Managed alcohol as a harm reduction intervention for alcohol addiction in populations at high risk for substance abuse

Muckle, Wendy; Oyewumi, Lami; Robinson, Vivian; Tugwell, Peter; Kuile, Aleida ter

doi:10.1002/14651858.cd006747

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…The use and related harms of “illicit” or nonbeverage alcohol such as rubbing alcohol, hand sanitizer, and mouthwash have been identified as concerns among homeless populations and can act as a barrier to obtaining housing [3–5]. Severe alcohol dependence almost invariably carries heavy health and social costs [6–8] including a range of acute, chronic, and social harms. For people living in socially marginalizing conditions, the combination of severe alcohol use and lack of housing contributes to increased vulnerability to harms such as stigma, freezing, violence, accidents, physical illness, and death.…”

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confidence: 99%

Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life

Pauly

Gray

Perkin³

et al. 2016

Harm Reduct J

121

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BackgroundThere is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations. The combination of alcohol use and lack of housing contributes to increased vulnerability to the harms of substance use including stigma, injury, illness, and death. Managed alcohol programs (MAPs) administer prescribed doses of alcohol at regular intervals to people with severe and chronic alcohol dependence and homelessness. As a pilot for a larger national study of MAPs, we conducted an in-depth evaluation of one program in Ontario, Canada. In this paper, we report on housing and quality of life outcomes and experiences of the MAP participants and staff.MethodsWe conducted a pilot study using mixed methods. The sample consisted of 38 people enrolled in or eligible for entry into a MAP who completed a structured quantitative survey that included measures related to their housing and quality of life. All of the participants self-identified as Indigenous. In addition, we conducted 11 in-depth qualitative interviews with seven MAP residents and four program staff and analyzed the interviews using constant comparative analysis. The qualitative analysis was informed by Rhodes’ risk environment framework.ResultsWhen compared to controls, MAP participants were more likely to retain their housing and experienced increased safety and improved quality of life compared to life on the streets, in jails, shelters, or hospitals. They described the MAP as a safe place characterized by caring, respect, trust and a nonjudgmental approach with a sense of family and home as well as opportunities to reconnect with family members.ConclusionsThe MAP was, as described by participants, a safer environment and a home with feelings of family and a sense of community that countered stigma, loss, and dislocation with potential for healing and recovery. The MAP environment characterized by caring, respect, trust, a sense of home, “feeling like family”, and the opportunities for family and cultural reconnections is consistent with First Nations principles for healing and recovery and principles of harm reduction.

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confidence: 99%

Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life

Pauly

Gray

Perkin³

et al. 2016

Harm Reduct J

121

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“…The main efforts should address this goal with specific cognitive-behavioral support [42]. In subjects not able to abstain, we observed that a significant reduction of ethanol intake to 50-60 g/day in a control-drinking situation is enough to significantly improve LV function.…”

Section: Abstinencementioning

confidence: 90%

Alcoholic Cardiomyopathy: Old and New Insights

Fernández‐Solà¹,

Riba²

2017

J Alcohol Drug Depend

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Alcohol cardiomyopathy (ACM) is a chronic dilated heart disease with decreased left ventricular ejection fraction that may be detected in one-fourth of high-dose alcohol consumers. It causes progressive diastolic and systolic dysfunction, supra and ventricular arrhythmias leading to heart failure and increased mortality. The main etiological factor for ACM is ethanol consumption that affects the myocardium in a dose-dependent manner. The mechanisms of ACM are diverse, synchronic and synergistic. Alcohol alters the channel and receptor structure of the cell membrane, decreases intracellular calcium transients, increases oxidative and inflammatory damage, decreases structural protein synthesis and interferes with excitation-contraction coupling mechanisms. Subjects with excessive alcohol consumption may have a subclinical cardiomyopathy with atrial and LV diastolic dysfunction measured by echocardiography or cardiac MR. Subclinical LV dysfunction may progress and later appear clinical features of heart failure. Cardiac myocytes adapt to ethanol aggression by cell and nuclear hypertrophy and dilatation of heart chambers. Progressive myocyte structure disarray and apoptosis produce myocyte loss, hypertrophy of the remaining cells, subendocardial and interstitial fibrosis and low-degree myocyte regeneration. In addition, ethanol also interferes with cardiac repair and adaptation mechanisms. Thus, local cardiomyokines (FGF-21) and growth factors (myostatin, IGF-1, leptin) are modified by ethanol, limiting cardiac remodeling and myocyte regeneration, and leading to abnormal hypertrophy and eccentric ventricle dilatation. This imbalance between aggression and protection mechanisms induces progressive myocyte loss and heart dysfunction. Alcohol abstention is the main goal in ACM, although control drinking (<-60 g/day) may allow recovery of LV function. Monitoring of systemic mediated alcohol-damage, and correction of vitamin and ion deficiencies is needed. Heart failure in ACM should be treated similar to other dilated cardiomyopathies. Heart transplantation is limited to subjects without other organ damage who are able to abstain from alcohol. New preventive and therapeutic strategies are under development to decrease alcohol-mediated myocyte damage and increase heart protective and repair mechanisms.

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“…Drinking under control programmes (DUCPs) represent a harm reduction strategy for people with severe alcohol dependence that are unwilling to pursue abstinence and are typically homeless so called 'street alcoholics' [12]. Different types of DUCPs include housing first programmes aiming at harm reduction by providing stable living conditions; wet houses with accommodation tolerating or managing alcohol consumption more systematically by 'providing beverage alcohol of known quality to programme participants at regular intervals to stabilise drinking patterns and to replace non-beverage alcohol which can be more hazardous' [13: 1]; wet drop-ins without accommodation, selling and/or tolerating alcohol brought to the meeting place and community action programmes using controlled alcohol access within, for example, work initiatives [14]. DUCPs in the Anglophone countries so far are mainly limited to the specific case of wet houses providing stable accommodation [13,15].…”

Section: ■ Introductionmentioning

confidence: 99%

Drinking under control programmes: perception of alcohol-related harm reduction measures in Poland. Results of qualitative study among outpatient alcohol treatment providers

Klingemann¹,

Klingemann²

2017

ain

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Introduction: Harm reduction programmes for drug addicts are well documented and accepted by practitioners, whereas harm reduction programmes for alcohol addicts are under researched and encounter resistance. The article presents the results of a qualitative study focused on the perception of two case studies of drinking under control programmes (DUCPs) by outpatient treatment providers working in abstinence-focused Polish alcohol treatment system. StreszczenieWprowadzenie: Programy redukcji szkód skierowane do osób uzależnionych od narkotyków są dobrze udokumentowane i akceptowane przez środowisko terapeutyczne. Jednocześnie programy tego typu skierowane do osób uzależnionych od alkoholu są rzadko tematem opracowań naukowych, a ich realizacja napotyka opór środowiska. Artykuł prezentuje wyniki badania jakościowego poświęconego percepcji dwóch przykładowych programów redukcji szkód dla osób uzależnionych od alkoholu, zrealizowanego z terapeutami uzależnienia od alkoholu. 162Justyna I. Klingemann, Harald Klingemann

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Managed alcohol as a harm reduction intervention for alcohol addiction in populations at high risk for substance abuse

Cited by 4 publications

References 14 publications

Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life

Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life

Alcoholic Cardiomyopathy: Old and New Insights

Drinking under control programmes: perception of alcohol-related harm reduction measures in Poland. Results of qualitative study among outpatient alcohol treatment providers

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