Canadian Medical Association Journal 2006 174;1:45-49
Podymow T, Turnbull J, Coyle D, Yetisir E, Wells G. Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol.
Dear Colleagues,
This remarkable report is necessarily
modest in its aims and its claims, yet it shows that giving alcohol in a
supervised manner to homeless heavy drinkers can yield positive outcomes both
for the subject and the community. This
was a pilot study of 17 subjects in Toronto (15 men, mean age 51, alcoholic for
mean period 35 years) who had been registered at a funded city shelter for over
a year.
The study used a ‘chronological’ control, looking at annualised use of
alcohol and treatment/social services before and after the study which lasted
for up to three years before and two years after registering in the study.
There were
significantly fewer primary interactions (up to 50%) with medical and police
officers after enrolment in this study.
And paradoxically, supplying supervised alcohol on request in the
shelter (13.6g alcohol beverage hourly from 7pm to 10pm) was reportedly
associated with substantially reduced consumption from 46 standard (US) drinks
to 8 (excluding the 3 subjects who died, one refusal and 3 others for whom
paired data were unavailable).
The lack of a
parallel control group and small size of the study do not detract from the
thrust of the findings which are highly significant.
The authors explain
the study’s genesis: “After an inquest into the freezing deaths of homeless
alcoholic men, a pattern was noted of heavy alcohol consumption before shelter
entry to achieve in-shelter abstinence, followed by early-morning alcohol-seeking
to avoid the symptoms of withdrawal.”
Predictably there
was a journal response requesting tax-payer alcohol for all. While he may have his tongue in his cheek,
CMAJ correspondent Dr Monczak seems unaware of the enormous potential savings
if these findings were translated across entire communities.
While this group is
already severely damaged and rehabilitation options limited, one can still be
simultaneously pragmatic and humane in dealing with them, just as the Swiss
dealt with heroin addiction over the past 20 years (using needle rooms,
detoxification services, heroin prescription, methadone, etc).
Comments by Andrew
Byrne ..
Comments by Andrew Byrne ..
