Homeless alcoholics can’t just quit

Managing alcohol addiction, including free drinks, has worked wonders — and shows why we must treat addictions equally

Every day, in the shadow of Parliament Hill, 30 homeless alcoholics are fed, housed and served drinks, each hour on the hour, between early morning and evening.

That this “managed alcohol” program run by Ottawa’s Inner City Health Inc. in the ByWard Market, is effective, is beyond dispute. For one thing, it has saved the local health-care system in the neighbourhood of $3.5 million by reducing or eliminating its clients’ frequent visits to hospital emergency rooms. For another, it has dramatically improved the quality of life for a group of people many would view as beyond hope.

What is remarkable is not so much that the program works, but that it is able to run relatively free of major controversy or political interference. Substitute 30 crack addicts for the homeless alcoholics, and it would be a different story.

In a country where harm reduction is frequently a lightning rod for controversy — whether the issue is free crack pipes or a safe injection site — we have a successful harm-reduction program flourishing in the nation’s capital. That’s a good thing, perhaps a remarkable thing, but it’s too bad we can’t extend its creativity to another group also in need of harm reduction — drug addicts.

It may seem counterintuitive to give addicts what is making them sick, but the Inner City Health program demonstrates it can help them live healthier, happier and less disruptive lives. Despite the fact that they are kept “buzzed” all day as a Citizen reporter put it, they are actually drinking less — maybe two-thirds less — than they would have been on the street. They can’t panhandle while on the program and must meet strict requirements, which they agree to. And the fact is many homeless alcoholics can’t quit. The best that can be done is to manage their addiction.

And that is quite a lot. Managed alcohol serves both its clients and society extremely well. Which makes the question of whether they should quit irrelevant.

Wendy Muckle, a registered nurse who is executive director of Ottawa Inner City Health says addicts have a chronic illness. Helping them learn how to manage their illnesses, she says, is often the only intervention that is effective.

“You get politicians who are basically saying ‘These people need to pull up their socks and get cured,’ when these people have chronic diseases. It is as stupid as saying a diabetic needs to pull up his socks.

“I think we have to figure out humane and safe ways to support people when they are in difficult periods of their lives, encouraging them to maintain a place in mainstream society.”

Unlike the managed alcohol program, Vancouver’s supervised injection site, Insite, exists under the constant threat of closure from those whose ideology tells them it should not exist.

But what is the difference between a program that reduces harm for addicted alcoholics and one that attempts to reduce harm for addicted drug addicts? Yes, alcohol is legal and heroin is not, but the amount of damage each substance can do to lives doesn’t discriminate between legality and illegality.

In fact Muckle says her view of which drug does the most harm has completely turned around. “Before I started this job, I would have said crack cocaine was the most harmful drug available. I now have to say it is alcohol.”

Programs such as Inner City Health can come up with creative solutions to work with alcoholics, but it is much harder and much more political with drug addicts. Muckle says she would love to have a similar program for crack and heroin addicts, if she could. In fact, she believes such an intensive program would not be necessary for most drug addicts.

A safe injection site, she said, would be a “kind of a beginning.” From there, a lot more could be done for that population. Something that would have a huge impact is housing.

Many people think residential treatment is the only option for drug addicts. Muckle disagrees. “We have to change the assumptions and provide other kinds of help than we do.” For some, residential treatment programs will be entirely ineffective, she says, mainly because they don’t last long enough to make a real difference. A long, slow process that includes group therapy, harm reduction programs and some place to live, would have a better chance of succeeding.

source: Ottawa Citizen