title: Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.
abstract: Managed 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.
  
  
  
  Structured 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.
  
  
  
  Compared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x (2) = 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 (x (2) = 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.
  
  
  
  The 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.
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada. vallance@uvic.ca.
authors.forename: Kate
authors.initials: K
authors.lastname: Vallance
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Stockwell
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Bernie
authors.initials: B
authors.lastname: Pauly
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Clifton
authors.initials: C
authors.lastname: Chow
authors.affiliation: School of Social Work, MacEwan University, 10700-104 Avenue, Edmonton, AB T5J 2P2, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Gray
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Krysowaty
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Perkin
authors.affiliation: Centre for Addictions Research of BC, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control*; D000437:Alcoholism / Q000201:enzymology / Q000453:epidemiology / Q000534:rehabilitation*; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001628:Beverages / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D040261:Harm Reduction; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008099:Liver / Q000201:enzymology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010865:Pilot Projects; D057566:Self Report; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Alcohol harm reduction; Alcohol use disorders; Homelessness; Hospital admissions; Housing First; Managed alcohol programs; Non-beverage alcohol; Non-potable alcohol; Police contacts