Trailblazing harm reduction

Managed Alcohol Programs serve an often-overlooked vulnerable population

It’s a made-in-Canada initiative designed to help some of society’s most vulnerable: people living on the street, or not far from it, with such a severe dependence on alcohol that they often resort to mouthwash or hand sanitizer to get it.

A managed alcohol program (MAP) provides people who haven’t found success with abstinence-based approaches with pre-measured doses of beer or wine—often paired with housing and other supports—as a way of reducing the harms from alcohol. But do they work? A national study, co-led by Bernie Pauly and Tim Stockwell at UVic’s Canadian Institute for Substance Use Research (CISUR), is finding out—and so far, signs point to yes.

“A striking finding for me has been that unstably housed participants are usually able to retain their housing over many months and often years after enrolling in a MAP, a remarkable change for many,” says Stockwell, CISUR director and UVic psychology professor. “Overall, we have found evidence that patterns of alcohol use become less hazardous once people settle into the programs.”

Pauly agrees. “We sometimes say MAPs provide housing, home and hope,” she says. “This stability provides a safer space for people to begin to consider a future they didn’t think was possible when they are on the street or in a hopeless situation just trying to survive.”

The Canadian Managed Alcohol Program Study (CMAPS) involves over 50 research partners at 13 different sites across Canada. Over 400 program participants and controls were interviewed, and data gathered on alcohol consumption, alcohol related harms, health, hospital visits and police contacts. Given that every MAP is different, engaging with local community partners is key to the success of the research.

“MAPs are varied in terms of how they are set up and delivered to different populations,” says Stockwell. “It’s essential that we get good descriptions of the programs, as well as their eligibility criteria and policies, so our research can help improve them.”

And improving programs it is. In addition to the traditional route of publishing findings in academic journals, CMAPS includes what’s called a “community of practice,” so that new information and research is shared immediately and widely with those delivering and receiving services, as well as with academic researchers.

One MAP in Ontario recently incorporated housing into their program after CMAPS research revealed it would greatly improve their participants’ outcomes. In Victoria, the CMAPS team recently hosted a dialogue with multiple community partners to explore different MAP models and make recommendations to address regional needs.

With cannabis recently legalized in Canada and given the long-term consequences of heavy alcohol use, CMAPS is planning to explore the feasibility of cannabis substitution for people with severe alcohol use problems and homelessness—the same population who access MAPs.

The project is also looking at the effectiveness of different models of MAPs, such as peer-run and Indigenous-led programs.

“These programs are leading the way in providing new insights about how to address historical and ongoing trauma, grief, loss and pain through social and cultural connections,” says Pauly, who is also a UVic nursing professor and Island Health Scholar. “People in MAPs often experience high levels of stigma and social exclusion, so reconnecting to community and gaining a sense of belonging, is important to healing.”

Edgewise: learn more

Canada’s first managed alcohol program (MAP) was established at Toronto’s Seaton House in the 1990s after a public inquiry into the freezing deaths of three men who were homeless and whose drinking prevented them from accessing adequate shelter. As with many cities, Toronto did not have shelters or supportive housing that allowed alcohol use onsite.

In a MAP, tailored amounts of beverage alcohol are provided to participants as a way to reduce harms related to alcohol use and replace non-beverage alcohol use. These doses of alcohol are usually dispensed to the participant at regular intervals throughout the day.

Most Canadian MAPs are incorporated into existing programs which include accommodation such as shelters, supportive housing, housing first programs, and long-term or residential care. In recent years, MAPs have also opened in non-residential settings like drop-in centres and hospitals.

MAPs have been found to reduce acute and social harms of drinking including withdrawal, seizures, and problems with finances and relationships. They also assist individuals in maintaining housing and reconnecting with family and community.

A CMAPS cost-benefit analysis of one successful MAP estimated that for every dollar spent on the program, the region saved between $1.10 and $1.20 on hospitalizations, ER visits, shelter, policing and other costs.

To learn more, visit cmaps.ca.