Alcohol dependence is common in homeless people, and treatment success is limited. Recognizing these issues, a group in Canada created a shelter-based program that does not require abstinence and aims to minimize the harms associated with alcoholism.

Along with medical and social services, the program provides participants up to 5 ounces of wine or 3 ounces of sherry per hour on demand, 7 days per week. This study examined outcomes in 17 subjects (average age 51 years) who were enrolled in the program for 5–24 months, had been homeless for at least 2 years, and had alcoholism for an average of 35 years.

• Subjects had significant decreases in the following while in the program (compared with 3 years before program entry):
• Average daily consumption, including nonbeverage alcohol (e.g., mouthwash) (decreased from 46 drinks to 8 drinks)
• Average monthly emergency-department visits (from 0.8 to 0.5)
• Average monthly police encounters (from 1.1 to 0.5)
• Subjects did not have significant changes in blood markers of alcohol use.

Comments by Richard Saitz, MD, MPH and Rosanne Guerriero, MPH:

This demonstration was not a clinical trial, the number of participants was small, and alcohol use off shelter premises was not recorded. Nonetheless, the findings are intriguing—the program appeared to benefit a group who had little success with treatment in the past. The real question is whether any of these benefits could have been achieved without serving hourly drinks to people with alcoholism.

Reference:

Podymow T, Turnbull J, Coyle D, et al. Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol. CMAJ. 2006:174(1):45–49.

Reprinted with permission from Alcohol and Health: Current Evidence.