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Managed Alcohol Programmes: A New Strategy for Harm Reduction

Managed Alcohol Programmes: A New Strategy for Harm Reduction

Is one solution to alcohol abuse… more alcohol? Some in Canada think so. A few years ago, several cities have implemented managed alcohol programmes (MAP) to tackle severe alcoholism, particularly among those with an unstable housing situation and who drink non-beverage alcohol.

After several years of seemingly successful results, other countries including Australia and Scotland are interested in replicating the concept. Already, a homeless shelter in Glasgow wishes to pilot the idea. 

While it’s true that such a programme appears to be beneficial in some way for some people, there is a lack of good evidence that these programmes are effective in their aims, which are to improve health and reduce harms that people accrue for their drinking.

What Are Managed Alcohol Programmes?

A managed alcohol programme could be described as a means of addressing alcoholism via harm reduction. It can be compared to methadone substitution therapy and prescription heroin programmes, both of which are also implemented in Canada. The idea is the same, but aiming to deal with the growing problem of non-beverage alcohol consumption among other issues.

Participants are provided with regular doses of alcohol throughout the day. In addition to an alcoholic drink, participants are provided with housing, food, and various forms of social support, usually partially paid from their social security benefits.

As an example, a centre will offer measured servings of alcohol (mainly wine or beer) at regular intervals from morning until bedtime. This may be every hour or so, provided the person doesn’t appear intoxicated. Ultimately, the drink-dispensing schedule is decided by the on-site staff and the person in care. And in order to keep things in check, anyone who consumes alcohol outside the facility is temporarily banned from the “bar”. This rule, however, may vary between MAP locations.

What’s a Non-Beverage Alcohol?

A non-beverage alcohol (NBA) is any consumer product based on alcohol that is not intended for internal consumption. Some examples include:

  • Mouthwash
  • Hair spray
  • Hand sanitiser
  • Rubbing alcohol
  • Perfume or Cologne
  • Antifreeze

Consuming such substances can be very damaging to health partly due to other additives as well as the alcohol content. In many of these examples, the alcohol itself is also a problem. Beverage alcohols are made with ethanol, which is not “healthy” although not toxic either. However, some non-beverage alcohols may contain methanol or butanol, which can be lethal.

Someone suffering from severe withdrawals who cannot get access to drinkable liquors can easily, out of desperation, turn to an alternative, despite the potential consequences.

 

Man misusing alcohol by the side of the road -

Why Managed Alcohol Programmes Are Getting Attention

MAPs are peaking people’s interests because, at least in Canada, they would appear to be addressing all the main issues. For example, it may not make sense to give alcohol to an alcoholic. However, when alcohol dependency is serious, stopping suddenly can be life-threatening without proper care. And if a person cannot get the right support, such as residential detox, the argument is that this is the second-best option.

In addition, MAPs are focused on people who are homeless or do not have a stable living situation. This is also a major issue in Canada, among other reasons, due to a high level of displaced indigenous populations. 

Among the general population, alcohol abuse is estimated to affect only about 4% of people globally. For the homeless, this figure rises to about 38%. For both groups, alcohol problems mean they cannot partake in most social housing schemes as such programmes almost always require you to be sober. 

Also, as mentioned before, MAPs aim to address a different issue – the consumption of non-beverage alcohol. In countries such as Canada, where alcohol is expensive and thus not easily available, people with a serious dependency often turn to alternatives to get their fix. 

Because of this, many of those who need help simply have nowhere to start. Which explains the argument that, in a sense, MAPs are offering an alternative approach to resolving an ongoing problem.

Have Managed Alcohol Programmes Been Beneficial?

Several studies claim that MAPs do more good than harm. Mainly, this is seen on a social level. For example, people who consume NBAs and/or go on binge-drinking sessions and suffer subsequent withdrawals often end up in hospitals or in conflict with law enforcement. Or in extremely cold weather, homeless people may end up dying due to exposure.

This takes a toll on the community and adds extra stress and expenses for public services. After MAPs were implemented, it seemed that the number and consequences of such episodes dropped.

Many participants also claim that MAPs have helped them gain some control over their lives. While they, for the moment, remained dependent on alcohol, they didn’t have to worry about being homeless or where to get their next drink. In a way, one could say they became functional alcoholics. 

Others took it a step further. As they “got their heads together”, they began to cut down on their drinking. Some were finally able to go on to rehab after spending time in a MAP – something they couldn’t do before.

Why Managed Alcohol Programmes Are Controversial

Given that MAPs have not been around for long, there is not enough evidence that they work. Upon closer examination, for every positive point, there is a potential argument against it. Even if there are seemingly obvious benefits to them, it is important to examine such programmes from both ends, as things may not be as clear-cut as they seem.

The Reduction in Harmful Drinking

While many participants managed to learn to regulate their drinking and abstain from NBAs, some also started consuming more alcohol overall. Prior to the programme, most went on binge-drinking sessions when they could acquire alcohol and endured sobriety when they couldn’t. With the programme, they had daily access to alcohol. And so, some participants increased their total consumption.

In one study, long-term (2+ months) participants drank about 7 standard drinks fewer per day, but consumed alcohol on average about 5.5 more days per month. However, the study also noticed that newer participants (<2 months) were more likely to consume NBAs off-premises.

