A managed alcohol program in Sudbury has been offering options and treatment for those who have severe alcohol dependence since 2013, and as a harm reduction-based treatment program, has been successful in reducing calls to emergency medical services (EMS), police, hospital visits and increased the participants’ quality of life.
It’s the chance to offer a way out of the harms that come from substance use, said Cindy Rose, manager of harm reduction and shelter service for CMHA Sudbury/Manitoulin, especially those who have escalated their use to include non-beverage alcohol, like hand sanitizer, shoe polish, cough syrup or mouthwash.
The program can then offer health care and long-term treatment and even housing support while the person recovers and learns to manage their substance use.
The theory behind the program is to replace non-beverage alcohol with doctor-prescribed amounts of wine, just enough to keep any withdrawal symptoms at bay, but not so much that the individual is unable to make decisions for their safety and their future.
Symptoms of alcohol withdrawal can begin as early as six hours after peak intoxication and can include seizures, hallucinations and mental confusion, and of those who experience these symptoms, a five- to 25-per-cent mortality rate.
Each individual’s health is monitored and adjustments to the treatments are made as required, with the hope that at some point in the future, they will be able to move on from or manage their alcohol-use.
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. It does not attempt to minimize or ignore the harms associated with substance use, but rather understands that abstinence is not an achievable goal for all, that substance use is a complex and nuanced issue and that establishing quality of life, safety and services free of judgment are paramount. It is referred to as ‘meeting people where they are at,’ meaning that treatment begins at any stage, rather than requiring an individual to reach often unattainable goals.
Harm reduction also acknowledges the role that poverty, trauma, healthcare, prejudice and individual capacity play in substance use disorders.
Each of Sudbury’s program participants must subsidize their own health care and accommodations, which includes the cost of alcohol.
Rose said that the program grew from need within the community, particularly the strain put on emergency services and hospitals.
“After examination, what we found was that a lot of hospital visits, a lot of emergency medical service calls and a lot of police interactions were with individuals who consistently access these services for reasons associated with intoxication,” Rose said. “That, and there was a need for permanent housing for individuals who are homeless and who live with substance use disorder.”
Though the program had to begin as a day-program, rather than a full time one as is the best practice, Rose said there was still an effect.
“After nine months of running the day program, we had an approximately 83-per-cent reduction of EMS calls for individuals,” Rose said. “We had one individual who had 71 calls in the months prior to starting with us, and we reduced that.”
She said all told there was approximately $50,000 in cost savings for emergency services.
In 2016, a study of similar programs found that participants not only reduced or eliminated the non-beverage alcohol use, but there were 41-per-cent fewer police interactions, 87-per-cent fewer emergency detox-program admissions, 32-per-cent fewer hospital admissions.
Participants can be referred to the program by their doctor, or can self-refer, and will complete an intake assessment to ensure the voluntary program is right for them. After that, they will meet with the clinical team who will come up with a treatment plan focused on their specific needs.
“Our clinical team monitors the ‘stabilization period' – the withdrawals – to make sure that we're providing them with enough alcohol so that they don't go into withdrawals, and there's no medical complications,” Rose said.
“Each individual is given their prescribed amount of wine hourly, from 7:30 a.m. to 9:30 p.m. The doctor will identify based on their usage outside of the program what would be the best suitable starting regime for them, and then it is scaled back after two weeks, as the individual stabilizes because their body's getting used to it,” Rose said. “We don't want them to go into withdrawals, but we want them to be able to function; to be able to volunteer, go back to school, take part in activities, so that they're successful in being able to live independently when they've achieved all of their goals here.”
The harm reduction home currently supports 15 residents but there is greater need, Rose said, as well as support for those who use multiple substances, such as opioids. These people are considered poly-substance users and may not qualify for a managed alcohol program.
“To be part of a managed alcohol program, your primary substance of use needs to be alcohol,” Rose said. “Here in Sudbury, poly-substance use is most often the situation we have. We are noticing from the pandemic there is a shift with the opioid crisis increasing and we're not necessarily getting as many referrals as we could, because a lot of people have increased substance use from alcohol to opioids or to other substances, that at this current time we're not equipped to support.”
Another issue is for those who need to be in long-term care, but do not qualify because they have an addiction – even if it is managed.
“The other challenge that we're seeing is that we have individuals who now require physical help with activities of daily living, those who could really benefit from long-term care,” Rose said. “But unfortunately, because of their addiction, they don't qualify for long-term care.”
The average age of those in the program is 50 and over, with many in their 70s.
“There's a gap in the system, this generation has physical needs that are exceeding independent living, or even retirement living and we can’t support them with long-term care.”
Rose said they’ve had some participants who have been able to live on their own and others who thought it possible, but returned to the program. “We don't ever close the door on anyone,” Rose said. “As long as there's no safety risk to any of the staff or individuals that are in our home, there's no timeline. For us, it’s always about where they are in their journey and how we can support them.”
The program is not one that can be included as part of justice planning or in place of jail time as it is voluntary, and requires complete acceptance from those involved.
But Rose said there is still a lack of harm reduction resources available.
“More recovery programs are needed,” she said. “We need more harm reduction and in a bigger capacity, especially in terms of safe supply and opioid assistance. The need is out there, the need is changing; we need to change with the community, but we need the funding to change with that as well.”
You can find out more about the CMHA managed alcohol program on their website, found here.
Jenny Lamothe is a reporter with Sudbury.com. She covers the diverse communities of Sudbury, especially the vulnerable or marginalized, including the Black, Indigenous, newcomer and Francophone communities, as well as 2SLGBTQ+ and issues of the downtown core.
