Impacts of a Scattered-Site Managed Alcohol Program for People With Alcohol Use Disorder in Halifax, Nova Scotia: A...

Managed alcohol programs (MAPs) are harm reduction services that provide regular, measured doses of beverage-grade alcohol alongside social and health services, aiming to reduce nonbeverage alcohol consumption and harms associated with excessive intoxication and withdrawal. Most MAPs are paired with supportive housing, which can be at a single building ("single-site") or more uncommonly across multiple apartments ("scattered-site"). The North End Community Health Centre - Mobile Outreach Street Health (MOSH) in Halifax, Nova Scotia, established Atlantic Canada's first MAP, using a scattered-site model, in April 2020 - during the COVID-19 pandemic. We aimed to describe program participants, summarize outcomes, and understand stakeholder perceptions of program successes and challenges.

Parallel, mixed methods program evaluation. Quantitative arm involved retrospective review of weekly program assessments documenting presence or absence of outcomes (April 2020-December 2022). Qualitative arm included 4 focus groups with key stakeholders (May-June 2021).

Over the first 33 months, 38 people enrolled in MAP. At the time of our study, 9 had died and 9 left the program. Of the 20 remaining participants, 13 consented to chart review (92% male; age mean 46, SD 11 years) and 9 had weekly outcome data available. Comparing year 1 to year 2, participants had mean person-week prevalence of any nonbeverage alcohol consumption (eg, hand sanitizer): 9% and 3%; acute alcohol-related harms: 25% and 9%; and seizures: 4% and 1%. Mean person-week prevalence of out-of-program drinking was 34% in year 1 and 33% in year 2. Focus groups highlighted MAP improved participants' health and decreased frequency of nonbeverage alcohol consumption, survival behaviors, and violence. Challenges included out-of-program drinking and lack of social programming.

This scattered-site MAP may support positive health and social outcomes for people with severe alcohol use disorder. Identified program gaps can be explored to better meet participant needs and reduce out-of-program drinking.