Treating alcoholism with alcohol isn’t exactly the backbone of most treatment programs but, according to a recent BBC News feature, that’s precisely the strategy one Canadian treatment center is taking. The Oaks—a 45-bed residence dedicated to clients with “physical health issues, mental health issues, alcoholism or some combination of the three”—offers a controversial program that defies traditional thinking when it comes to sobriety. Philosophically, it’s a lot like fighting fire with fire—the same method used by farmers in setting small, controllable grass fires ahead of larger fires so that there’s nothing left to burn. The same logic applies to treatment at The Oaks. By providing residents controlled, timed regiments of alcohol, the facility’s directors believe they’re actually doing good by keeping much larger problems, costs and complications at bay. It’s an approach that is as unique as it is divisive.
Fighting Fire With Fire
Like any proper alcoholic, in my first days of sobriety, the notion of having alcohol while in treatment would have thrilled me. Hell, it would have even made some sort of dark, slippery sense. After all, who should (or could) stop drinking right away? Shouldn’t there be some sort of gradual tapering-down? That thinking was just the incorrigible, careless, irresponsible alcoholic in me talking. It’s the same voice that told me I needed a case of beer at five in the morning to get me through a long, unemployed day. Like my sponsor is fond of saying: some part of my brain is always trying to kill me.
The Oaks has adopted what it calls a “Managed Alcohol Program” (MAP)—a so-called “harm reduction strategy” that provides lifelong alcoholics with “controlled access to alcohol usually alongside accommodation, meals, and other supports.” The MAP doesn’t seek to curb drinking so much as reduce the number of police calls, ER visits and incidents of public intoxication. In fact, the BBC article observes that “it is not unrealistic to assume that the city of Ottawa has saved millions of dollars” because of the program’s unorthodox approach.
Treatment at The Oaks involves a scheduled series of pours (the wine served is “13% alcohol, made on the premises”), which begins at 7:30 am. Residents line up to a counter where wine is served every hour. The first pour is 7 ounces, which is “a larger-than-average sized glass of wine in Europe.” Over the course of the day, patients consume pours of 5 ounces up until 9:30 pm. For some, it’s a huge change of pace. As one patient commented in the BBC article: “I used to drink all day and now I just drink once every hour.” And while the wine might not be Napa Valley quality, it’s most certainly better than guzzling mouthwash or hairspray.
An Idea So Crazy, It Works (For Some)?
The MAP draws as much attention as it does ire. Started in 2001, the MAP began as reaction to what medical professionals saw as a much-needed solution among Ottawa’s homeless community. “The thought was that if we could stabilize the craziness of [alcoholics’] lives, the day that begins with the search for alcohol and all the complications that occur with that, then maybe we could make inroads with their mental health, addiction to alcohol and their physical illnesses,” Dr. Jeff Turnbull, one of the MAP’s founders, said in the BBC piece. Similar programs have since emerged elsewhere across the world, including Amsterdam, where a government non-profit “offers beer in exchange for cleaning up litter in a city park that is a frequent gathering spot for alcoholics.” The project, known as The Rainbow Group, pays alcoholics for their work and gives them a meal. Proponents of the program praise the routine and structure that it gives alcoholics and a sorely lacking sense of purpose.
More than anything, MAPs are credited largely for their role as a last resort among alcoholics who have tried treatment several times—but failed to succeed. “In many cases, abstinence treatment has really not been effective for this group of people,” one British Columbia addiction specialist said. “It’s really an option to assist people to live a better quality of life and to reduce those harms that go with drinking.” While some studies suggest that alcoholics can enjoy a safer living environment through MAPs, it doesn’t mean alcoholics are automatically enjoying a better life. In reality, most research results on MAPs are maddeningly inconclusive. And while The Oaks claims that its program “restores dignity and creates a sense of community,” not everyone agrees.
Into The Bottle
Critics of harm reduction strategies like Ottawa’s MAP are perhaps primed to hate the approach. “The addiction community is very divided about harm reduction,” Dr. Turnbull says. “There are some proponents who feel so strongly about abstinence as the only treatment for alcoholism, they just couldn’t see an alternative.” But other experts support this tapering method, arguing that MAPs can help break the one-size-fits-all approach of most treatment programs. “I think one of the things that we sometimes err on when we think about addiction is that we think about addiction as you either have it or you don’t,” a Toronto medical director observed of MAPs like the one offered at The Oaks. More often than not, there is no middle ground when it comes to sobriety. And many people increasingly believe complete abstinence for everyone isn’t realistic.
When it comes down to it, MAPs result in a glass-half-full/glass half-empty view for alcoholics in the program: they aren’t sober but they’re not beyond hope, either. And while MAPs may not provide clean, clear-cut solutions that satisfy the proponents of traditional treatment programs, evidence suggests that they do, in fact, offer some solid first steps to recovery that the most vulnerable population of alcoholics are desperate for. It may be difficult to imagine but, maybe for some alcoholics, alcohol just might be the answer that ultimately saves them from the ravages of alcoholism.