Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.

Kate Vallance,Kathleen Perkin,Bernie Pauly,Bonnie Krysowaty,Erin Gray,Clifton Chow,Jinhui Zhao,Tim Stockwell

doi:10.1186/s12954-016-0103-4

Abstract

BackgroundManaged alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013.MethodsStructured interviews were conducted with 18 MAP and 20 control participants assessed as alcohol dependent with most using non-beverage alcohol (NBA). Qualitative interviews were conducted with seven participants and four MAP staff concerning perceptions and experiences of the program. Program alcohol consumption records were obtained for MAP participants, and records of police contacts and use of health services were obtained for participants and controls. Some participants’ liver function test (LFT) results were available for before and after MAP entry.ResultsCompared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x2 = 43.84, P < 0.001), 87 % fewer detox admissions (t = −1.68, P = 0.06), and 32 % fewer hospital admissions (t = −2.08, P = 0.03). MAP and control participants shared similar characteristics, indicating the groups were broadly comparable. There were reductions in nearly all available LFT scores after MAP entry. Compared with controls, MAP participants had 43 % fewer police contacts, significantly fewer police contacts (−38 %) that resulted in custody time (x2 = 66.10, P < 0.001), 70 % fewer detox admissions (t = −2.19, P = 0.02), and 47 % fewer emergency room presentations. NBA use was significantly less frequent for MAP participants versus controls (t = −2.34, P < 0.05). Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and withdrawal seizures. Qualitative interviews with staff and MAP participants provided additional insight into reductions of non-beverage alcohol use and reductions of police and health-care contacts. It was unclear if overall volume of alcohol consumption was reduced as a result of MAP participation.ConclusionsThe quantitative and qualitative findings of this pilot study suggest that MAP participation was associated with a number of positive outcomes including fewer hospital admissions, detox episodes, and police contacts leading to custody, reduced NBA consumption, and decreases in some alcohol-related harms. These encouraging trends are being investigated in a larger national study.

Highlights

Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing
We present analyses of changes in alcohol use, related harms and use of police, and health-care services for the MAP participants and for a group of control participants assessed as meeting the entry criteria for the MAP
Chi-square (x2) tests were used to compare the proportions of police contacts leading to custody time for participants while on the MAP compared with periods off the MAP as well as compared with controls

Summary

Introduction

Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. Severe alcohol dependence almost invariably carries heavy health and social costs and is sometimes associated with homelessness or housing instability [1,2,3]. Those who are severely dependent on alcohol and experiencing homelessness face significant barriers to accessing temporary accommodation and in some cases will go without shelter as a consequence of alcohol use [4]. Non-beverage alcohol such as rubbing alcohol, mouthwash, or alcoholbased hand sanitizers may be consumed These sources of alcohol are relatively low-cost and readily available and may contribute to a variety of additional health risks when consumed in large volumes [7,8,9]. There is only limited evidence that ingredients added to non-beverage alcohols pose risks to health over and above the significant risks associated with beverage alcohol consumption [10]

Methods

Results

Discussion

Conclusion