Harm reduction interventions and Indigenous peoples: The first Managed Alcohol Program in Montreal
Background: Hazardous alcohol use is one of the major risk factors for people’s health worldwide and certain populations, such as Indigenous peoples experiencing homelessness, are disproportionately affected by its consequences. A myriad of interventions that target these complex issues have been developed. Among them, managed alcohol programs (MAPs) are harm-reduction interventions that aim to reduce the effects of severe alcohol use and homelessness. MAPs provide accommodation, social and health support in addition to regular doses of alcoholic beverages to stabilize drinking patterns and replace the use of non-beverage alcohol (mouthwash, hand sanitizer, etc.). Although the positive impacts of MAPs have been reported, very little is known about the implementation process of these programs and their adaption to the living conditions of urban Indigenous peoples.
Objectives: This paper aims to discuss the results of a qualitative evaluation of the first MAP in Montreal (Canada), implemented by the indigenous organization Projets Autochtones de Montréal.
Methods: Ethnographic methods (informal interviews), and semi-structured interviews (n=16) were used to explore the implementation of the MAP and its effects on the lives of its residents. The collected data were thematically analyzed.
Results: Efforts to implement the MAP model encountered challenges such as residents’ patterns of alcohol use, hostile behaviors and conflicts, loss of purpose and boredom, and staff shortage and turnover. However, certain factors facilitated the implementation of the MAP including staff capacity for teamwork, flexibility, cultural sensitivity, and residents’ support. Several beneficial impacts such as stabilization of alcohol use and reduction/cessation of drug use were also reported. Improvement of residents’ health (e.g., cessation of chronic health conditions such as Hepatitis C; recovery from accidental injuries, etc.) was also noted.
Conclusion: This presentation explores the main barriers and facilitators for the implementation of the first MAP in Montreal. Despite of the challenges encountered during the implementation process, beneficial changes in substance use patterns and health improvement were reported.
