The notion of providing alcohol to ‘alcoholics’ is controversial. However, NDARC’s Professor Kate Dolan argues that Australia needs managed alcohol programs (MAP), which provide those with severe and intractable alcohol dependence a regulated amount of alcohol.
Professor Dolan told the Canadian press this week that Australia has fallen behind the rest of the world in treating alcohol addiction.
“We used to lead the world in harm reduction services,” Professor Dolan told The Fifth Estate, but “the alcohol field has not progressed as much as the illicit drug use field.”
Her comments follow visits to MAPs in Ottawa and Vancouver, Canada in 2015.
She said she was impressed by the facilities, which give a regulated, hourly dose of wine to homeless alcoholics to help manage their addiction and keep them safe.
The establishment of a MAP in Australia has been hampered by a lack of evidence of feasibility and acceptability, Professor Dolan explained. In 2014, she sought to address this gap by reviewing the literature, surveying potential MAP service users, and estimating costs and service utilisation savings offered by a MAP in Sydney.
In a paper titled Feasibility of a Managed Alcohol Program (MAP) for Sydney’s homeless, Professor Dolan and colleagues argue that MAPs are cost-effective through reductions in spending on health care and emergency services.
Participants also significantly reduce their alcohol consumption and learn a sense of community.
“MAP improves their quality of life and while some take a break from drinking, few quit,” said Professor Dolan. “MAP lessens the blow of alcohol on this group.”
Professor Dolan is currently designing a business plan for a MAP in Australia.
“We have been trying to address the issue of chronic homelessness and alcohol dependency for a while.
“We were toying with the idea of a wet room where people could drink off the street and this would provide an opportunity to engage them without them becoming abstinent.”
Key facts: a Sydney MAP
- Alcohol dependence affects almost half of Sydney’s homeless adult population.
- Alcohol dependent homeless people experience higher rates of chronic illness, injuries and assaults, longer hospital stays, increased mortality, and higher levels of contact with the criminal justice system. Many also suffer from mental illness and alcohol-related brain injury.
- MAPs are a novel approach for delivering health and social services to a population that has not responded to or engaged with existing services.
- MAPs operate within homeless shelters and involve dispensing a regulated amount of alcohol at set times to those with severe and intractable alcohol dependence. MAPs currently operate in Canada, the United States of America (USA), Norway, and the United Kingdom (UK).
- A systematic literature review was conducted between July and September 2014. Of 1,376 records identified for screening, 14 were retained in the final analysis.
- Results indicate reductions in alcohol use, days intoxicated, contact with police, incarceration, healthcare costs, emergency department contacts and hospital admissions. Improvements in mental health, attending healthcare appointments and receiving medical treatment were also evident.
- A survey of eligible homeless alcohol dependent residents of the inner Sydney short stay alcohol withdrawal service, Gorman House, was conducted from 9 July to 3 November 2014. Of the 51 participants (which were 94 per cent male, with a median age of 45 years), almost half (45 per cent) were rough sleeping, nearly all (96 per cent) had high scores consistent with alcohol dependence on the Alcohol Use Disorders Identification Test (≥ 20) [AUDIT] and reported street drinking (94 per cent).
- The majority of respondents indicated strong interest in a MAP with a preference for the residential model (76 per cent expressed interest in the bring-your-own alcohol model and 69 per cent in a service where alcohol is provided). Willingness of respondents to pay a proportion (at least 25 per cent) of their income for the service was up to 90 per cent for a residential facility where alcohol is provided.
- Findings demonstrate technical, operational, and economic feasibility of a MAP for Sydney.
- A 15-bed residential facility is estimated conservatively to result in a net reduction in service utilisation costs of around $480,000 per year (range $390,000‐$580,000).