This guide begins by describing the problem of chronic public inebriation and reviewing factors that increase its risks. It then identifies a series of questions to help you analyze your local chronic public inebriation problem. Finally, it reviews responses to the problem and what is known about these from evaluative research and police practice.
The problem of chronic public inebriation takes many forms and has numerous negative social consequences.† While chronic inebriation occurs in many different settings, such as the home, workplace, and bars, this guide focuses on chronic inebriation in outdoor public spaces, with a particular emphasis on chronic inebriation among those who spend a good portion of their daily lives on the street.
As used in this guide, "chronic inebriation," "chronic inebriate," or "alcoholic" refer to individuals whose lives are dominated by the use or abuse of alcoholic beverages such that they have substantially withdrawn from conventional society.1, ††
Chronic public inebriation is but one aspect of the larger set of problems related to alcohol abuse and street disorder. This guide is limited to addressing the particular harms created by chronic public inebriation. Related problems not directly addressed in this guide, each of which requires separate analysis, include:
† Multiple sources confirm the frequently conjoined issues of mental illness, homelessness, alcoholism and other substance abuse. See Bahr (1973), Finn (1985), Finn and Sullivan (1987), Snow and Anderson (1993), and Wiseman (1979).
†† According to the World Health Organization, a person is alcohol dependent if he or she has three or more of the following six manifestations, occurring together for at least one month or repeatedly within one year: compulsion to drink, lack of control, withdrawal state, tolerance, salience, and persistent use (WHO 1992). The city of San Diego, California, employs a simple measure to classify an individual as a "chronic inebriate." Their criterion is whether the individual in question has been admitted five or more times to the city's sobering center within a 30-day period.
Some of these related problems are covered in other guides in this series, all of which are listed at the end of this guide. For the most up-to-date listing of current and future guides, see www.popcenter.org.
When chronically inebriated individuals disruptively or persistently violate community standards by being intoxicated, panhandling, acting aggressively, or passing out in places not "approved" for such behaviors, the police may be called to intervene. As is also the case in dealing with mentally ill and homeless populations, it is important to recognize that chronic public inebriation is not, in and of itself, solely a police problem. It is also a medical and social services problem. That said, a number of the problems caused by, associated with, or resulting from chronically inebriated individuals often manifest themselves as police problems, such as disorderly conduct, threats, public urination and defecation, passing out in public, thefts, and assaults.
Chronic public inebriates are nearly as likely to be victims of crime and other hazards as they are to be offenders, and some of that victimization will not be reported to police. Their inebriation leaves them less capable of defending and caring for themselves and their property. From a moral, legal, and professional standpoint, it is important to acknowledge that chronic inebriates do not forfeit the rights and expectations afforded all other members of the community just because they are caught up in a harmful or negative dynamic.
Image1: Chronic inebriates such as the one pictured here may become victims of crime as they are less capable of defending and caring for themselves.
Photo Credit: Shutterstock No.81784615
Evolution of Chronic Inebriation Law and Policy
As far back as ancient Egypt, public policymakers battled problems associated with chronic public inebriation.2 Public intoxication was first criminalized by the English in 1606.3 By 1619, criminalization of public drunkenness reached the American colonies, but it took until 1810 before treatment of public inebriates began with Benjamin Rush's "sober houses."4
In the United States, beginning in the mid-1960s, law and public policy began shifting away from criminalizing public inebriation to treating it as a medical and public health problem,5, ‡ a shift that helped foster the idea that effective responses to chronic public inebriation would not be solely a police responsibility but would require broader community action. In 1970, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act went into effect. This act provided state and local governments with financial resources to support alcohol-abuse reduction programs. It also created the National Institute on Alcohol Abuse and Alcoholism. By 1973, states were being pressed to decriminalize public drunkenness in favor of a social model based in treatment.6 In 1987, the federal government began funding alcohol-dependency treatment programs for homeless people.7
‡ U.S. courts have considered whether a homeless person might successfully invoke constitutional protections, such as the Eighth Amendment's prohibition against "cruel and unusual punishment," because they lacked a private place to drink. See, for example, Robinson v. California, 370 US 660 (1962) and Powell v. Texas, 392 US 514 (1968) for leading cases on this issue. See also McMorris (2006).
Chronic public inebriation is commonly entwined with a number of specific behavioral problems and conditions, including the following:
‡‡ The likelihood of rehabilitation among individuals who are both alcoholics and homeless is exceedingly low (Argeriou and McCarty 1993; Podymow et al. 2006; Castaneda et al. 1992; Richman and Smart 1981; Richman and Neuman 1984; Cox et al. 1998). Another body of research, however, observes success among strategies predicated on stabilizing residency as an element of substance abuse counseling (Larimer et al. 2009; Grella 1993; Coffler and Hadley 1973).
Beyond street-level consequences, chronic inebriates pose a significant and disproportionate drain on public resources. In Anchorage, Alaska, almost 2,000 chronic inebriates accounted for approximately 19,000 visits to that city's sobering center in a single year.α Moreover, a mere 200 individuals accounted for 56 percent of all visits to the center during 2007.9 A study in San Diego, California, reached similar conclusions,β noting that the episodic emergency care demands created by chronic inebriates have a significant cumulative impact on the community's safety-response system through emergency room overcrowding, ambulance diversion, and a shortage of available bed space.10, γ Roanoke, Virginia, provides a similar example: an analysis of that city's drunk-in-public arrests revealed that 2,642 different individuals were responsible for 4,099 incidents during 1997. Within this group, 45 individuals (1.7 percent) were responsible for 919 incidents (22.4 percent).11, δ
α Throughout this document, the terms "sobering center" and "detoxification center" are used interchangeably to indicate a short-term facility where inebriated individuals can sober up in a protected environment.
β The City of San Diego studied the impact of 529 homeless alcoholics, many of whom also had other medical or mental illness issues, on public resources. From 2003 to 2005, 308 individuals (58 percent) were transported by emergency medical personnel 2,335 times, 409 individuals (77 percent) accounted for 3,318 emergency-room visits, and 217 individuals (41 percent) required 652 hospital admissions, resulting in 3,361 inpatient days. Health care charges totaled $17.7 million. Payment for only 18 percent of charges was received.
