Managed Alcohol Programmes: a realist review to identify what works, for whom, and in what circumstance

Background

Alcohol use disorders (AUD) affect more than 280 million people worldwide, causing more than 5% of all deaths each year. At the most severe end of AUD is alcohol dependence. People experiencing homelessness as well as alcohol dependence are vulnerable to a range of harms, and existing treatment options are often inadequate for this group. 

Abstinence-based treatment programmes are the norm, but are difficult to comply with and do not address the underlying issues of homelessness and alcohol dependence. Instead, alcohol harm reduction approaches provide individuals with support to reduce the harms associated with their drinking, without the need to stop drinking. Services using alcohol harm reduction approaches are rare, particularly for those experiencing alcohol dependence and homelessness. 

Managed alcohol programmes (MAPs) are one harm reduction approach, specifically designed for this group. MAPs provide alcohol in regulated doses through the day, alongside wider support for housing, physical/mental health, welfare, and social connections. MAPs are a relatively new initiative for the United Kingdom (UK). 

Methods

We will use a realist review to explore the current evidence base for MAPs. Realist reviews aim to synthesise existing evidence to examine the contexts, mechanisms and outcomes of complex interventions, on the assumption that the outcomes of these interventions are directly caused by underlying mechanisms which have been activated in particular contexts. Unlike systematic reviews, realist reviews are not limited to randomised controlled trials and can include more grey literature. This makes a realist review a more appropriate methodology for exploring MAPs, for which there are currently no experimental studies. 

Results

We will present our findings from a realist review to identify what works, for whom, and in what circumstances when delivering MAPs. The realist review will address important evidence gaps related to implementation and the relationships to outcomes.

Conclusion

Our theoretically informed exploration of service implementation will be critical to informing the design, development, and optimisation of future MAPs in Scotland, across the UK, and beyond.