Shelter-based managed alcohol administration to chronicallyhomeless people addicted to alcohol
Open accessAbstract
BACKGROUND: People who are homeless and chronically alcoholic have increased health problems, use of emergency services and police contact, with a low likelihood of rehabilitation. Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence. The shelter-based Managed Alcohol Project (MAP) was created to deliver health care to homeless adults with alcoholism and to minimize harm; its effect upon consumption of alcohol and use of crisis services is described as proof of principle. METHODS: Subjects enrolled in MAP were dispensed alcohol on an hourly basis. Hospital charts were reviewed for all emergency department (ED) visits and admissions during the 3 years before and up to 2 years after program enrollment, and the police database was accessed for all encounters during the same periods. The results of blood tests were analyzed for trends. A questionnaire was administered to MAP participants and staff about alcohol use, health and activities of daily living before and during the program. Direct program costs were also recorded. RESULTS: Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months. Their monthly mean group total of ED visits decreased from 13.5 to 8 (p = 0.004); police encounters, from 18.1 to 8.8 (p = 0.018). Changes in blood test findings were nonsignificant. All program participants reported less alcohol consumption during MAP, and subjects and staff alike reported improved hygiene, compliance with medical care and health. INTERPRETATION: A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters.
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Alcohol dependence is linked to acute harms such as unintentional injuries and victimization, and to chronic medical conditions such as liver disease, cancer, and cardiovascular disease.
“Alcohol dependence is associated with both acute harm (e.g., unintentional injuries, victimization) and chronic, alcohol-related medical conditions (e.g., liver disease, cancer, cardiovascular disease).1,2”
From Housing first is associated with reduced use of emergency medical services (2014) · cites this paper as [2]
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Harm Reduction Focusing on Severe Alcohol Misuse in Copenhagen
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Hospice Use Among Individuals With Severe Persistent Mental Illness
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Access to healthcare among managed alcohol program participants: A mixed methods study
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- Authors
- Podymow, T.
- Affiliations
- University of Ottawa (CA)
- Corresponding author
- Podymow, T.
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2006-01-03
- Volume
- 174
- Issue
- 1
- Pages
- 45-49
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC1319345
- OpenAlex
- W2160741586
- Cited by
- 135
- References
- 32
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 14 · 2020: 9 · 2019: 10 · 2018: 8 · 2017: 7 · 2016: 2 · 2015: 7 · 2014: 7 · 2013: 7 · 2012: 7
- FWCI
- 13.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Government of Canada
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- managed alcohol programs, chronic homelessness, alcoholism, harm reduction, emergency department visits, police encounters, alcohol consumption, program costs
- MeSH terms
- Alcoholism, Chronic Disease, Crisis Intervention, Emergency Service, Hospital, Female, Ill-Housed Persons, Humans, Male, Middle Aged, Patient Compliance, Treatment Outcome, Health Care Costs, Disease Management, Harm Reduction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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