In the news – Treating alcoholics with wine

by solas

The recommended treatment for chronic alcoholism is abstinence. But the BBC reported yesterday that at the Oaks – a permanent home for those who once lived on the streets in Ottawa- residents are given a measure of wine at hourly intervals. It is called the Managed Alcohol Program, or known by the residence as ‘the pour’ and aims to change the drinking behaviour of inveterate addicts.

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Ottawa’s Managed Alcohol Program – or MAP – was designed to address the needs of homeless people who had tried to stop drinking and failed. The scheme was the brainchild of a group of health professionals around 15 years ago.

Although this on the hour approach is controversial, “There’s a profound reduction in 911 calls, hospital emergency visits, paramedic and police encounters,” says Dr Turnbull.

Resident Elisa Pewheoalook has been drinking for 40 of his 53 years – a life blighted by alcohol. It’s not bad, the wine here,” he says. “Out on the streets I was drinking mouthwash, hairspray. It didn’t taste good, but all I wanted was the effect. I don’t drink that stuff anymore – it makes me feel sick to think of it. And I drink much less here.

Charlotte Waite, Director of Children, Young People and Families at Solas, advocates a harm reduction approach and adds “We take this approach to our work across the board, although in practice it can look different in each project. We stop short of actively giving our customers alcohol or drugs although we know in Cardiff the Wallich run successful ‘wet houses’ where long term, enduring drinkers are in supported accommodation, where they continue to drink. This is along the lines of the ‘Housing First’ model, which Solas are strong advocates for as the evidence base for the success of this model is so strong. People whose needs are complex and whose homelessness is enduring, when given a home with little or no conditions attached, other than paying the rent and allowing a support worker in, settle well and manage their lives, even when they continue drinking or using drugs. Solas are developing this model for young people.

Our Dyfrig House scheme is an abstinent project, for those people who need to not be around other drinkers or drug users to make and consolidate changes.

As with the Footsteps to Recovery programe, the focus is on recovery, so time is spent building recovery capitol and re-building life without the dependency on alcohol or drugs. Having said that, these too are harm reduction projects, as we recognise that change is a process and not an event and so lapse can be a normal.

So in short, there is huge value in support that doesn’t exclude those that want to continue to drink and use drugs. Having said that, the support we provide at Dyfrig House and Footsteps is for those people who have already made changes and who need support to stay stopped.

Paul a resident at Dyfrig House had this reaction to the article…

To drink? Or not to drink? – that’s the question…..

“It’s a question that blight’s the lives of many people with alcohol dependence. I have numerous memories of different people in different organisations repeatedly telling me things such as “If you truly want to control your alcohol, then you must give it up completely” or “controlled drinking just doesn’t work, if you could control it, you would have by now, only abstinence works”.

Thus, after repeated failed attempts at controlled drinking, for nearly 10 years, I have tried to follow the “only abstinence works” approach with questionable success.

The “only abstinence works” approach has two components within it: 1. Giving up alcohol; and 2. staying off alcohol, having given up.

Now, I’m absolutely brilliant at the “giving up” alcohol bit! That’s easy. I can give up alcohol 24 times in a day! But I’m totally rubbish at “staying off” alcohol or “relapsing” as it’s now called.

So it is with fascination and amusement that I have noticed that recently something has “popped up” that seems to totally challenge the “only abstinence works” approach.

That’s what’s happened recently where the media have been sharing the approach of a few homeless hostels in Canada. The difference being that in Canada, the staff provide hourly “pours” of alcohol to their residents between the hours of 7.30am and 9.30pm. This has certainly caught the eye of the Media and the BBC, for example, has been very enthusiastic in sharing this Canadian story across many mediums.

This is interesting as it’s a different approach. So I ask myself, WHAT’S IT ALL ABOUT? Why are the Canadians doing such a thing? Well it’s not because they don’t have the same detox programmes or facilities as the UK as they do. Also, it’s not because they don’t have AA / 12 step programmes as they are very firmly established in Canada.

So I again ask myself, WHAT’S IT ALL ABOUT? Well, having read a number of articles on the programme it seems that these few Canadian Shelters that provide an hourly “pour” of alcohol are plain weird! They are a sort of “dry-wet” shelter; that is residents have to be in the shelter for 30 minutes before the hourly pour and must not be displaying signs of intoxication. However, their residents are not breathalysed.  An alternative way of looking at it might be a “wet shelter” with rules about drunkenness. Or finally a “dry shelter” that provides alcohol!!!

We have wet shelters in the UK, so why the big fuss? So again, I ask myself WHAT’S IT ALL ABOUT? Well the difference is that the staff are actually PROVIDING the alcohol on an hourly basis. This is the unusual bit! Nowhere else in the world does this.

So I ask, WHY? Why do they do this? Well, after reading many articles it became apparent that the strategy was brought in by one Hostel because in Canada it gets very cold at winter! Some time ago, in one cruel and cold winter, one wet hostel found that three of its residents had died from hypothermia after staying out the night, whilst another suffered the loss of all his toes due to frostbite. This is because, even though it was a wet hostel, the residents would spend all day and part of the night begging for money for alcohol and then retiring to their wet shelter at night.

So at last! I get it! It seems to me to be that the provision of hourly pours of alcohol primarily takes away the need for the residents to stay out in the cold constantly “topping up”. The name for such an approach is “Harm Reduction”, that is, reducing as much of the harm or associated harm from the problem behaviour (similar to needle exchange for IV drug users).

Interestingly, it soon became apparent that the Canadian pour approach had further unexpected positive effects. Mainly that the residents were able to actually participate and do things within the hostel or plan to do things like attending appointments, as they knew their next “fix” of alcohol was in effect covered. Prior to the pour most residents would be pout all day begging for money for alcohol. Hence, it appears that the Canadian Pour helped people who were traditionally horrendous at accessing healthcare.

To summarise therefore, it seems to me that the “only abstinence works” approach lives on, for now. However, the “controlled drinking” approach appears to be fighting back with a possible better solution than an abstinence model for some homeless people who either do not want to, or cannot stop drinking.”

Read the full BBC article HERE

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