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Managed alcohol programs: Helping chronic alcoholics with regular doses of alcohol

The Bottom Line

  • The harmful use of alcohol resulted in approximately three million deaths worldwide in 2016.

  • Managed alcohol programs are a promising harm-reduction approach for people living with severe alcohol dependence who often experience homelessness or housing instability.

  • Know the key signs of alcohol problems among older adults (loss of co-ordination, falls and slurred speech; problems sleeping; poor personal care; etc) and seek help.

There are growing concerns globally about the health and social harms caused by alcohol.(1) The harmful use of alcohol resulted in approximately three million deaths worldwide in 2016 (5.3% of all deaths globally).(1) In 2018, it was estimated that approximately 6 million Canadians (12 years and over) were considered heavy drinkers. Of those, 22.9% were between the age of 50 to 64, and 7.4% were 65 and over.(2) This situation highlights the importance of policies, programs and services aimed at reducing the harmful use of alcohol.

Managed alcohol programs are a harm-reduction approach for people living with severe alcohol dependence who often experience homelessness or housing instability.(3; 4) The Canadian Mental Health Association defines harm reduction as "an evidence-based, client-centred approach that seeks to reduce the health and social harms associated with addiction and substance use, without necessarily requiring people who use substances from abstaining or stopping."(5)

Individuals in managed alcohol programs have had multiple and repeated attempts at detox and treatment, and often experience large gaps in health and social services. Managed alcohol programs provide controlled access to alcohol (for example, regulated doses of wine, beer or sherry at predetermined times during the day) and replace dangerous non-beverage alcohol (for example, mouthwash, hand sanitizer and hairspray) for whom abstinence has not worked.(4) The primary focus of these programs is to reduce harms (for example, reduce antisocial behaviours, safely stabilize consumption and replace non-beverage alcohol with beverage alcohol).(6) 

The first managed alcohol program was created over 20 years ago in Toronto as a response to a coroner’s inquest that determined three homeless men froze to death after being turned away from shelters due to their alcohol dependence.(4) The number of managed alcohol programs has since increased significantly (23 programs located in five provinces - British Columbia, Alberta, Saskatchewan, Manitoba and Ontario). These programs are offered in a range of settings (shelters, supportive housing and hospitals) and for specific populations (chronically homeless, Indigenous peoples and older adults).

Like other harm-reduction approaches (for example, supervised injection facilities for drugs users), managed alcohol programs raise questions among the public. By providing alcohol to chronic alcoholics, are we abandoning them or making the situation worse? Or is it a necessary evil in order to help manage their addiction and to keep them safe?

What the research tells us

A recent rapid synthesis conducted by the McMaster Health Forum examined the effectiveness of managed alcohol programs in supporting individuals with severe alcohol-related problems.(7) The synthesis revealed the limited body of research evidence on this topic. However, research is currently being conducted in the field by the Canadian Managed Alcohol Program study at the University of Victoria.

Nonetheless, the rapid synthesis found the following evidence supporting managed alcohol programs:
1) decreased number of beverage alcohol consumed per day;
2) increased safety and quality of life;
3) lower incidence of alcohol-related harm;
4) fewer police interactions;
5) decreased emergency-department visits and hospital admissions;
6) no significant individual or group-level differences in liver function tests; and
7) potential cost savings (through reductions in spending on health care and emergency services).

Recognize the signs and seek help

The Centre for Addiction and Mental Health have identified key signs of alcohol problems among older adults, including:
- loss of co-ordination, falls and slurred speech;
- problems sleeping;
- poor personal care (for example, not bathing, not eating or not eating well, not taking care of health problems);
- irritability, depression or confusion;
- stomach problems, lack of desire to eat;
- making excuses or making up stories to cover up drinking problems;
- tension in relationships, losing touch with friends or family;
- lack of interest in usual activities, desire to stay alone a lot of the time; and
- signs of alcohol withdrawal (for example, racing pulse, tremors and agitation).(8)

It is important to remember that these signs may be similar to medication problems. So, if you or a loved one have any of these signs:
- Seek help from a health professional;
- Contact a helpline or the health and social services in your province specialized in substance use; 


The content of this blog post is based on a rapid synthesis prepared by the McMaster Health Forum: 
Mattison CA, Belesiotis P, Wilson MG. Rapid synthesis: Determining the features of managed alcohol programs. Hamilton, Canada: McMaster Health Forum, 11 February 2019.


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References

  1. WHO. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018
  2. Statistics Canada. Heavy drinking, by age group. Ottawa: Canada, Government of Canada, 2019.
  3. Muckle J, Muckle W, Turnbull J. Operating principles from Ottawa's managed alcohol program. Drug and Alcohol Review 2018; 37(Suppl 1): S140-S142.
  4. Canadian Institute for Substance Use Research. The Canadian Managed Alcohol Program Study (CMAPS). Victoria: Canada, University of Victoria; 2018.
  5. Canadian Mental Health Association- Ontario. Harm reduction. Toronto: Canada, 2019.
  6. Canadian Institute for Health Information. Alcohol harm in Canada: Examining hospitalizations entirely caused by alcohol and strategies to reduce alcohol harm. Ottawa: Canadian Institute for Health Information; 2017.
  7. Mattison CA, Belesiotis P, Wilson MG. Rapid synthesis: Determining the features of managed alcohol programs. Hamilton, Canada: McMaster Health Forum, 11 February 2019
  8. Canadian Association for Mental Health. Alcohol use in older adults. Toronto: Canada, Canadian Association for Mental Health, 2019.
 

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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