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Harm Reduction, Alcohol and Homelessness

Ottawa’s Managed Alcohol Project

Kim Meier

Reprinted from "Alcohol" issue of Visions Journal, 2006, 2 (9), p. 28-29

Reaching out to a homeless population affected by alcoholism is no easy task. This is a highrisk group of individuals more prone to chronic illness and mortality than the general population. They also have more frequent, more expensive and longer visits to hospitals. With mental illness, lack of social support, no home address and lengthy addiction histories, treating homeless individuals with alcohol use problems can prove to be a difficult undertaking.

A team of researchers, headed by Dr. Tiina Podymow, investigated the success rates of a shelterbased managed alcohol program in reducing the harms associated with being homeless and having long-term alcohol addiction. The Managed Alcohol Project (MAP) “wet shelter” study took place in Ottawa. Results were published in the Canadian Medical Association Journal earlier this year.

MAP participants were mostly older males with an average of 35 years of alcohol use history and consumed an average of 46 drinks a day. Most had been homeless for more than two years before entering MAP, and all had failed or refused treatment in abstinence programs. The group averaged 13.5 visits to health emergency departments and 18.1 police reports per month.

Participants in the study lived for an average of 16 months in a 15-bed wet shelter, with meals provided. Assisted by a client-care worker, they were administered up to 140 ml of wine or 90 ml of sherry, by request. A 24-hour oncall nurse was available to the shelter, and participants underwent weekly trips to the doctor. Investigators monitored alcohol intake, police reports, hospital visits, hygiene, sleeping patterns, eating habits, and medicine compliance.

Subjects were monitored for up to two years following participation in the wet shelter program. Dr. Podymow and her associates found that emergency visits to the hospital had been reduced by more than a third, with a group average of 8.1 per month. The number of police reports per month for the group also halved, with an average of 8.8. Alcohol intake drastically decreased to eight drinks daily. Participants had improved hygiene and nutrition, were able to regularly attend medical appointments, and all but two consistently took their prescription medication.

Investigators found that while the MAP cost approximately $771 per participant per month while staying in the shelter, an estimated $447 was saved monthly in emergency department services, hospital care, and police services after release from the program.

Researchers note that members of the MAP wet shelter received more supportive care than found in a typical homeless shelterAlthough Dr. Podymow concedes the investigation was done with no abstinence comparison group, the harm reduction approach of wet shelters has shown to be successful. In fact, a few participants were able to continue with treatment and quit using alcohol completely. “If it wasn’t for the program,” one of the program’s two female participants tells CBC News, “I seriously say I would’ve been dead by now.

What is harm reduction?

Harm reduction is a public health philosophy that acknowledges the reality of certain behaviours in society. An alternative to abstinence, the harm reduction approach to addictions treatment seeks to minimize the negative effects of alcohol abuse by empowering the user to control his or her intake to a manageable level. The goal of harm reduction is to promote health and safety and reduce risk to users who are unable to quit.

 
About the Author

Kim is an undergraduate student in cognitive science at Simon Fraser University, currently on a co-op term at Canadian Mental Health Association, BC Division

Footnotes
  1. Podymow, T., Turnbull, J., Coyle, D. et al. (2006). Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol. Canadian Medical Association Journal, 174(1), 45-49

  2. Ottawa program offers drinks to homeless alcoholics. (2006, January 3). CBC News. Retrieved from www.cbc.ca/ottawa/story/ ot-shelters20060103.html

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