Program gives booze to homeless alcoholics

The headline on CNN.com blares “Study: Free booze benefits homeless alcoholics.” Well, that sounds intriguing, but before you go out and actually take beer to the homeless guy with the cardboard sign scrawled with “Who am I kidding? I need a drink!” you’d better take a closer look at this study. Poking holes in the media’s latest groundbreaking scientific discovery is a fun sport. Join me, won’t you?

A well-meaning bunch in Toronto tried out a harm-reduction approach for a small group of chronically homeless alcoholics. The reported results were encouraging. While they were in the program, participants had fewer emergency room visits and run-ins with the police and 10 of the participants reported they drank less during the program despite the fact that the shelter provided participants with up to 15 glasses of wine or sherry a day, an amount one author laughingly described as “a small amount.”

To read the Reuters story carried by CNN.com, you’d conclude that the key to helping homeless alcoholics is giving them free wine all day long. But, the positive health outcomes and reduction in police encounters may have nothing to do with free wine. It may have everything to do with the fact that the program offered free room and board, aid with activities of daily living (maid service?), and help getting enrolled into benefits programs. An aide took them to medical appointments and dispensed medications, and medical care was provided on site by nurses and two doctors. I don’t think it was the booze that helped them out. And all of that medical supervision only reduced trips to the emergency room by half.

Offering free room and board isn’t enough to attract this population, the authors would counter. Free booze draws them into an environment where preventative medical care can be provided. But without a control group, the impact of the open bar is just speculation. Perhaps the key component wasn’t actually providing the liquor—it was the fact that, unlike most shelter programs, participants don’t have to go cold turkey to participate.

But what about the reduction in alcohol use? Bogus. First problem: only 10 of the 17 participants are included in that analysis--three refused to answer the questions and three died (!)--and you have to wonder if these participants were fudging their reported drinking to these fine folks who were trying to help them. Finally, in a tiny footnote in the published study, we find out that anything they drank off the premises was not included in the comparison. Do you think maybe some of them may have snuck out back from time to time to supplement their boxed Chablis with a little Thunderbird?

Kudos to the authors who are trying to help a population that seems beyond hope, but they’ve taken harm reduction over the line into enabling. Giving shelter, food, medical care and social services to alcoholics who won’t jump on the wagon may create the same positive outcomes. Despite what the CNN's headline implies, putting up a free martini bar next to every methadone clinic is not the answer.