Managed-alcohol program helps battle addiction

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      Self-identified alcoholic Wesley Delorme said he used to drink Listerine by the bottle until he passed out.

      However, last fall he enrolled in a pilot eight-person managed-alcohol program (MAP)—operated by the PHS Community Services Society and comanaged by Vancouver Coastal Health and UVic’s Centre for Addictions Research of B.C.—for “illicit” drinkers.

      Delorme told the Georgia Straight he’s stopped getting alcohol-induced seizures since then and he’s not blacking out anymore. He lives on-site at the province-owned building (on a city-owned site) where MAP is taking place, 1005 Station Street.

      “I haven’t touched mouthwash in about four months,” Delorme confirmed.

      As he sits in project manager Clare Hacksel’s PHS office and talks about how MAP has allowed him to reclaim his life, jokes flow as freely as his Listerine and rubbing alcohol once did. Delorme only stops to look at the framed picture of his dead friend, Hector Rich, whose 12-year consumption of nonbeverage alcohol resulted in cirrhosis of his liver and, finally, his death.

      “This program would’ve been good for Hector,” Hacksel claimed.

      “Maybe he’d still be alive,” Delorme noted.

      The program began last October and costs about $350 per month per participant, Hacksel confirmed. Vancouver Coastal Health spokesperson Anna Marie D’Angelo told the Straight there is “no end date” for the study, as researchers at CAR B.C. are assessing the data on an ongoing basis.

      Clare Hacksel discusses the ins and outs of the pilot program and addresses concerns around it.

      MAP is restricted to those with severe addictions to nonbeverage alcoholic substances, such as rubbing alcohol, which has an alcohol content of 95 percent in its undiluted form. Foremost, the point of MAP is “preventing premature deaths”, according to Dr. Ronald Joe, medical manager of inner-city addictions at Vancouver Coastal Health.

      Then, once stabilized, a doctor will conduct regular assessments of a participant, and then a nurse administers a maximum of 12 measured alcoholic drinks—vodka, beer, or wine—in a supervised setting over a 24-hour time span, with no more than one drink per hour.

      “The main impact is that they become so intoxicated, because they can’t regulate their drinking—addiction is, by definition, not being able to control the quantity that you can consume—so they end up taking more than they should,” Joe told the Straight by phone. “If you’re drinking 95-percent alcohol, it doesn’t take much to really cause blackouts, and so they end up falling. We have a lot of broken bones, and when they’re blacked out they can vomit and aspirate their vomit, causing pneumonia and severe infection. Those are the two common events that occur.”

      Joe was quick to state the results so far are “preliminary”. However, he said that, overall, drinking in the participant group has gone down significantly, binge drinking has been curtailed, and other side benefits have sprung up, such as renewed or improved contact with family. And if there are less visits to the emergency ward following seizures and falling down, there is less of a strain on the public purse, Joe added.

      “We can say that the amount of drinking has been reduced by more than half,” Joe said. “So if we’re talking about a group of candidates that have been drinking, say, 30 or 40 drinks a day, I don’t know about you, but we would certainly have backed out with about a third of that.”

      David Eby, executive director of the B.C. Civil Liberties Association, told the Straight he became sensitized to the issues leading to MAP’s creation while sitting through testimony at the inquiry into the death of Frank Paul, a Mi’kmaq man who died in December 1998 after Vancouver police took him from custody and dumped him in an alley.

      “He was drinking rice wine, and there was evidence from the police about the impacts from rice wine on health, and evidence from medical folks about the impacts of rice wine and the scourge of that on chronic alcoholics on the Downtown Eastside for years,” Eby said by phone. “It destroys the liver and it poisons people. It’s got a very high salt content. And so, basically, it was this incredibly tragic story about a guy who was treated in the most expensive, least humane way possible.”

      Had Paul been in Ontario, where several managed-alcohol programs exist, rather than B.C., he’d also likely still be alive, Eby claimed.

      Clare Hacksel demonstrates how alcohol is distributed to pilot participants of the managed-alcohol program.



      glen p robbins

      Jan 11, 2012 at 5:54pm

      You need treatment facilities. An alcoholic requires at least 90 days away from substance in a controlled environment under supervision. The province needs about a dozen good treatment facilities - 150 'houses' for male and female treatment - 100 new detox facilities.