γ A study in the United Kingdom found that an alcoholic patient's use of health care services before getting treatment for alcohol abuse is up to 15 times greater than that of the general population, but after alcohol treatment these costs decline significantly (Malone and Friedman 2005).
δ While a dated statistic, Bahr (1973:228) recounts that just six "alcoholic" individuals in the mid-1960s had been arrested in Washington, D.C., 1,409 times and had been incarcerated a combined total of 125 years. Figures like this are common even tod.
The traditional police approach to the management of chronic inebriates has been characterized as "a rare mixture of almost paternal indulgence, strictness and an ad hoc decision-making not found elsewhere."12 Dealing with chronically inebriated individuals also exacts an emotional toll on police officers.13 It can lead, for example, to the following:
Taken together, chronic inebriates create a demand for service widely disproportionate to their numbers. Moreover, chronic inebriation (and its companion offenses) is often processed rapidly through criminal courts. Because individuals charged under public drunkenness statutes typically spend little time in custody, this creates a "revolving door" system in which all stakeholders suffer and service demands stay high. Beyond this, the prospect of reintegration into mainstream society is a daunting proposition for many chronic inebriates. Those individuals, who have spent so much of their lives on the streets, must relearn the basics of normal daily living. Many chronic inebriates have long-term cognitive damage from their rough lifestyles as well as underlying mental illnesses.18, ζ
ζ Deni McLagan with Mental Health Systems in San Diego talks about the difficulties of changing decades of dysfunctional behavior among long-time chronic inebriates: "The first 30 days we're modeling social behaviors with them, such as hygiene, riding the bus, feeding themselves, taking medications. We're just trying to get the guy to shave and bathe in the first month. In the second or third, we'll get them employment."
The level and degree of harm caused by chronic public inebriation is affected by a number of contributing factors, which may include the following:
This can compel police to deal with the problem solely as a criminal issue, with less than optimal results.
An area with many retailers of alcoholic beverages may attract chronic inebriates to the area and facilitate their problem behavior. However, hot spots - places where inebriates tend to concentrate and cause problems (e.g., parks, transit stations, the periphery of shelters, near liquor stores) - near businesses that sell alcohol do not necessarily coincide with dense clusters of the establishments themselves, nor do they coincide with areas in which general crime levels are high or with areas with a high level of lethal violence related to alcohol use.19
These areas are more likely to attract chronic inebriates, because they often are accompanied by better opportunities for procuring alcohol and the money needed to purchase it, as well as providing some measure of anonymity for inebriates.
Public areas tend to often serve as points of congregation for chronic inebriates, and poorly designed and managed ones facilitate problem behavior.
While normally designed to eliminate problems, sometimes laws and regulations that facilitate the sale of single-serving containers, fortified wines, malt liquor, and other low cost/higher alcohol-content beverages are likely to increase chronic inebriates' consumption and intoxication levels, and, thereby, their problem behavior.
The existence of laws that criminalize - and the absence of laws that decriminalize - public inebriation provide resources for a medical-treatment response will shape how police and others are able to address the problem.
Whatever its cause, homelessness is likely to coincide with a high level of chronic public inebriation, because residential stability is an important predicate for effective substance abuse treatment.20
Each community usually has its local standards and sensibilities about public order. Some communities are considerably more tolerant than others of deviant or disorderly behavior in public. General community attitudes are usually then reflected in elected officials' attitudes towards the problem.
Like individual communities, police departments also vary. Some police agencies can afford to devote personnel to the careful management of chronic public inebriation; others cannot.
Understanding the factors that contribute to your problem will help you frame your own local analysis questions, determine effectiveness measures, recognize key intervention points, and select appropriate responses.
Any systematic understanding of your particular local problem also begins with identification of those individuals and organizations within your community who are affected by or are called to respond when chronically inebriated individuals create a service demand.
The various groups of community stakeholders will likely have divergent - and sometimes conflicting - priorities, perspectives, and goals that will have to be effectively reconciled. In addition to criminal justice agencies, the following groups have an interest in the problem of chronic inebriation and should be considered for the contribution they might make in gathering information about the problem and forming systematic responses to it:
Based on the data and input from community stakeholders, the nature and scope of local problems will start to come into focus. Before planning your response, you need to establish the basic scope and dimension of your problem. Some relevant questions might include:
Measurement allows you to determine to what degree your efforts have succeeded and suggests how you might modify your responses if they are not producing the intended results. Even though the seriousness of a given problem may drive a desire for immediate action, the most successful responses are borne out of careful planning. As such, you should take measures of your problem before you implement responses to determine how serious the problem is and after you implement them to determine whether they have been effective. You should take all measures in both the target area and the surrounding area. For more detailed guidance on measuring effectiveness, see Problem-Solving Tools Guide No. 1, Assessing Responses to Problems: An Introductory Guide for Police Problem-Solvers and Problem-Solving Tools Guide No. 10, Analyzing Crime Displacement and Diffusion.
In thinking about the relative success or failure of a given response, you will want to consider exactly what goals and outcomes are desirable, appropriate, and realistic for your community. Some communities that have employed the following responses regard success as the mere removal of an obvious problem from public view (e.g., reducing the number of chronic inebriates in the city parks). Some are much more holistic, defining success not only in terms of removing public disorder or lessening certain service demands, but as a measure of facilitating positive change in the lives of the chronic inebriates themselves. While broad proclamations of success or failure are often difficult to make without some qualification, you will likely need to assess any response with a mixture of both qualitative and quantitative techniques to gauge your effectiveness.
Evaluation (or assessment) measures are of two types: process measures and outcome measures. Process measures show the extent to which responses were properly implemented. Outcome measures show the extent to which the responses reduced the level or severity of the problem. Because your local circumstances may differ from those of other places, you might develop additional questions unique to your local problem. The following are potentially relevant measures:
Your analysis of your local problem should give you a better understanding of the factors contributing to it. Once you have analyzed your local problem and established a baseline for measuring effectiveness, you should consider possible responses to address the problem.
