Evaluation of participants' experiences enrolled in a community-based mobile withdrawal management service

Background
As with many jurisdictions globally, the city of Winnipeg, Canada continues to experience significant problematic alcohol use. This ongoing endemicity functions to strain addiction treatment services, including withdrawal management resources, creating barriers for public access, while increasing both pressure on health care resources and costs to the system.
The Mobile Withdrawal Management Service (MWMS) was formed in 2019 in Winnipeg to provide an alternative to facility-based detoxification services. The program engages individuals voluntarily seeking support to withdraw from substance(s) while remaining in the community. MWMS operates 365 days a year and is deliberately interdisciplinary. 
The program offers up to 30 days of detox management and stabilization. Team members visit individuals in the community, whether in their homes or in temporary housing should they be precariously housed or unhoused. 
Interventions for alcohol withdrawal include psychosocial support and medical management such as benzodiazepine administration for withdrawal symptoms, and, where appropriate, ongoing pharmacological management with naltrexone, or alternatively, acamprosate. Targeted outcomes are centred on participant objectives, ranging from stand-alone detox to bridging towards long-term treatment. Individuals are offered aftercare options such as ongoing peer support, linkages (if needed) to primary care, and group programming. 
 
Methods
In this study, we present qualitative results from participants with MWMS.  Data was generated through phone surveys, conducted by a research assistant unconnected to the clinic or the program.  There were thirty-five individuals sampled who participated on a voluntary basis.
 
Results
Participant response was positive; 97% of respondents indicated they would recommend MWMS, or a program based on a similar model.  In contrast, 58% described challenges accessing conventional withdrawal services prior to enrollment in MWMS.
Forty-six percent of respondents had suggestions for improvement, which included longer program duration, greater geographic reach, and enhanced coordination with other programs.
Limitations to the study included selection bias as the sample was not randomly selected; voluntary participation requires caution when generalizing results to the broader community.
 
Conclusions
These results reveal substantial participant satisfaction with the mobile model of withdrawal care delivery. This coincides with a high demand for detox services in general, but the program provides services outside the conventional facility-based model, an approach respondents supported.  Community-centered care also appears to have inherent therapeutic advantages, while simultaneously reducing costs in service delivery and increasing program agility and responsiveness.
Future directions for research include direct comparison of both cost-effectiveness and outcomes of the MWMS model versus with facility-based services.