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Introduction and Aims: People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues.Design and Methods: Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs.Results: Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections.Discussion and Conclusions: MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed. [ABSTRACT FROM AUTHOR]

Issue. Low-risk drinking guidelines have been developed independently in a number of jurisdictions resulting in different sets of advice with different definitions of 'low risk'. This paper discusses some of the fundamental issues addressed by an expert advisory panel during the course of developing national guidelines for Canadians and summarises key sets of evidence that were influential. Approach. The underlying reasoning and connection between the evidence and the guidelines is discussed in relation to: (i) how to minimise risk of long-term illnesses; (ii) how to minimise risk of short-term harms, for example injury; and (iii) alcohol use during pregnancy. Both absolute and relative risks were considered in the development of the guidelines. Findings. Meta-analyses of all-cause mortality were used to identify upper limits for usual drinking levels where potential benefits and risks were balanced for the average person in comparison with lifetime abstainers (10 standard drinks per week for women, 15 for men). Emergency room studies and situational risk factors were considered for advice on reducing short-term: (i) when not to drink at all; (ii) how to reduce intoxication; and (iii) upper limits for occasional daily consumption by adults aged 25 to 64 years (3 standard drinks for women, 4 for men). Shortcomings in the research data were highlighted. Implications. It was estimated that total compliance with these guidelines at a national level would result in substantially reduced per capita alcohol consumption and approximately 4600 fewer deaths per year.[Stockwell T, Butt P, Beirness D, Gliksman L, Paradis C. The basis for Canada's new low-risk drinking guidelines: A relative risk approach to estimating hazardous levels and patterns of alcohol use. Drug Alcohol Rev 2012;31:126-134] [ABSTRACT FROM AUTHOR]

Aims This paper examines the relationship between frequency of drinking, usual daily consumption and frequency of binge drinking, taking into consideration possible age and gender differences. Participants and design Subjects were 10 466 current drinkers (5743 women and 4723 men) aged between 18 and 76 years, who participated in the GENACIS Canada (GENder Alcohol and Culture: an International Study) study. Setting Canada. Measurements The independent variable was the annual drinking frequency. The dependent variables were the usual daily quantity consumed, annual, monthly and weekly frequency of binge drinking (five drinks or more on one occasion). Findings Logistic regressions show (i) that those who drink less than once a week are less likely than weekly drinkers to take more than two drinks when they do drink; (ii) that the usual daily quantity consumed by weekly drinkers is not related to their frequency of drinking; but that (iii) the risk and frequency of binge drinking increase with the frequency of drinking. Conclusions Given that risk and frequency of binge drinking among Canadians increases with their frequency of drinking, any public recommendation to drink moderately should be made with great caution. [ABSTRACT FROM AUTHOR]

This paper reports the social, demographic and drug abuse backgrounds of cocaine abusers seen at an alcohol and drug abuse assessment centre in Kitchener, Ontario. It compares cocaine abusers to cannabis users and alcoholics of the same age at the same centre. Cocaine and cannabis abusers abusers are mainly young, single males while alcohol abusers are much older. The cocaine and cannabis abusers are both heavy drinkers but the cocaine group contained more high-risk drinkers, more drug injectors and had a higher alcohol consumption. Cocaine abusers are young poly-drug users for whom drinking is also a major problem. Treatment plans should take these problems into account. [ABSTRACT FROM AUTHOR]

This paper reports the results of a community survey on the use of professional help, reading materials, and group programs for three common problems in living: coping with stress and anxiety, dealing with problems in child- rearing, and coping with problems with alcohol or drugs. Respondents were 581 residents of a city in the Canadian Midwest. Reading material was the most commonly used source of help for child-rearing and stress and anxiety problems, followed by professional help and group programs. The three sources of help were used with approximately equal frequency for alcohol and drug problems. The results suggest that the self-help reading materials and group programs have a high degree of public acceptance and that the optimal utilization of these services should be studied in more depth. [ABSTRACT FROM AUTHOR]

This paper summarizes the major trends in the development of alcohol and drug treatment services in Ontario from 1979 to 1989. Data were obtained from all treatment services in the province by surveys undertaken in 1980, 1983, 1986 and 1989. Supplementary archival data are included on the use of American treatment programs by Ontario residents over a similar time period. Across the period of analysis, there has been a rapid increase in the number of alcohol and drug programs (130 to 217), their total cost ($44.4 million to $77.1 million) and the total treatment caseload (30 356 to 61 622). With respect to different types of services, the largest growth in capacity has occurred for specialized assessment/referral centres. Use of short-term residential resources within the province has risen slightly but this has been augmented by a rapid increase in the use of similar programs in the United States. Contrary to expectations from research evidence and provincial policy initiatives, only modest gains have been experienced with non-residential treatment alternatives compared to the increases in availability and utilization of residential treatment programs. [ABSTRACT FROM AUTHOR]