Sobering Unit in Wash. Saves Money, Lives

July 25--On a given weekday afternoon, the sobering units at Clark County's Center for Community Health can be completely empty. That's because most people arrive in the evening through the early morning hours, said Jared Sanford, Lifeline Connections' executive director.

Figuring out the busiest times and adjusting staffing levels was part of the staff's learning curve since the sobering center opened in January.

So far, there have been 2,600 admissions of a total of 408 clients. Some of those repeat visitors are the hardest to reach and costliest to the system, Sanford said. Often, these people are chronically homeless and facing long-term substance abuse problems.

"We do have folks that are frequent fliers," Sanford said.

Most of them walk to the back door and buzz themselves in. Others are dropped off by police or taxis. People can stay for 12 hours and must leave for four hours before returning.

The center is a free first-come, first-served place to sober up, sleep and eat a meal. It's a safe, cheaper alternative for people who would otherwise wind up in jail or in the emergency department. The average daily cost of dealing with a substance abuse problem in a hospital is more than $1,300 a day, according to the Washington State Hospital Association.

If those 2,600 admissions had ended up in the hospital for a full day's stay, the cost to taxpayers would be at least $3,380,000. The sobering unit's $84 daily cost brings the bill down to $218,400 -- a savings of more than $3 million. Even if the number of admissions were cut in half (because the stay is 12 hours, not a full day) that's still nearly $1.5 million saved in the first six months of operation.

However, it's also about $84 to house somebody in the Clark County Jail. At the sobering center, counselors try to engage with clients and possibly connect them with services that are offered in the same building, Sanford said. The services ideally go in sequence: from five-day physical detoxification to 30-day cognitive and behavioral treatment to 90-day outpatient counseling and support. Lifeline is connected with a variety of agencies that assist people with food, housing and employment.

If Lifeline is able to close the revolving door for just a handful of those heavy users of the system, it would save a lot of money, Sanford said.

Drug trends

One surprising statistic that came from analyzing who was coming into the sobering unit is that 42.7 percent of people reported methamphetamine was the primary drug they had used in the previous 24 hours.

Based on drug trends and the people who use the long-term services at Lifeline, Sanford believed meth use had waned, but the data from clients using the sobering center suggest the drug may be making a resurgence.

In Lifeline Connections' residential and outpatient treatment programs, clients are primarily dealing with heroin and opioid use. Another difference is that the clients in the sobering unit tend to skew older -- they're people who have been dealing with substance abuse for years -- whereas those in the programs are mostly in their 20s and 30s, Sanford said.

Sandra McCloskey said that in about the last nine months, she has seen an increase in people working through felony drug court who are dealing with methamphetamine abuse. It used to be more common to see people struggling with addiction to heroin, pain killers, or other opioids, said McCloskey, who is the therapeutic courts coordinator for Clark County Superior Court.

"I think it goes in cycles," she said.

One of her theories for the recent uptick is that when methamphetamine use was high, around the early to mid-2000s, there were more programs and prevention geared toward combatting it. The Combat Methamphetamine Epidemic Act of 2005 prevented some drugs that contain main ingredients used in making meth from being sold over the counter. Methamphetamine use declined, and prevention efforts shifted to the next drug of choice.

Pick-up services

Most people who come into the sobering unit walk in off the street, Sanford said. Others are picked up by emergency responders after 911 gets a call about somebody perhaps passed out or acting out from a drug- or alcohol-fueled bender. Although police officers can meet these people and take them to the sobering unit, ambulance companies can't. Legally, such companies as American Medical Response have to take people to a hospital first.

"We still see them because we have to medically clear them, but they don't have to stay as long in the emergency department," said Angela Graves, clinical manager for the emergency department at PeaceHealth Southwest Medical Center. "As we all know, it takes hours to get sober."

After a short evaluation to make sure there's no pressing medical issues, the patient is put in a cab and transported to the Center for Community Health to sober up.

The way things are done should change in about a year. A new bill was signed into law on May 1 allowing ambulances to transport people in need of chemical dependency services to alternative facilities, such as the sobering unit. The guidelines for doing so still have to be worked out, but emergency departments should soon get relief.

To further ease the strain on emergency responders, Sanford is looking into getting his organization a van that would pick people up and take them to the sobering unit. The van would tap into emergency dispatch and go to the 911 calls currently assigned to police and firefighters.

A similar resource is used in Portland, Sanford said. Lifeline Connections has to secure funding and a vehicle before something similar can become a reality in Clark County.

Copyright 2015 - The Columbian, Vancouver, Wash.