      The average alcoholic (who is actually a higher income earner than one might expect) cost the system (health - crime etc) about $4,000 per year.

      I have many 'friends' who have walked the east side with shopping carts, in and out of jail - destitute - who have gotten sober through treatment - and the message these people provide to other (particularly young people) would make anyone stand up and cheer.

      We need to help more people get clean and sober - the miracles that can occur are truly spectacular.

      R U Kiddingme

      Jan 11, 2012 at 6:44pm

      Where is my managed Skittles program?

      glen p robbins

      Jan 11, 2012 at 10:17pm

      RUK - pretty thoughtless

      2nd Nation

      Jan 12, 2012 at 6:42am

      OK, the cost to "the system" (i.e. "people that pay taxes") is quoted as $4000 pp. What is the cost of the programs?

      And unless we'll be *raising* taxes further then what program will we cut to pay fgor more alcohol treatment? Will it come from children's education? Parks? Programs for the arts? ...?


      glen p robbins

      Jan 12, 2012 at 11:08am

      The World Health Organization (this year) says alcohol is the largest contributor to cost including new links to cancer. 40% of the public has no issue with alcohol, while approx 15% of the population consumes about 40% of the liquor. You need a lot of money to drink (regular consumption) over a long period of time (ie good income). Alternatively - the 'new' problem - is young people on drugs which takes an addict out much - much faster than alcohol.

      Revenues raised from taxes on alcohol in BC are a wash to the cost to crime - health - and other social considerations and the cost is now creeping past the revenue side.

      10-12% of the public has a problem with alcohol use. Let's conservatively say 250,000. There's one billion of the 2 billion in annual total cost (social cost accounting). The program I am advocating would cost $35 million to start up and $50 million per year to run (not all of which is paid by government - welfare etc.). Over 10 years I believe we could 'convert' at least 200,000 (20,000 per year) alcoholic, functional alcoholic, drinking problem. beyond the amount already being helped through 12 step - clean houses --detox etc. saving $800,000,000 in social costs at a cost of one half billion - a highly profitable plan for tax payers. The decrease in cost to employers over the same period (long time employees sick etc - people who stay clean who smoke often stop) higher productivity would be another billion dollars. If we added in another $65 million for other state of the art facilities for 'others' with dollars to attend (in conjunction with the larger social cost undertaking) government might earn 30 million per year.

      You can't have for profit in this because profit inevitably screws up good social ideas - particularly in this area of health (save for the rich persons facility).

      Implementing this plan in conjunction with possibly the best 12 step model anywhere in the world here in Vancouver and within 10 years I guarantee BC would be the most healthy productive society on the planet.

      Jamie K. Scott

      Jan 12, 2012 at 7:49pm

      The MAP is for people who have repeatedly failed 12-step programs. The failure rate in 12-step programs is high even with the best programs available. So both the MAP and 12-step programs may be needed to cover both types of folks. And I bet the likelihood will be higher that some people in the MAP will eventually want to try a 12-step program or some other alternative (e.g., counseling) to deal more effectively with their drinking problem, as compared to those who have tried 12-step and repeatedly failed, and have no alternative options but to continue drinking non-beverage alcohol. I appreciate GPR's concern, but the early results indicate there is a place for both approaches. I applaud the folks who have set this model up, especially the fact they are testing their hypothesis, and will let the outcome, rather than blind faith or/and prejudice, decide what kinds of policy to advocate. Kudos to you all!

      glen p robbins

      Jan 13, 2012 at 2:36pm

      Jamie - I agree with you. About 3-5% who come to 12 Step make it one year. One year in with increase odds to about 75% to last 5-8 years (average based on memory) {with no great research past 8 years}.

      12 Steps difficulty is that people leave the 'meetings' and go into the outside world - if folks aren't going to "90 meetings in 90 days" {intensive adjustment - washing of the brain} - they start feeling a little better (health) and start thinking everything is ok - and the addiction has 'em cornered again. The core of the plan is to ensure a relatively seamless 'adjustment' from the mental - physical - and spiritual illness brought on by abuse and make the necessary physical - mental and spiritual adjustment from the 'treatment' to give folks who are addicted a bona fide shot at a comeback to life.

