Harvard professor and author Gene Heyman. Ph.D. had this to say about a community’s response to addiction, “We typically do not advocate incarceration and medical care for the same activities” (2009). Consider this: When caught, a thief goes immediately to jail. Someone having a heart attack goes immediately to the emergency room – deciding the course of action for the thief and the heart attack sufferer is clear and everyone stands united. However, because of a worldview conflict surrounding the root cause of addiction, how to best care for a person who is publicly intoxicated or under the influence of mind altering drugs has grown cloudy. Placement in a jail cell or admission into an emergency hospital room are opposite destinations, but that is a decision that law enforcement officers and health care professionals face regularly.
Since there are laws against public intoxication and driving while intoxicated, this person is clearly breaking the law; yet addiction specialists theorize that this person has a disease called alcoholism and needs therapeutic counseling.
There is no doubt that medical care is necessary for someone who has a dangerously high blood alcohol level, and no one wants this person to die. Poisons overloading the physical body are a dangerous situation requiring medical monitoring at the very least.
There are 3 differing perspectives: is this person suffering from a disease, or are they committing a crime, or are both true? As a society that desires law and order while valuing human life, how should we respond both immediately and in the long term? This one behavior (drinking alcohol to excess or using mind altering drugs) can lead to two different conclusions depending upon your perspective.
A prevalent point of view claims that the addicted diseased person has failed to take the responsible steps to treat his or her substance use disorder (SUD) and therefore did not remain sober. A cancer patient must take chemotherapy and treatments in order to stay alive. The alcoholic, in this line of thinking, must go to meetings, therapy, and talk with a sponsor, etc. to avoid relapse.
But is that a fair comparison? The cancer patient isn’t endangering others like a drunkard who is fulfilling his heart desires (i.e. drunk driving, out of control behavior, threatening to fight, provoking others, etc.)? Was cancer a choice? Some would argue the so-called alcoholic did not choose to be an alcoholic but is that even true?
One of my concerns is for law enforcement. A police officer who finds a publicly intoxicated person acting out of control and endangering other people has a difficult decision to make: to the custody of the jail or to the care of the hospital?
Another concern is for the medical staff at emergency rooms. Managing people under the influence of unknown substances takes a lot of resources and is dangerous. Statistics on violence against healthcare workers are alarming (Gillespie 2010). Of course, like police officers, medical emergency room workers must interact with the publicly intoxicated person. But each time an out of control drunkard (and by that term I’m referring to substance and drug use of all types because alcohol is a drug) must be taken to an E.R., limited community resources are expended and divided.
What are Sobering Centers?
So what about the relatively new idea of Sobering Centers as a solution to some of these concerns?
The American College of Emergency Physicians (ACEP) defines Sobering Centers as, “facilities that provide a safe, supportive, environment for mostly uninsured, homeless or marginally housed publicly intoxicated individuals to become sober” (De Lorenzo, et al 2018).
A Sobering Center in Austin, TX states its mission as follows:
“The Sobering Center Austin provides a safe environment for publicly intoxicated individuals to sober up and, when appropriate, initiate recovery. It aims to enhance public health and public safety by providing an alternative to the emergency room and jail. The Sobering Center Austin is for persons who meet the legal definition of intoxication. Individuals may only be referred and transported to the facility by law enforcement or emergency medical services. It is not a place where friends or family members can bring someone to sober up” (2020).www.soberingcenter.org
An Innovative Solution Offering Some Hope
At first glance, the Sobering Center (SC) seems like a great idea. Law enforcement can do their job more efficiently, the legal system is relieved of some of its challenges with overcrowding of jails, and hospitals can focus on caring for the sick. For those reasons, SC’s are an innovative way to address a pervasive problem. However, an SC is a place without financial or legal consequences for the addicted person served. Within the context of this temporary fix, an opportunity is created though. At best, it creates an opportunity for hope.
There are two types of hope: temporal and eternal. Eternal hope is biblically derived and provided by God through Jesus Christ. Romans 15:13 is a great verse about hope: May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope. Biblical hope is a sure hope not just a “hope so” like when we say, “I sure hope that I win that bicycle!” when referring to a prize-winning contest. That’s temporal hope. Biblical hope is assured when the promise of hope is a promise made by God. God is the only One capable of always fulfilling His promises and He is incapable of lying; therefore, God can always be trusted. Christians must learn to trust Him at His Word (the Bible).
The hope that is offered by a Sobering Center is temporal hope (earthly, or only focused on the things of this life) because it is offered by mankind for mankind — mainly just wishful thinking.
