Responses to the Problem of Chronic Public Inebriation

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.

General Considerations for an Effective Response Strategy

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

† 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).

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

† 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. 

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.§ 

‡ 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).

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 

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.

Specific Responses to Chronic Public Inebriation

Restricting Alcohol Sales to Chronic Inebriates

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.†

† 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). 

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. 

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.† 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.

† 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. 

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

9. Restricting panhandling.† Controlling 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 

† See Problem-Specific Guide No. 13, Panhandling, for further information.

Facilitating Counseling, Treatment, and Social Services

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

Changing the Way Public Spaces Are Used

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.

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.† 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.

† 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. 

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 

Responses with Limited Effectiveness 

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.† 

† 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). 

15. Conducting enforcement sweeps or crackdowns alone.† 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.‡

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.§ 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.

† See Response Guide No. 1, The Benefits and Consequences of Police Crackdowns, for further information. 

‡ 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).

§ See Response Guide No. 1, The Benefits and Consequences of Police Crackdowns, for further information.