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A place for the alcoholic homeless to receive alcohol in a safe and measured way: Rabbi Mendel Kastel explains how this new program could offer a pathway to truly turn lives around.
It sounds initially controversial but could it actually be the one remedy that is so desperately needed for those facing alcohol abuse issues and homelessness?
Recently, Jewish House aligned with St Vincent’s Hospital to develop, and try to get up and running, a managed alcohol program (MAP) for inner city Sydney. Essentially, it is a residential program for rough-sleeping homeless chronic alcoholics – those in our society who are ineligible to enter refuge programs because of their active drinking. Existing shelters usually require abstinence from all clients as an entry requirement. However, the problem is that this requirement may actually result in increased dangerous drinking for those in desperate need of help as they “binge” prior to entry to accommodation so as not to “waste” it. One of the most obvious dangers is the health risk in engaging with this kind of drinking, and ultimately it being a major barrier for those in crisis. A limited but important body of international research demonstrates that a focus should actually be on a managed alcohol program as part of a way to mitigate these risks. The difference with a MAP is that the clients are actually administered measured doses of alcohol at prescribed times by qualified staff, rather than bingeing, or worse, remaining on the streets as rough-sleepers.
The reality is, nearly half of the rough sleepers in the City of Sydney are alcohol dependent and we need to deal with that. Around 30 percent of all presentations to St Vincent’s Hospital are alcohol or other drug related and the homeless occupy hospital beds around four times more than that of the general population. In addition, rough sleepers are more likely to have contact with police and justice, and more likely to be victims of crime, than the general community.
Rough sleepers are socially isolated from the institutions and organisations designed to support people in crisis, and they are disenfranchised and extremely vulnerable. They have poor health outcomes, increased problems with mental health and require specialist case management to restore dignity, health and re-engagement with society.
Taking an approach that is based on the philosophy of harm reduction and optimising outcomes for the chronically homeless is a step forward. By understanding the complexities around this dependence and allowing entry to a residential facility for alcoholics, it is the first step in improving their health and restoring their dignity. In providing the clients with measured amounts of alcohol, there is an opportunity to avoid health concerns surrounding withdrawal – complications of which can be fatal. The facility will, in addition to the provision of alcohol, provide psycho-social and medical support services to the clients to maximise the opportunities to these vulnerable individuals.
There is research providing evidence that this is a program that can drive encouraging results, and there are current MAPs operating in Canada, USA and the UK. Approximately 14 studies based on overseas research and the data from these programs describe prescribed doses of alcohol administered to clients at specific times throughout the day. Generally, one standard drink per hour. Clients can choose to refuse the drink if they wish. Interestingly and contrary to assumptions, clients frequently refused the offers of alcohol at the prescribed rate. Their alcohol consumption decreased as a result of their involvement in the program. There have also been significant reductions in health care services costs such as hospital admissions and emergency department contacts by MAP clients compared to the homeless cohort; contact with police dropped by over 50 percent, and, their health outcomes have improved, in addition to improvements in hygiene and appearance.
So integrating this program in the inner city of Sydney would provide a valid alternative residential service for alcoholic rough sleepers. The current number of rough sleepers in the City of Sydney is around 400, thus the number of alcohol dependent individuals could be expected to reach nearly 200. Of this cohort, a MAP would be able to provide assistance for up to 15 clients at a time.
By supporting the efforts of the St Vincent’s Hospital Alcohol and Drug Service and trying to see a program like this launch in Australia, there is an opportunity for us to reach out to these individuals and offer them a pathway to turn their lives around. From first glance this may be a controversial program, however the research and case studies speak for themselves; and with current frameworks not truly tackling what is a significant problem for those in our society, we have an opportunity to adopt a new approach and see real change.