Treating alcoholism with alcohol? Absurd harm reduction strategy has worked before

Community groups in Vancouver’s drug-ridden Downtown Eastside have been on the forefront of Canada’s foray into harm reduction strategies. They've been providing clean needles for heroin users and even clean pipes for crack smokers in a bid to limit the negative side effects of substance abuse.

But now it seems they have gone one bridge too far, combating alcoholism by giving addicts alcohol. It is a bizarre and controversial strategy that flies in the face of the Canadian government’s own drug treatment policy stance and seems to defy common sense. But comparable “managed alcohol” programs in Ontario have worked in the past.

Earlier this month, Vancouver's Drug Users Resource Centre made headlines with a vending machine that distributed crack pipes for a quarter, no questions asked.

That same group is also behind a craft beer program that provides fresh brew for alcoholics. It is at this point that the oft-celebrated harm reduction program appears to slide into the absurd.

According to the National Post, Vancouver’s Portland Hotel Society is responsible for the program that teaches alcoholics how to brew their own beer. The program supplies members with about five litres of beer or wine per month. Members pay a $10 monthly fee, which gets them brewing lessons, access to the supply and membership into an alcoholic support group.

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The idea sounds like a bit of a lark, more of a brewing co-op one might join with their friends than a strategy to combat chronic substance abuse. The goal is to keep alcoholics from turning to downing rubbing alcohol, or illegally scoring booze, to get their fix. But unlike heroin or crack, booze is not illegal and there are other avenues that can help combat alcoholism.

And unlike harm reduction strategies that address heroin and crack use, a brewery co-op doesn’t combat life-ending side effects associated with alcoholism. Providing clean needles, or even clean crack pipes, to help addicts avoid contracting diseases such as AIDS is one thing. Giving someone beer so they don’t drink mouthwash seems less pressing.

There are, however, two prongs to consider in the harm reduction strategy. The first prong is reducing the harm addicts do to themselves and success of that remains up for debate at this point. The second prong is reducing the harm addicts do to society. And on that front, there may be some benefits to Vancouver’s free beer program.

There are currently three programs operating in Ontario that provide small supplies of alcohol to homeless addicts. Programs known as Managed Alcohol Projects are currently operational in Hamilton, Ottawa and Toronto. And the City of London is currently working to establish a program of its own.

Managed alcohol programs work somewhat similarly to Vancouver’s brewery co-op strategy. Alcoholics living on the street attend a shelter and receive small amounts of alcohol as well as any medical help or social assistance they may require.

Toronto's Seaton House was the first shelter to offer a managed alcohol program, beginning in 1996. The program now has some 100 managed alcohol beds and 28 infirmary care beds. According to a recent report, the continuous care made available to Toronto’s chronically inebriated homeless decreased emergency department visits by 93 per cent and medical service calls by 96 per cent. In 2010, the program saved Toronto an estimated $3,300 per client in emergency service calls and hospitalizations daily.

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A 2006 study by Ontario researchers found that an Ottawa shelter-based Managed Alcohol Project helped stabilize alcohol intake for homeless people with chronic alcoholism, as well as reduce visits to hospital emergency rooms and police encounters.

The focus of the study was a managed alcohol program operating out of the Shepherds of Good Hope shelter. The program allows participants three ounces of sherry or five ounces of wine every hour.

A recent testimonial from one user of the program suggests the consistency and security of the program gave him a chance to turn his life around. The client gained weight, was able to control his diabetes and became generally healthier.

On a larger scale, the report into the Ottawa project found that police encounters involving the 17 participants dropped from an average of 18.1 instances per month to 8.8 instances. Emergency department visits fell from 35 per month to eight. Participants also required fewer ambulance rides, drank less non-beverage alcohol (such as mouthwash) and decreased their average beverage consumption from 46 drinks per day to eight.

In a 2011 report studying whether London, Ont., should open its own managed alcohol program, it was suggested that that city’s homeless population was responsible for $1.5 million in annual costs to emergency and police departments, not to mention the cost of hospitalization, time in custody and social services.

Establishing a managed alcohol program with 16 to 20 beds would cost an estimated $943,000 per year. In short, there is money and resources to be saved.

Needle exchange programs and vending machines that provide clean crack pipes are hard enough to understand, although studies suggest a strategy of weaning addicts off illicit behaviour has had more success than hard-line measures.

But there is something even more confounding about giving alcohol to alcoholics, even if the numbers back it up. The Canadian AIDS Society supports harm reduction strategies. So do the Canadian Nurses Association and the B.C. Centre for Disease Control.

Is the Canadian Craft Brewer's Association next?

Photo via CBC

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