One study of the persons who were served at an SC found that only 3% pursued additional help either from a treatment or rehabilitation program (Koh 2020). The raw numbers were 51 out of 1,605 who “sobered” there. A $1.8 million expenditure that produced a 3% yield causes me to pause on championing the efficacy of Sobering Centers. With such small results, is it a solution? From a Christian perspective, I question the kind of treatment programs to which an SC refers its clients because they will most likely have a Christ-less, secular, unbiblical approach (the vast majority of addiction programs use secular, self-help programs that sobriety comes from any “higher power”). Do SC’s point addicts to all types of programs, including biblical ones? I am doubtful. But that’s where real, eternal hope is offered: in biblical programs that point their clients to Christ.
Digging Deeper into the Research
Because of my curiosity and interest in this topic, I conducted further research by reading such original sources as the American College of Emergency Physicians (ACEP). In examining the data in the ACEP table (2013), I was especially interested in the category of “unduplicated clients.” Since it was not defined, I assumed that description meant the number of unique visitors truly served without repeat. It was fascinating to me to see that in Seattle, only 2,000 of the 18,522 total client encounters were unduplicated clients (italics denotes their terminology). In other words, 89% of the client encounters in Seattle were REPEAT clients, also known as repeat offenders, if you were to use the law enforcement term. Again, we are faced with the question: are these individuals ‘clients to be served’ or ‘offenders of a crime’ to be served consequences? How one answers that question will determine what consequences, if any, should be given to those persons.
While only 3 of the 11 cities (27%) with SCs reported the data for the unduplicated clients (I wish the other 8 SC’s had reported this data!), the three SC’s that did report their data for unduplicated clients had very high duplication numbers of repeated client encounters (2013). San Francisco had 66% of repeated client encounters and Bethel, Alaska, had the best number with only 44% of repeated client events (2013). While Seattle reported the highest number of repeated client encounters at 89%, they did offer follow-up care for its clients (2013) which encouraged me.
Charissa Koh (2020) mentions that repeat clients were 3 times as likely to seek additional treatment. I am unaware of how that particular assertion was calculated since my research did not arrive at the same conclusion (I’m not saying it is not true, just eager to see more data about how the statistic of “3 times more likely” was calculated). In essence, a large number of client encounters at an SC are repeat offenders. $1.8 million was spent on a smaller number of people even though the number of encounters is large (Koh 2020).
Overall, I did not find the data on the ACEP table very helpful in determining the various approaches in each facility nor in ascertaining their effectiveness. Having filled out similar regulatory questionnaires formed by government agencies who were collecting efficacy data, I recognize that the questions can be interpreted in a variety of ways and therefore the way the responses are given will vary greatly. There is just no way around it unless the criteria is standardized around more specific boundaries in the reporting requirements. The ACEP table indicated a wider variety of responses than I had expected.
For that reason, it appears to me that each of the cities with SC’s have different approaches. This variety in one sense is good, but it still makes me wonder what I would find if I were to visit each one of them. Would I find a different mission and vision statement for each of them? Would I find that each one operates differently at a systematic level? I am sure there must be operating variances in how each of these 11 Sobering Centers fulfill their mandate. Regardless, they are trying to meet a community need and can be applauded for their work.
Pros & Cons
Sobering Centers offer limited temporary help for three groups of persons: the addicted, law enforcement, and medical personnel at emergency rooms and urgent care centers. And here are the pros and cons.
Pro: Immediate Help for the Addicted
The addicted are helped by an SC in that they are kept alive in what can be a very serious and life-threatening situation. Their life is valued. Addicts are pointed to other service options through referrals (note: only Santa Barbara, CA, did not refer out for other services). After a night of poor choices resulting in possible feelings of shame, the hope is that an addict MIGHT have a moment of clarity and seek further help – in this report, it did occur 3% of the time (2013).
Con: Removal of Consequences May Diminish Motivation
Ultimately, the addict must make the right choice to seek help for himself and feelings often change once he walks out of the SC feeling better. Without any consequences, addicts more often than not change their minds about seeking further treatment. Circumstances often encourage change.
With SC’s removing the consequences for the addicted, many transformed addicts will tell you firsthand that their own motivation to seek help was some experience or some consequence of their behaviors. When the legal charges and financial costs of their stay at the SC are deleted, I wonder what motivation remains to seek help. In the same WORLD Magazine article referenced above, Nancy Hohengarten, a county judge and a board member of a Sobering Center, claimed that the utilization of “incarceration as a method of persuasion” has been “largely ineffective” (Koh 2020). Some transformed addicts I know personally would disagree. The consequences alone did not produce a change but they created a motivation for seeking further help.
The effectiveness of SC’s is yet to be seen in my opinion. It appears that the process of sobering at an SC is a supervised nap after some vital signs are taken, followed by a referral for additional services, and the addict is released back to the street or home. Sadly, most addicts do not seek further help without some type of external pressure (i.e. legal, familial, financial or vocational). Even with those pressures and consequences, many addicts still fail to seek further help. Removing a consequence for choices that got them to an SC is consistent with a disease model approach to addiction, and this could be the reason for the high number of duplicated clients. Absence of consequences for the addict probably encourages more irresponsible behavior.