In the long run, this wouldn’t be helpful is, as some reports find that daily drinking does more harm to the body, especially the liver, than binge episodes. It seems that while MAPs solve one problem, they create another. So far, there has been no proof that these programmes do anything for a person’s physical health.

It’s an Ethical Issue

All managed alcohol programmes are experimental – that is, experimenting on a vulnerable public. Although all participants are voluntary participants, one can argue that they may not be in the right state of mind to decide what is best. 

In essence, managed alcohol programmes are the opposite of the abstinence-based approach, which sticks to the “no means no” principle on alcohol intake. However, someone who is dependent on alcohol will not be likely to say no if offered a free and ongoing supply, especially if the alternative is to give it all up for good. 

Lack of an Alternative

Thus, the argument above raises the question: if a full rehab programme were also offered alongside, would any of the MAP participants volunteer for that instead? And if the majority wouldn’t, is the data we have now even reliable?

Knowing that the opportunity was open to certain MAP participants who claim “it didn’t work” also raises questions about the quality of addiction rehabilitation treatment.   Unlike MAPs, abstinence-based treatment has been proven to work. Therefore, if there is ongoing negative feedback, perhaps there is more to the Canadian alcoholism issue than meets the eye.

Sources Are Strictly Canadian

The data is strictly focused on only one country – Canada. And what may work for one, will not work for another. Thus, all claims and data have to be questioned just because the information is limited from only one perspective. For example, NBA consumption is not really an issue in Scotland. Neither are homeless populations freezing in the snow. In Canada, however, both issues are serious.

Although the programmes offer support to those who want it, they do not appear to demonstrate a clear-cut plan on how to deal with alcoholism completely. And even if they did, they don’t seem to provide much motivation to change to a sober lifestyle.

Taking Out of Serious Treatment

Alcohol abuse is a serious problem in Scotland, but the same type of programme may not be as beneficial there as it is in other countries. MAPs are largely aimed at helping those who consume NBAs, which is not as common in Scotland as in Canada – as already stated.

In addition, the funding for managed alcohol programmes has to come from somewhere. Most likely, this would be the same source that funding for other drug and alcohol rehabilitation comes from. So, by using rehab-focused funds for MAPs, access to public funding for abstinence-based treatment centres will be harder.

In Scotland, where waiting lists for addiction treatment are already long, the introduction of MAPs might worsen the ongoing lack of resources. Since Scotland is unlikely to see benefits from MAPs, spending already limited funds on them will take away treatment from others.

Comments from Addiction Treatment Specialists

Professor Jonathan Chick, the Medical Director at Castle Craig Hospital advises caution regarding instituting a similar programme in Scotland, commenting:

“I am not convinced that the Canadians have actually shown evidence of the benefits of such programmes. 

Overall, the latest Canadian data from the six cities shows that the…. improvement in liver tests is transient. But the critical measure of alcohol-related problems, including medical and social and legal, could not be shown to be improved by MAPs…. There is [also] no evidence [that MAPs] improve health.”

He also believes that the decision to pilot a MAP project in Glasgow was rushed, adding, “There have been no outcomes published yet and it would have been preferable to wait until there was good evidence from the Canadian project and whether they had met the objectives they aimed for.”

Dr. Maria Kelly, Associate Medical Director at Castle Craig adds, “I believe those seen as eligible for MAP should be offered the chance to detox in a safe setting and receive abstinence based treatment. It may be helpful as a stepping stone to that chance. The risk with harm reduction as an end in itself is that it accepts inequality. I believe we should be striving to give everyone a chance to change their lives no matter how radically. We know that medical detox with rehabilitation can achieve that for anybody and the longer that safe treatment lasts the more chance even the most troubled addicted person can become free of dependence.

It has been wonderful to see the early results showing a real reduction in Scottish alcohol related harms related to MUP (Minimum Unit Price). Jonathan began work on that idea 20 years ago!”

Managed Alcohol Programmes Are No Good for Scotland

Most healthcare professionals today recognise that there is more than one way to recover from addictive behaviour.  At Castle Craig Hospital and Smarmore Castle, we work towards a goal of absolute sobriety but we are always ready to consider and to evaluate new approaches to tackling the problems presented by addiction.

Such problems may be medical, social, economic, or of some other kind and it may be that for some people, MAPs have a role to play in the same way that, for example, a methadone maintenance programme has for some.

If there are those that can benefit from MAPs, they likely have alcohol use disorder, not an addiction. In which case, someone who doesn’t want to quit but just learn to manage their drinking, can look for alternative approaches such as Moderation Management. 

Ultimately, at Castle Craig, we continue to emphasise the importance of abstinence. If someone suffers from alcoholism, complete sobriety is a proven route and can be the way to assure full recovery even for those who initially lacked social support and has damaged their health.

It’s essential to understand the regular attributes of alcoholism and consider different components when you think you or somebody you care about has a drinking issue. Keep on investigating the assets on this site and, when you are prepared, connect with one of our private treatment programme professionals. We have effectively treated a large number of individuals who’ve battled with alcohol abuse, drug dependency and gambling addictions.

In case you’re worried about alcoholism and stopping drinking, contact our 24-hour help-line team at +44-844-740-1394 or email us at [email protected] with questions, remarks, or concerns.