Managed Alcohol Programs (MAPs)


CISUR is leading a national study of Managed Alcohol Programs in Canada.  This project will rigourously evaluate MAPs in Canada and generate insights into their implementation and effectiveness. The results of this research will be used to reduce unintended negative consequences of MAPs and inform the development of program and policy recommendations.

Watch the CBC documentary on "The Oaks," a Managed Alcohol Program in Ottawa:

MAP participation was associated with a number of positive outcomes including fewer hospital admissions, detox episodes, and police contacts leading to custody, reduced NBA [non-beverage alcohol] consumption, and decreases in some alcohol-related harms. These encouraging trends are being investigated in a larger national study.

- From CISUR's pilot study of a MAP in Thunder Bay, Ontario
(see the 2016 article in "Harm Reduction Journal")

About MAPs and this project

In Toronto, a managed alcohol program (MAP) was initiated following a coronial enquiry into the freezing deaths of problem drinkers who had been denied access to shelter accommodation. Emulated in four other sites, MAPs involve the provision of accommodation alongside controlled access to alcohol to replace non-beverage alcohol and reduce heavy drinking episodes for individuals otherwise resistant to abstinence treatment.

This harm reduction approach is increasingly being considered in Canada as a response to the harms of unstable housing and severe alcohol problems that have not been responsive to abstinence-based treatment. Related motivation is to encourage reduced use of non-beverage sources of alcohol such as methylated spirits, rubbing alcohol, hand sanitizer and mouthwash.

These programs still attract scepticism and controversy. This project aims to provide a rigourous evaluation of health and social outcomes for 200+ program participants across five Canadian MAP sites in comparison with 200+ similar individuals drawn from nearby non-MAP agencies. Benefits, potential harms and best practices will be investigated by accessing health and police records, conducting brief interviews monthly for up to two years and in-depth interviews with clients and program staff.

Registry of MAPs in Canada

Findings to date

Findings from our initial evaluation of the Managed Alcohol Program (MAP) in Thunder Bay indicated that the objectives of the program to reduce harm and improve quality of life for MAP program participants were being met. This success was evidenced by the overall pattern of improvement in formal indicators related to housing, mental and physical well-being, reductions in alcohol-related harms, decreasing non-beverage alcohol (NBA) use and more stable patterns of alcohol consumption. Further, the observed substantial reductions in hospital admissions and times in police custody indicate substantial economic savings for the local community. The MAP participants reported reductions in rates of police contacts, hospital admissions and detoxification admissions of between 40% and 80%. There was also a reduction of NBA use and, although some use did continue, it was at a lower level.

An overarching achievement of the program was the creation of a safe and stable environment reported by participants in both qualitative and quantitative data. This was striking and stands in sharp contrast to the harms this population is exposed to on the street. The safety and stability provided by the program also enabled many participants to reconnect with family members and have greater feelings of self-worth and well-being. Further detail on the findings of this evaluation are available in two journal articles published in Harm Reduction Journal (see "Resources" tab). This MAP site also forms part of the Canadian Managed Alcohol Program Study (CMAP) currently underway.

Data collection for Phase I has been completed in six sites with 175 MAP participants and 189 controls recruited. Eighty MAP participants and staff across the programs have completed qualitative interviews. Access to police, health and death records has been secured for all sites as part of the follow-up comparison planned between MAP participants and controls with similar profiles. The MAP Community of Practice is well established with webinars and teleconferences alternating each month to share learnings and best practices as well as exchange of research findings and ideas. We are now in Phase II of the research with a specific focus on additional data collection and analysis that will allow for a larger sample, longer term follow-up of participants and controls to determine effectiveness. As well, we are undertaking specific qualitative analysis of implementation issues and the development of Indigenous led research in collaboration with Indigenous partners. To date, we have established an Indigenous Advisory Group and relationships with Indigenous partners interested in MAP programs.

Join our MAP "community of practice"

The project includes a collaboratively-driven and goal-orientated action-learning community of practice (COP) component that brings together researchers and knowledge users from across the country to share knowledge and develop expertise around the practice of MAPs. The COP consists of synchronous learning activities including a virtual seminar series of webinars (see "Resources" tab) involving leaders with direct experience in MAPs and virtual roundtable meetings involving researchers and practitioners. A key function of the MAP COP is to promote discussion of current evidence as well as protocols and best practices for managed alcohol programs. If you are interested in becoming involved in the MAP COP, please contact the coordinator

Funding bodies

Canadian Institute of Health Research Partnerships for Health System Improvement grant Phase I, July 2014 to March 2017 and Phase II April 2017 to March 2019. This includes funding from the Michael Smith Foundation for Health Research. Vancouver Coastal Health and the Centre for Addiction and Mental Health are contributing additional funds.

Researchers

There are over 50 additional co-investigators, knowledge users, collaborators, students and community partners working with us on the study

Journal Articles

CISUR-led research:

Other:

Reports

Infographics

CISUR Infographic:

Inside a Managed Alcohol Program in Thunder Bay, Ontario (pdf; 2016)

REACH Edmonton Infographic:

MAPs in Edmonton (pdf)

Thumbnail image of CARBC Managed Alcohol Program infographic "Managed Alcohol Program infographic by REACH Edmonton

PowerPoint Presentations

Webinars + E-newsletters

"Community of Practice" (COP) Webinars & E-newsletters:

Videos

Related News Stories

2017

2016

2015

2014

2013