Radical harm reduction: coming out from under the radar

Human and Social Development

Clients at the Art Manuel House managed alcohol program get a pre-measured amount of alcohol at regular intervals. (Photo credit: Ashley Wettlaufer)

The practice of providing alcohol to people with severe alcohol dependence is a complex and sometimes controversial approach to harm-reduction, and it’s one that many communities in Canada have tried—some very publically and some quietly under the radar. These programs which give alcohol in measured, regular doses throughout the day, usually along with housing and other supports, are known as Managed Alcohol Programs, or MAPs.

For the first time, a peer-reviewed journal has compiled the largest collection of peer-reviewed articles on MAPs that aims to bring this radical harm-reduction strategy out into the open and shed light on how, in their different forms, they contribute to the health and well-being of participants.

This special issue of Drug and Alcohol Review features four papers by researchers at the University of Victoria’s Canadian Institute for Substance Use Research (CISUR, formerly CARBC) from the Canadian Managed Alcohol Program Study (CMAPS), which looks at data from approximately 380 individual MAP participants and controls across the country—the largest study ever conducted.

The issue’s co-editors, CMAPS principal investigators Bernie Pauly and Tim Stockwell of UVic, say this represents the most significant publication of findings related to MAPs and is a significant step forward in developing knowledge to inform best policies and practices around MAPs. *

“It’s intended to stimulate debate and focus future research on strategies to improve outcomes for this vulnerable and often under-serviced population,” Stockwell and Pauly write in the editorial accompanying the research findings.

The work highlights the diversity of MAPs across Canada. Pauly’s paper looks at 13 MAPs and found that they all had a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health services and cultural connections. However, they varied widely in how they were implemented, who was eligible to participate, whether permanent housing was provided and if a gendered lens or Indigenous worldviews informed program development and delivery.

“The initial results are promising in reducing acute and social harms as well as economic costs,” says Pauly. But more research is needed on long term chronic harms. We also need to take a closer look at how we can better provide culturally appropriate care to Indigenous people and more relevant services for women.”

The paper led by CISUR director Tim Stockwell looks at alcohol-related harms and housing stability among established MAP participants compared to new participants and controls. Another led by CISUR research affiliate Clifton Chow looks at how MAPs recorded and managed drinking outside of the program. The fourth, by Rebekah Erickson, a psychology honours student with CISUR, looks at the potential negative unintended consequences of alcohol being unaffordable to people with alcohol dependence and housing instability and found that even the heaviest drinkers will reduce their drinking when alcohol prices rise.

CISUR’s research on MAPs—widely regarded as a made-in-Canada harm-reduction approach—is gaining recognition both locally and globally. CISUR is currently working with community partners to explore the need for MAPs in Victoria and other communities. 

Learn more

View an interactive map of Managed Alcohol Programs in Canada.

* A press kit containing images isavailable on Dropbox. Please email to request copies of the research papers.

MAP contacts for media:
Ron Kuhlke and Loretta Brown (Eastside Illicit Drinkers Group for Education and Vancouver Area Network of Drug Users) at 604-683-6061 or

Alison Hunt (Executive Director, Art Manuel House) at 416-703-9645 x 228 or

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Media contacts

Bernie Pauly (CISUR/Department of Nursing) at 250-472-5915 or bpauly@uvic.ca

Tim Stockwell (CISUR/Department of Psychology) at 250-472-5445 or timstock@uvic.ca

Rebekah Erickson (CISUR/Department of Psychology) at 250-472-5445 or rebekah_erickson@outlook.com

Suzanne Ahearne (University Communications + Marketing) at 250-721-6139 or sahearne@uvic.ca

In this story

Keywords: addiction, alcohol, community, health, homelessness, human rights, Indigenous, mental health, nursing, research

People: Bernie Pauly, Tim Stockwell, Rebeckah Erickson

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