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Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Managed Alcohol Programs (MAPs) are designed to improve health and housing outcomes for unstably housed people with an alcohol use disorder (AUD). The present study assesses the association of MAP participation with healthcare and mortality outcomes. Methods A retrospective cohort study assessed health outcomes for 205 MAP participants and 128 controls recruited from five Canadian cities in 2006–2017. Survival and negative binomial regression models were used to calculate hazard ratios (HR) of death and emergency room (ER) visits and hospital bed days (HBDs). Covariates included age, sex, AUD severity and housing stability score. Results In fully adjusted models, compared with times outside MAPs, participants had significantly reduced risk of mortality (HR = 0.37, P  = 0.0001) and ER attendance (HR = 0.74, P  = 0.0002), and fewer HBDs yearly (10.40 vs 20.08, P  = 0.0184). Over the 12 years, people enrolled in a MAP at some point had significantly fewer HBDs per year than controls after MAP enrolment (12.78 vs 20.08, P  = 0.0001) but not significantly different rates of death or ER presentation. MAP participants had significantly more alcohol-related but significantly fewer nonalcohol-related ER presentations than controls. Conclusion Attendance at a MAP was associated with reduced risk of mortality or morbidity and less hospital utilization for individuals with unstable housing and severe AUDs. MAPs are a promising approach to reduce mortality risk and time spent in hospital for people with an AUD and experiencing homelessness. [ABSTRACT FROM AUTHOR]

The objectives of this study were to profile the landscape of women's alcohol use programs in Canada. We explored service users' and providers' beliefs about alcohol use problems and how this affected treatment choices for alcohol use problems. Data were collected through standardized measures alongside in-depth semi-structured narrative interviews in six women's alcohol treatment sites in Canada. Findings demonstrated that service users and service providers often supported an abstinence choice and were ambivalent about the viability of controlled or managed use in both abstinence- and harm reduction–based programs. Findings showed that women service users in this study had significant rates of trauma and depression which were associated with their alcohol use; the majority still adopted dominant alcohol addiction discourse which emphasizes the need for abstinence. We offer a number of recommendations to improve the viability of harm reduction for alcohol use in women's treatment programs. [ABSTRACT FROM AUTHOR]

To explore access and treatment for alcohol use disorders (AUDs) among people of South Asian ancestry living in Canada or the United State, EQUATOR guidelines were applied to 34 manuscripts identified through an English language literature search (1946–2017) for this narrative review. The population studied has poor access to and engagement with treatment for AUD. Early evidence suggests benefit from adopting language-specific materials, offering South Asian–specific therapy groups, and incorporating traditional healers. Specific engagement and therapy considerations may increase AUD treatment access and effectiveness among South Asians living in Canada or the United States. [ABSTRACT FROM AUTHOR]

Alcohol policy in North America is dominated by moderation and abstinence-based modalities that focus on controlling population-level alcohol consumption and modifying individual consumption patterns to prevent and reduce alcohol-related harms. However, conventional alcohol policies and interventions do not adequately address harms associated with high-risk drinking among individuals experiencing severe alcohol use disorder (AUD) and structural vulnerability such as poverty and homelessness. In this commentary we address this gap in alcohol harm reduction, and highlight the lack of, and distinct need for, alcohol-specific harm reduction for people experiencing structural vulnerability and severe AUD. These individuals, doubly impacted by structural oppression and severe AUD, engage in various high-risk drinking practices that contribute to a unique set of harms that conventional abstinence-based treatments and interventions fail to adequately attend to. Managed alcohol programs (MAPs) have been established to address these multiple intersecting harms, and though gaining momentum across Canada, have had a hard time finding their place within the harm reduction movement. We illustrate how MAPs play a crucial role in the harm reduction movement in their ability to not only address high-risk drinking practices among structurally marginalized individuals, but to respond to harms associated with broader structural inequities such as poverty and homelessness. [ABSTRACT FROM AUTHOR]

