Sunday Meeting Report – September 21, 2014 (30 attendees)

by Barrie Webster

Last Sunday’s speaker was Dr. Tim Stockwell, Director, Center for Addictions Research BC at the University of Victoria. Dr. Stockwell studied psychology and philosophy at Oxford University and completed his PhD at the Institute of Psychiatry, University of London. He then moved to Australia where he spent 16 years directing Australia’s National Drug Research Institute.

Tim is committed to the advancement of evidence-based public policy on substance-use. In 2004, he established the Centre for Addictions Research for BC (CARBC) aiming to shed light on the social, cultural, and psychological determinants of harmful substance use. The Centre applies rigorous measures of patterns of use and related harms, and pursues knowledge of effective policy and practice. Unfortunately, there is a sharp contrast between evidence and the current practices involved in dealing with addiction.

Dr. Stockwell is recognized as one of the top leaders in the substance-use field. His interests in alcohol policy matters include prevention strategies, treatment methods, liquor licencing issues, taxation, the measurement of drinking patterns and their consequences, and regulatory policies to reduce alcohol- related harm. On top of his many accomplishments, Tim has developed an enviable record of effective liaison with senior policy-makers, national and international parliamentary processes, and the media.

Alcohol addiction is associated with both physical and mental difficulties. It is only one of the addictive substances that need attention, and it was often combined with the problem of homelessness. Further, alcohol and other drug use are the leading causes of death among young adults.

There are two approaches to dealing with alcohol addiction, one requiring complete cessation of alcohol use altogether, and the other promoting harm reduction. While Dr. Stockwell has found harm reduction to be somewhat more effective through his work, he is not ready to discount the value of abstinence. “Harm reduction refers to policies, programs, and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unwilling or unable to stop.” The focus is on prevention of harm rather than on prevention of drug use itself; however, harm reduction complements work that seeks to prevent or reduce overall levels of drug use. Harm reduction takes the form of safer drugs, safer use, and safer settings. But both the harm reduction and the abstinence philosophies may place clients at increased risk if they are pursued in isolation.

There are three responses to alcohol dependence combined with homelessness. In abstinence-based shelters/housing, no drinking is allowed. In tolerant shelters/housing, drinking is allowed, but is not managed. In a managed alcohol program (MAP), the safe shelters/housing actively control alcohol use and seek to reduce harm by delivering measured quantities of ‘clean’ alcoholic beverage on a regular basis. And the dosage can gradually be decreased as the addicted person chooses. Managed alcoholprograms, only one part of harm reduction, are available in only a few locations across Canada. Evidence gathered suggests that MAPs can improve health, improve quality of life, reduce the need for police involvement and emergency hospital admissions, and reduce the harms of drinking itself. Further, participants are much safer in the program than on the street and they have often been enabled to reconnect with family. To sum up, Dr. Stockwell’s thesis is that “we need to work harder to ensure that there is more harm reduction integrated into abstinence programs – and more abstinence integrated into harm reduction programs for problem drinkers.