In a cramped, smoky room at the Shepherds of Good Hope hostel in Ottawa, a staff member pours U-brew wine into coffee mugs. Ten street alcoholics, 2 in wheelchairs and 1 with a walker, wait patiently for their share. From 7:30 am until 10 pm the coffee mugs will be refilled hourly.
Normally, alcoholics aren't allowed to drink in shelters like this because they tend to become disruptive, and this means hard-core alcoholics don't have access to the services they badly need. “The system wasn't serving these people well and so we decided to [try a new one],” says Dr. Jeffrey Turnbull, medical director at the Shepherds of Good Hope. The result is an innovative harm-reduction program, Hope Recovery Stage 2.
Turnbull, vice-dean of education at the University of Ottawa, says the theory is that serving safe drinks in a safe environment helps moderate the addiction and lessens the harm alcoholics face daily on the streets. The novel approach is similar to the harm-reduction method used at methadone clinics.
“You have to figure out unconventional ways to help treat them,” says Dr. Tiina Podymow, a nephrologist who volunteers at the hostel. She says the participants are the “worst of the worst alcoholics,” having declined to the point where they drink mouthwash or similar products. “Within the first month, we see a difference with this program. They get cleaned up. They have better hygiene. They talk to a doctor. They get into the idea of regular care.”
The approach has caught the attention of the World Health Organization and UNESCO. It is one of 12 international projects selected as a best-practice model by Project Unisol, a WHO and UNESCO initiative to advance the role of universities in promoting the health of disadvantaged people.
Turnbull modelled the Shepherds of Good Hope program after a pioneering project at Seaton House, a Toronto men's hostel. The Toronto project was launched in 1996 after a coroner's inquest into the freezing deaths of 3 alcoholic street people. Since then, it has served more than 140 clients.
Organizers in both Toronto and Ottawa believe their programs save money by reducing the burden placed on emergency services and health care in general.
Seaton House medical director Tomislav Svoboda is writing his PhD thesis on the cost-effectiveness of the harm-reduction program there. “These people are high users of the system but they're getting inappropriate use of these services,” he says.
Mary Cleary, director of the Ottawa program, agrees. “Some clients used to have daily seizures and an ambulance would be dispatched. But they never got any services. All they got was crisis intervention.”
In Ottawa, only 10 participants can be served because of limited funding and space. The year-old program received seed money from the city. The federal government recently contributed $140 000, just $9000 short of the total budget needed to extend the program for 2 more years. The remaining shortfall will be covered by donations.
“The goal is to make it a sustainable model and to expand it to meet the needs of the rest of [this population],” says Turnbull.
Figure. Dr. Tiina Podymow and client: we see a difference in a month Photo by: Janis Hass
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