See also
- Long-term effects of alcohol consumption
- Moderation Management, alcohol treatment program that aims to reduce consumption but not eliminate it
A managed alcohol program is a program meant to reduce harm for chronic alcoholics. The program involves providing a regular dose of alcohol to individuals with alcohol addiction, typically at a shelter-based harm reduction centre. [1]
The centres operating a managed alcohol program are distinct from typical homeless shelters. The latter usually enforce abstinence from alcohol, whereas the former permit alcohol consumption "in managed doses or in specific areas". [2] These shelters ensure that high-risk homeless individuals can avoid "exposure to extreme weather conditions, assault on the street, alcohol poisoning, or the substitution of non-beverage for alcohol products". [2] They are also distinct from wet shelters, with criteria for admission and offering a greater breadth of services, such as on-site or referral medical, mental health, and social services. [2]
Such programs enable individuals to reduce alcohol consumption, improve hygiene, and improve nutrition and overall health. [2] Other benefits include providing the affected individual with community services and housing, a reduction in health care and emergency service expenses, and less time in prison. [2]
In March 2006, the Canadian Centre on Substance Abuse published the report The Costs of Substance Abuse in Canada 2002, stating that in 2002 the costs to Canadian society associated with alcohol abuse to be $14.6 billion, representing 36.6% of costs incurred for all substance abuse (including tobacco and illicit drugs). [3] These costs involved the loss of productivity, and the provision of services such as health care and law enforcement. [4]
The report stated that between 8,100 and 9,100 deaths were attributable to alcohol abuse, representing over 500,000 potential years of life lost (PYLL). [5] The leading causes of death were cirrhosis, motor vehicle collisions, and suicide. [6] Deaths attributed to alcohol abuse represented 1.9% of all deaths in Canada in 2002. [6] Alcohol abuse also resulted in over 1.5 million acute care days in a hospital. [5]
Five broad categories of costs associated with alcohol abuse were identified in the report. [7] Direct health care costs include acute care hospitalization ($1.46 billion), prescription drugs ($768 million), specialized inpatient treatment ($755 million), family physician visits ($173 million), ambulatory care ($80 million), specialized outpatient treatment ($52 million), and psychiatric hospitalization ($20 million). [7] Direct law enforcement costs include police services ($1.9 billion), corrections and probation ($660 million), and court services ($513 million). [7] Direct prevention and research costs include prevention programs ($34 million), research ($17 million), and operational costs ($2 million). [7] Other direct costs include traffic collision damage ($757 million), fire damage ($157 million), administrative costs for transfer payments ($62 million for worker's compensation and $4 million for social welfare), and workplace health promotion ($17 million). [7] The indirect costs are productivity losses from long-term disability ($6.2 billion), premature death ($923 million), and short-term disability ($24 million for reduced activity, $16 million for days in bed). [7]
The first managed alcohol program in Canada, the Annex Harm Reduction Program, [2] was established in 1996 at Seaton House, the largest homeless shelter in Toronto. [8] The program was founded as a result of the death of three homeless men in the city in 1995. [9] Its target clients are homeless men with "difficult behaviours, mental illness or severe alcohol and drug problem". [2] Individuals who are "too high-functioning" are not accepted into the program. [9] These men receive one alcoholic beverage per hour at most, though staff may refuse to grant an inebriated client alcohol. [9] They may also exchange non-beverage alcohol such as mouthwash or household cleaning products for beverage alcohol. [2] Although permitted up to 15 alcoholic beverages per day, the average client consumes six drinks daily. [10] Individuals who consume alcohol outside the program are not served alcohol in the program. [10]
The program is administered by two full time registered nurses and case workers, and serves as a teaching program for St. Michael's Hospital. [10] Since inception, visits to the emergency department have decreased 93%. [10] In 2010, the program resulted in a cost reduction for the city of Toronto of $3300/day/client for emergency medical services, police, and health care services not utilized. [10] Between 12–24 clients die each year in the program, typically "the culmination of chronic alcoholism, pre-existing health conditions and many years spent living in poverty and on the street". [10]
