Harm Reduction

When chronic alcoholics dilute a 500 millilitre bottle of rubbing alcohol it provides the equivalent of 30 beers.
Photograph by: Ian Lindsay , PNG


VANCOUVER -- In October the Vancouver Coastal Health Authority and the Portland Hotel Society began a pilot program that serves 12 daily doses of alcohol — one every hour from 10:30 a.m. to 10:30 p.m.— to eight chronic alcoholics living in the Downtown Eastside.

Four months later there are some signs that the program is having beneficial effects, says Dr. Ron Joe, Vancouver Coastal Health's manager of inner city addiction.

Known as the Managed Alcohol Program (MAP), Vancouver's is based on similar programs that have been operating in Ontario for the past 15 years, says Joe.

"We want to offer the same program for severe drinkers here. These are people who are not just drinking regular alcohol but drinking Listerine, hand sanitizer and rubbing alcohol.

"Basically they are drinking poison. And the evidence from studies back east shows that a maintenance program has beneficial results," he said.

When chronic alcoholics dilute a 500 millilitre bottle of rubbing alcohol it provides the equivalent of 30 beers, says Joe,

Some people in the study drank three or four bottles of rubbing alcohol a day giving them an alcoholic intake equivalent to 120 beers, he says.

"These are all individuals who have done the rounds of detox and all the conventional and available treatment," he said.

"It's unfortunate, but we can't cure this condition. I wish we could. But we have to accept this harm reduction approach. Ideally, we want to get these persons to abstinence," he said.

The alcohol — the participant's choice of vodka, wine or beer — is dispensed by medical staff at the Station Street Community, 1005 Station St, a supportive housing complex of 80 units which opened a year ago to house the homeless.

All those participating in the study live there and are among the small population of chronic alcoholics that routinely show up in hospital emergency departments with serious injuries from falls or fights or unconscious from over-drinking.

Joe said it is costly for the medical system and some have "three or four visits to emergency a week."

"If we are going to provide health care to people, no matter what, then alcoholism is their condition and we should try to treat it. We have not been treating it well using conventional methods," he said.

Since the program began there has been an overall improvement in the health of the eight people.

"They have a lot of chronic underlying diseases. There are a few with high blood pressure which has now stabilized and some chronic skin conditions have improved," he said.

Joe says the behaviour of the test group has changed and they no longer create the commotion they formerly did.

"In a residential building it's usually 10 per cent of the residents who create 90 per cent of the problems. So that has calmed down," he said.

Clare Hacksel, project manager at Station Street Community, said people who knew the participants are amazed at the changes in them.

"These are folks who knew them from before and they are shocked at the improvement," she said. "We've certainly noticed the change here."

A number of the group are Aboriginal and have begun to reconnect with their families and their cultural and spiritual heritage, says Joe.

"I'm surprised that we have seen these changes within four months," he said.

"A couple of the group are talking about abstinence and it's significant that on Welfare Wednesday, when drinkers normally go out, they decided as a group to stay in," he said.

The most notorious incident involving chronic alcoholism was the death of Frank Paul in December, 1998. Paul died of exposure after being dumped drunk and comatose in an alley by a Vancouver police officer.

His death resulted in a costly public inquiry which led to condemnation of the way he was treated by police and also pointed to flaws in the way chronic drunks were treated by medical and emergency services.

"Unfortunately for Frank Paul we didn't have the right treatment option for his medical condition. We have since identified that gap in treatment," said Joe.

It costs about $350 a month to supply alcohol to each of the eight participants, he says.

If the program was open to everyone, he wouldn't expect to see thousands trying to sign up.

"I'd say about 100, as a guess," said Joe.

gbellett@vancouversun.com