Managed alcohol programs in the context of the COVID-19 pandemic: a pilot study
Date
2021-12-24
Authors
Goulet-Stock, Sybil
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Abstract
Introduction: Managed Alcohol Programs (MAPs) are a harm reduction strategy designed for
individuals with severe alcohol use disorders (AUD) experiencing unstable housing. During the COVID-19 pandemic, there was a rapid development of MAPs to assist with physical distancing and isolation and to reduce the harms associated with severe AUD, high-risk drinking, and unstable housing. The unprecedented context of the COVID-19 pandemic and the rapid development of MAPs resulted in the implementation of new MAP models. MAPs may be critical for stabilizing alcohol consumption patterns, reducing alcohol-related harms, and reducing the risk of COVID-19 infection and COVID-19-related harms in this population of individuals with severe AUD experiencing housing instability. This mixed methods pilot study provides a mixed description of nine MAP participants in MAPs that emerged in the context of the COVID-19 pandemic in British Columbia. There are no other studies to date that have included programs using a clinician scattered- site outreach or fixed-site MAP model. This is also the first study of health-authority based MAPs. Objectives: 1) To describe the specific characteristics of the MAPs operating in the context of the COVID-19 pandemic; 2) To explore whether entry into a MAP was associated with improvements in the health, safety, and well-being of individual participants; 3) To explore whether entry into a MAP was associated with reductions in their usage of emergency, hospital, police, and correctional services; 4) To explore whether entry into a MAP was associated with their having less hazardous patterns of alcohol use; 5) To explore whether entry into a MAP was associated with improvements in participants’ ability to follow COVID-19-related physical distancing and hygiene guidelines; 6) To illustrate participant’s goals related to MAP participation. Methods: This pilot research uses a longitudinal mixed methods quantitative and qualitative design. Data were collected between November 2020 and March 2021. An assessment of mental and physical health, safety, well-being, health services and police service usages, and patterns of alcohol and other substance use, quality of life, wellbeing, physical distancing and risk behaviours, and alcohol-related harms was conducted using a series of standardized scales, non-standardized questions, and open-ended questions. Trained interviewers administered the surveys to nine participants at baseline, and every 2 weeks for up to 3 months following the initial interview. A one-time semi-structured qualitative interview was also conducted with four of the MAP participants. Four MAP managers, staff, and clinicians participated in semi-structured qualitative interview interviews about their program history, development, and key program dimensions. Results: This pilot study provides a mixed description of nine MAP participants in British Columbia in the context of the COVID-19 pandemic. MAP participants described improved capacity to follow COVID-19 guidelines, enhanced housing stability, improved health, safety, and wellbeing, and experienced fewer alcohol-related harms. Seven participants also reduced their drinking. However, six participants reported a high frequency of other substance use while on the MAP. In qualitative interviews, each MAP participant described positive outcomes after joining the program. Individual case findings illustrate differences in outcomes for each participant. Limitations: Study limitations include the small sample size, the lack of a comparison or control group, and the use of some retrospective data. Implications: The results are consistent with other research finding that MAPs can serve as an important part of the treatment continuum for unstably housed people with AUDs, particularly in the current context of the COVID-19 pandemic. The findings also indicate that there may be value in extending this alcohol harm reduction approach beyond the duration of the pandemic and that it be further integrated into the substance use treatment continuum. Recommendations for future research with MAPs are discussed.
Description
Keywords
Managed Alcohol Programs, MAPs, Alcohol, Alcohol Dependence, Harm Reduction, Alcohol Harm Reduction, Homelessness, The COVID-19 Pandemic