Case Study: Saving Lives and Resources at New Rural Sobering Center in Butte County
An emergency visit or arrest for public intoxication often results in expensive, avoidable personal and societal cost. The individual is left with hospital or legal bills and fines, and the community has used expensive healthcare, law enforcement, and court resources to care for or process the community member. In addition, the individual receives little, if any, long-term support to change behaviors and prevent future arrests.
A study published in Translational Behavioral Medicine estimates that the United States could save as much as $1 billion a year by instead diverting eligible intoxicated individuals to sobering centers.
Opportunities to expand this service are growing across the United States, and sobering centers are currently covered under the California Advancing and Innovating Medi-Cal (CalAIM) program’s Community Support services through a section 1115 Medicaid waiver. This case study explores admission criteria, a patient’s path, success factors, results, and learnings at the Butte County Sobering Center, which opened in August 2024 in Chico, California, as a Medi-Cal Community Supports service.
A sobering center is a short-term facility that provides a safe environment for those who are publicly intoxicated from alcohol and/or other drugs to rest and recover. The National Sobering Center directory lists more than 15 centers in California and more than 90 in the United States and Canada. Sobering centers provide an alternative for referrals “by paramedics, law enforcement, emergency departments, other programs, or via self-referral and walk-in,” according to a California Health Care Foundation report, Sobering Centers Explained: An Innovative Solution for Care of Acute Intoxication.
Those who are found to be intoxicated in public settings often are homeless or lack stable housing situations. They typically are sent to either the emergency department or jail, where there may not be adequate medical, human, and financial resources to address their needs, resulting in the utilization of more healthcare or law enforcement services in the future. Sobering centers, which are supported by the American Medical Association (AMA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), offer a lifesaving and cost-saving alternative to assist a vulnerable population that suffers from alcohol use disorder and/or drug addiction.
In California, sobering centers are one of 14 Medi-Cal, or Medicaid, Community Supports, nontraditional services eligible for managed care plan reimbursement that help address members’ health-related social needs and help them live healthier lives while avoiding higher, costlier levels of care. Sobering centers help meet CalAIM goals by providing access to equitable, integrated care for at-risk individuals who otherwise would have had difficulty in receiving the care and support they need to live healthy, meaningful lives. Utilization of these centers saves emergency department, hospital, and law enforcement time and resources.
In addition to treating immediate needs, sobering centers provided through Medi-Cal offer a path to long-term recovery by providing substance use education and counseling as well as care navigation and warm hand-offs for additional substance use, healthcare, and homeless care. Sobering centers also may provide connections to criminal justice, and probation services, functioning as referral hubs, according to the California Health Care Foundation report.
Sobering Center Services
Sobering centers offer support such as:
- Medical triage
- Lab testing
- Temporary bed
- Rehydration
- Food services
- Nausea treatment
- Wound and dressing changes
- Showers
- Laundry facilities
Butte County Sobering Center – A Program of Horizon Services
One such sobering center has seen high uptake and impactful results since opening in Chico, California in August 2024. Horizon Treatment Services, a California-based organization, was operating sobering centers in Alameda and Santa Clara counties when they began working with Butte County Behavioral Health on the new 12-bed center.
The Behavioral Health Department, which is the primary contracting entity for the Chico sobering center, secured space for the center within a building that also includes a larger healthcare facility and other behavioral health services. As the designated space was fairly turnkey, Horizon quickly deployed IT infrastructure, refreshed the space with some paint, installed furnishings, and managed other important details such as signage. The Horizon team also moved quickly to hire its team members, training them together during a focused series of labs over two weeks to foster a cohesive team. The agency’s EHR platform was able to leverage its prior Sobering Center deployments to quickly scale operations into a new region with only slight modifications.
The new service was shared in the local news, with flyers, and through conversations with key players to build awareness about its services and to celebrate the momentous occasion at a grand opening event.
A Patient’s Path Through a Sobering Center
A patient’s path, as shown in Figure 1, is structured to provide them with the support they need in the moment and the resources they’ll need in the future while reducing the personal and societal costs associated with a jail or emergency visit for intoxication.
Figure 1: Sobering Center Patient’s Path
Admission Criteria
Community members who present with the following symptoms are directed to other services:
1. The person is experiencing active withdrawals
2. They have experienced head trauma or a recent head strike, or they have bleeding, open wounds or fractures.
3. They are unable to carry out daily living activities, such as bathing or dressing, when sober.
4. Their vital signs are unstable.
5. They show an altered mental status without an explanation.
6. The client is on a 5150 hold, or the temporary detention of someone experiencing a mental
health crisis.