The following response strategies provide a foundation of ideas for addressing your particular problem. These strategies are drawn from a variety of research studies and police reports. Several of these strategies may apply to your community's problem.
It is critical that you tailor responses to local circumstances, and that you can justify each response based on reliable analysis. In most cases, an effective strategy will involve several different responses. Law enforcement responses alone are seldom effective in reducing or solving the problem. This has proven especially the case in confronting chronic inebriation.21
Do not limit yourself to considering what police alone can do: carefully consider whether others in your community share responsibility for the problem and can help police better respond to it. In some cases, the responsibility of responding may need to be shifted toward those who have the capacity to implement more effective responses. For more detailed information on shifting and sharing responsibility, see Response Guide No. 3, Shifting and Sharing Responsibility for Public Safety Problems.
For further information on managing the implementation of response strategies, see Problem-Solving Tools Guide No. 7, Implementing Responses to Problems.
1. Educating the community about the problem. Unless community members are directly affected by chronic public inebriation, they may be unaware of the broader harms caused by the problem or fail to understand the factors that give rise to it and, as a result, fail to support your planned responses. It is especially important to convey to local people that arrest and punishment of chronic inebriates alone will not solve the problem.
2. Developing community support for your response. Community support is crucial to the long-term viability of your response strategy. Many of the specific responses described below require changes that will directly affect business, government, and social service practices. If, for example, the police response is perceived - rightly or wrongly - by community advocacy groups, charities, or social service providers as being heavy handed or counter to human dignity, community support for your efforts may suffer.
3. Decriminalizing public inebriation. Many, but not all, states and local jurisdictions have shifted toward a medical treatment model to address chronic public inebriation. Decriminalizing chronic inebriation shifts the bulk of the processing of this group from criminal justice to social service agencies. This can lead to confusion, resentment, and misunderstanding among the professionals who are involved. If your jurisdiction is newly shifting toward decriminalizing public inebriation, it is important that you understand and anticipate the following implications:
Combined responses. Most jurisdictions blend therapeutic and punitive mechanisms for processing chronically inebriated persons.22 Try to avoid allowing decriminalization and a medical treatment model to be characterized as a soft or weak approach to the problem.
Diverse special populations. Local populations of chronic inebriates are diverse in composition. Some chronic inebriates will be homeless; others will not (conversely, some homeless persons will be chronically inebriated, and others will not). Some members of both the homeless and chronic-inebriate populations will also have mental illnesses, other substance abuse problems, or other serious problems. In short, the homeless and the chronically inebriated are neither wholly discrete nor wholly overlapping groups. Decriminalization efforts should recognize the diverse and complicated issues these special populations present.23
Dispersed problem areas. In a previous era, "skid rows" served as a concentration point for the destitute, drunk, and disaffiliated. The combined forces of urban renewal, gentrification, and preservation have led these concentrations to disperse. Instead, smaller "mini-skid rows" have emerged in many places.24
Local enforcement attitudes. Those responsible for enforcing applicable laws have differing sensibilities and priorities. Many factors influence the character of local law enforcement: community culture, dominant policing style, administrative priorities and style, individual officers' priorities, beat conditions for patrol officers, and so forth.25
Inadequacy of judicial action alone. Decriminalization of chronic inebriation tends to reduce rather than end the use of criminal processing to deal with public drunkenness.26 When chronic inebriation is effectively decriminalized by court decrees alone, rather than by carefully planned legislation and properly resourced alternatives, it can cause confusion among police who might perceive decriminalization as undermining their capacity to deal with the problem. Deprived of the ability to charge individuals with public drunkenness, police may simply reclassify other behaviors to align with available sanctions (e.g., charging inebriates with such catch-all offenses as disorderly conduct), thus defeating the diversionary goal of decriminalization.27, † Ideally, police should be involved in planning a decriminalization model and be continually involved as implementation strategies are developed.28
Organized change. For decriminalization of chronic inebriation to have sustainable and positive outcomes, it must be undertaken by a group of organizational-level stakeholders whose shared goals are mirrored in the policy change.29
Anticipating and resolving goal conflict. Because interorganizational goals may not be aligned or reflected in the simple act of decriminalization, it can result in conflict or confusion as to new roles and responsibilities.30 Decriminalization invariably places police in closer contact with therapeutic service providers (i.e., sobering centers, hospitals, and social workers). Criminal justice and social service staff often have differing operational mandates, and the tension between the two spheres must be addressed.31
Shifting costs. Reducing the role of the criminal justice system in processing chronic inebriates implies that other actors and organizations in society will assume the associated costs.32 Some of the costs that might have to be redistributed in a decriminalization model are: personnel to provide custodial and medical care of inebriates and perhaps to actively seek out chronic inebriates in public places; detoxification facilities in lieu of jail cells; transportation of inebriates to sobering centers; judicial hearing officers to hear contested involuntary commitments; and new recordkeeping systems.
Legal interpretations. Even as legal and social sensibilities have changed with regard to the problem of chronic inebriation, the decriminalization question has not been settled fully. Some courts continue to see police enforcement of various laws prohibiting conduct associated with routine life activities (such as sleeping and bathing) in public places as unconstitutional.†† Such legal decisions greatly influence and complicate the police role in dealing with chronically inebriated individuals.33
Community attitudes. Efforts to address chronic inebriation as a social problem may be met with hostility or indifference from the public. Some community members may regard chronic inebriation as self-induced and resent the allocation of public resources to address it. Because the chronic inebriate is seen as unproductive (and by extension, morally flawed) or "infectious,"34 rendering assistance may be regarded as enabling the negative behavior. As such, some community members may prefer that chronic inebriates be kept "out of sight and out of mind."
4. Tailoring interventions to individual needs. Because not all chronic inebriates have the same medical, psychological, and social needs, the system must have sufficient flexibility if it is to effectively address individual circumstances. 35, ‡ At a minimum, interventions should differentiate among individuals in each of the four general behavioral/need classifications of chronically inebriated persons described below. ‡‡
† The police manage Skid Row residents in ways that are often only obliquely matters of law enforcement (Bittner 1967). Police often rely on "outdated, ambiguous and possibly unconstitutional laws" in dealing with chronic inebriates (Gammage, Jorgensen, and Jorgensen 1972:39).
