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Luis’s last binge started in late August. On the 13th straight day of heavy drinking, he was feeling “really, really bad, like I was gonna pass out.”
He walked into his regular liquor store in Santa Cruz to buy more booze. “The people know me,” he said. “The state I was in, they told me to hold off. I said, ‘No, forget this.’”
He knew he was not far from the sobering center, so he went there instead, where the staff helped stabilize him for a day. Then Luis spent eight days in detox, after which he went into a residential center. “I decided to stay and keep on with the program,” he said.
The day of this interview, Luis had been off the sauce for 17 days. “It feels great,” he said. “Now I wake up full of energy. I am ready for the day. I want to complete the program and graduate from there, and continue with AA [Alcoholics Anonymous] meetings as well.”
That’s how it’s supposed to work at the Santa Cruz County Sheriff’s Office Sobering Center. Opened in February 2024, the sobering center is a low-barrier entry point to substance use treatment and mental health care. People who have been picked up by police for the first time for driving under the influence or for public inebriation can be brought to the sobering center for up to 24 hours to dry out. This way, they can avoid the traditional criminal justice system pathway that puts them in the county jail with people potentially facing more serious charges. Instead, sobering center clients will be cited and given a notice to appear in court.
And now, under the state’s California Advancing and Innovating Medi-Cal (CalAIM) initiative, the cost of these services can be paid for by Medi-Cal managed care plans as a covered Community Support (PDF).
There are around 17 sobering centers operating in California right now, and many counties are looking into the concept. What makes the Santa Cruz project unique and successful is strong support from County Sheriff Jim Hart as well as effective management from Janus of Santa Cruz, the nonprofit organization that operates the county’s sobering center. Janus CEO Amber Williams and her staff coordinated all the transitions Luis made, which can be difficult or impossible in other counties.
Under Hart’s leadership, law enforcement and public health are joined in mutual respect for and belief in this new approach. His distinctive innovation is the requirement that any arresting agency in the county that wants to use the county jail must also commit to bringing eligible people to the sobering center.
When it comes to first-time offenders for driving under the influence or being intoxicated in public, “no other county in California mandates usage of a sobering center,” said Williams.
Sobering Center a Good Match for Large Student Population
Santa Cruz County’s unusual demographic makeup — shaped in large part by the student bodies of local universities, most notably UC Santa Cruz — makes a sobering center especially constructive. “There’s 50,000 kids here, and some of these kids are going to make mistakes. For them to be brought in and sit in the drunk tank, it’s inhumane. It’s scary,” Hart said. “We can do better by them.”
The center will also help people who struggle with chronic alcohol use or substance use disorder, Hart explained, and will save county resources by reducing calls for service and limiting unnecessary bookings. Said Hart, “We can keep arresting them over and over. It’s like banging your head against the wall. Why not try to interrupt that and try to get a company or treatment center like Janus involved?”
Janus has been operating a full continuum of mental health and addiction care for many years, with services ranging from high-risk detox to residential treatment to services for people charged with driving under the influence, or DUI. At the sobering center, the availability of these services is near immediate. As soon as a person who has been driving under the influence is brought in, Janus counselors ask them if they would like to enroll in a DUI program, and explain to them that doing so will help their case in court. “When you go before the judge, you can already show you are resolving the matter,” Williams said.
The sobering center is located adjacent to the county jail, which makes it easy and convenient for arresting officers to direct people to the correct setting. Most visitors come once to the sobering center. Some make two or more visits. “There is a population in the community that keeps cycling through the jail, with high costs and high medical needs,” Williams said. “Now we are able to manage them in our setting.”
Hart estimates that roughly 200 people a month are being diverted from the jail to the sobering center. That comprises about a quarter of the people coming into the jail. “It allows our staff to address people who are more violent, or dealing with a mental health crisis. It allows us to prioritize people coming in other than being drunk in public.”
“Bad things happen in jail ,” he said. “Our jail admissions are led by mental health challenges, addiction, and poverty. That is what drives the system. We want to reduce that incidence of bad things happening. ” Hart thinks the sobering center will have diverted 2,000 people from jail over its first 12 months in operation.
“Jim [Hart] has been in leadership in Santa Cruz County for 36 years,” Williams said. “People trust him here. Same for Janus. I’ve been here 23 years. I understand the population, I love the population.”
