In an unconventional approach to addressing the issue of homelessness and alcohol addiction, San Francisco has initiated a pilot program that provides free alcohol to homeless individuals struggling with alcoholism.
The initiative, known as the "Managed Alcohol Program" (MAP), is funded by taxpayers and is operated by the city's Department of Public Health. The program's primary objective is to reduce the number of homeless individuals on the streets and alleviate the burden on the city's emergency services.
The MAP, which has been implemented in countries such as Canada and Australia, is typically administered by a nurse and trained support staff in a facility such as a homeless shelter or a transitional or permanent home. The California Health Care Foundation, in a 2020 article, described the program as a method to minimize harm for those with alcohol use disorder. The foundation stated, "By prescribing limited quantities of alcohol, the model aims to prevent potentially life-threatening effects of alcohol withdrawal, such as seizures and injuries."
The San Francisco MAP was established during the COVID-19 pandemic to prevent vulnerable homeless individuals, who were placed in isolation in hotel rooms, from suffering from alcohol withdrawal. The program, which initially started with 10 beds, has since been expanded into a 20-bed program operating out of a former hotel in Tenderloin. The program operates on a $5 million annual budget, as reported by the San Francisco Chronicle.
Alice Moughamian, the Nurse Manager of the Managed Alcohol Program and the San Francisco Sobering Center, explained in an October presentation that the program provides clients with a motel room, three meals a day, and enough alcohol "to meet their addiction needs, but keeping someone at a safe level of intoxication."
The program's initial success in stabilizing alcoholic patients prompted health officials to expand the pilot into a long-term program. Ten beds are earmarked for "the Latinx and indigenous population," while 12 additional beds are supported at the city's traditional sobering center, Moughamian said.
Bryce Bridge, a social worker involved with the program, said during the presentation that once a client is identified as having alcohol abuse problems and admitted, they are assessed to determine individual needs. Clients are connected to a primary care doctor, provided resources to secure government identification if they lack a social security card or other documents, and assisted with psychiatric care, wellness activities on site, and other evidence-based treatments.
Bridge also mentioned that marijuana use is "fairly common in our sites" and said there is no policy prohibiting marijuana consumption, though health providers monitor that activity to prevent ill health effects or interpersonal conflicts.
However, the program has recently come under scrutiny after Adam Nathan, CEO of an AI company and chair of the Salvation Army San Francisco, criticized the program in several social media posts. Nathan wrote, "Inside the lobby, they had kegs set up to taps where they were basically giving out free beer to the homeless who've been identified with AUD (Alcohol Use Disorder)." He further claimed, "It's set up so people in the program just walk in and grab a beer, and then another one. All day."
Nathan questioned the effectiveness of the program, asking, "Where's the recovery in all this?" He suggested that providing free drugs to drug addicts doesn't solve their problems but merely prolongs them.
In response to Nathan's claims, public health officials stated that alcohol is dispensed by a nurse and homeless people who aren't participating can't just walk into the facility and get a free beer. The program operates in a former Tenderloin tourist hotel that has a bar, but on-site taps are "inoperable and unused," the statement reportedly said.
Despite the defense from public health officials, the program has also received criticism from San Francisco Mayor London Breed, who said in February that harm reduction was "not reducing harm" but "making things far worse."
Tom Wolf, who is in recovery for heroin addiction, questioned the use of taxpayer dollars for the program. He said, "Are we just going to manage peoples addictions with our taxpayer dollars in perpetuity forever? It seems like thats basically what were saying." Wolf suggested that the money should be spent on detox and recovery.
However, Moughamian clarified that the goal of MAP is not to decrease the amount of alcohol consumed or to taper someone towards abstinence. She said, "The goal is to mitigate the many health, legal and interpersonal harms associated with unsafe alcohol use."
San Francisco health officials claim that the program has saved $1.7 million over six months in reduced hospital visits and police calls made by participants who previously heavily relied on emergency services. Officials reported that after clients entered the program, visits to the city's sobering center dropped 92%, emergency room visits declined more than 70%, and EMS calls and hospital visits were both cut in half.
The San Francisco Fire Department has spoken positively about the program, stating that the managed alcohol program "has proven to be an incredibly impactful intervention" at reducing emergency service use for a "small but highly vulnerable population."
Managed alcohol programs have been adopted more rapidly in other countries, including Canada, Portugal, and the U.K. Canada has more than 40 such programs, according to the University of Victoria's Canadian Institute for Substance Use Research. A 2022 study of Canada's managed alcohol programs found that homeless people suffering from severe alcoholism had a reduced risk of death and fewer hospital stays after participating.
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