Managed alcohol programs for Indigenous Peoples in Canada: A scoping review

Managed Alcohol Programs (MAPs), provide regulated access to beverage alcohol alongside housing and health and social supports for individuals with severe AUD and chronic homelessness. While evidence for MAP effectiveness is growing, less is known about their implementation and impact within Indigenous and geographically remote contexts. We conducted a scoping review following PRISMA guidelines evaluate the literature on MAPs operating in Indigenous, northern, rural, and remote communities. A comprehensive search of PubMed, Embase, PsycINFO, and CINAHL was completed in July 2025, supplemented by grey literature and reference list screening. Studies were eligible if they described programs that regulated alcohol consumption for individuals experiencing homelessness and AUD within Indigenous or geographically remote contexts. Two reviewers independently screened articles, and data were extracted using a standardized form. Of 264 records identified, 13 studies met inclusion criteria. Programs were located primarily in Canada, with additional sites in Australia and the United States. Four key themes emerged: (1) integration of Indigenous cultural knowledge and healing practices; (2) housing stability and the creation of "home" within MAPs; (3) reductions in alcohol-related harms, including decreased non-beverage alcohol use and acute healthcare utilization; and (4) barriers and facilitators to implementation. Indigenous-led and culturally grounded MAPs emphasized self-determination, Elders' involvement, and land- and culture-based healing. Participation in MAPs was consistently associated with improved housing security, safer drinking environments, and reduced health and social harms. However, implementation challenges included stigma, funding instability, and infrastructure limitations in remote settings. MAPs appear to offer a promising, culturally adaptable harm reduction approach for individuals with severe AUD in Indigenous and geographically underserved communities. Indigenous leadership, cultural integration, and community-driven design are critical to program acceptability and sustainability. Further research is needed to evaluate long-term health outcomes and to expand evidence in northern, rural, and remote contexts.