Free booze for alcoholics: Could managed alcohol programs work in N.W.T.?
Participants in Ottawa program are given wine every hour to manage their addictions
For the majority of his life in Pond Inlet, Nunavut, Elisa Pewatoalook's daily priority was getting his hands on mouthwash, hairspray and, if he was lucky, vodka.
But every day for the last four years, Pewatoalook has known where and when he could feed his addiction.
"They serve you alcohol every hour on the half-hour," he says.
Pewatoalook is part of a managed alcohol program, also known as MAP, in Ottawa. The program is run by the non-profit Shepherds of Good Hope but is funded mostly by the City of Ottawa.
While the practice may seem counterintuitive to some, health officials in Yellowknife say giving booze to alcoholics could be a solution for some of the social issues that riddle the capital's downtown.
Skeptics, however, say managed alcohol programs show the system is giving up on people with drinking problems, essentially sedating them enough to keep them out of the way.
Officials with the N.W.T.'s Department of Health and Social Services say opening a MAP in Yellowknife isn't currently on the table, but they're open to it.
'Very compassionate' approach
Pewatoalook says what's keeping him in the program and off the street is that, when he wakes up in the morning, his first thought is no longer about where he's going to get his next fix.
Knowing that he will get a drink every hour allows him to focus on other areas of his life, like getting a job or improving his relationship with his daughter.
"I need it to be stable. It helps me a lot to be stable. Knowing that I'm going to be having drinks inside keeps me away from drinking alcohol outside."
Pewatoalook is now one of the program's success stories, having moved from an emergency shelter to permanent housing.
"I don't need to go out there and look for it. I don't have to steal anything for it."
When it comes to dealing with the consequences of alcohol addiction, Dr. David Pontin is on the front lines. The emergency room doctor moved to Yellowknife in 2006 after working in Victoria and Vancouver's Downtown Eastside.
Pontin says when the alcoholism is essentially "under control," physicians can begin to look at the patient's other health issues.
"For some reason we always insist that addiction has to be the first thing, and sometimes the only thing, that we manage before we can get to the mental health issues, before we can get to the physical issues," Pontin says.
"Managed alcohol programs, what I think their strength is, is that they say, 'Hey listen, we see where you are with your alcohol use, we understand this is a dangerous addiction, but we'll put that aside for now. We'll help you with that part of your addiction when the time comes, but let's get you housed, let's deal with your psychiatric issues, your depression, your anxiety.'
"I think that is a very sane and very compassionate approach to alcohol problems."
The cost of alcoholism
Health issues caused by alcohol addictions are filling up the emergency room at Yellowknife's Stanton Territorial Hospital.
"I would say we're somewhere in the range of about half of all admissions to Stanton have alcohol as a factor," Pontin says.
"Alcohol is without a doubt our biggest drug problem."
Pontin says Stanton's emergency room has "super users," who rely on the services more than the rest of the population, often for alcohol-related issues.
"It's not a lot of people, maybe 20 or 30, but those 20 or 30 people are driving enormous health-care costs."
Economically, research shows managed alcohol programs have dramatically cut down on emergency services and health-care spending in the areas they operate.
A University of Victoria study recently looked at a managed alcohol program in Thunder Bay, Ont., called Kwae Kii Win.
The study, published in May, found that participants were admitted to the emergency room 47 per cent fewer times than when they weren't in the program. Their interactions with police were also down 41 per cent.
At Shepherds of Good Hope, the program in Ottawa, program manager Ray McQuatt says he's seen the savings first hand.
"The City of Ottawa really buys into the program because we save so much money in emergency services costs," McQuatt says.
"These same individuals aren't utilizing the hospital, the jail cells, the ambulances, there's less frequent police interaction. That saves the city a lot of money."
Abstinence approach
For a managed alcohol program to open in Yellowknife, the territory or the municipality would need to fund it. An organization like the Yellowknife Salvation Army or the NWT Disabilities Council — which runs the Yellowknife day shelter — would need to take the program on.
But not everyone agrees that giving alcoholics alcohol is the best approach.
The Salvation Army has been offering shelter to homeless men from across the territory for decades. It has myriad programs for people living on the street and those battling addictions.
When it comes to addictions, globally, the Salvation Army takes a sobriety-based approach.
"We've had success for over a century doing addictions programs all over the world and doing an abstinence-based program, where the model of the program is to work towards not utilizing whatever the addiction is," says Lt. Dusty Sauder, executive director of the Salvation Army in Yellowknife.
Sauder says he has seen many men work their way up through the Salvation Army's programs and go on to live fulfilling, sober lives.
Philosophically, he doesn't disagree with the managed alcohol approach.
"I do know that in communities a wide spectrum of services to address those issues is required and maybe one of those may be a managed alcohol program if that's what the need is," he says.
"But we will focus on what we do and what we've done for many, many years and what we've seen as successful from our practices."
Many communities across the North have also adopted the abstinence approach: there are 15 dry communities across the three territories, and many others have alcohol restrictions.
'A matter of common sense'
But Pontin says there's evidence to support that harm reduction works.
"It doesn't even come close to being controversial. There's a lot of things in medicine that are controversial — physician-assisted death, whether or not we should be prescribing marijuana," he says.
"Many of us are dealing with the day-to-day devastation of alcohol and what it's done to this community. For us, it's a matter of common sense."
Pontin adds that if a managed alcohol program were introduced in the N.W.T.'s capital city, it could become a victim of its own success.
"It might attract people to come to town, to come and drink if they know that they can come and stay here and get free alcohol," he says.
"If that were the case, then I think we would just be discovering that we were meeting an unmet need that's already there."
A need, Pewatoalook says, has existed in the North for decades.
"It would definitely work up there. It would help especially with those who are homeless and don't have much else to do but drink.
"I'm still trying to get my feet on the ground and I don't know what my future will be. Right now, I'm just focused on myself and being in the program."
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