Integrating a model of care within a community-based managed alcohol program with indigenous men experiencing homelessness and alcohol use: a retrospective chart review.

Abstract

Background: In Montréal, many members of the Indigenous community are affected by homelessness and substance use, explained in part by the loss of cultural identity. These challenges are compounded by barriers to health and social services, and reduced shelter capacity during the pandemic. In response, an urban Indigenous-led community organization developed a managed alcohol program (MAP) in partnership with a university hospital (UH) addiction medicine team in Montréal, Canada. We describe health outcomes, service access, and substance use among Indigenous men experiencing homelessness and severe alcohol use enrolled in the MAP.

Methods: A retrospective medical chart review of residents admitted to the MAP was conducted following its opening in December 2020. Descriptive data were abstracted from the university hospital's electronic medical records and the MAP's medical charts. Pre-admission outcomes were captured for the one-year period prior to the start of the program (December 2019 to December 2020), and post-admission outcomes were collected during each resident's observed follow-up period for up to one year after program entry (December 2020 to December 2021). Descriptive analyses were used to summarize resident characteristics and outcomes.

Results: Findings are reported for 12 Indigenous men enrolled in the program during the study period. Residents had a mean age of 51 years, and the majority identified as Inuit (41.7%). The mean duration in the MAP was 208.3 days (range: 32-396 days). Most residents reported an underlying health condition (83.3%), diagnosed psychiatric disorder (75.0%), and substance use disorder other than alcohol (75.0%). During the observed follow-up period, mean alcohol use decreased from 29.1 to 20.0 drinks per day. Decreased use of other substances, including cannabis and tobacco, was also observed. Emergency department (ED) utilization was reportedly lower during follow-up, with 12 residents accessing ED services prior to admission compared to 5 during follow-up.

Conclusions: A partnership between an urban Indigenous-led community organization and an addiction medicine team can support harm reduction and access to care. Findings suggest that similar collaborative models may be relevant for supporting care among Indigenous populations experiencing homelessness and severe alcohol use.