Drs. Otis Warren and Shannon Smith-Bernardin join us to discuss how alcohol relates to social issues. What more can we do for patients that are brought in drunk? What solutions exist at both the individual ED and healthcare system level?

Objectives:

1. Understand the challenges in treating alcohol use disorder in the emergency department
2. Understand alcohol use in the context of social determinants of health
3. Learn about diversion/sobering centers and their potential impact on the treatment of alcohol use disorder and emergency departments

Take-home points:

1. Alcohol use disorder is a chronic disease that should be treated as such. Many of the drivers of alcohol-related ED encounters, however, are driven by social factors.
2. Sobering centers are an alternative to the emergency department or jail for people who are acutely intoxicated on alcohol.
3. Diversion is a triage system that is based on an agreement between law enforcement and EMS allowing for diversion of intoxicated patients to sobering centers if they meet certain criteria.

Additional resources:

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(4):1843‐1857. doi:10.1353/hpu.2016.0166

Smith-Bernardin SM, Kennel M, Yeh C. EMS Can Safely Transport Intoxicated Patients to a Sobering Center as an Alternate Destination. Ann Emerg Med. 2019;74(1):112‐118. doi:10.1016/j.annemergmed.2019.02.004

Smith-Bernardin S, Carrico A, Max W, Chapman S. Utilization of a Sobering Center for Acute Alcohol Intoxication. Acad Emerg Med. 2017;24(9):1060‐1071. doi:10.1111/acem.13219

Guests:

Shannon Smith-Bernardin

Dr. Smith-Bernardin is a professor at UCSF and has a PhD in nursing and health policy. She has extensive experience with sobering centers and diversion programs and has studied their safety, effectiveness, and implementation.

Otis Warren

Otis Warren is an Associate Professor of Emergency Medicine at Brown University. Dr. Warren has been a champion for sobering centers in and around Providence, RI. He and Dr. Smith-Bernadin authored "Identification and Practice Patterns of Sobering Centers in the United States" in the Journal of Health Care for the Poor and Underserved, helping launch the national debate on diversion of intoxicated patients away from emergency departments and to sobering centers.

Contributors:

• Charles Zhang
• Harrison Alter
• Livia Santiago-Rosado
• Austin Tam