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Practical considerations for residential-managed alcohol programs: lessons from Ottawa Inner City Health.

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Managed Alcohol Programs (MAPs) offer a harm reduction approach for individuals with severe Alcohol Use Disorder (AUD) and homelessness. These programs integrate housing, healthcare, and social support, demonstrating success in improving participant well-being and reducing emergency care reliance.

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Area of Science:

  • Public Health
  • Addiction Medicine
  • Social Work

Background:

  • Alcohol Use Disorder (AUD) significantly contributes to global morbidity and mortality, with disproportionate impacts on homeless populations.
  • Managed Alcohol Programs (MAPs) are harm reduction strategies providing controlled alcohol with comprehensive support for severe AUD and homelessness.
  • Integrating social and medical care within MAPs requires tailoring services to individual needs and contexts.

Purpose of the Study:

  • To explore the operational strategies and clinical practices of the Ottawa Inner City Health (OICH) MAP.
  • To detail how OICH MAP integrates housing, healthcare, and social supports for individuals experiencing homelessness and severe AUD.
  • To offer practical insights for the effective operation and sustainability of MAPs.

Main Methods:

  • Case study analysis of the OICH MAP, operational since 2001.
  • Description of person-centered care delivery by an interdisciplinary team, including peer workers and an Indigenous healer.
  • Examination of integrated care through partnerships with community organizations, pharmacies, and subspecialists.

Main Results:

  • The OICH MAP embeds services within supportive housing, offering structured alcohol delivery, meals, social support, and comprehensive health services.
  • Person-centered clinical care is tailored to individual circumstances, focusing on hygiene, nutrition, health screening, and complication management.
  • Collaborative and trauma-informed approaches reduce emergency care use and promote dignity, stability, and community.

Conclusions:

  • MAPs have advanced to become recognized harm reduction models, effectively addressing complex needs of homeless individuals with severe AUD.
  • The OICH MAP exemplifies successful integration of housing, healthcare, and social support.
  • Challenges in scaling MAPs, refining protocols, and developing policy frameworks necessitate continued research and dialogue.