      My 'business plan' would take more MAP and others into 90 day treatment-abstinence - to clean out and begin to renew. I hear weekly stories of young and old who have been drinking 'anything' with alcohol in it. It is incredible how powerful addiction is. Only a person with experience with an addiction can help another person with an addiction - a university degree or other training helps but it isn't enough.

      Certainly - not all addicted folks - are in MAP - but at least 85% of addicted folks will require 12 Step - the folks who require MAP are the most desperate because they are often homeless and without resource. Many hardcore addicted folks are living and working on our communities - they have money and possessions and their family's are suffering with a miserable secret. Folks with money - can afford liquor -- to feed their habit. The folks who need MAP are at the point they will drink anything - anything at all - the mind and body are in such shape - there is nothing they can do.

      Jamie you are correct imo - a plan and a process must be in place - not just from the abstract - economic social position - but from the point of view of humanity. We live in a world where we butcher one another - and then go crazy when soldiers pee on dead bodies - as disgraceful as that is - it's still pretty absurd when you think about it.

      The fact that some people have everything and many others have nothing - and addicted people like those who need MAP - is acceptable -- is pretty disgusting.

      Addiction is a modern day social Holocaust.

      Nicole L.

      Jan 14, 2012 at 12:26pm

      As an alcoholic who maintains her sobriety through the rooms and program of Alcoholics Anonymous, I was disturbed by this article. While MAP may aid in reducing the immediate physical repercussions of alcoholism, ultimately it does little to address the mental, emotional, and spiritual components of the disease.

      The substance(s) that an addict abuses - be they 'regular' or 'non-beverage' alcohol, drugs, food, or a combination of all four, as was my story- holds little relevance because ultimately the usage itself is merely a manifestation of a much deeper symptom. Reducing the amount of alcohol that MAP's candidates are consuming is akin to putting a band-aid on a broken bone . I've known many alcoholics who have stopped drinking, only to replace alcohol with another destructive substance or behavior. Until a person becomes willing to fully address why he or she drank (or used other substances) in the first place, true recovery is an impossibility.

      Genuine addiction is a progressive disease, and while it may be arrested in an individual it is never cured. MAP misleads its participants into believing that they may be able to control their drinking, while further perpetuating the myth that addiction is a choice. As a result, both the participants and society as a whole suffer immensely.

      Martin Dunphy

      Jan 14, 2012 at 3:21pm


      May I suggest, respectfully, that you read the article with a bit more attention. MAP does not "mislead its participants into believing that they may be able to control their drinking".
      It is a program designed to, first and foremost, prevent their imminent deaths.
      It is for people who drink mouthwash and rubbing alcohol, people for whom 12-step programs such as AA have, sometimes repeatedly, proven useless.
      It is not for your garden-variety alcoholic.
      It does not "perpetuate the myth that addiction is a choice".
      It is for people who long ago have abandoned the facade that "choice" is even an option any more.
      It is a program for, essentially, no-hopers.
      Once they are stabilized, anything else is a bonus.
      But without first making sure they are ALIVE, there is no point even talking about anything else.
      And that is the primary focus here.
      Later, you can talk about 12-step programs that might be good for some people but actually have very low success rates in terms of prolonged abstinence.

      glen p robbins

      Jan 16, 2012 at 5:31pm

      Nicole - Food and Coffee are not considered in the same way that drugs and alcohol are--they do not induce dependency -. The MAP program is valid to these extents. When an alcoholic resorts to drinking unregulated 'poison' they are ruining themselves so quickly that it is much more difficult to 'resuscitate them' from the oncoming damage. Theoretically the MAP program would permit them to drink regulated alcohol - but in the abstract this the concept does not manifest with the greatest utility for all- unless it is linked with the capacity to move people into treatment process. If 'candidates' are willing to enter into rehabilitation then they could qualify for MAP - it is merely a thin holding pattern to keep those most seriously afflicted AND IMPOVERISHED individuals from cascading to complete physical incapacity.

      Martin's points need to be thoughtfully integrated into the fabric of the overall - progressive discussion-- imo. Remember, an alcoholic or drug addicted person can be brought back to the brink - where people with more conventional illnesses cannot -- and in the better case scenario's become more aware functional people than the average person if the simple but sophisticated method is internalized.