Serving Alcohol to Beat Alcoholism

Trying to help alcoholics kick the habit by serving them alcoholic drinks might seem like a far-fetched idea – but it is a one with potential to revolutionise the way alcohol dependency is treated, according to a panel of experts backing a plan to open a ‘managed alcohol’ homeless shelter in Sydney.

Rabbi Mendel Kastel – the Chief Executive Officer of Jewish House, a crisis support service which targets Sydney’s Jewish community – together with the Director of Drug and Alcohol Services at St Vincent’s Hospital, Dr Nadine Ezard, want to establish a ‘Managed Alcohol Program’ (‘MAPS’) whereby alcohol dependent residents would be offered drinks once every hour at shelters.

Alcoholism and homelessness often go hand in hand – around 45% of Sydney’s homeless community suffer from alcohol dependence – and, as reported in one of our recent blogs, alcoholism is often a contributing factor to homelessness.

Despite the prevalence of alcohol addiction within the homeless community, there are few support services to help sufferers through their ordeal – as people are usually turned away from shelters if they are visibly intoxicated.

A 2011 study found that alcohol-dependant homeless people are four times more likely than an ordinary person to occupy a hospital bed, usually due to alcohol-related disease or injury. Their mortality rates are three to four times higher than the general community.

Homeless people who abuse alcohol are also far more likely to have run-ins with police – usually for minor offences such as offensive language and conduct (such as swearing and public urination), larceny and drug possession.

Considering the resulting burden on public resources, it makes sense to look for an alternative approach which supports the needs of homeless people while at the same time taking pressure off hospitals, police and the courts.

International Trials Back Approach

Managed alcohol programs currently operate in the United States, Canada, the UK and Norway – but there are none yet in Australia.

The international trials have found that allowing homeless people to access alcohol in shelters – rather than forcing them to be abstinent – can actually decrease overall alcohol consumption.

One study examined 17 homeless adults who were served alcohol daily at shelters for around 16 months. It found that the participants were less likely than other homeless alcoholics to be admitted to hospital and to be charged by police. The researchers concluded:

‘All program participants reported less alcohol consumption during MAP, and subjects and staff alike reported improved hygiene, compliance with medical care and health… A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters.’

A similar study conducted in America followed 95 chronically homeless individuals who were battling alcoholism. They were placed in a special housing program which – unlike most housing programs and shelters – did not require them to abstain from drinking. It found that:

‘Although the project-based Housing First program did not require abstinence or treatment attendance, participants decreased their alcohol use and alcohol-related problems as a function of time and intervention exposure.’

Programs Will Benefit the Community

Kastel and Ezard say that implementing a Managed Alcohol Program in Sydney could benefit the wider community by decreasing the reliance of homeless people on health services.

A study conducted by the Foundation for Alcohol Research and Education (FARE) surveyed residents of Sydney shelter Gorman House in 2014, finding that 76% would be interested in a shelter which would allow them to bring their own alcohol, while 69% were interested in services which would dispense alcohol throughout the day.

The study conducted a cost-benefit analysis, estimating that opening a 15 bed facility would save the community between $390,000 to $580,000 per year.

Where to From Here?

Experts believe that establishing a MAP in Sydney could be extremely valuable for the community – but say that before we jump the gun, more research is required to ‘test’ the model in an Australian context.

As summarised in FARE’s report:

‘Establishment of a rigorously evaluated MAP may herald an important policy shift in meeting the housing, social, health and welfare needs of homeless people with ongoing severe alcohol dependence. What is required next is the development of a MAP pilot implementation plan and model of care, commencing with stakeholder analysis and engagement.’

So, while a managed alcohol program is on the cards for Sydney, it could be some time before the proposal reaches fruition.