Investigating the need for alcohol harm reduction and managed alcohol programs for people experiencing homelessness and alcohol use disorders in Scotland

Abstract Background While there is robust evidence for strategies to reduce harms of illicit drug use, less attention has been paid to alcohol harm reduction for people experiencing severe alcohol use disorder (AUD), homelessness, and street-based illicit drinking. Managed Alcohol Programs (MAPs) provide safer and regulated sources of alcohol and other supports within a harm reduction framework. To reduce the impacts of heavy long-term alcohol use among MAP participants, cannabis substitution has been identified as a potential therapeutic tool. Methods To determine the feasibility of cannabis substitution, we conducted a pre-implementation mixed-methods study utilizing structured surveys and open-ended interviews. Data were collected from MAP organizational leaders (n = 7), program participants (n = 19), staff and managers (n = 17) across 6 MAPs in Canada. We used the Consolidated Framework for Implementation Research (CFIR) to inform and organize our analysis. Results Five themes describing feasibility of CSP implementation in MAPs were identified. The first theme describes the characteristics of potential CSP participants. Among MAP participants, 63% (n = 12) were already substituting cannabis for alcohol, most often on a weekly basis (n = 8, 42.1%), for alcohol cravings (n = 15, 78.9%,) and withdrawal (n = 10, 52.6%). Most MAP participants expressed willingness to participate in a CSP (n = 16, 84.2%). The second theme describes the characteristics of a feasible and preferred CSP model according to participants and staff. Participants preferred staff administration of dry, smoked cannabis, followed by edibles and capsules with replacement of some doses of alcohol through a partial substitution model. Themes three and four highlight organizational and contextual factors related to feasibility of implementing CSPs. MAP participants requested peer, social, and counselling supports. Staff requested education resources and enhanced clinical staffing. Critically, program staff and leaders identified that sustainable funding and inexpensive, legal, and reliable sourcing of cannabis are needed to support CSP implementation. Conclusion Cannabis substitution was considered feasible by all three groups and in some MAPs residents are already using cannabis. Partial substitution of cannabis for doses of alcohol was preferred. All three groups identified a need for additional supports for implementation including peer support, staff education, and counselling. Sourcing and funding cannabis were identified as primary challenges to successful CSP implementation in MAPs.

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COVID-19 Social Restrictions: An Opportunity to Re-visit the Concept of Harm Reduction in the Treatment of Alcohol Dependence. A Position Paper

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.623649 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christos Kouimtsidis ◽

Bernadette Pauly ◽

Tessa Parkes ◽

Tim Stockwell ◽

Alexander Mario Baldacchino

Keyword(s):

Substance Use ◽

Alcohol Use ◽

Harm Reduction ◽

Alcohol Use Disorders ◽

Position Paper ◽

Substance Use Treatment ◽

Health And Social Care ◽

Substance Use Services ◽

Alcohol Harm Reduction ◽

The Impact

The COVID-19 pandemic is presenting significant challenges for health and social care systems globally. The implementation of unprecedented public health measures, alongside the augmentation of the treatment capacity for those severely affected by COVID-19, are compromising and limiting the delivery of essential care to people with severe substance use problems and, in some cases, widening extreme social inequities such as poverty and homelessness. This global pandemic is severely challenging current working practices. However, these challenges can provide a unique opportunity for a flexible and innovative learning approach, bringing certain interventions into the spotlight. Harm reduction responses are well-established evidenced approaches in the management of opioid dependence but not so well-known or implemented in relation to alcohol use disorders. In this position paper, we explore the potential for expanding harm reduction approaches during the COVID-19 crisis and beyond as part of substance use treatment services. We will examine alcohol use and related vulnerabilities during COVID-19, the impact of COVID-19 on substance use services, and the potential philosophical shift in orientation to harm reduction and outline a range of alcohol harm reduction approaches. We discuss relevant aspects of the Structured Preparation for Alcohol Detoxification (SPADe) treatment model, and Managed Alcohol Programs (MAPs), as part of a continuum of harm reduction and abstinence orientated treatment for alcohol use disorders. In conclusion, while COVID-19 has dramatically reduced and limited services, the pandemic has propelled the importance of alcohol harm reduction and created new opportunities for implementation of harm reduction philosophy and approaches, including programs that incorporate the provision of alcohol as medicine as part of the substance use treatment continuum.

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Decision-Making Measured by the Iowa Gambling Task in Patients with Alcohol Use Disorders Choosing Harm Reduction versus Relapse Prevention Program

European Addiction Research ◽

10.1159/000499709 ◽

2019 ◽

Vol 25 (4) ◽

pp. 182-190 ◽

Cited By ~ 4

Author(s):

Marie Brière ◽

Laure Tocanier ◽

Phillippe Allain ◽

Dewi Le Gal ◽

Guillaume Allet ◽

...

Keyword(s):

Decision Making ◽

Alcohol Use ◽

Harm Reduction ◽

Prevention Program ◽

Relapse Prevention ◽

Iowa Gambling Task ◽

Alcohol Use Disorders ◽

Gambling Task

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Managed alcohol programs in the context of Housing First

Housing Care and Support ◽

10.1108/hcs-02-2019-0006 ◽

2019 ◽

Vol 22 (4) ◽

pp. 207-215 ◽

Cited By ~ 1

Author(s):

Rebecca Schiff ◽

Bernie Pauly ◽

Shana Hall ◽

Kate Vallance ◽

Andrew Ivsins ◽

...

