A Hospital-based Managed Alcohol Program in a Canadian Setting. Issue 2 (22nd March 2023)

• Record Type: Journal Article
• Authors: Nolan, Seonaid; Fairgrieve, Christopher; Dong, Huiru; Garrod, Emma; van Heukelom, Holly; Parappilly, Beena P.; McLean, Mark; Tsui, Judith I.; Samet, Jeffrey H.
• Is Part Of: Journal of addiction medicine. Volume 17:Issue 2(2023)
• Page Start: 190
• Page End: 196
• Publication Date: 2023-03-22
• Subjects: alcohol use disorder -- managed alcohol program -- alcohol addiction -- substance use disorder -- harm reduction -- hospital; Substance abuse -- Periodicals; Substance abuse -- Treatment -- Periodicals; Substance-Related Disorders -- Periodicals; 616.86005
• DOI: 10.1097/ADM.0000000000001080
• Languages: English
• ISSNs: 1932-0620

Abstract

Abstract : Objectives: A managed alcohol program (MAP) is a harm reduction strategy that provides regularly, witnessed alcohol to individuals with a severe alcohol use disorder. Although community MAPs have positive outcomes, applicability to hospital settings is unknown. This study describes a hospital-based MAP, characterizes its participants, and evaluates outcomes. Methods: A retrospective chart review of MAP participants was conducted at an academic hospital in Vancouver, Canada, between July 2016 and October 2017. Data included demographics, alcohol/substance use, alcohol withdrawal risk, and MAP indication. Outcomes after MAP initiation included the change in mean daily alcohol consumption and liver enzymes. Results: Seventeen patients participated in 26 hospital admissions: 76% male, mean age of 54 years, daily consumption prehospitalization of a mean 14 alcohol standard drinks, 59% reported previous nonbeverage alcohol consumption, and 41% participated in a community MAP. Most participants were high risk for severe, complicated alcohol withdrawal and presented in moderate withdrawal. Continuation of community MAP was the most common indication for hospital-based MAP initiation (38%), followed by a history of leaving hospital against medical advice (35%) and hospital illicit alcohol use (15%). Hospital-based MAP resulted in a mean of 5 fewer alcohol standard drinks daily compared with preadmission ( P = 0.002; 95% confidence interval, 2–8) and improvement in liver enzymes, with few adverse events. Conclusions: Participation in a hospital-based MAP may be an effective safe approach to reduce harms for some individuals with severe alcohol use disorder. Further study is needed to understand who benefits most from hospital-MAP and potential benefits/harms following hospital discharge.