Policy Continuity Expected
Sheriff Hart will be leaving office soon, and his successor, Undersheriff Chris Clark, will take office on December 6.
He is a strong supporter of the sobering center. “We see a lot of substance use disorder and mental health,” Clark said. “Usually, it’s both. We respond to 300 crisis-related calls a month. That is a lot for an agency our size. How do we deal with people in those situations? How do we train our deputies to interact with people in those incidents? How do we respect the sanctity of life and the safety of everybody involved?”
Clark thinks the culture of the sheriff’s office is “somewhat special. I chose to work here because of the forward-thinking, progressive nature of the office as a whole. . . . There could be a perception that Santa Cruz is left leaning, but the support for law enforcement has always been good.”
The sobering center fulfills the public’s desire for order in the streets, Clark believes. “You’ll have people high on drugs, acting out, suffering significant mental illness, laying on the sidewalk. Are they a danger? No, not necessarily. But people feel threatened. What the sobering center does for us, when a person is in a crisis, high or drunk, it allows them to be directly connected to services at Janus.”
The budget of the sheriff’s office is about $140 million. The office uses part of those funds to pay for a share of the sobering center’s operating expenses. And law enforcement agencies get a return on this investment: For low-level crimes such as public drunkenness or DUI, there is reduced turnaround time for staff. A person can be delivered and admitted to the sobering center in 10 minutes or less, whereas a jail booking can take much longer.
As a result, the local agencies “get their officer back on the street faster, in a world where staffing is critical,” Clark said. It’s a direct effect, and it happens right away. “That ought to get the attention of most agencies in the state,” he added.
Emergency Departments Appreciate Sobering Center
The benefit to the health care system is equally significant. From a clinical standpoint, many people end up in the emergency department who would be better served elsewhere. “The sobering center is a good example of that,” said Dennis Hsieh, MD, an emergency physician and chief medical officer of the Central California Alliance for Health, the managed care plan that contracts with Medi-Cal to cover residents of Santa Cruz County.
When people who are drunk or high are brought to the emergency department, “not much is done for them except giving them a place to sober up,” Hsieh said in an interview. “It prevents other patients who need to be seen from being moved through the ED as quickly as they should be.”
Emergency departments carry enormous fixed costs that make them expensive to operate, including qualified staffing, specialized equipment, and oxygen hookups that are not usually needed for sobering up. The ED can do the job “but it’s overkill,” Hsieh said, comparing the process to “using a bulldozer to dig a hole in your back yard for a seed, as opposed to using a small shovel.”
The sobering center also helps the health plan meet its goal of assuring that members receive rapid and safe access to services. From the health plan perspective, he said, the sobering center is “a way to provide the right care at the right place at the right time. They get a place that specializes in focusing on them.”
Furthermore, the sobering center is well-positioned to help connect patients to longer-term services and is cost-effective for the health plan. It offers “compassionate, supportive, and professional patient-centered care” that enables patients to avoid jail and focus on recovery, Hsieh said.
A Big Step
That is how it has worked out for Luis.
“In my personal life, I was having a lot of problems,” he said in an interview from the residential treatment center. He was having DUIs and losing jobs. “Everything kept stacking up. I started arguing constantly with my wife.
“I am tired of that. I wanted to break that routine. I went to the sobering center, now I’m here.
“Without the sobering center, to be honest, I don’t know what I’d be doing,” he continued. “In some ways it is helpful to listen to other people. I am learning, doing group meetings, talking about our feelings. All that helps me out. I think it’s a big step for me.”
Authors & Contributors
J. Duncan Moore Jr.
J. Duncan Moore Jr. is a freelance writer based in Kansas City, Missouri, who has been writing about health care for more than 25 years. He is a founder of the Association of Health Care Journalists.
Shmuel Thaler
The 2016 Santa Cruz County Artist of the year, Shmuel Thaler has been a staff photographer at the Santa Cruz Sentinel since 1987. His photographs have appeared in every major newspaper in the United States. He spent much of 2020 documenting the Black Lives Matter actions, the election, the CZU August Lightning Complex fires, and the pandemic for the Sentinel. His photograph of Santa Cruz Police Chief Andy Mills and Mayor Justin Cummings was seen by millions when it went viral, aired on every major TV network, and was shared by Octavia Spencer, Katie Couric, George Conway, and thousands of others on social media.
