Investigating the need for alcohol harm reduction and managed alcohol programs for people experiencing homelessness and alcohol use disorders in Scotland

Abstract

Introduction and Aims Managed alcohol programs (MAP) are a harm reduction approach for those experiencing alcohol use disorders (AUD) and homelessness. These programs were developed in Canada and have had positive results; very few exist in the UK and Ireland. The aim of this study was to scope the feasibility and acceptability of implementing MAPs in Scotland. Design and Methods Using mixed‐methods, we conducted two linked phases of work. Quantitative data were collected from the case records of 33 people accessing eight third sector services in Scotland and analysed in SPSS using descriptive and inferential statistics. Qualitative data were collected in Scotland via semi‐structured interviews with 29 individuals in a range of roles, including strategic informants (n = 12), service staff (n = 8) and potential beneficiaries (n = 9). Data were analysed using Framework Analysis in NVivo. Results The case record review revealed high levels of alcohol use, related health and social harms, illicit drug use, withdrawal symptoms, and mental and physical health problems. Most participants highlighted a lack of alcohol harm reduction services and the potential of MAPs to address this gap for this group. Discussion and Conclusions Our findings highlight the potential for MAPs in Scotland to prevent harms for those experiencing homelessness and AUDs, due to high levels of need. Future research should examine the implementation of MAPs in Scotland in a range of service contexts to understand their effectiveness in addressing harms and promoting wellbeing for those experiencing AUDs and homelessness.

“You know, we can change the services to suit the circumstances of what is happening in the world”: a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland

“…People who experience homelessness have an increased risk of problem drug and alcohol use [ 6 , 11 – 13 ]. Use of illicit drugs and alcohol is common [ 14 ]. Problem alcohol use has significant detrimental effects on health and society, affecting more than 280 million adults worldwide [ 15 ].…”

“…For people with problem alcohol use, there is a risk of withdrawal if they cannot maintain their supply which can lead to serious health consequences and even death. They might also substitute alcohol with illicit drugs [ 14 , 43 ] which can increase harm, for example by being unaware of ways to reduce overdose risk such as use of naloxone or as a result of unsafe supply. There are additional risks associated with retraction of informal support service from friends, families and communities due to social distancing measures.…”

‘It’s like a safety haven’: considerations for the implementation of managed alcohol programs in Scotland

“…Managed alcohol programs (MAPs) are evidence-based alcohol harm reduction approaches specifically developed for those experiencing the dual challenges of AUD and homelessness. Initially developed in Canada in the late 1990s, they have grown in prominence in recent years and now exist in Ireland, with plans to develop MAPs in Australia (Ezard et al, 2018;Holmes, 2019), Scotland (Carver et al, 2021;Scottish Housing News, 2020), and Portugal (Fuertes et al, 2021). Within MAPs alcohol is provided in measured, regular doses throughout the day, along with other supports, such as housing, healthcare, and community activities (Pauly et al, 2018).…”

“…In a related paper (Carver et al, 2021) we presented study findings regarding the need for MAPs in Scotland due to high levels of alcohol consumption, mental health problems, and polysubstance use amongst a small cohort of clients living in hostel accommodation whose case records were reviewed. Those experiencing mental health issues tend to have challenges accessing primary and secondary healthcare and MAPs have the potential to address some of these concerns with healthcare professionals being on-site or well-connected to the service (Pauly et al, 2018).…”

“If I knew I could get that every hour instead of alcohol, I would take the cannabis”: need and feasibility of cannabis substitution implementation in Canadian managed alcohol programs

“…MAP participants had a lower total volume of alcohol per drinking day and reported fewer days of drinking non-beverage alcohol compared to controls. Analyses of qualitative data from CMAPS illustrate that MAPs are spaces for healing and recovery for participants, who are frequently displaced and criminalized on the street and within largely abstinence-based housing and health services [ 19 ]. Participants describe MAPs as safe environments that reduce precarity associated with homelessness and severe AUD in abstinence-based systems, enhance social integration and connection to community and family, provide a sense of purpose and shared ownership, and for some Indigenous participants, promote connection to Indigenous identity and culture (when cultural supports are provided) [ 15 , 22 , 23 ].…”