Reducing alcohol-related harm for people experiencing homelessness and housing instability during COVID19: A Vancouver Island case study

Funding body

Victoria Hospitals Foundation

Background

While there is an abundance of evidence on harm reduction strategies for illicit drugs, there has been less attention to harm reduction strategies for alcohol. People experiencing severe alcohol use disorder (AUD) and homelessness and/or housing instability experience inequities in alcohol-related harms, including acute harms (e.g withdrawal seizures, injuries), chronic harms (e.g. cancers, liver disease), and social harms (e.g. financial, legal issues). This population is at increased risk of infection and alcohol-related harms during the COVID-19 pandemic. 

Since March 2020, a spectrum of Managed Alcohol Program (MAP) models have developed on Vancouver Island aimed at reducing alcohol-related harm and health system burden and promoting the use of public health guidelines. There is an urgent need to better understand MAP models on Vancouver Island and specific regional issues in implementation to better inform policy and practice. The focus of this study will be to conduct a case study evaluation of Vancouver Island MAPs to examine models of MAP delivery, the experiences of MAP providers and participants, and MAP impacts on alcohol related harms as well as COVID-19 prevention and management. This research will provide important opportunities for understanding MAP models across diverse contexts, including urban, rural, community, and in-patient MAPs to generate new knowledge and inform regional, provincial, and national procedures and policy related to MAP during COVID-19 and beyond.

Progress to date

Project activities to date include ethics application development, submission, and approval; engagement with Managed Alcohol Program (MAP) community partners; MAP staff recruitment for qualitative interviews; and the majority of the data collection for this project. In 2022 the Principal Investigator and research team members travelled to Port Hardy to meet with health care leaders and MAP staff across the Central and Northern Island to gain an understanding of existing services and first-hand experiences with MAPs. The desire for additional MAPs that would serve rural areas and meet the needs of specific communities was also discussed.

We completed interviews with staff from MAP services at two Island Health-operated sites in the Central Island and one community-based MAP operated by Gwa’sala ‘Nakwaxda’xw First Nation (Gwa’dzi MAP) in the North Island. We conducted the majority of these interviews in person and the remainder over Zoom. We also met with organizations and/or communities on the Island who expressed interest in knowing more about MAP services across Canada. This included sharing a presentation with staff from Gwa’dzi MAP, the Nuu-chah-nulth Tribal Council, and the Ts’ewulhtun Health Centre in Duncan which is run by the Cowichan Tribes. We are now completing data collection and analysis for this project.

In total we have conducted 11 interviews, facilitated two focus groups, and made three presentations to community health groups. We also received two reports on alcohol use in the community: one that specified the start of a MAP for select community members in Alert Bay and one discussing the current crisis of alcohol use disorders in the Tofino area.

In fall 2022 we began to analyze the data that have been generated and in November 2022 we presented preliminary findings to Island Health staff during Knowledge to Action Month in a talk titled: We Needed One, and then COVID Happened: Managed Alcohol Programs in the Context of COVID-19.