†† In Jones v. City of Los Angeles [444 F.3rd 1118 (2006)], the Ninth U.S. Circuit Court of Appeals ruled that the homeless plaintiffs had been subject to "cruel and unusual punishment" as a result of the city's enforcement of a local ordinance aimed at preventing people from sitting or sleeping on city streets, sidewalks, and alleys.
‡ Chronic alcohol abuse is known to cause or contribute to the following health problems: Central nervous system: alcoholic dementia, blackouts (anterograde amnesia), central pontine myelinosis, cerebellar degeneration, epilepsy, Marchiavia-Bignami syndrome, polyneuropathy, sleep impairment, Wernicke-Korsakoff syndrome, withdrawal, and delirium tremens; Muscles: acute or chronic myopathy, cardiovascular system, Beriberi heart disease, cardiac arrhythmias, cardiomyopathy, and hypertension; Metabolism: hyperlipidaemia, hyperuricaemia, hypoglycaemia, and obesity; Endocrine system: pseudo-Cushings syndrome; Respiratory system: chest infections; Gastrointestinal system: acute gastritis: carcinoma of mouth, oesophagus, or large bowel; liver disease; and pancreatic disease; Haemopoiesis: macrocytosis, thrombocytopenia, and leucopenia; Bone: osteoporosis and osteomalacia (Kumar and Clark 2002).
‡‡ While a more comprehensive taxonomy might be possible, this simple distinction is sufficient to distinguish among the major categories of client need. For a fuller explanation of this scheme, see Vermont Public Inebriate Task Force (2010).
A Sample Triage Plan
To determine an inebriated individual's needs, first responders should ascertain whether:
While the four categories of the Sample Triage Plan do not address all contingencies - such as pending criminal charges or warrants - policy makers should ask whether decision-making mechanisms of this kind are in place to direct inebriated subjects to the proper level of service and supervision. As above, this also implies that relevant system staff will be trained to perform this triage and that all parties adhere to a consistent scale for assignment.
Source: Adapted from Vermont Public Inebriate Task Force (2010).
5. Providing integrated social and health services. Because many chronic public inebriates are homeless as well as having other physical and mental health issues, any effective program of responses must recognize this broad constellation of needs. Necessarily then, a well-conceived response to the problem of chronic inebriation must also include elements that address these other issues. For example, responses focused on reducing homelessness - that lead to greater residential stability for an individual - might also position that person to receive regular alcoholism counseling and mental and physical health care. Increased residential stability, receipt of regular counseling, and health care, in turn, might reduce that person's motivation to commit petty crimes or to engage in inappropriate uses of public space and other negative acts.36
Building on the research concerning alcoholism and homelessness, stakeholders in Seattle, Washington, developed a unique response that took aim at the enormous resource burdens chronically inebriated individuals were placing on the area. A group of 199 individuals who presented among the highest costs on the system were selected for no-cost housing in the Housing First residential facility. They were offered free meals and on-site health services, but there was no requirement for substance abuse treatment placed on them. Costs associated with these services averaged $1,220 per person per month. After one year, a program evaluation revealed that in the year preceding placement at Housing First, the program participants had incurred over $8 million in collective costs (jails, EMS, hospital, emergency department, detoxification, Medicare, and so forth). After one year in the program, participants' costs had dropped to $4 million. The average daily alcohol consumption among residents had dropped from 15.7 to 10.6 drinks per day. From these results, researchers concluded that stable housing, coupled with ready access to health services, while posing considerable up-front expense, could yield marked reduction in several related system costs (Levin, 2009). A subsequent study observed similar results: after one year in the Housing First residential program, average associated monthly costs per person dropped from $4,066 to $958. The total average monthly cost per person - after factoring in housing costs - was $2,449 (Larimer et al., 2009).
6. Training service providers to respond appropriately. While many community service providers - such as police officers, EMTs, doctors, social workers, and lawyers - already possess extensive technical and specialized training in their particular area of competency, most successful responses involve a level of coordination, shared goals and integrated procedures across professional boundaries. With any changes to a given agency's standard operating procedures - especially those that require the cooperation of individuals in other organizations - a period of retraining to establish new policy or procedural guidelines will be necessary. As with community and business leaders, those individuals who are responsible for implementing your programs will need to be educated as to what the new expectations and procedures are, and why these changes are necessary and important.
7. Prohibiting alcohol sales to chronic inebriates. The central element of this response is to prohibit the sale or distribution of alcoholic beverages to specific individuals deemed to be chronic inebriates and who engage in a disproportionate amount of undesirable behavior. Decreased alcohol availability should yield a similar decrease in problems caused by chronic inebriates.α
Some communities implementing this response have "dusted off" existing, but unenforced, laws prohibiting alcohol sales to "habitual drunkards."37 For others, new enabling legislation may be required. The Green Bay, Wisconsin, Police Department established a "no-serve" list as one element of their overall response to chronic public inebriation.38 The criteria for being placed on their no-serve list included: having three or more alcohol-involved arrests in a 3-month period; being incapacitated by alcohol, requiring detoxification three or more times in a 3-month period; or involvement in behavior within a particular area of town that resulted in a police call for service. The police then sought to educate business owners in the area as to their legal responsibility to decline service to listed individuals. An interesting dimension of Green Bay's response is that the initiative survived a challenge by a local civil rights group, although not through a formal court ruling.39 You should consult your legal counsel to ensure that a similar approach would be valid in your jurisdiction.
