Welcome to our web site which is dedicated to dependency treatments, research and education. On this site you will find summaries of research articles, lectures and conferences from Dr Andrew Byrne and his colleagues. 75 Redfern St, Redfern, Australia. Phone 9319 5524
Managed Alcohol Programs - (MAP). Slow
progress of effective hostel protocol to save money, suffering and dignity of
our most marginalised citizens.
I have been writing these summaries for many
years but there is little more dramatic I can think of than the findings of
three published studies and numerous other reports of allowing alcohol to
alcoholics in refuges under strict supervision with psychosocial supports.I wrote enthusiastically about a Canadian
study by Tiina Podymow in 2006 ( http://www.redfernclinic.com/c/2006/01/supplying-alcohol-to-alcoholics-may_9924.php4
).The other two are from 2009 and 2012,
both from Seattle (see refs below).
Essentially these interventions allow
limited quantities of alcohol such as one standard drink per hour in previously
‘dry’ hostels. Thus there is a supervised supply from trained staff inside the
establishments from opening at 5 or 6pm up to 10pm or later.
The published findings of events before and
after implementation of the ‘managed alcohol program’ show substantial and
significant improvements.Both medical
and police interactions dropped while overall alcohol consumption also
dropped.The authors of some of the
studies quantify the benefits using estimates of the costs of police and
medical services, each showing very dramatic savings per individual.
These subjects were all hostel residents who
had had multiple attempts at abstinence, detoxification, meetings and medical
interventions without success.Hence for
some of these high-end alcohol users “managed alcohol” may be a better goal
than enforced abstinence in return for the bed for the night.The may also be some parallels with the use
of nicotine replacement therapies, opiate maintenance treatments and other harm
reduction strategies.Outright overnight
bans on alcohol in these hostels may be a well meaning policy which has
paradoxically increased harms to those it was intended to help.
The very fact that the trials were able to
be performed is impressive.It is my
belief that these publications are so persuasive that a randomised trial is
warranted on a large scale, such are the potential benefits to the alcoholic
drinkers, their families and society at large.
The take-home message from the three reports
is that when abstinence based interventions for chronic alcoholics are
unsuccessful, further pursuit of abstinence, even temporarily may lead to
unwanted consequences which are expensive, painful and time consuming.And they are avoidable.
One possibly reason for the findings might
be that residents facing overnight lock-up may drink very heavily in the period
immediately before entering the hostel.Such binge drinking is known to be associated with complications from
falls and injuries, chest infections, nerve/skin damage from pressure necrosis,
liver disease, ulcers, etcetera.
In 2011 Time Magazine was so impressed that
they ran an enthusiastic article (The ‘Wet House’ Where Alcoholics Can Keep
Drinking - link below).This was
based on an original story in the New York Times (link below).
Next time you hear of someone’s operation
being postponed due to lack of hospital bed, recovery services or operating
theatre time, it is possible that the services are being used by a person in
the position above suffering some urgent but preventable medical or surgical
complication requiring your local hospital services.This may also apply to casualty waiting
times, blood transfusion services, ambulance, rehabilitation and more.Likewise, when the police are tied up with
local issues of this nature they could be attending to other important policing
Since writing this I have become aware that
Prof Kate Dolan has done a lot of work in this area and has provided much
needed summaries of the English and Canadian experience with detailed
suggestions for Managed Alcohol Programs in Sydney (refs below).
Podymow T, Turnbull J, Coyle D, Yetisir E,
Wells G. Shelter-based managed alcohol administration to chronically homeless
people addicted to alcohol. CMAJ 2006 174;1:45-49http://www.cmaj.ca/content/174/1/45.full
Larimer ME, Malone DK … (et al.) Marlatt GA.
Health care and public service use and costs before and after provision of
housing for chronically homeless persons with severe alcohol problems. JAMA.
2009 Apr 1;301(13):1349-57http://www.ncbi.nlm.nih.gov/pubmed/19336710
Collins SE, Malone DK, et al. WG, Marlatt
GA, Larimer ME. Project-based Housing First for chronically homeless
individuals with alcohol problems: within-subjects analyses of 2-year alcohol
trajectories. Am J Public Health. 2012 Mar;102(3):511-9http://www.ncbi.nlm.nih.gov/pubmed/22390516