3 January 2006

Supplying alcohol to alcoholics may help reduce harms (and total consumption)

Canadian Medical Association Journal 2006 174;1:45-49

Podymow T, Turnbull J, Coyle D, Yetisir E, Wells G. Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol.

Dear Colleagues,

This remarkable report is necessarily modest in its aims and its claims, yet it shows that giving alcohol in a supervised manner to homeless heavy drinkers can yield positive outcomes both for the subject and the community.  This was a pilot study of 17 subjects in Toronto (15 men, mean age 51, alcoholic for mean period 35 years) who had been registered at a funded city shelter for over a year. 

 The study used a chronological control, looking at annualised use of alcohol and treatment/social services before and after the study which lasted for up to three years before and two years after registering in the study. 

 There were significantly fewer primary interactions (up to 50%) with medical and police officers after enrolment in this study.  And paradoxically, supplying supervised alcohol on request in the shelter (13.6g alcohol beverage hourly from 7pm to 10pm) was reportedly associated with substantially reduced consumption from 46 standard (US) drinks to 8 (excluding the 3 subjects who died, one refusal and 3 others for whom paired data were unavailable). 

 The lack of a parallel control group and small size of the study do not detract from the thrust of the findings which are highly significant. 

 The authors explain the studys genesis: “After an inquest into the freezing deaths of homeless alcoholic men, a pattern was noted of heavy alcohol consumption before shelter entry to achieve in-shelter abstinence, followed by early-morning alcohol-seeking to avoid the symptoms of withdrawal.”

 Predictably there was a journal response requesting tax-payer alcohol for all.  While he may have his tongue in his cheek, CMAJ correspondent Dr Monczak seems unaware of the enormous potential savings if these findings were translated across entire communities. 

 While this group is already severely damaged and rehabilitation options limited, one can still be simultaneously pragmatic and humane in dealing with them, just as the Swiss dealt with heroin addiction over the past 20 years (using needle rooms, detoxification services, heroin prescription, methadone, etc). 

 Comments by Andrew Byrne ..

Comments by Andrew Byrne ..