The San Francisco Sobering Center

In 2002, approximately 50 community stakeholders, including the San Francisco Department of Public Health, convened to find a solution to the persistent overuse of San Francisco emergency departments as sobering places for homeless chronic inebriates. The San Francisco Sobering Center (SFSC) was thus established in an effort to improve care and decrease the costs associated with chronic alcoholics. By providing health care, offering a physical place to rest while sobering, and identifying chronic inebriates who are high-utilizers of ambulance services, the SFSC seeks to reduce emergency department visits and decrease the rate of alcohol-related ambulance transports.

The primary target populations cared for by SFSC are homeless individuals with alcohol dependence. Clients are referred to SFSC by emergency services, police, social workers, and emergency departments. In order to qualify for a bed at SFSC, individuals must have no history of medical or psychiatric conditions requiring medical treatment. Clients typically stay 6-8 hours at the SFSC and receive food, clothing, and access to shower facilities. Preceding discharge, SFSC staff interview clients to determine their housing status and medical history. In addition, SFSC alerts relevant case managers and primary care providers of the client's visit and release. The SFSC is funded by the San Francisco Department of Health's general fund.

The goal of the San Francisco Sobering Center is to reduce the burden of alcohol-dependent people on hospital emergency departments by providing a space for intoxicated individuals to sober and receive health care services.

Since 2003, the San Francisco Sobering Center has provided services to 8,100 clients and potentially prevented over 29,000 unnecessary emergency department visits and ambulance transports. The estimated cost of ambulance transport and emergency department utilization ranges from $1,850 to $3,800. Given the daily cost of $2,700 to keep the SFSC operational, the 10-14 average daily clients amount to a substantial cost avoidance for the City of San Francisco. Approximately two percent of the clients account for over 70% of SFSC occupancy, signaling that the SFSC is successfully working with the community and emergency services to target chronic inebriates. In addition, the SFSC maintains an independent van transportation service that works with emergency services and the San Francisco Police Department to pick up clients directly, allowing emergency and police units to return to patrol.