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“There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness

BACKGROUND: The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for t...

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Autores principales: Pauly, B., Brown, M., Evans, J., Gray, E., Schiff, R., Ivsins, A., Krysowaty, B., Vallance, K., Stockwell, T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916004/
https://www.ncbi.nlm.nih.gov/pubmed/31842903
http://dx.doi.org/10.1186/s12954-019-0332-4
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author Pauly, B.
Brown, M.
Evans, J.
Gray, E.
Schiff, R.
Ivsins, A.
Krysowaty, B.
Vallance, K.
Stockwell, T.
author_facet Pauly, B.
Brown, M.
Evans, J.
Gray, E.
Schiff, R.
Ivsins, A.
Krysowaty, B.
Vallance, K.
Stockwell, T.
author_sort Pauly, B.
collection PubMed
description BACKGROUND: The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). METHODS: We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of “messy”, “ordered” and “social arenas” maps that provide insight into the social worlds of participants and the impact of MAPs. RESULTS: Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. CONCLUSIONS: In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.
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spelling pubmed-69160042019-12-30 “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness Pauly, B. Brown, M. Evans, J. Gray, E. Schiff, R. Ivsins, A. Krysowaty, B. Vallance, K. Stockwell, T. Harm Reduct J Research BACKGROUND: The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). METHODS: We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of “messy”, “ordered” and “social arenas” maps that provide insight into the social worlds of participants and the impact of MAPs. RESULTS: Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. CONCLUSIONS: In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding. BioMed Central 2019-12-16 /pmc/articles/PMC6916004/ /pubmed/31842903 http://dx.doi.org/10.1186/s12954-019-0332-4 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Pauly, B.
Brown, M.
Evans, J.
Gray, E.
Schiff, R.
Ivsins, A.
Krysowaty, B.
Vallance, K.
Stockwell, T.
“There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
title “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
title_full “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
title_fullStr “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
title_full_unstemmed “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
title_short “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
title_sort “there is a place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916004/
https://www.ncbi.nlm.nih.gov/pubmed/31842903
http://dx.doi.org/10.1186/s12954-019-0332-4
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