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Managed alcohol intake improves health of homeless alcoholic people, study shows

Calgary Barbara Kermode-Scott

A managed programme for homeless people with chronic alcoholism can stabilise their alcohol consumption, a new Canadian study shows, decreasing the number of visits to emergency departments and encounters with police.

The study, published last week in the journal of the Canadian Medical Association, showed that the number of police encounters fell by 51% and emergency department visits fell by 40% among the participants, a small group of homeless alcoholic people who had repeatedly failed to complete abstinence programmes (CMAJ 2006;174:1).

The managed programme was run from a shelter for the homeless in Ottawa by the city’s Inner City Health Project, the University of Ottawa, and various social agencies. The investigators’ goal was to see whether a harm reduction programme would decrease the adverse health, social, and economic consequences of substance misuse (without abstinence) in long term homeless people with severe, refractory alcoholism.

Fifteen men and two women with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in this pilot programme for between five and 24 months (mean duration 16 months). The programme provided close supervision, help with activities of daily living, on-site health care, and a maximum of one drink hourly (up to a maximum of 140 ml of wine or 90 ml of sherry) on demand between 7 am and 10 pm each day.

All participants reported that their alcohol consumption fell over the course of the programme. Their average alcohol intake fell from 46 drinks a day before they entered the programme to eight afterwards. Blood test markers of alcohol use remained stable, and participants and care workers reported improvements in health, nutrition, and hygiene.

The researchers reviewed the participants’ hospital records for all emergency department visits and admissions during the three years before their enrolment in the programme and in the two years after, and the police database was accessed for all encounters during the same periods. The mean number of emergency department visits fell from 13.5 before the programme to 8.1 afterwards (P= 0.004), and the number of police encounters fell from 18.1 to 8.8 (P=0.018).

"The conclusions of this pilot study speak for themselves," said Jeff Turnbull, one of the study’s authors. "The limitations are clear. However, I do think as a pilot study it certainly demands now a more thorough investigation of this approach … A formal cost effectiveness analysis done prospectively with larger numbers would be appropriate."

"The abstinence community has expressed difficulties with this type of approach," Dr Turnbull added. "I understand 100% [of them]."

He pointed out that several participants—people who had been alcoholic and living on the streets for many years—had been medically detoxified successfully and had been housed. "These are people whom every abstinence based programme had failed," he said.

The Ottawa shelter based project now has 24 people enrolled in the programme. Another managed alcohol programme is operating in Toronto, and three more programmes are being established across Canada.