Grant: Partnerships for Health System Improvement (PHSI)

Canadians with unstable housing may also experience problems with substance use, which can create barriers to accessing temporary or stable accommodation. Problems may be compounded by use of hazardous non-beverage alcohol such as rubbing alcohol, methanol, mouth wash and hand sanitizers. In Toronto, a Managed Alcohol Program (MAP) was initiated in 1996 following a coronial enquiry into the freezing deaths of three drinkers who had been unable to access to shelter accommodation. Similar programs in four other sites, MAPs involve the provision of accommodation alongside controlled access to alcohol to replace non-beverage alcohol and reduce heavy drinking episodes for individuals for whom abstinence treatment has not been successful. One published study of a Canadian MAP has indicated promising results, notably fewer emergency department presentations, improved access to health care and reduced alcohol consumption. These programs are controversial and not well researched. This application seeks funding for a rigourous evaluation of health and social outcomes for over 200 program participants across five Canadian MAP sites in comparison with similar individuals drawn from nearby non-MAP agencies. Benefits, potential harms and best practices will be investigated by accessing health and police records, conducting brief interviews monthly for up to 2 years and in-depth interviews with clients and program staff.