Exploring the Potential of Implementing Managed Alcohol Programmes to Reduce Risk of COVID-19 Infection and Transmission, and Wider Harms, for People Experiencing Alcohol Dependency and Homelessness in Scotland

Abstract

People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of ‘MAPs as a response to COVID-19′: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.

The Potential for Managed Alcohol Programmes in Scotland during the COVID-19 Pandemic: A Qualitative Exploration of Key Areas for Implementation Using the Consolidated Framework for Implementation Research

“…The situation for those experiencing alcohol dependence and homelessness was worsened by the COVID-19 pandemic in that, in the UK, the availability of alcohol, access to alcohol treatment and other services, and housing, all changed, particularly at the start of the pandemic in March 2020 [ 8 , 9 ]. Alcohol consumption increased among some of the general population and among many experiencing alcohol dependence [ 10 , 11 ].…”

“…Alcohol consumption increased among some of the general population and among many experiencing alcohol dependence [ 10 , 11 ]. Access to alcohol for those experiencing homelessness was impacted by factors such as shop closures, the use of credit/debit cards over cash, and loss of income from street begging, alongside related challenges regarding rules around wearing of masks, hand washing, social distancing, and self-isolation [ 9 ]. Alcohol treatment and associated physical and mental health services were impacted, with some services closing completely, others reducing dramatically, and many moving online [ 8 ].…”

“…Alcohol treatment and associated physical and mental health services were impacted, with some services closing completely, others reducing dramatically, and many moving online [ 8 ]. Provision of housing also altered, with the rapid rehousing of people into hotels and increased shelter provision [ 9 , 12 , 13 ]. There were additional concerns for people experiencing homelessness due to the potential increased risk of contracting COVID-19 and becoming severely ill [ 14 , 15 ].…”

“…Alcohol harm reduction is an appropriate alternative to detoxification and treatment, providing support and safer drinking options without the expectation or requirement of abstinence [ 7 , 9 ]. Managed alcohol programmes (MAPs) are an example of an alcohol-specific harm reduction intervention and have been specifically established for those experiencing homelessness and alcohol dependence.…”

Understanding and Tackling the Complex Challenges of Homelessness and Health

“…Two papers report concurrent challenges due to COVID-19. Parkes [ 3 ] provides insight into the impact of COVID-19 and considers a harm reduction alcohol management programme; Nunes [ 4 ] highlights the impact of Third Sector organisations in supporting socially and emotionally.…”