The Managed Alcohol Program in Ottawa, opened in 2001, [11] is a shelter for homeless alcohol addicts that provides controlled hourly doses of alcohol. [2] It is operated by the Shepherds of Good Hope and funded by the city. [12] Each client receives seven ounces of white wine upon waking, and five ounces of wine once an hour until bedtime. [12] The goal is to prevent binge drinking and consumption of alternate stimulants, and to eventually graduate the clients to a "domiciliary hostel program" once their alcohol consumption has stabilized. [13] A study conducted by the Ottawa Police Service tracked 23 individuals before and after admission into the program between 2001 and 2007. This group totalled 1074 incidents involving police, costing about $122,000, before admission to the program, and 53 incidents costing $6,000 after admission. [14]
In Thunder Bay, the Kwae Kii Win managed alcohol program resulted in a 47% decrease in emergency service use and a 41% decrease in interaction with police. [12] There was also a reduction in the number of people drinking non-beverage alcohol. [15] Claremont House is Hamilton opened in 2005, and is located on the West 5th Campus of St. Joseph's Healthcare Hamilton. [11]
In a 2011 study prepared for the South West LHIN in London, a domiciliary hostel managed alcohol program was expected to cost $45/person/day to provide up to 20 beds with one full-time nurse, one full-time social worker, two full-time equivalent registered nurses, six health workers, and an on-site physician for six hours per week. [16] Including food, alcohol, and other expenses, the cost would be about $82/person/day.
Some, without evidence, have criticized the program as "giving up" on problem alcoholics by sedating them with alcohol, or that the free alcohol could attract individuals from outside the program area. [12]
Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnostic entity. Predominant diagnostic classifications are alcohol use disorder (DSM-5) or alcohol dependence (ICD-11); these are defined in their respective sources.
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical and criminal justice contexts. In some cases, criminal or anti-social behaviour occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.
Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.
The Substance Abuse and Mental Health Services Administration is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of treatment and rehabilitative services in order to reduce illness, death, disability, and the cost to society resulting from substance abuse and mental illnesses. The Administrator of SAMHSA reports directly to the Secretary of the U.S. Department of Health and Human Services. SAMHSA's headquarters building is located outside of Rockville, Maryland.
The long-term heavy consumption of alcohol can cause severe detrimental effects. Health effects associated with alcohol intake in large amounts include an increased risk of developing an alcohol use disorder, malnutrition, chronic pancreatitis, heart failure, atrial fibrillation, gastritis, stomach ulcers, alcoholic liver disease, certain types of dementia, and several types of cancer. In addition, damage to the central nervous system and peripheral nervous system can occur from chronic heavy alcohol consumption. Besides, an increased risk for accidents exist like car accidents and related injuries. Even light and moderate alcohol consumption increase the risk for developing certain types of cancer. In fact, a 2018 study confirms that no level of alcohol consumption is safe, even a little.
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.
Homelessness in Canada has grown in hugeness and complexity since 1997. While historically known as a crisis only of urban centres such as Montreal, Laval, Vancouver, Edmonton, Calgary, and Toronto, increasing homelessness in suburban communities requires new services and resources.
Alcohol education is the practice of disseminating disinformation about the effects of alcohol on health, as well as society and the family unit. It was introduced into the public schools by temperance organizations such as the Woman's Christian Temperance Union in the late 19th century. Initially, alcohol education focused on how the consumption of alcoholic beverages affected society, as well as the family unit. In the 1930s, this came to also incorporate education pertaining to alcohol's effects on health. For example, even light and moderate alcohol consumption increases cancer risk in individuals. Organizations such as the National Institute on Alcohol Abuse and Alcoholism in the United States were founded to promulgate alcohol education alongside those of the temperance movement, such as the American Council on Alcohol Problems.
Housing First is a policy that offers permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was popularized starting in the 1990s, and in the following decades became government policy in the United States and various other countries.