7. They aren’t intoxicated.
In some cases, a community member’s symptoms require an emergency department visit.
Sobering center team members use the following criteria to make that determination:
1. The person begins to go into withdrawal after intake.
2. Their vital signs are unstable.
3. They have symptoms of severe dehydration, chest pain, respiratory distress, and/or
abdominal pain.
4. They have an acute medical need such as vomiting blood, actively seizing, or have a fracture.
5. They are showing signs that they are suicidal.
Success Factors
Horizon’s experience at its other two sobering centers provided a foundation for a successful launch of the Chico location. The project also benefitted from no-cost consulting services provided by a sobering center expert through the California Department of Health Care Services (DHCS) Providing Access and Transforming Health (PATH) Technical Assistance (TA) Marketplace program.
Other key success factors included support and partnership from key players such as county Behavioral Health, managed care plans, nearby emergency departments, other behavioral health providers, local law enforcement, and community partners. The county, for instance, helped clear barriers, generate funding from local cities, and link Horizon to relevant stakeholders. A report on the sobering center was presented to the Nor Cal PATH Collaborative and Implementation group of 80+ providers and partners serving Butte and nine other counties in the region. In addition, the Horizon team participated in a Recovery Month event at Hope Commons Church in Chico.
Building strong relationships and value propositions is critical because introducing a sobering center often disrupts stakeholders’ existing processes and culture. For example, law enforcement officers initially were concerned about the legalities and liabilities of dropping people off somewhere besides jail. Being unfamiliar with the concept of sobering centers, some were skeptical, diligently concerned that using it could backfire on them if something happened to the client after drop-off. Horizon recommends finding champions within each partner organization to help generate buy-in and to problem-solve internally.
It is also important that Emergency Management Services (EMS) team members such as paramedics have flexibility as they make decisions about transporting an intoxicated community member to a sobering center instead of jail. Regulatory requirements such as AB 1544 place restrictions on EMS’ ability to use Sobering Centers as an alternative destination site. This is currently being explored for Horizon’s Butte County Sobering Center, but certain program design elements would need to be adjusted, including the addition of registered nurse staff to certain shifts when EMS drop-offs would take place.
Results
Harm Reduction
Horizon CEO Jaime Campos shares advice for others embarking on opening sobering centers. “The most important takeaway is for someone to define what success looks like in the context of sobering centers,” he says. “To the untrained eye, it can look like the program is not successful when a patient cycles in and out over and over again. Holding a harm reduction lens is very important. We have seen firsthand stories of hope and healing after clients come to us well over 20, 50 times and beyond. Eventually they develop a rapport with our sobering staff and finally reach out to break the cycle of repeat admission and start their recovery journey! That’s what it’s all about.
“And even for those who aren’t interested in an immediate change concerning their substance use, the community wins by freeing up their emergency response resources while the client also wins by having a safe place to rest and get hydration and referral resources to reflect on when they’re ready.”
Survey Responses
Horizon’s patient feedback also has been extremely positive for its new Sobering Center program. Of 257 responses to its patient experience survey from August through December 2024, the center received an average of 4.60 stars out of 5 overall, combining the categories outlined in Figure 2.
Figure 2: Sobering Center Patient’s Path
Referrals and Utilization
Sobering center referrals to other services is a helpful measure of impact, Campos says. If not for the sobering center, many of their clients would find themselves in jail or the emergency room, or simply homeless on the streets engaging in high-risk behaviors associated with their drug and/or alcohol use. In one example from a Horizon sobering center, a male client who regularly utilized sobering services started to accept referrals to other providers as well as temporary shelters. The client's utilization of the sobering center decreased as he began medication- assisted treatment, found housing, and connected with a primary healthcare provider.
Campos celebrates their impact to date: “The program is truly achieving an open-access and low-barrier operational characteristic so the majority of the utilization (95%) is composed of those needing to simply walk in to get the help they need. In this sense, Butte has benefited from a great improvement in access to care.”
Learnings
Transportation
Unlike Horizon’s Bay Area communities, Butte County is rural, which poses a challenge for transportation. While Horizon’s other sobering centers offer that service, it was not recommended for this location because of the time it takes for their vans to reach clients in remote locations. Partnering with hospitals and law enforcement can be helpful to address transportation needs. Such coordination requires careful planning and education about sobering center admission criteria so the partners can accurately triage potential clients before embarking on the trip.