Keyword(s):

Harm Reduction ◽

Support Services ◽

Housing First ◽

Content Type ◽

Treatment Models ◽

Key Characteristics ◽

Services And Supports ◽

Alcohol Harm Reduction ◽

Alcohol Programs

Purpose Recently, Managed Alcohol Programs (MAPs have emerged as an alcohol harm reduction model for those living with severe alcohol use disorder (AUD) and experiencing homelessness. There is still a lack of clarity about the role of these programs in relation to Housing First (HF) discourse. The authors examine the role of MAPs within a policy environment that has become dominated by a focus on HF approaches to addressing homelessness. This examination includes a focus on Canadian policy contexts where MAPs originated and are still predominately located. The purpose of this paper is to trace the development of MAPs as a novel response to homelessness among people experiencing severe AUD and to describe the place of MAPs within a HF context. Design/methodology/approach This conceptual paper outlines the development of discourses related to persons experiencing severe AUD and homelessness, with a focus on HF and MAPs as responses to these challenges. The authors compare the key characteristics of MAPs with “core principles” and values as outlined in various definitions of HF. Findings MAPs incorporate many of the core values or principles of HF as outlined in some definitions, although not all. MAPs (and other housing/treatment models) provide critical housing and support services for populations who might not fit well with or who might not prefer HF models. Originality/value The “silver bullet” discourse surrounding HF (and harm reduction) can obscure the importance of programs (such as MAPs) that do not fully align with all HF principles and program models. This is despite the fact that MAPs (and other models) provide critical housing and support services for populations who might fall between the cracks of HF models. There is the potential for MAPs to help fill a gap in the application of harm reduction in HF programs. The authors also suggest a need to move beyond HF discourse, to embrace complexity and move toward examining what mixture of different housing and harm reduction supports are needed to provide a complete or comprehensive array of services and supports for people who use substances and are experiencing homelessness.

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“A place to be safe, feel at home and get better”: Including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada

10.21203/rs.3.rs-944738/v1 ◽

2021 ◽

Author(s):

ROSSIO MOTTA OCHOA ◽

Natalia Incio-Serra ◽

Hélène Poliquin ◽

Sue-Ann MacDonald ◽

Christophe Huỳnhe ◽

...

Keyword(s):

Alcohol Use ◽

Alcohol Dependence ◽

Harm Reduction ◽

Research Approach ◽

Structured Interviews ◽

Complex Needs ◽

Barriers To Access ◽

Wide Range ◽

A Site ◽

Alcohol Programs

Abstract BackgroundThe harmful use of alcohol is one of the leading health risk factors for people’s health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada. MethodsCommunity based participatory research approach and qualitative methods–including semi-structured interviews and focus groups–were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. ResultsParticipants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants’ alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal’s wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. ConclusionsIntegrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users’ engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.

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“Everyone Has the Right to Drink Beer”: A Stakeholder Analysis of Challenges to Youth Alcohol Harm-Reduction Policies in Lebanon

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162874 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2874 ◽

Cited By ~ 1

Author(s):

Rima T Nakkash ◽

Lilian A Ghandour ◽

Nasser Yassin ◽

Sirine Anouti ◽

Ali Chalak ◽

...

Keyword(s):

Alcohol Use ◽

Harm Reduction ◽

Stakeholder Analysis ◽

Premature Death ◽

Evidence Based ◽

Control Policies ◽

Alcohol Control ◽

Non Governmental Organizations ◽

The Right ◽

Alcohol Harm Reduction

Background: Alcohol use is a major risk factor in premature death and disability, especially among youth. Evidence-based policies to prevent and control the detrimental effect of alcohol use have been recommended. In countries with weak alcohol control policies—such as Lebanon, stakeholder analysis provides critical information to influence policy interventions. This paper assesses the views of stakeholders regarding a national alcohol harm reduction policy for youth. Methods: We interviewed a total of 22 key stakeholders over a period of 8 months in 2015. Stakeholders were selected purposively, to include representatives of governmental and non-governmental organizations and industry that could answer questions related to core intervention areas: affordability, availability, regulation of marketing, and drinking and driving. We analyzed interview transcripts using thematic analysis. Results: Three themes emerged: Inadequacy of current alcohol control policies; weak governance and disregard for rule of law as a determinant of the status quo; and diverting of responsibility towards ‘other’ stakeholders. In addition, industry representatives argued against evidence-based policies using time-worn strategies identified globally. Conclusions: Our findings indicate that alcohol harm reduction policies are far from becoming a policy priority in Lebanon. There is a clear need to shift the narrative from victim blaming to structural conditions.

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“There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness

Harm Reduction Journal ◽

10.1186/s12954-019-0332-4 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 3

Author(s):

B. Pauly ◽

M. Brown ◽

J. Evans ◽

E. Gray ◽

R. Schiff ◽

...

Keyword(s):

Alcohol Dependence ◽

Harm Reduction ◽

Situational Analysis ◽

Drinking Patterns ◽

Social Worlds ◽

Case Study Methodology ◽

Alcohol Harm Reduction ◽

Alcohol Programs ◽

Health Justice ◽

The Impact

Abstract Background The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). Methods We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of “messy”, “ordered” and “social arenas” maps that provide insight into the social worlds of participants and the impact of MAPs. Results Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. Conclusions In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.

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