A similar approach was taken by the Pinellas Park, Florida, Police Department.40 Its analysis of the problem revealed that a very small group of individuals (28) was responsible for the bulk of arrests and other alcohol-involved calls for service. Pinellas Park police similarly relied on a disused "habitual drunkard" ordinance to target individuals. To be placed in what the Pinellas Park police refer to as "the Book," one must have been convicted of driving under the influence, or have three convictions for disorderly intoxication.41 Once compiled, the Book was annotated with photographs of the identified individuals. As in Green Bay, the police then educated area business owners as to their legal obligations. The Book was presented to 25 area alcohol vendors. As enforcement of the ordinance began, there was an immediate drop in calls for service related to chronic inebriation. To make certain the information contained in the Book was current, it was reviewed on a monthly basis and revised as necessary.
α Although the circumstances were somewhat unique, a total ban on alcohol sales and possession in Barrow, Alaska, provided further evidence that reducing the availability of alcohol reduced alcohol consumption and attendant problems, even among chronic public inebriates (North Slope Borough Department of Public Safety 1995).
8. Establishing alcohol impact areas. Alcohol Impact Areas (AIAs) are designed to address the problem of chronic inebriation by placing geographically linked restrictions on the sale, consumption, purchase privileges, or licensing related to alcoholic beverages. Cities that have established AIAs include Spokane, Seattle, and Vancouver, Washington, and Portland, Oregon.
There are a number of different strategies by which cities have approached AIA regulation. Perhaps the most common response is to enact restrictions on the sale of particular types and sizes of alcoholic beverages - with an emphasis on those most commonly purchased by chronic inebriates - within a specific geographic area. Restricted items might include fortified wine, high-alcohol-content beer,42 malt liquor, and beverages packaged as single servings or containers under a certain volume.β Generally, what evolves is a list of banned beverage brands, types, and sizes that is disseminated to liquor vendors in the AIA. Once developed and distributed, the list must be monitored and amended as new products enter the market.
Responsibility for enforcing AIA regulations might shift from police to an alcohol license regulating agency. Establishing an AIA may require changes in laws at both a state and local level. In Washington State, the state legislature enacted guidelines for AIAs that were then implemented by local governments.43
β Under Washington State law regarding AIAs, restricted beer and wine products must have minimum alcohol content of 5.7 percent by volume and 12 percent by volume, respectively.
Image2: Many cities have instituted alcohol impact
areas that either restrict or prohibit alcohol
consumption.
Photo Credit: Wikipedia Commons (http://en.wikipedia.org/wiki/
File:Streetdrinking24102008148.jpg)
9. Restricting panhandling.γControlling panhandling in areas where chronic public inebriation is prevalent can reduce a primary source of money that chronic inebriates use to purchase alcohol. Some police agencies have discovered that increasing the time and effort required of chronic inebriates to acquire the money needed to buy alcohol has the effect of reducing the quantity of alcohol they consume in a day, reducing the likelihood that they will reach levels of alcohol incapacitation on any given day.44
γ See Problem-Specific Guide No. 13, Panhandling, for further information.
Programs that offer counseling, treatment, and/or social services in lieu of incarceration often identify program candidates on the basis of their histories of alcohol-related offenses.45 Whereas enforcement responses rely on police action, diversion interventions usually occur during, after, or in lieu of a period of incarceration, and accordingly, prosecutors, courts, or corrections agencies are more likely to assume responsibility for administering and managing diversion programs. 46 These programs vary greatly in their duration and level of comprehensiveness. They may be brief intervention strategies with a reduction in alcohol consumption as the primary goal.47 They may focus on increasing residential stability,48 providing medical and therapeutic services,49 or some combination of efforts designed to align the interests of the criminal justice system with the social service and therapeutic community. Two common response techniques are described below.
10. Using sobering centers. Sobering centers are short-term (a few hours to overnight) facilities where individuals not in need of medical treatment can safely sober up. Sobering centers may be publicly or privately run, or some combination of the two. Under the facility's supervision, inebriated individuals use sobering centers in lieu of "sleeping it off" in local jail "drunk tanks" or out in public. These facilities afford temporary protection from predators while the individual has a diminished capacity to care for himself. Individuals are often taken to a sobering center by a special shuttle or police patrol. There they may be screened for medical problems and can be referred for medical treatment, if necessary. Many facilities provide case management services and referrals to substance abuse counseling. Sobering centers offer alternatives to more expensive hospital emergency departments and often-overcrowded jails.50
While many communities have found sobering centers to be an important element of their response strategies, when they are the primary response (or combined with a predominantly criminalization model), there is evidence they do little to interrupt the problem of chronic inebriation.51 Other researchers have argued that the success of so-called "brief intervention" strategies is strongly dependent upon the willingness of the individual to change and the context in which the intervention is made.52 Regardless of that debate, there is evidence that providing a safe place for chronic inebriates to sober up can help reduce calls for service and reduce victimization of the inebriates. On the other hand, inadequate detoxification resources (either the number of sobering centers or the bed space in them) is likely to result in increased behavioral problems on the street, such as panhandling.53
A common strategy for integrating sobering centers into the process of dealing with chronic inebriates positions these facilities as a point of assessment and decision-making for responders. For example, Escondido Community Sobering Service, run by the nonprofit group, Interfaith Community Services in Escondido, California, provides a place for noncombative and other low-risk inebriates to "sleep it off." The center enjoys both police and community support, because it reduces taxpayer expenditure associated with inebriates and frees the police to attend to other matters.54 This partnership demonstrates one way in which public-private partnerships can facilitate mutual goals.
Prior to the center's opening, officers might spend as much as 3 hours booking an inebriate into jail. The availability of this center greatly shortens the officer's investment of time. Moreover, inebriates who agree to sober up at the center aren't necessarily given a criminal citation, so long as they are cooperative. Faced with the choice between 4 hours at the center or 12 hours (or more) in jail, many find the center attractive. The center also represents considerable savings for the community. According to the nonprofit that manages the center, the average cost per intake is approximately $38, compared to $138 for jail housing and an additional $100 in police salaries associated with processing.
Permitting an inebriate use of this alternative is, in part, a matter of police discretion. Not everyone taken into custody has the option of going there. They cannot be a flight risk nor can they have been taken into custody as the result of fighting. Additionally, the inebriate must heed the direction of center staff, which includes waiting for clearance to leave.