Transitional living refers to any type of living situation that is transitional. The primary purpose or mission of transitional living environments is temporary. Transitional living facilities often offer low cost housing. Transitional living residents that cater to those recovering from economic hardship often graduate from a shelter to lesser crowded living situation. Transitional living may or may not have other common threads among residents. Transitional living provides professional support, education, and a stable living environment. Common types of transitional living include transitioning from jail or prison, an addiction treatment center or a mental health facility. They may also target homelessness, especially among youth. Transitional living is provided by many well known private and non profit organizations, by government, churches and other charitable organizations.
Seaton House is the largest homeless shelter in Toronto, Ontario, Canada. It is located at 339 George Street in the Garden District neighbourhood. The facility provides temporary lodging, food, clothing, medical care, for single men and also attempts to provide tools for enabling them to establish their independence. The shelter houses up to 700 men though, in the past, it has exceeded capacity and housed as many as 900 men. It is expected to close in 2020.
Surrogate alcohol is a term for any substance containing ethanol that is intentionally consumed by humans but is not meant for human consumption. Some definitions of the term also extend to illegally produced alcoholic beverages.
The California Department of Alcohol and Drug Programs (ADP) was a California state agency concerned with substance abuse prevention and treatment. Created by the California Legislature in 1978, ADP brought together the Governor's Office of Alcoholism and the California Department of Health's Division of Substance Abuse to form the single state authority for substance abuse prevention and treatment, and is currently within the auspices of the California Health and Human Services Agency. In this capacity, ADP provided leadership and policy coordination for the planning, development, implementation, and evaluation of a comprehensive statewide system of alcohol and other drug (AOD) prevention, treatment and recovery services. As of July 1, 2013, functions of ADP were transferred to the Department of Health Care Services.
Recreational drug usein Kenya is common among men, women, and youth from both rural and urban environments. The drugs reported to have been used are cigarettes, tobacco, kuber, shisha, packaged alcohol, chang'aa, hashish, bhang, cocaine, heroin, khat, inhalants, prescription drugs, and synthetic drugs. In recent years, recreational drug use has led to instances of abuse which can be traced to several causes which include social stigma, poor parenting and poverty, and peer pressure. Some of the major effects are violence, utilization of health-care services, greater risk of contracting HIV, chemical dependence, and social stigma. Local communities and the national government have made efforts to address these issues.
Shepherds of Good Hope is a social service organization based in Ottawa, Ontario. It is one of four homeless shelters in the city. Its client-base includes people of different faiths, beliefs and genders. This organization provides three main services: Support Services, Supportive Living and Shelter Services. Shepherds of Good Hope also operates a soup kitchen, and serves breakfast, lunch and evening meals.
Healthcare in Luxembourg is based on three fundamental principles: compulsory health insurance, free choice of healthcare provider for patients and compulsory compliance of providers in the set fixed costs for the services rendered. Citizens are covered by a healthcare system that provides medical, maternity and illness benefits and, for the elderly, attendance benefits. The extent of the coverage varies depending on the occupation of the individual. Those employed or receiving social security have full insurance coverage, and the self-employed and tradesmen are provided with both medical benefits and attendance benefits. That is all funded by taxes on citizens' incomes, payrolls and wages. However, the government covers the funding for maternity benefits as well as any other sector that needs additional funding. About 75% of the population purchases a complementary healthcare plan. About 99% of the people are covered under the state healthcare system.
A sobering center is a facility or setting providing short-term recovery and recuperation from the effects of acute alcohol or drug intoxication. Sobering centers, instead, are fully staffed facilities providing oversight and ongoing monitoring throughout the sobering process. Sobering centers include alternatives to jail and emergency departments, as well as drop-in centers”. There are small numbers of sobering centers around the world. There are over 40 sobering centers in the United States, with dozens more in development.
Linda Carter Sobell, Ph.D., ABPP, is the President's Distinguished Professor at Nova Southeastern University (NSU) in Fort Lauderdale, Florida. She is a professor of clinical psychology, addiction specialist, co-director of NSU's Guided Self-Change clinic, a Motivational Interviewing Trainer, and is board-certified in cognitive and behavioral psychology.
Guided self-change (GSC) treatment has been accepted by American Psychological Association Division 12, Society of Clinical Psychology, as an empirically supported treatment.
Discrimination against drug addicts is a form of discrimination against people who suffer from a drug addiction.
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