Background: We sought to examine the factors associated with discontinuation of MMT among persons on methadone who use alcohol.Methods: We evaluated the impact of drug-related and other factors on discontinuation of MMT among persons enrolled in MMT and who reported any use of alcohol versus those who were enrolled in two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Extended Cox models with time-dependent variables identified factors independently associated with time to first MMT discontinuation.Results: Between December 2005 and 2015, 823 individuals on MMT who also reported using alcohol at least once were included in these analyses. During the study period, 391 (47.5%) discontinued methadone. Daily heroin injection (Adjusted Hazard Ratio [AHR] = 2.67, 95% Confidence Interval [CI]: 2.10-3.40) and homelessness (AHR = 1.42, 95% CI: 1.10-1.83) were positively associated with MMT discontinuation, whereas receiving other concurrent addiction treatment in addition to MMT (AHR = 0.07, 95% CI: 0.05-0.08), as well as >60 mg methadone dose (AHR = 0.48, 95% CI: 0.39-0.60), Hepatitis C virus seropositivity (AHR = 0.65, 95% CI: 0.47-0.90), and HIV seropositivity (AHR = 0.72, 95% CI: 0.57-0.91) were negatively associated with MMT discontinuation. Any/heavy alcohol use was not independently associated with MMT discontinuation.Conclusions: This study reinforces the known risks of continued heroin injection and homelessness for MMT discontinuation among individuals who also consume alcohol and highlights the protective effect of both MMT dose and receipt of concurrent addiction treatment. [ABSTRACT FROM AUTHOR]

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]

Introduction and Aims: Managed alcohol programs (MAP) are intended for people with severe alcohol-related problems and unstable housing. We investigated whether MAP participation was associated with changes in drinking patterns and related harms.Design and Methods: One hundred and seventy-five MAP participants from five Canadian cities (Hamilton, Ottawa, Toronto, Thunder Bay and Vancouver) and 189 same-city controls were assessed for alcohol consumption, health, safety and harm outcomes. Length of stay in a MAP was investigated as a predictor of drinking patterns, non-beverage alcohol consumption and related harms. Statistical controls were included for housing stability, age, gender, ethnic background and city of residence. Negative binomial regression and logistic regression models were used.Results: Recently admitted MAP participants (≤2 months) and controls were both high consumers of alcohol, predominantly male, of similar ethnic background, similarly represented across the five cities and equally alcohol dependent (mean Severity of Alcohol Dependence Questionnaire = 29.7 and 31.4). After controlling for ethnicity, age, sex, city and housing stability, long-term MAP residents (>2 months) drank significantly more days (+5.5) but 7.1 standard drinks fewer per drinking day than did controls over the last 30 days. Long-term MAP residents reported significantly fewer alcohol-related harms in the domains of health, safety, social, legal and withdrawal.Discussion and Conclusions: Participation in a MAP was associated with more frequent drinking at lower quantities per day. Participation was associated with reduced alcohol-related harms over the past 30 days. Future analyses will examine outcomes longitudinally through follow-up interviews, police and health care records. [ABSTRACT FROM AUTHOR]

This research contributes a first-hand account of the experiences of youth's substantial unpaid familial caregiving in the context of long-term illness, disability or problems related to alcohol and/or other drugs. A qualitative focus group methodology explored the benefits and challenges of youth's caregiving via a sample of 15 youth caregivers (or young carers) from both the Greater Toronto area and the Niagara Region of Southern Ontario. The findings reveal evidence for a unique "young carer penalty," a term coined by this research to build upon the gendered "care penalty" experienced by adult women (especially mothers) when performing care work. [ABSTRACT FROM AUTHOR]