Many communities have used analysis of sobering-center admissions to develop more informed strategies. Analysts for the San Diego Serial Inebriate Program discovered that detoxification of chronic inebriates in area hospital emergency rooms created an overflow crisis; inebriates used so much bed space that emergency rooms had to divert incoming patients to other hospitals. Moreover, they discovered that local detoxification center policy was inadvertently fostering a "revolving door" of serial offenders by refusing to admit individuals who had been through its intake five times within the past 30 days; those individuals would then commonly be booked into jail, only to be released 4 to 24 hours later, without criminal charges. Realization of the detoxification crisis prompted the police and community to develop a program in conjunction with a local detoxification center, the prosecutor's office, and local courts. The program was based on a model developed for drug courts in which reduction of repeated offending was a primary goal. This was accomplished through graduated sentencing in which mandatory attendance at Alcoholics Anonymous meetings was a central feature. In so doing, the demand was reduced both on sobering centers and area emergency rooms.55
11. Providing alcohol treatment in jail or under court order. The place of rehabilitation and substance abuse treatment as an alternative or adjunct to incarceration has been studied for many decades.56 Arrest and prosecution can be the gateway to treatment.
In a study of responses that presage modern drug courts, researchers near Los Angeles tracked the re-arrest rates of individuals who, in exchange for a suspended sentence, agreed to enter residential treatment for alcoholism.57 The recommended length of stay was 90 days, and the facility could not legally compel an individual to remain for the duration. If individuals successfully completed treatment, they were given 177 days' credit. If they were rearrested within 12 months from the date of referral, the suspended sentence was enforced. The researchers found a nearly 15 percent decline in the re-arrest rate of people who completed the program. Interestingly though, the average number of days spent incarcerated during the first post-treatment year rose markedly. The researchers note that judges had a tendency to impose longer jail terms after discharge from a rehabilitation center, but there were nonetheless significant savings for the justice system. The researchers attribute these savings to less frequent arrests and arraignments.58
Some research also notes a connection between initial sentence length and receptivity to treatment. In a study of the San Diego Serial Inebriate Program, researchers found that the threat of jail is an important inducement for treatment. Only about half of those who entered the system chose treatment, but they chose it more often when the jail term they faced was longer. Treatment was accepted by 20 percent of those who faced a sentence of 30 days or fewer as opposed to 63 percent of those looking at 150 days or more in jail.59
Another example of jail diversion treatment can be found in St. Louis. Mirroring what has already been well established, almost half of the St. Louis study subjects reported "stable housing" as the one area of life in which they most needed help. This was followed very closely by "problems of mental stability and coping with everyday life."60 The St. Louis jail diversion project was successful in fostering many positive outcomes for individuals, and also produced improved organizational cooperation and coordination between criminal justice system staff and mental health/substance abuse treatment providers.61
12. Restricting chronic public inebriates' access to public spaces. Managers of public spaces, including police, using the legal principles of eviction, trespass, and conditional release from incarceration, might ban targeted chronic inebriates from specific public spaces.62 Banishment might, with the cooperation of merchants and facility managers, extend to businesses and social service facilities, such as homeless shelters, so as to avoid simply displacing the serial offenders and their problematic behavior. You should consult with local legal counsel to ensure that any place bans are implemented lawfully.
In instances where a very small number of individuals is at issue, responses that simply disperse or move the problem may be acceptable on some level. In situations where larger groups of individuals are involved, more comprehensive responses may be necessary.
An analysis by San Diego police revealed that the bulk of problems related to chronic inebriation at the Clairemont Town Mall was traceable to the actions of just four individuals. Moreover, it was discovered that officers from the private security company (contracted by mall management) had developed a complacent attitude with regard to these four people. The police worked with the property manager and interviewed merchants, mall patrons, and the inebriates themselves, and devised a solution. The interviews disclosed that the inebriates used the mall because panhandling, drinking, and improper lodging were tolerated there. Remarkably, the private security officers had permitted the individuals to live in an inoperable motor home located in an adjacent parking lot. When those involved took a series of measures - educating mall business owners and staff about appropriate responses to the problem, analyzing the environmental conditions that facilitated property misuse, replacing the security company, and obtaining restraining orders - the four individuals left the property and did not return.
Source: San Diego Police Department, Northern Division (2001).
13. Altering environmental conditions to discourage chronic inebriates' offensive behavior. Managers of places where chronic inebriates tend to congregate or cause substantial problems should analyze and alter the characteristics of a given location to reduce opportunities for its inappropriate use.δ Stakeholders should give particular thought to those environmental features of known hot spots that might make it more or less inviting to chronic inebriates as a place to drink (e.g., proximity to alcohol outlets, seclusion from eyes of police, sufficient privacy to relieve themselves, access to foot traffic for panhandling, comfortable seating, protection from the elements). In short, responses should be informed by asking what changes to a given area might discourage misuse.
Police in Santa Ana, California, addressed a significant set of problems in the Harbor Plaza Shopping Center through a combination of efforts, including changes to the surroundings that facilitated misuse of the area. Most of the latter changes were simple: locking a dumpster that had been used as shelter and for foraging, closing access to secluded areas with locked gates, encouraging merchants to lock and restrict use of restrooms to customers, replacing burned-out lights, and removing pay phones that were serving as a "business center" for prostitution and other undesirable activities. None of these actions was particularly expensive or logistically complex, but in concert, they had an impact.63
δ For more detailed guidance on analyzing crime opportunities at particular places, see Problem-Solving Tools Series Guide No. 8, Using Crime Prevention Through Environmental Design in Problem-Solving.
14. Increasing criminal penalties. Increased criminal penalties in and of themselves do little to curb crime associated with chronic inebriation.64 The primary flaw in this approach owes to the simple fact that the deterrence supposedly induced by harsher sanctions assumes the would-be offender is engaged in a calculation of costs and benefits, either before making the decision to become a chronic inebriate or in deciding to sustain that pattern of behavior.