Outreach
With the rural nature of the county, outreach is also vital to ensure clients in need of services know about the sobering center and the services it offers. Horizon’s team goes out into the streets and visits camps to let them know who they are and what is available to them. Proactively reaching out to let the community know they have a place to go when they need it is also a great way to build program volumes as a new program gets established.
Co-Locating Services
To address rural transportation and outreach challenges and meet clients where they are, Horizon recommends co-locating complementary services such as detox with sobering centers for the ability to triage clients quickly as they are ready. While the Chico location benefits by sharing a space and close proximity with some behavioral health services, Butte sobering center leaders recognize that a detox center would improve their impact and are exploring potential solutions. “Federal or state funding would be helpful to help rural counties establish detox programs if they’re having difficulty participating in the Medi-Cal Organized Delivery System (ODS) waiver,” Behavioral Health Director Scott Kennelly says. Sobering centers can also be anchored to health systems, police departments, and jails.
Blending and Braiding Funding Sources
Funding for sobering centers requires blending and braiding resources from state-level grants, local and county revenue streams, and other sources. Along with leveraging CalAIM’s Community Support reimbursement benefit, Horizon coordinates multiple funding sources by connecting with the county and the Northern California region’s Medi-Cal managed care plan, Partnership HealthPlan of California. Horizon is also exploring the possibility of offering Enhanced Care Management (ECM) services under CalAIM to help sobering center patients navigate health and social services.
Around 90% of the sobering center encounters are eligible to be billed to Partnership, while reimbursement rates cover approximately 30% of the visit cost. Butte County Behavioral Health also uses opioid settlement funding to support the center’s services.
SAMSHA provides information on financing and fiscal sustainability for behavioral health crisis services in its 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care.
Next Steps and Additional Resources
1. The National Sobering Collaborative, of which Horizon Services is a founding member, provides resources, published research, and a directory of sobering centers.
2. Medi-Cal managed care plans, which administer ECM and Community Supports services under CalAIM as delegated by the California Department of Health Care Services, can provide information about local needs and reimbursement. A directory of managed care plans by county is available at
this link, and the Community Supports Policy Guide provides eligibility information.
3. Local PATH Collaborative Planning and Implementation groups, a CalAIM Providing Access and Transforming Health (PATH) initiative, are also a tremendous resource for providers and county agencies. These groups are focused on building networks of ECM and Community Supports services to care for Medi-Cal members with complex needs and can be a source of information and referrals.
4. DHCS also provides funding and resources to support starting or expanding services such as sobering centers. Opportunities include the PATH TA Marketplace and PATH CITED Round 4. On the TA Marketplace website, visitors can filter by sobering centers to explore technical assistance resources. Sobering centers also were among projects selected for Capacity and Infrastructure Transition, Expansion and Development (CITED) funding in Rounds 1-3, which averaged $1.1 million in awards to ECM and Community Supports providers.
Learnings
Sobering centers are opening across California and the United States as a viable alternative to the high costs and revolving doors of emergency department and jail visits associated with public intoxication. The centers are well regarded among medical, law enforcement, and social service communities as a way to reduce costs and recidivism among this vulnerable population and provide a path to recovery and a transformed life. Partnerships among community organizations, county departments, and managed care plans are keys to implementation success for this innovative service.
Acknowledgments
HC2 Strategies developed this report in partnership with Horizon Treatment Services.
HC2 Strategies facilitates the Nor Cal PATH Collaborative and eight others that support 24 counties and Indian
Health communities statewide in implementing new Medi-Cal ECM and Community Supports services.
- Rebecca Brandes, MPH, Director of Community Impact
- Lauran Hardin, MSN, CNL, FNAP, FAAN, Chief Integration Officer
- Christine Pickering, MBA, APR, Chief Communications Officer
- Jerilene Tibayan, MHA, Project Manager
Horizon Treatment Services provides alcohol, drug, and mental health related services to adults and adolescents through nine programs in Alameda, Butte, and Santa Clara counties. All Horizon programs are evidence-based and provide a safe environment for understanding and addressing substance use disorder and mental health-related issues that keep people from their full potential.
- Jaime Campos, CEO
- Jen Slusser-Macternan, Director of Outreach and Talent Development