Let me be clear that consequences alone do change the human heart; only the Holy Spirit working in partnership with the Word of God is powerful enough to produce real heart changes in terms of one’s desires. Remember that Romans 2:4 tells us about God’s intentions for repentance through his kindness, forbearance, and patience.
Pro: Law Enforcement Benefits
The many benefits of SC’s for law enforcement in our local communities are appreciated. Now they have a place to take an intoxicated person other than jail or the E.R. They can send the calm, compliant drunkard to a Sobering Center. Imagine the chaos that would ensue though when persons from rival gangs or some other perceived enemy run into each other at an SC. So violent or threatening drunkards would NOT be appropriate for an SC and need to go to jail. Violent or threatening behavior at an SC would necessitate that police officers be called back to the SC to arrest the non-compliant person.
From a law enforcement perspective, an SC provides the same provision as would a rescue mission, a homeless shelter, or jail cell. Intervention in the situation is necessary because this is a law-breaking citizen who might pose a threat to the community. SC’s give the police another option.
Con: Vicious Cycle That Lacks Transformation
The serious concern is that the person sobers up, fails to learn a lesson, fails to experience a consequence designed by society’s laws (and God according to Romans 13) to bring change, and gets intoxicated again, becoming a repeat offender. How would law enforcement react to the second, third, fourth, etc. incidence of needing an SC? This is a vicious cycle that frustrates law enforcement officers who already see this pattern at work in the current system.
Pro: Medical Personnel Benefits
A positive benefit of SC’s for medical personnel is that they are spared the time, frustration, and seemingly futile effort of tending to a drunkard versus caring for the wounded, sick, etc. Freeing up beds and resources for others is a positive benefit, and the safety of these medical professionals is high priority as well. Less wait times at an E.R. may be another benefit to the community at large.
Con: Community Resources are Expensive
Our community resources are consumed when a drunkard becomes publicly intoxicated, and it doesn’t appear that the SC approach saves tax-payer dollars. On the law enforcement side, an SC could perhaps be less expensive when compared to the costs associated with the apprehension, transportation to a jail, actual time in custody, and the resources lost from law enforcement officers. Incarcerating a drunken person is not a quick process. But medical care is expensive. Who is most qualified to care for the person? Who should pay for the care? What is a viable solution to this ongoing problem? Again, a police officer tending to this situation cannot be available to serve the community in other urgent concurrent problems in the community. And a medical person is not being utilized to care for other urgent pressing community health issues.
Overall, from a biblical viewpoint, I don’t view an SC as an effective solution; rather, an improvement. The duplicated clients data I referred to previously, though admittedly limited, is one main reason.
The addicted person who arrives at an SC is shown a form of biblically-derived unconditional love. Despite their sinful choices, they are provided with loving care and a chance to get sober. However, I don’t believe any real heart change will routinely or magically occur after sobering up in an SC. There is the possibility that an addict would seek further help, but if that further help never acknowledges the One True God of the Bible, is it really a help at all?
Without any financial or legal consequences, will the addicted person be motivated to seek help or will they continue in their addictive choices? Will this delay in seeking help likely result in the individual’s death?
The SC looks like a gracious thing from a worldly perspective, but grace might just be mislabeled with what the church calls cheap grace, and therefore not gracious at all. Sometimes grace comes in the form of an arrest and a night or two in jail because it provides motivation for real change and true hope rather than a “hope so.”
We Christians believe in a God who does not overlook or turn a blind eye to our sin but actively placed His wrath on His own Son. The punishment for our sins was placed upon God’s only begotten Son so that we might receive the free gift of eternal life (Ephesians 2:8-10, John 3:16). It was not cheap grace because the cost was Jesus’ death on the Cross. The gift is offered freely to all of us, but it cost Jesus His earthly life to atone for our sins.
Heyman, G. (2009) Addiction: A Disorder of Choice. Cambridge, Mass.: Harvard Univ. Press, p.1
Gillespie GL, et al. (2010). “Workplace violence in healthcare settings: risk factors and protective strategies”. Rehabilitation Nursing, Sep-Oct;35(5):177-84. ncbi.nlm.nih.gov/pubmed/20836482/
De Lorenzo, R. A, et al. (2018, April) Sobering Centers. American College of Emergency Physicians. https://www.acep.org/by-medical-focus/mental-health-and-substanc-use-disorders/sobering-centers/
Sobering Center Serving Austin and Travis County. (2020, March). Our Mission, Our Impact. Accessed March 30, 2020. https://soberingcenter.org/
Koh, C. (2020, Mar. 11). A Sobering Task. World Magazine. https://world.wng.org/content/a_sobering_task.
ACEP. (2013). Sobering Centers in the US. https://www.acep.org/globalassets/uploads/uploaded-files/acep/clinical-and-practice-management/resources/publichealth/sobering-centers-2013_feb14.pdf