Alcohol harm reduction and managed alcohol programs

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SHOW NOTES
 
Summary

Through providing small doses of alcohol to clients regularly, managed alcohol programs reduce the risks associated with heavy drinking and non-beverage alcohol consumption without requiring abstinence.

In this episode of the Addiction Practice Pod, Dr. Marcus Greatheart and David Ball talk with public health researcher and executive director of the Vancouver Area Network of Drug Users, Brittany Graham, about the purpose of managed alcohol programs and how they fit into the continuum of care for alcohol use disorder. We also hear from harm reduction advocate and peer leader, George Sedore, about what led him to join a managed alcohol program and how this has impacted his life.
 

Learning Objectives

1. Summarize the goals and objectives of a managed alcohol program (MAP).
2. Describe the types of MAPs in operation and identify when they may be appropriate.
3. Identify how patients can move within the alcohol use continuum of care, including MAPs.
4. Discuss the benefits of MAPs beyond alcohol consumption, including social determinants of health.

 
Lineup

In this episode, you’ll hear:

• 3:31 – Brittany Graham – Executive Director, Vancouver Area Network of Drug Users
• 18:29 – George Sedore – Member-Organizer, Eastside Illicit Drinker’s Group for Education

 
Pearls

Here’s what listeners can take away from this episode:

1. Managed alcohol programs aim to reduce the risk of harms associated with heavy drinking without requiring individuals to stop or reduce their drinking. Some programs are also paired with shelters or housing programs, to provide a safer and more inclusive alternative to abstinence-based housing.
2. Some of the goals of a managed alcohol program are to support wellness, avoid withdrawal, reduce/eliminate non-beverage alcohol consumption, and promote safer use through harm reduction education. Other important impacts include improving access to food, accommodation, and primary care. Another benefit of managed alcohol programs is that they bring people together, and provide community for individuals looking to reduce the harms associated with their alcohol use.
3. As a health care provider, it is important to listen to your client’s goals around their alcohol use. For your clients who are not interested in reducing or stopping their drinking, understand that this could be for a multitude of reasons. Having a conversation about managed alcohol programs can support your client’s wellness and show them that you respect their goals.
4. Managed alcohol programs function as a key point of access to other health and social services, and treatment, for alcohol use disorder. Individuals on a managed alcohol plan can be supported by clinicians to move along the alcohol use continuum of care as their goals and drinking behaviours change.

 
Claim CME self-learning credits.
 

Resources

Guidance

• British Columbia Centre on Substance Use (BCCSU) and Canadian Institute for Substance Use Research (CISUR). Managed Alcohol Programs – Canadian Operational Guidance Document. 2023. Vancouver, B.C.: BCCSU.
• BCCSU. Operational Guidance for Implementation of Managed Alcohol for Vulnerable Populations. 2020. Vancouver, B.C.: BCCSU.
• Pauly B, Graham B, Vallance K, Brown M, Stockwell T. Scale Up of Managed Alcohol Programs. CISUR Bulletin #20. Victoria, B.C.: University of Victoria.

Articles

• Brown L, Skulsh J, Morgan R, Kuehke R, Graham B. Research into action: The Eastside Illicit Drinkers Group for Education (EIDGE) experiences as community-based group in Vancouver, Canada. Drug Alcohol Rev. 2018;37:S156-S158.
• Child Y, Beausoleil R, Hunt-Junnouchi F, Onespot-Whitney K, Browne M, Owens T; Aboriginal Coalition to End Homelessness. Indigenous pathways to health and well-being: Managed Alcohol Program (MAP) Feasibility Study. 2018.
• Crabtree A, Latham N, Morgan R, Pauly B, Bungay V, Buxton J. Perceived harms and harm reduction strategies among people who drink non-beverage alcohol: Community-based qualitative research in Vancouver, Canada. Int J Drug Policy. 2018;59:85-93.
• Evans J, Semogas D, Smalley J, Lohfeld L. “This place has given me a reason to care”: Understanding ‘managed alcohol programs’ as enabling places in Canada. Health Place. 2015;33:118-124.
• Pauly B, Brown M, Evans J, et al. “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness. Harm Reduct J. 2019;16(1):70.
• Pauly B, Gray E, Perkin K, et al. Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life. Harm Reduct J. 2016;13(1):15.
• Pauly B, King V, Smith A, et al. Breaking the cycle of survival drinking: insights from a non-residential, peer-initiated and peer-run managed alcohol program. Drugs (Abingdon Engl). 2021;28(2):172-180.
• Smith-Bernardin SM, Suen LW, Barr-Walker J. et al. Scoping review of managed alcohol programs. Harm Reduct J. 2022;19(82).
• Stockwell T, Pauly BB, Chow C, et al. Does managing the consumption of people with severe alcohol dependence reduce harm? A comparison of participants in six Canadian managed alcohol programs with locally recruited controls: Do Managed Alcohol Programs Reduce Harm? Drug Alcohol Rev. 2018;37:159-166.
• Vallance K, Stockwell T, Pauly B, et al. Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study. Harm Reduct J. 2016;13(1):13.

Additional resources

• Eastside Ilicit Drinker’s Group for Education (EIDGE). The Vancouver Alcohol Strategy: Designing Harm Reduction-focused Alcohol Policy from the Grassroots in Vancouver’s Downtown Eastside. 2023.
• UBC Learning Circle. Exploring the first year of progress within an Indigenous-owned (and operated) community-based managed alcohol program [Webinar]. 2021.
• Canadian Managed Alcohol Programs Study (CMAPS). Overview of Managed Alcohol Program (MAP) sites in Canada (and beyond).
• Eastside Illicit Drinker’s Group for Education (EIDGE). “Think Before You Drink” [Pamphlet]. 2021.
• EIDGE. “Cannabis and Alcohol Harm Reduction: Tips and Information for People Who Drink and Are Interested in Using Cannabis as a Harm Reduction Tool” [Pamphlet].
• Addiction Practice Pod. Season 2 Episode 2: Treatment and care for alcohol use disorder [Podcast]. 2021.