Giving alcohol to treat problems with alcohol may seem pretty controversial to some. However, this may be exactly what is needed to address a problem experienced by those with severe alcohol dependence and homelessness. People who have chronic relapsing problems with alcohol that have not been responsive to abstinence-based treatment seem to have better outcomes in a managed alcohol program.
Kwae Kii Win Centre, part of Shelter House in Thunder Bay, provides supportive housing, food, and alcohol to formerly homeless people with severe and reoccurring alcohol related problems. Prior to entering the program, clients had not responded to abstinence-based approaches, had multiple police contacts and emergency room attendances, and often consumed non-beverage alcohol (such as mouthwash and rubbing alcohol) while living on the streets.
We recently published two articles in the peer reviewed Harm Reduction Journal and an economic costing report based on our evaluation of the Managed Alcohol Program established in Thunder Bay in 2012. Prior to this, there was almost no peer reviewed published research on MAP except for the well known Podymow, 2006 article on the Ottawa MAP. This research is the first study of MAP to include a control group.
In our recent CARBC evaluation, our research team found that providing regulated doses of alcohol in a supportive housing environment can improve the lives of people with severe and reoccurring alcohol problems and homelessness while reducing social, police and health service costs. Compared to those with severe and reoccurring alcohol problems not in a MAP, MAP residents had 43% fewer police contacts, 70% fewer detox admissions, 47% fewer hospital admissions, and spent 33% less time in custody over the study period. Importantly, they also reported less frequent use of non-beverage alcohol, fewer alcohol-related harms (such as withdrawal seizures) and had improved scores on liver function tests.
Compared to life on the streets, participants described the MAP as a safe place characterized by respect, trust and a non-judgemental approach. They reported a sense of belonging and of having a secure home, a base from which they could also reconnect with family members and access other health and social services.
Remarkably, the program appears to save money too. Accounting for the significant reductions in frequency of health, social and legal service use by participants, the researchers estimated a cost savings of approximately $1.09 to $1.21 for every dollar spent.
These pilot study results are part of a larger national research program that the team is currently conducting across Canada involving six MAPs and 364 participants. These findings are very encouraging but we need to look at how they compare with the findings from the national study to inform future best practice.
The research is funded by the Canadian Institutes of Health Research (including funding from the Michael Smith Foundation for Health Research) and Shelter House.
For more information, visit CARBC’s MAP project website.
With acknowledgement and gratitude to the Thunder Bay Kwae Kii Win Residents and Staff especially Patty Hajdu, past Executive Director of Shelter House, Thunder Bay.
The Thunder Bay Research Team: Bonnie Krysowaty, Erin Gray, Clifton Chow, Kate Vallance, Kathleen Perkin, Jinhui Zhao, Kendall Hammond, Lynda Gagne, and Ashley Wettlaufer