Abstract
BackgroundThere is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations. The combination of alcohol use and lack of housing contributes to increased vulnerability to the harms of substance use including stigma, injury, illness, and death. Managed alcohol programs (MAPs) administer prescribed doses of alcohol at regular intervals to people with severe and chronic alcohol dependence and homelessness. As a pilot for a larger national study of MAPs, we conducted an in-depth evaluation of one program in Ontario, Canada. In this paper, we report on housing and quality of life outcomes and experiences of the MAP participants and staff.MethodsWe conducted a pilot study using mixed methods. The sample consisted of 38 people enrolled in or eligible for entry into a MAP who completed a structured quantitative survey that included measures related to their housing and quality of life. All of the participants self-identified as Indigenous. In addition, we conducted 11 in-depth qualitative interviews with seven MAP residents and four program staff and analyzed the interviews using constant comparative analysis. The qualitative analysis was informed by Rhodes’ risk environment framework.ResultsWhen compared to controls, MAP participants were more likely to retain their housing and experienced increased safety and improved quality of life compared to life on the streets, in jails, shelters, or hospitals. They described the MAP as a safe place characterized by caring, respect, trust and a nonjudgmental approach with a sense of family and home as well as opportunities to reconnect with family members.ConclusionsThe MAP was, as described by participants, a safer environment and a home with feelings of family and a sense of community that countered stigma, loss, and dislocation with potential for healing and recovery. The MAP environment characterized by caring, respect, trust, a sense of home, “feeling like family”, and the opportunities for family and cultural reconnections is consistent with First Nations principles for healing and recovery and principles of harm reduction.
Highlights
There is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations
For people living in socially marginalizing conditions, the combination of severe alcohol use and lack of housing contributes to increased vulnerability to harms such as stigma, freezing, violence, accidents, physical illness, and death
We are aware of at least ten Managed alcohol programs (MAPs) programs in Canada that offer some form of alcohol administration for those who have been unsuccessful in maintaining housing even when alcohol use is tolerated on-site
Summary
There is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations. Many Housing First programs seek to reduce harms for this population, primarily by providing stable housing and tolerating the use of alcohol on-site, which can have intrinsic health and social benefits [9,10,11,12,13,14,15,16]. There is limited evidence as to impacts and outcomes of MAPs. Podymow et al [17] conducted an evaluation of 17 adults involved in the Ottawa MAP and showed improved health outcomes, fewer ED visits, fewer police contacts, and reduced alcohol consumption over an average of 16 months in the MAP. We focus on the housing and quality of life outcomes and experiences of participants from one of two pilot studies we have conducted [18, 19]
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