[andyt]

In October the Vancouver Coastal Health Authority and the Portland Hotel Society began a pilot program that serves 12 daily doses of alcohol - one every hour from 10: 30 a.m. to 10: 30 p.m. - to eight chronic alcoholics living in the Downtown Eastside.

Four months later there are some signs that the program is having beneficial effects, says Dr. Ron Joe, Vancouver Coastal Health's manager of inner city addiction. Known as the Man-aged Alcohol Program (MAP), Vancouver's is based on similar programs that have been operating in Ontario for the past 15 years, says Joe.

"We want to offer the same program for severe drinkers here. These are people who are not just drinking regular alcohol but drinking Listerine, hand sanitizer and rubbing alcohol.

"Basically they are drinking poison. And the evidence from studies back east shows that a maintenance program has beneficial results," he said.

When chronic alcoholics dilute a 500 millilitre bottle of rubbing alcohol it provides the equivalent of 30 beers, says Joe.

Some people in the study drank three or four bottles of rubbing alcohol a day giving them an alcoholic intake equivalent to 120 beers, he says.

"These are all individuals who have done the rounds of detox and all the conventional and available treatment," he said.

"It's unfortunate, but we can't cure this condition. I wish we could. But we have to accept this harm reduction approach. Ideally, we want to get these persons to abstinence," he said. The alcohol - the participant's choice of vodka, wine or beer - is dispensed by medical staff at the Station Street Community, 1005 Station St., a supportive housing complex of 80 units which opened a year ago to house the homeless.

All those participating in the study live there and are among the small population of chronic alcoholics that routinely show up in hospital emergency departments with serious injuries from falls or fights or unconscious from over-drinking.

Joe said it is costly for the medical system and some have "three or four visits to emergency a week."

"If we are going to provide health care to people, no matter what, then alcoholism is their condition and we should try to treat it. We have not been treating it well using conventional methods," he said.

Since the program began there has been an overall improvement in the health of the eight people.

"They have a lot of chronic underlying diseases. There are a few with high blood pressure which has now stabilized and some chronic skin conditions have improved," he said.

Joe says the behaviour of the test group has changed and they no longer create the com-motion they formerly did.

"In a residential building it's usually 10 per cent of the residents who create 90 per cent of the problems. So that has calmed down," he said.

Clare Hacksel, project man-ager at Station Street housing project, said people who knew the participants are amazed at the changes in them.

"These are folks who knew them from before and they are shocked at the improvement," she said. "We've certainly noticed the change here."

It costs about $350 a month to supply alcohol to each of the participants, Joe says.



Read more: http://www.vancouversun.com/health/Mana ... z1mqoRXr3r

[andyt]

I wonder if at some point the drunks will sue the docs, since using such large amounts of alcohol for a long time has such severe health effects. As opposed to heroin, for instance.

[Proculation]

When the question of the injection clinics went on the news, like a lot of people I thought: "Next what, they will give alcohol to alcoholics next ??"

It was supposed to be a rhetorical joke...

[Gunnair]

Though I get the harm reduction, and I agree with parts of it, I'd like to see some real numbers on what giving these guys booze is actually doing. Helping to clear up skin conditions and blood pressure may be linked to something else.

What'a the dollar value of the program versus the dollar value of status quo?

[andyt]

The injection clinics don't give out drugs. This program is more like the NAOMI study that did give heroin or dilaudid to addicts, with good results.

[Lemmy]

There's economics at play here too. When you provide someone with something for free, there are two effects: an income effect and a substitution effect. In other words, the alcoholics are benefiting by getting the free booze, but it also gives them money to spend on other things. So, since their addiction is being fed for free, they can spend their money on food, shelter, whatever. The positive health benefits are, in part, from not drinking Aqua Velva any more, but also from likely eating a sandwich once in a while now.

[Yogi]

This is bullshit if ever I heard it! You don't treat an addiction by feeding it, supporting it, or enabling it.

[Brenda]

I can hardly see that 12 drinks a day would satisfy an alcoholic who was consuming the equivalent of 120 beers a day...

[Gunnair]

Lemmy wrote:

There's economics at play here too. When you provide someone with something for free, there are two effects: an income effect and a substitution effect. In other words, the alcoholics are benefiting by getting the free booze, but it also gives them money to spend on other things. So, since their addiction is being fed for free, they can spend their money on food, shelter, whatever. The positive health benefits are, in part, from not drinking Aqua Velva any more, but also from likely eating a sandwich once in a while now.

