CMAJ • August 29, 2006; 175 (5). doi:10.1503/cmaj.1060112.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Dealing with alcoholism

Stephen Hwang

Centre for Research on Inner City Health, St. Michael's Hospital, University of Toronto, Toronto, Ont.

[Dr. Hwang responds:]

The main finding of the study by Tiina Podymow and colleagues1 was that the homeless participants in their harm reduction program had significantly fewer numbers of emergency department visits and police encounters after entry into the program, as determined by a review of hospital and police records. Data on these service utilization outcomes were no doubt more reliable than the self-reported data on alcohol consumption.

Few would argue that one of our duties as physicians is to encourage patients with alcoholism to strive to abstain from alcohol. Many of these individuals may find it helpful to participate in programs such as Alcoholics Anonymous. But what do we recommend to someone who drinks 8 bottles of wine a day, sleeps on the street and expresses an unwillingness to contemplate abstinence? Harm reduction programs such as the one described provide a means of engaging these people in a way that may ultimately lead to positive change in their lives. Podymow and colleagues suggest that this approach may reduce certain societal costs related to high service utilization, but the question of whether it reduces harm at the individual level remains unanswered.

REFERENCE

  1. Podymow T, Turnbull J, Coyle D, et al. Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol. CMAJ 2006;174(1):45-9.[Abstract/Free Full Text]




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