Exploring the potential for Managed Alcohol Programmes during the COVID-19 pandemic in Scotland: Findings from a mixed methods study

Background: People experiencing homelessness and alcohol use disorders (AUDs) are at higher risk of developing acute and chronic health and social harms, and are more likely to be negatively impacted by the COVID-19 pandemic, due to increased likelihood of severe disease/death and reduced access to alcohol. Access to AUD treatment can be challenging and abstinence-based programmes difficult to comply with. Many prefer harm reduction options but there is a lack specifically for this group. Managed alcohol programmes (MAPs) are a harm reduction intervention for those experiencing homelessness and AUDs which provided regular doses of alcohol throughout the day alongside health, housing and social support. MAPs were established in Canada, and also exist in Ireland and the US, with increased provision during the pandemic (but none existed in Scotland until late 2021). Research suggests MAPs have positive effects on individuals’ alcohol use/related harm and social outcomes. Building on our previous research in Scotland (Carver et al. 2021; Parkes et al., 2021) this study explored the potential of MAPs during the COVID-19 pandemic.

Methods: A mixed methods study was conducted involving case record reviews (n=12), semi-structured interviews (n=40) and meeting notes. Artists were commissioned to create a range of visual images to capture the emerging themes, to facilitate dissemination.

Results: The case note review highlighted the complexity of health problems experienced, high levels of alcohol and drug use and issues related to the pandemic. Five themes were generated relating to MAPs as a response to COVID-19: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response.

Conclusion: MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.