Background: This article extends the risk environment framework to understand the factors that universities identify as influencing university students' risky drinking behaviours and universities attempts at managing risky alcohol use on their campuses.Methods: This article examines data collected as part of qualitative fieldwork on university corporate security services, and others involved in university alcohol policy implementation (e.g., residence services), conducted at five Canadian universities. Interviews (n=56), fieldnotes from 246h of observations of university corporate security personnel, and university policy documents (i.e., codes of student behaviour, residence policies) were analysed to understand the influence of risk environments on high-risk alcohol use.Results: We identify three risk environments on university campuses in relation to the use and regulation of alcohol: the physical, social, and policy environments. Residence buildings and abutting spaces (physical risk environment) and the university "party" culture (social risk environment) are principal contributors to risk within their risk environments. University policies and practices (policy risk environment) attempt to modify these environments in order to manage risky alcohol use.Conclusion: We suggest current approaches to regulating student alcohol use may not be the best approach to preventing harms (e.g., health problems, legal troubles) to students. Given university policies and practices have the potential to shape and influence risky alcohol use and associated harms we argue it is necessary for university administrators to adopt the best practices of "harm reduction" and seek new ways to address on-campus alcohol use. [ABSTRACT FROM AUTHOR]

Using ethnographic findings from two community-based substance abuse programs for indigenous peoples in the United States and Canada, this article examines how greater attention to cultural context can help to inform the treatment of alcohol problems among Native North American women. Cultural context shapes not only therapeutic activities and interactions within substance abuse programs, but also how such programs develop within different communities. These findings add to the growing evidence that gender can powerfully shape how Native American clients engage spiritual resources and respond to conventional styles of psychotherapeutic talk, supporting emergent efforts to rethink “cultural competency” in mental health services for Native North Americans. [ABSTRACT FROM PUBLISHER]

Although brief intervention (BI) is an empirically validated treatment modality for alcohol dependence, it has generally failed to gain wide acceptance in practice. Most studies have focused exclusively on individuals with alcohol problems, and little is known about the effectiveness for patients with other drug problems. The objective of this study was to examine the effectiveness of BI compared to standard therapy for drug and alcohol dependence in an outpatient treatment program. The study was conducted at the Addictions Unit of the McGill University Health Centre in Montreal. The trial compared 72 patients randomly assigned at intake to an individual 5-session brief intervention (BI) or a 6-month conventional treatment (CT) consisting of individual and group therapy. At 6 months' follow-up, the BI (N = 19) and CT (N = 20) groups were compared in terms of substance use, psychological, health, and occupational outcomes. There were approximately equivalent changes in both treatment groups compared to intake. Under the conditions of the present trial, CT did not show superiority over BI, providing additional support for the notion that BI can be an effective first step in the treatment of alcohol and drug dependence in a variety of health care settings. [ABSTRACT FROM AUTHOR]

* AIM Identify whether centralised assessment and intake programs are useful for alcohol and drug systems. * DESIGN Review of evaluation findings on centralised programs in Ontario. Canada, the USA and Victoria. Australia. * FINDINGS Models implemented in Canada and the US operated at local level and variations were a product of settings and stakeholders. Some advances were made. The assessment and referral centres (A/Rs) in Canada accounted for around one fifth of all case loads. A greater proportion of treatment naive people attended A/Rs and these agencies had a considerable network of services. However. A/Rs were not the hub of the system: many agencies developed their own intake structures and A/Rs took on treatment functions. In the US. only some locations with centralised intake units (ClUs) reported a greater uptake of referrals and high needs clients were more likely to attend. Centralisation resulted in improved assessments and increased levels of client satisfaction but not treatment matching. Some treatment agencies in Victoria developed centralised models for screening / assessment while referral destinations were generally in-house. In rural settings, there was cross-agency centralisation. * CONCLUSIONS Centralised intake requires extensive implementation planning to counter pressures that impede the potential for systems change. [ABSTRACT FROM AUTHOR]