I'd be curious to see if that is fact. If these people are taking their welfare checks and eating better, getting healthier, and costing the system less, then I'd say continue. If not, then I'm not sure what it's accomplishing.

Hence my being interested in hard facts and figures and not feel good soundbites.

[Lemmy]

Of course, we'd need to do some research to measure income and substitution effects and to see what their consumption choices are. The other possibility is that they're using their income effects to spend MORE money on booze. It may be that they're STILL spending all their money on alcohol AND taking the freebies too.

Remember 20 years ago when the idea of a "designated driver" first started to be promoted by anti-drinking and driving advocates? Many bars offered free soft-drinks to people who declared themselves to be the "DD". Well what happened? The answer is that the income effect doesn't just make pop cheaper, it gives the bar patron income to spend on booze as well. As a result, complimentary soft-drinks for DDs actually made the drinking and driving problem worse.

That possibility exists with this scheme too. If this program is getting alcoholics to switch from Aqua Velva to Labatt Blue, that's great. But the income effect may be that they're drinking more of both.

[andyt]

Quote:

"We want to offer the same program for severe drinkers here. These are people who are not just drinking regular alcohol but drinking Listerine, hand sanitizer and rubbing alcohol.

"Basically they are drinking poison. And the evidence from studies back east shows that a maintenance program has beneficial results," he said.

Quote:

Joe says the behaviour of the test group has changed and they no longer create the com-motion they formerly did.

"In a residential building it's usually 10 per cent of the residents who create 90 per cent of the problems. So that has calmed down," he said.

Quote:

"It's unfortunate, but we can't cure this condition. I wish we could. But we have to accept this harm reduction approach. Ideally, we want to get these persons to abstinence,"

It also attracts the drinkers to a place where they can get treatment for their other illnesses (skin conditions etc) and counselling, including the possiblity they may reach out for actual alcohol treatment.


The bottom line is that it costs us less than the present (emerg visits, police involvement, etc) and is less harmful for them.

[Regina]

Treating them with Campral seems more appropriate.

[Gunnair]

andyt wrote:

Quote:

"We want to offer the same program for severe drinkers here. These are people who are not just drinking regular alcohol but drinking Listerine, hand sanitizer and rubbing alcohol.

"Basically they are drinking poison. And the evidence from studies back east shows that a maintenance program has beneficial results," he said.

Quote:

Joe says the behaviour of the test group has changed and they no longer create the com-motion they formerly did.

"In a residential building it's usually 10 per cent of the residents who create 90 per cent of the problems. So that has calmed down," he said.

Quote:

"It's unfortunate, but we can't cure this condition. I wish we could. But we have to accept this harm reduction approach. Ideally, we want to get these persons to abstinence,"

It also attracts the drinkers to a place where they can get treatment for their other illnesses (skin conditions etc) and counselling, including the possiblity they may reach out for actual alcohol treatment.


The bottom line is that it costs us less than the present (emerg visits, police involvement, etc) and is less harmful for them.

Again, I wonder at just how sure they are that these people aren't supplementing the shit they drink with free stuff. I didn't see anywhere in the article that said they were under 24 hr surveillance to ensure they're behavior was indeed changing.

As far as the treatment, that seems to contradict other points in the article that suggests these people are beyond treatment and this is simply a way to reduce the damage.

[andyt]

http://www.cmaj.ca/content/174/1/45.full

Quote:

Abstract

Background: People who are homeless and chronically alcoholic have increased health problems, use of emergency services and police contact, with a low likelihood of rehabilitation. Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence. The shelter-based Managed Alcohol Project (MAP) was created to deliver health care to homeless adults with alcoholism and to minimize harm; its effect upon consumption of alcohol and use of crisis services is described as proof of principle.

Results: Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months. Their monthly mean group total of ED visits decreased from 13.5 to 8 (p = 0.004); police encounters, from 18.1 to 8.8 (p = 0.018). Changes in blood test findings were nonsignificant. All program participants reported less alcohol consumption during MAP, and subjects and staff alike reported improved hygiene, compliance with medical care and health.

Interpretation: A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters.

This is harm reduction - ie the drinkers do better than they otherwise would. They don't all of a sudden go on to live happy, productive, sober lives, but the likelihood of somebody who's been an alcoholic for 35 years doing that are pretty slim anyway. Nobody is suggesting this is the way to go for functioning alcoholics who still have some hope. It's for the down and outers.

[Gunnair]

Regina wrote:

Treating them with Campral seems more appropriate.

I don't think so. Not unless they have volunteered for a 24/7 rehab. Giving them Campral without all the other aspects of rehab would be a waste as they would likely go home and drink.