"There is a Place": impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
"There is a Place": impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness
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DOI：
10.1186/s12954-019-0332-4
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发表时间：
2019-12-16
影响因子：
4.4
通讯作者：
Stockwell, T.
中科院分区：
文献类型：
--
作者：
Pauly, B.;Brown, M.;Stockwell, T.
背景严重酒精依赖和无家可归的双重问题与不稳定的生活和多重急性，社会和慢性危害有关。虽然对减少非法药物使用危害的服务给予了很大关注，但对减少这一群体危害的关注较少。酒精管理计划（MAPs）是旨在减少严重饮酒、贫困和无家可归的危害的减少危害干预措施。MAPs通常提供住宿，健康和社会支持，以及定期管理的饮料酒精来源，以稳定饮酒模式并取代非饮料酒精（NBA）的使用。方法我们研究了地图在减少与物质使用和无家可归相关的危害和风险方面的影响。使用案例研究方法，数据收集从五个地图在加拿大的五个城市，每个程序构成一个案例。共有53名计划参与者，4名过去的参与者和50名计划工作人员接受了采访。我们使用情境分析来制作一系列"混乱"、"有序"和"社交舞台"的地图，这些地图提供了对参与者社交世界和地图影响的洞察。在进入MAP之前，参与者通常处于一个循环的世界中，在多个领域（健康，司法，住房和庇护所）中，通常需要戒酒才能获得援助。居民们描述说，他们生活在一个以街头为基础的生存世界中，其特点是犯罪化、保健需求得不到满足、耻辱化和不安全的饮酒场所，以及一个不时出现多重损失和切断联系的世界。地图通过提供一个减少伤害的世界来打破这些模式，在这个世界中，获得住宿和支持并不取决于清醒与否。地图代表了一个新的竞技场，重点是通过提供更安全的空间和酒精供应来减少伤害，并为土著参与者、土著传统和文化提供与家人和朋友重新联系的机会。因此，MAP是更安全的空间，但也是潜在的愈合空间。结论在有限的酒精危害减少选择的景观，地图创建一个新的竞技场的人经历严重的酒精依赖和无家可归。虽然地图降低参与者的不稳定性，但由于缺乏对减少酒精危害的理解和不安全的计划资金等持续挑战，计划本身仍然不稳定。
Background The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). Methods We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of "messy", "ordered" and "social arenas" maps that provide insight into the social worlds of participants and the impact of MAPs. Results Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. Conclusions In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.