Scotland’s scheme treating alcoholics with regular top-ups of booze

Adrian Chiles discusses his struggles with alcohol dependence

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Scotland has an alcohol problem. The most recent data shows that in the year 2021-22, 35,124 people were admitted to hospital for alcohol-related reasons. In 2021 alone, 1,245 people died directly from alcohol, an increase of five per cent on 2020. Multiple surveys over the years have shown that Scots think alcohol produces negative effects, describing it as causing a “great deal” or “quite a lot of harm” to the nation. For some in Scotland and elsewhere in Britain, alcohol has consumed their lives. As their alcohol dependence is so severe, they are now at a somewhat dead end and in a vulnerable position.

But a new pilot scheme in Glasgow is offering a lifeline to those who have exhausted all other options — but the answer is not becoming t-total.

Instead of being forced into abstinence, they are given regular doses of alcohol. They will not get drunk but will instead be prevented from suffering seizures due to withdrawal.

The Managed Alcohol Programme (MAP) was inspired by similar initiatives elsewhere in the world, particularly one in Canada, where residents queue up to receive an hourly “pour” of homegrown wine.

But the ten residents living in Glasgow’s MAP house can receive any beverage, usually guided by what they drink ordinarily, paid for by their benefits around six times a day.

Typically they are given beer, cider and wine — spirits are not completely off the cards either — and the frequency is negotiated individually.

Dr Mathis Heydtmann, a consultant hepatologist and medical advisor for the programme who was involved in the planning for several years, told that these men are homeless, and their alcohol problems so severe that they have unsuccessfully tried to detox ten or so times.

Some of the men used to drink around an entire bottle of spirit a day, the equivalent of 40 units. The NHS’s recommended guidance is no more than 14 units per week.

Dr Heydtmann said: “Ideally, we would like to get people off alcohol and I’m personally doing everything I can to get people off it where I can.

“But some are just so far advanced in their addiction that they can’t do that. For those people, there are no alternatives: going in and out of hospital or detoxing with the risk of seizures is more dangerous. It’s about harm reduction.”

By giving the residents alcohol but stopping them from binging, their addiction can be stabilised.

While the initiative may be controversial, Dr Heydtmann believes it is saving money for the NHS, as well as the ambulance and custodial services.

He continued: “What is the alternative? Lying on the streets, begging, stealing, being a nuisance and assaulting others would be the alternative for a lot of them.

“We were thinking about what to do with these people because it’s a huge cost to society — an estimate of over £900,000-a-year per person.

“Coming off alcohol completely is not the aim. It’s like palliative care: we are looking to give them an alternative without pressuring them to reduce drinking or come off alcohol, which is the case in many other places. We’re hoping to teach them to drink the amount they want without binging.”

Drinking in the UK, particularly in Scotland, is a health problem, Dr Heydtmann believes. Scotland has some of the highest rates in hospital admissions and death rates from chronic and acute liver disease in comparison with other European countries, according to Public Health Scotland.

In the UK, liver disease deaths have increased by more than 400 per cent since 1970, compared to any other disease such as cancer, lung and cardiovascular disease, where mortality has decreased.

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Before entering, the men are examined for signs of advanced liver disease and any brain damage, and they take a psychiatric assessment. From the psychiatric addiction and homelessness point of view, they are some of society’s most vulnerable people.

For some, their lives are totally transformed. Initially, they are malnourished, underweight, withdrawn, out of contact with loved ones, and self-neglectful. But in time, they become confident, enjoy activities other than drinking, take up old or new hobbies, make contact with relatives and begin to take care of themselves, attending things like dentist appointments.

One man has begun writing poems, and another has taken up singing and is planning to make a CD. Recently, the group organised a museum trip together.

But the initiative has not always been smooth sailing. Occasionally, the residents have brought extra alcohol into the house, and given others this additional booze. Other times they have started fights. Only two people have been ejected from the programme in 12 months after they became aggressive in the middle of the night and the police had to be called.

Some residents have impending court hearings or have not gone to prison because the judge knows that they are safe at the MAP. Many are aware the situation could be “much worse” as they could be in a prison or in an abusive environment, Dr Heydtmann explained.

Several residents are now doing well. Whereas all ten had previous run-ins with the police and frequent trips to A&E — in one case some 200 over a two-year period — since coming into the MAP, only one or two have had such incidents.

While there is a significant reduction in many of the problems they experienced before, health improvements take time and are difficult to measure — for example, the last blood tests the men had were taken when they were drunk.

In the future, MAP hopes to expand and pilot a scheme for women. But this would be a challenge as they bring an added dimension of vulnerability. Although, Dr Heydtmann explained it is felt that this is exactly what is “needed” for some women in society.

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