Objective: An experimental trial was used to assess the effectiveness of a self-help book and a personalized assessment-feedback intervention, both separately and in combination with each other, in a general population survey. Method: Participants (N = 86; 66.3% male) were recruited through a random digit dialing telephone survey conducted by the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Respondents were randomly assigned to one of four conditions in a two-by-two factorial design: "no-intervention" control group, "personalized feedback only," "self-help book only" and "both personalized feedback and self-help book." Respondents were followed up in 6 months' time, and differences in drinking status were compared between experimental conditions using a multivariate analysis of covariance with baseline drinking severity as the covariate. Results: Support was provided for an interaction hypothesis in which respondents who received both interventions reported significantly improved drinking outcomes at 6-month follow-up, compared with respondents who received just one of the interventions or who received no intervention. Conclusions: Because respondents were recruited from a representative sample of the general population into a randomized trial with a nointervention control group, this research design maximized both external and internal validity in examining the effectiveness of self-help interventions. [ABSTRACT FROM AUTHOR]

Objectives: To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism.Methods: A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons.Results: Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication.Conclusions: Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed. [ABSTRACT FROM AUTHOR]

AbstractProblem drinking is a serious health issue, but often patients whose alcohol consumption places them at risk are not diagnosed by physicians. Case finding is an essential component of "best practice." In many cases if given the appropriate advice, counselling and behavioural interventions, problem drinkers can be helped to reduce their use of alcohol and improve functioning in other areas of their lives. Some patients may benefit from more comprehensive therapy including the prescription of disulfiram, calcium carbimide or naltrexone. For those with serious problems with alcohol, referral to specialized addiction treatment programs and other community resource centres may also be appropriate. [ABSTRACT FROM AUTHOR]

Provides insight into the Addiction Research Foundation's (ARF) Task Force on Treatment Services for Alcoholics' influence on the development of Ontario's system of assessment/referral (A/R) centers. Ontario's addiction treatment services in 1978; Task force recommendations; Assessment-referral services as public policy advice; Stakeholder perspectives; Policy gains.

Presents a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices in Canada. Factors affecting acceptance of nonabstinence goals; Differences between outpatient programs and residential treatment services.

Details of admissions to Southern Ontario Detoxication Centres were obtained for a sample of 50 skid-row alcoholics admitted to a rural residential rehabilitation programme (Bon Accord Farm). In the year prior to admission to Bon Accord the men averaged 3.7 detox admissions, while in the year after leaving this average increased to 7.2 admissions. Rates of detox admission after leaving and changes in these rates from the previous year were unrelated to length of stay. It is suggested that Bon Accord should be seen as one of a range of social agencies that made up the social world of public inebriates and that such agencies should be principally valued for their humanitarian and care giving functions. An improved co-ordination of skid-row agencies is suggested as is a more careful assessment of candidates for rehabilitation programmes. [ABSTRACT FROM AUTHOR]

Discusses how length of treatment for alcoholism relates to improvement in Ontario. Techniques employed to treat alcoholics; Use of minimal, moderate and long-term treatment; Indicators used; Alcoholic involvement scale; Physical health; Social stability.

As in most parts of the developed world, Canada has experienced a considerable expansion in specialized services for the treatment of alcohol and drug abuse since the 1960s. This paper contrasts the addiction treatment system within two of Canada's largest provinces — Ontario and Quebec. Within the limitations of descriptive survey data, some of the similarities and differences between these treatment networks during the mid-1980s are discussed. For example, the Quebec system was characterized by more private fee-for-service programs and larger facilities that provided a range of services along the continuum of care. In Ontario, there were more separate programs, but they tended to be smaller and more specialized within the treatment continuum. Quebec had a higher rate of participation in outpatient, day treatment and short-term residential programs. [ABSTRACT FROM AUTHOR]

Comments on a study about the relationship of alcohol treatment to more broadly based prevention efforts as well as to population levels of health problems. Significance of the study; Reconsideration about the theory which stated alcohol treatment and prevention effects are mutually exclusive.

Reports the opening of a detoxification center in Vancouver, British Columbia to help drug and alcohol addicts who already have a stable living situation and support network. Details of the center's goal to achieve relapse prevention through a long-term program; Description of the clients; Cost of the Daytox program, which is run by the Vancouver Coastal Health Authority.