How do you lower the toll of alcohol abuse on homeless people with an addiction?
Serve them drinks.
A proposed radical change to the way Sydney shelters treat homeless people with alcohol dependency has some influential and unlikely advocates.
St Vincent’s Hospital, Rabbi Mendel Kastel – a NSW police chaplain and the founder of Bondi’s Jewish House crisis and homelessness service – and other partners are in talks to develop Sydney’s first “managed alcohol” homeless shelter.
“It would herald a major shift in our approach,” said Dr Nadine Ezard, the director of drug and alcohol services at the hospital.
The proposal would have drinks offered to shelter residents on-the-hour. In Canada, these have been glasses of wine offered at low prices and capped at a maximum of 15 per day.
Backers of the idea cite small, emerging studies from North America suggesting the shelters reduce the toll of drinking on individuals and the government for two reasons.
The first reason is there’s less incentive to binge drink on deadline, shortly before hostels stop taking clients for the night.
The second is more abstract: people drink less when freed from the stress of having to search for a bed every night and when they feel part of a community.
“An often misunderstood component of public health is that dignity is priceless and more powerful than any drug,” says Dr Kieran Le Plastrier, Jewish House’s clinical director.
One American study that followed 95 residents in housing that did not ban alcohol consumption over two years found the average amount the residents drank during binge sessions dropped by 10 standard drinks. They also showed significantly fewer symptoms of alcoholism.
Advocates say the approach benefits the public purse, too.
Only chronically homeless people with long-established alcohol dependency would be admitted to the program – a segment of society that tends to make heavy use of government services.
A feasibility study by Dr Ezard late last year conservatively estimated it would reduce each individual resident’s use of hospital and emergency services alone by $30,000 a year, or up to $500,000 per shelter.
While other forms of addiction have long been managed through initiatives such as methadone programs, this would represent a major break with orthodoxy in the management of alcoholism amongst homeless people.