There is, however, one caveat to the general ineffectiveness of increased jail terms for alcohol-related offenses. In jails where chronic inebriates may receive alcohol counseling while serving time, they need to be incarcerated long enough that the treatment can be effective.65 Where this is possible, longer incarceration might position the inebriate to receive more sustained counseling than otherwise. For some treatment models, legal coercion may be a necessary component,66 but coercion or extended incarceration, except under carefully defined circumstances and usually in conjunction with other responses, appears insufficient to cause meaningful change.ε
15. Conducting enforcement sweeps or crackdowns alone.ζ As with increased criminal penalties, any police response that is predicated solely on a deterrence model typically has little lasting value in addressing chronic inebriation. Crackdowns on chronic inebriates often focus on "hot spots" like parks, transit stations, and near shelters and liquor stores where inebriates tend to cluster and cause problems.θ
An increase in crackdowns and "zero tolerance" policing of uncivil behavior (drunkenness, loitering, and so on) gained favor as police agencies moved away from traditional-style policing and embraced "broken windows" approaches.67 While crackdowns and similar approaches can produce change that is sudden, obvious and drastic, as a stand-alone response, they hold little promise of engendering a lasting impact on chronic inebriation.η As noted above about increases in jail time, in some instances crackdowns might be used to put a large number chronic inebriates in (albeit coerced) contact with treatment and other therapeutic, medical, or social service resources, provided jail-based programs are in place to receive them.
ε When the St. Petersburg (Florida) Police Department began aggressively enforcing chronic inebriation laws in the city's downtown, many of the "regulars" relocated to other jurisdictions. When interviewed about their decision, these regulars reported what motivated them to move was not the threat of more jail time but the fact no smoking was permitted in the St. Petersburg jail (St. Petersburg Police Department 1997).
ζ See Response Guide No. 1, The Benefits and Consequences of Police Crackdowns, for further information.
θ While beyond the scope of this guide, an expansive literature on the subject of "hot spot" policing exists. See Weisburd, Maherand, and Sherman (1991), Clarke (1983), Brantingham and Brantingham (1981, 1984), Bursik and Grasmick (1993).
η See Response Guide No. 1, The Benefits and Consequences of Police Crackdowns, for further information.
The table below summarizes the responses to chronic inebriation, the mechanism by which they are intended to work, the conditions under which they ought to work best, and some factors you should consider before implementing a particular response. It is critical that you tailor responses to local circumstances and that you can justify each response based on reliable analysis. In most cases, an effective strategy will involve implementing several different responses. Law enforcement responses alone are seldom effective in reducing or solving the problem.
| # | Response | How It Works | Works Best If… | Considerations |
|---|---|---|---|---|
| General Considerations for an Effective Response Strategy | ||||
| 1 | Educating the community about the problem |
Increases stakeholder acceptance of responses; improves police understanding of community needs and concerns |
....done consistently and broadly at each stage of response planning and execution |
Community is not single-minded; may be multiple constituencies with divergent perceptions of the problem and different sensibilities as to what constitutes an appropriate response |
| 2 | Developing community support for your response |
Enhances resources needed to address problem; reduces criticism of police efforts to address problem |
....done consistently and broadly across many parts of the community and at each stage of response planning and execution |
May require considerable resources and effort to develop mutual understanding of the problem's scope and appropriateness of the proposed response; requires continual reinforcement and cultivation |
| 3 | Decriminalizing public inebriation |
Shifts resources from punishment to medical treatment which is more likely to reduce chronic inebriation |
....if undertaken by organizationlevel stakeholders whose shared goals are mirrored in the change |
System staff may have conflicting organizational cultures that are resistant to change; staff may not accept new procedures or responsibilities without considerable retraining; can be cost intensive and logistically complicated; public may perceive change as condoning negative behavior |
| 4 | Tailoring interventions to individual needs |
Differentiates between the various needs of chronic inebriates |
....resources and procedures are in place to address the demands created by each group |
Can be resource intensive; may require a great deal of planning to make categoryappropriate responses available |
| 5 | Providing integrated social and health services |
Addresses various issues that compound one another |
....mental health, housing, and other social services are integrated into the broader strategy |
Requires that system staff coordinate responses to ensure individuals are given access to whatever services or treatment they need |
| 6 | Training service providers to respond appropriately |
Improves understanding of goals and organizational roles and responsibilities which improves overall response |
....each responder understands his/ her role and responsibilities in the process as well as that of others |
May require a great deal of planning and education of system staff, some of whom may be resistant to new duties or procedures |
| Specific Responses to Chronic Public Inebriation | ||||
| Restricting Alcohol Sales to Chronic Inebriates | ||||
| 7 | Prohibiting alcohol sales to chronic inebriates |
Increases chronic inebriates' difficulty in procuring alcohol which reduces overall consumption and intoxication levels |
....police and alcohol merchants coordinate efforts to identify restricted individuals and restrictions are honored and enforced |
May be resource intensive to identify and process restricted individuals; typically requires enabling legislation; requires compliance of alcohol vendors, who may perceive restrictions as detrimental to their business; requires consistent database management of restricted individuals |
| 8 | Establishing alcohol impact areas |
Increases chronic inebriates' difficulty in procuring alcohol which reduces overall consumption and intoxication levels |
....supported by alcohol vendors in the alcohol impact area and if done in conjunction with the provision of other social, medical, and treatment services |
