verbal abuse and violence accurate?.
        Emerg Med J. 2009; 26: 164-168
        • Imlach Gunasekara F.
        • Butler S.
        • Cech T.
        • et al.
        How do intoxicated patients impact staff in the emergency department? An exploratory study.
        N Z Med J. 2011; 124: 14-23
        • Warren O.
        • Smith-Bernardin S.
        • Jamieson K.
        • Zaller N.
        • Liferidge A.
        Identification and practice patterns of sobering centers in the United States.
        J Health Care Poor Underserved. 2016; 27: 1843-1857
        • Smith-Bernardin S.
        • Schneidermann M.
        Safe sobering: San Francisco’s approach to chronic public inebriation.
        J Health Care Poor Underserved. 2012; 23: 265-270
        • Jarvis S.V.
        • Kincaid L.
        • Weltge A.F.
        • Lee M.
        • Basinger S.F.
        Public intoxication: sobering centers as an alternative to incarceration, Houston, 2010-2017.
        Am J Public Health. 2019; 109: 597-599
        • Mechem C.C.
        • Yates C.A.
        • Rush M.S.
        • Alleyne A.
        • Singleton H.J.
        • Boyle T.L.
        Deployment of alternative response units in a high-volume, Urban EMS System.
        Prehosp Emerg Care. 2020; 24: 378-384
        • Klein L.R.
        • Cole J.B.
        • Driver B.E.
        • Battista C.
        • Jelinek R.
        • Martel M.L.
        Unsuspected critical illness among emergency department patients presenting for acute alcohol intoxication.
        Ann Emerg Med. 2018; 71: 279-288
        • Ross D.W.
        • Schullek J.R.
        • Homan M.B.
        EMS triage and transport of intoxicated individuals to a detoxification facility instead of an emergency department.
        Ann Emerg Med. 2013; 61: 175-184
        • Scheuter C.
        • Rochlin D.H.
        • Lee C.M.
        • Milstein A.
        • Kaplan R.M.
        Cost impact of sobering centers on national health care spending in the United States.
        Transl Behav Med. 2019; 10: 998
        • Castro-Marin F.
        • Maher S.A.
        • Navarro T.
        • et al.
        Impact of a mass gathering alcohol sobering facility on emergency resources.
        Prehosp Emerg Care. 2018; 22: 326-331
        • Larimer M.E.
        • Malone D.K.
        • Garner M.D.
        • 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: 1349-1357
        • Srebnik D.
        • Connor T.
        • Sylla L.
        A pilot study of the impact of housing first-supported housing for intensive users of medical hospitalization and sobering services.
        Am J Public Health. 2013; 103: 316-321
        • Fischer Marlee
        • Plorde Michele
        • Meischke Hendrika
        • Husain Sofia
        Lessons learned from a sobering center pilot for acute alcohol intoxication in south King County, Washington.
        J Subst Abuse. 2020; 25: 123-127
        • Cornwall A.H.
        • Zaller N.
        • Warren O.
        • Williams K.
        • Karlsen-Ayala N.
        • Zink B.
        A pilot study of emergency medical technicians’ field assessment of intoxicated patients’ need for ED care.
        Am J Emerg Med. 2012; 30: 1224-1228
        • Patel S.
        • Leslom S.
        • DZW Dezman
        A comparison of three sobering center screens using a prospective cohort of intoxicated emergency department patients.
        Ann Emerg Med. 2017; 70: S52-S53
        • Flower K.
        • Post A.
        • Sussman J.
        • Tangherlini N.
        • Mendelson J.
        • Pletcher M.J.
        Validation of triage criteria for deciding which apparently inebriated persons require emergency department care.
        Emerg Med J. 2011; 28: 579-584
        • Maio R.F.
        • Wu A.
        • Blow F.C.
        • Zink B.
        EMS providers do not accurately note motor-vehicle crash patients with positive serum alcohol concentrations.
        Prehosp Disaster Med. 1995; 10: 110-112
        • Silvestri Salvatore
        • Rothrock Steven
        • Kennedy Dan
        • Ladde Jay
        • Bryant Marsha
        • Pagane Joseph
        Can paramedics accurately identify patients who do not require emergency department care?. 2002; 6 (4): 387-390
        Date: 2020
        Date accessed: December 10, 2020