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

Area of Science:

• Public Health
• Indigenous Health
• Harm Reduction

Background:

• Managed Alcohol Programs (MAPs) provide regulated alcohol access, housing, and support for individuals with severe Alcohol Use Disorder (AUD) and chronic homelessness.
• Evidence for MAP effectiveness is growing, but less is known about their implementation and impact in Indigenous and geographically remote contexts.

Purpose of the Study:

• To conduct a scoping review of literature on MAPs operating in Indigenous, northern, rural, and remote communities.
• To evaluate the implementation, impact, and cultural adaptability of MAPs in underserved populations.

Main Methods:

• Scoping review following PRISMA guidelines.
• Comprehensive search of multiple databases (PubMed, Embase, PsycINFO, CINAHL) and grey literature.
• Independent screening and data extraction by two reviewers for eligible studies.

Main Results:

• 13 studies met inclusion criteria, primarily from Canada, Australia, and the US.
• Key themes included integration of Indigenous cultural knowledge, housing stability, reduced alcohol-related harms, and implementation barriers/facilitators.
• Indigenous-led, culturally grounded MAPs emphasized self-determination and land-based healing.
• MAP participation was linked to improved housing security, safer drinking, and reduced health/social harms.
• Implementation challenges included stigma, funding instability, and remote infrastructure limitations.

Conclusions:

• MAPs are a promising, culturally adaptable harm reduction approach for severe AUD in Indigenous and remote communities.
• Indigenous leadership, cultural integration, and community-driven design are crucial for MAP acceptability and sustainability.
• Further research is needed on long-term outcomes and to expand evidence in underserved contexts.