Typically requires enabling legislation; requires compliance of alcohol vendors who may perceive the restrictions as detrimental to their business; requires regular updates to banned products lists; requires additional oversight of alcohol vendors; some displacement of problem to other areas may occur |
| 9 | Restricting panhandling |
Increases chronic inebriates' difficulty in procuring alcohol which reduces overall consumption and intoxication levels |
....panhandling restrictions are enforced |
Laws prohibiting panhandling should be carefully drafted to survive legal challenges; some displacement of chronic inebriates to other areas might occur; some increased theft of alcohol might occur |
| 10 | Using sobering centers |
Reduces inebriates' risks to themselves and others; promotes follow-up alcohol treatment; reduces criminal justice system costs |
....done in conjunction with the provision of other social, medical, and treatment services |
May be resource intensive to provide shelter for a large population of inebriates; often requires publicprivate coordination; may be negatively perceived as facilitating chronic inebriation; short-term treatment may be perceived as wasteful of resources by treatment staff |
| 11 | Providing alcohol treatment in jail or under court order |
Increases inebriates' motivation to accept treatment |
....the inebriate is receptive to the treatment and the treatment is provided in a sustained and consistent manner |
May be resource intensive to provide treatment for a large population of inebriates; success may depend heavily on inebriates' motivation to participate in the program |
| Changing the Way Public Spaces Are Used | ||||
| 12 | Restricting chronic inebriates' access to public spaces |
Removes inebriates from places where their behavior causes problems for others; discourages inebriates from misbehaving in public |
....small groups of individuals cause the bulk of problems and if done in conjunction with the provision of other social, medical, and treatment services |
May be resource intensive to identify and process the formal removal of each individual; requires careful attention to individuals' due process rights; some displacement of problem individuals to other areas may occur |
| 13 | Altering environmental conditions to discourage chronic inebriates' offensive behavior |
Alters the characteristics of an area that facilitate undesirable behavior |
....changes are predicated on a systematic analysis of problem area with consultation of design, engineering, or transportation specialists |
Environmental changes can be costly; may require major changes in traffic flow, architecture, or other system-level features; underlying design problems can be difficult to detect |
| Responses with Limited Effectiveness | ||||
| 14 | Increasing criminal penalties |
Intended to deter public intoxication and disorderly behavior |
....used as leverage to promote alcohol treatment |
Chronic alcoholism undermines deterrent effect of punishment; most problematic individuals already spend lengthy periods incarcerated with little deterrent effect |
| 15 | Conducting enforcement sweeps or crackdowns alone |
Can quickly remove large numbers of inebriates from public view |
....done in conjunction with the provision of other social, medical, and treatment services |
May be perceived as unduly harsh and risks violations to individuals' due process rights; may be resource intensive; likely only to remove inebriates from public view for short term |
[1] Bahr (1973).
[2] Goodman and Idell (1975): 259.
[3] Clark (1975): 220; Pratt (1975): 66.
[4] Baumhol (1990).
[5] Ellikson (1996).
[6] Clark (1975).
[7] Huebner et al. (1993).
[8] Snow and Anderson (1993).
[9] University of Alaska Anchorage, Behavioral Health Research & Services (2005): 13.
[10] Castillo et al. (2008):13.
[11] McDonald (2001):4.
[12] Wiseman (1979): 65.
[13] Fagan and Mauss (1978).
[14] Finn and Sullivan (1987): 4.
[15] Finn and Sullivan (1987).
[16] Aaronson and Dienes (1977):616-617.
[17]Finn and Sullivan (1987):4.
[18] Greene (2007).
[19] Block and Block (2007).
[20] Argeriou and McCarty (1993); Podymow et al. (2006); Castaneda et al. (1992); Richman and Smart (1981); Richman and Neuman (1984); Cox et al. (1998). Larimer et al. (2009); Grella (1993); Coffler and Hadley (1973).
[21]Bittner (1967); Nimmer (1971); Pittman and Gordon (1967); Rubington (1970).
[22] Aaronson and Dienes (1977).
[23]Aaronson and Dienes (1977); Blumberg (1978); Snow and Anderson (1993); Finn and Sullivan (1987); Gammage, Jorgensen and Jorgensen (1972).
[24] Aaronson and Dienes (1977).
[25] Aaronson and Dienes (1977); Bayley (1990); Bittner (1967).
[26] Aaronson and Dienes (1977).
[27] Aaronson, Dienes and Musheno (1982).
[28]Aaronson and Dienes (1977).
[29] Aaronson and Dienes (1977).
[30] Kingsley and Mair (1983); Wiseman (1980).
[31] Aaronson and Dienes (1977).
[32] Tuncks (1990).
[33]Daggett and Rolde (1977, 1980); Landsman (1973); McMorris, (2006).
[34] Blumberg (1978):196.
[35]University of Wisconsin-Madison Police Department (1997).
[36] Larimer et al. (2009); Levin (2009); Thornquist et al. (2002).
[37] Pinellas Park (Florida) Police (1998); Green Bay (Wisconsin) Police Department (1999).
[38] Green Bay (Wisconsin) Police Department (1999)
[39]Green Bay (Wisconsin) Police Department (1999), p. 4.
[40] Pinellas Park (Florida) Police (1998).
[41] Pinellas Park (Florida) Police (1998).
[42]Washington State Legislature (no date).
[43]Washington State Legislature (no date).
[44] Madison (Wisconsin) Police Department (2006).
[45] McDonald (2001).
[46]McDonald (2001).
[47]Hopkins and Sparrow (2006): 395.
[48] Levin (2009); Larimer et al. (2009).
[49] Dunford et al. (2006); Gregoire and Burke (2004).
[50] Western Australia. Drug and Alcohol Office (2007); Beavan (2008); King County, Washington Department of Health and Human Services (2011); Alameda County Behavioral Health Care Services (2008).
[51] Podymow et al. (2006).
[52] Heather and Kaner (2001).
[53] Stark (1992).
[54] Lowery (2011).
[55] San Diego (California) Police Department (2001).
[56] Wiseman (1980); Coffler and Hadley (1973); Jackson, Fagan and Burr (1958).
[57] Coffler and Hadley (1973).
[58] Coffler and Hadley (1973).
[59] Dunford et al. (2006).
[60] Orihuela and Loman (2010): 18.
[61] Orihuela and Loman (2010): 27.
[62] University of Wisconsin-Madison Police Department (1997).
[63] San Diego (California) Police Department, Northern Division (2001).
[64] Santa Ana (California) Police Department (1993).
[65] Wiseman (1980).
[66] Gregoire and Burke (2004).
[67] Dunford et al. (2006); Gregoire and Burke (2004).
[68] Wilson and Kelling (1982).
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Wiseman, Jacqueline. 1979. Stations of the Lost: The Treatment of Skid Row Alcoholics. Chicago: University of Chicago Press.
World Health Organization. 1992. “Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines.” International Classification of Diseases. 10th ed., Geneva: World Health Organization.
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