Non-beverage alcohol consumption among individuals experiencing chronic homelessness in Edmonton, Canada: a cross-sectional study

Abstract

Background Among individuals experiencing homelessness, the prevalence of alcohol use disorder is extremely high. Alcohol-related harms are compounded by the use of non-beverage alcohol (NBA; e.g. rubbing alcohol, cooking wine). The dangers of NBA consumption pose significant risks to the individual and to others when consumed in large quantities and when mixed with other substances. The objectives of this paper are to describe the alcohol consumption patterns of individuals experiencing homelessness, identify substance use patterns, psychological stressors, and related harms associated with NBA consumption, and compare NBA consumers to non-NBA consumers in relation to their use of services and perceived barriers to care. Methods Using a cross-sectional survey, 150 individuals experiencing homelessness were recruited from Edmonton’s inner city and adjoining areas. Frequency, quantity, and volume of alcohol consumption were used to assess patterns of alcohol use in the last 6 months. Descriptive statistics and bivariate analyses were used to compare participants reporting NBA consumption and non-NBA consumption (p ≤ 0.05). Results The majority of participants were male (71.3%) and self-identified as Indigenous (74.0%). Overall, 24% (n = 36) reported NBA consumption within the last six months. NBA consumers were older than non-NBA consumers (p = 0.005), reported different perceived living stability (p = 0.022), and had higher psychological distress (p = 0.038). The majority of NBA consumers reported not receiving harm reduction services while also not needing such services (n = 18, 51.4%), which differed from non-NBA consumers (p = 0.003). Structural barriers (e.g. availability, location, cost) were most frequently reported as reasons for unmet harm reduction (60.9%) and hospital care (58.3%) needs, while barriers to skills training (58.5%) and counselling services (53.6%) were mostly motivational (e.g. personal beliefs). Conclusions Within such an already marginalized population experiencing homelessness, individuals who consume NBA represent a vulnerable subpopulation who require adapted and distinct health and social services to stabilize and recover. Current harm reduction services are not prepared to effectively assist this group of individuals, and specific treatment programs are rare. Managed alcohol programs are a feasible approach but must be tailored to the specific needs of those who consume NBA, which is especially important for Indigenous people. More comprehensive assessments of NBA consumption are needed for program development and policy recommendations.

Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal

“…The frequent use of non-beverage alcohol—a substance both affordable and accessible—by people who experience homelessness has been extensively reported in the literature (e.g., [ 19 , 21 , 76 ]). In Canada, its consumption is widespread among these populations and its harmful effects, a matter of concern [ 7 , 27 ].…”

Scoping review of managed alcohol programs

“…Our review found several potential health- and harm reduction-related benefits of MAPs, including improved quality of life, reduced alcohol consumption particularly with decreased NBA use (particularly for programs with Stringent outside drinking policies compared to Lax), less hazardous consumption patterns, and potential stabilizations in biological markers of alcohol use during MAP participation. Decreased consumption of both beverage alcohol and NBA has several downstream benefits, including fewer traumas, assaults, seizures, hazards from NBA including ethanol, higher alcohol content, and additive ingredients [ 77 ], and effects of acute intoxication. Potential harms of continued alcohol consumption that are not yet represented in the MAP literature include the progression of liver disease and cirrhosis, cancer, hypertension, or cardiac disease [ 1 , 7 , 78 – 81 ].…”

Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal

“…Moreover, this research has identi ed the incidences of heavy alcohol use and binge drinking patterns, particularly among runaway and street youth (May eld Arnold et al, 2012; Nyamathi et al, 2012;Smart et al, 1994). These studies have also reported the prevalence of non-beverage alcohol drinking among people experiencing homelessness when they cannot afford regular alcohol (Erickson et al, 2018;Ezard et al, 2018;Podymow et al, 2006;Stockwell et al, 2018;Westenberg et al, 2021). However, to our knowledge few studies (Stockwell et al, 2013) have examined how the social contexts in which these persons drink constitute a signi cant source of harm and shape their drinking patterns.…”

“…Due to its affordability and accessibility the frequent use of non-beverage alcohol among people who experience homelessness has been extensively reported in the literature (e.g., Egbert et al, 1985;Erickson et al, 2018;Westenberg et al, 2021). However, most participants indicated that they did not drink this type of alcohol.…”

“…(Pennings et al, 2002). Due to its high concentration of alcohol, drinking non-beverage alcohol poses serious risks of injury, disease and even death (Westenberg et al, 2021). Although using benzodiazepines to avoid or reduce alcohol withdrawn symptoms is considered a safe evidence-based detoxication strategy (Sachdeva et al, 2015), abrupt cessation of benzodiazepines could have side effects including sleep disturbance, increased anxiety, panic attacks, headache, muscular pain and stiffness, seizures, etc.…”