MANAGING THE ADDICTION

Every day, in the shadow of Parliament Hill, 30 homeless alcoholics
are fed, housed and served drinks, each hour on the hour, between
early morning and evening.

That this "managed alcohol" program run by Ottawa's Inner City Health
Inc. in the ByWard Market, is effective, is beyond dispute. For one
thing, it has saved the local health care system in the neighbourhood
of $3.5 million by reducing or eliminating its clients' frequent
visits to hospital emergency rooms.

For another, it has dramatically improved the quality of life for a
group of people many would view as beyond hope. What is remarkable is
not so much that the program works, but that it is able to run
relatively free of major controversy or political interference.
Substitute 30 crack addicts for the homeless alcoholics, and it would
be a different story.

In a country where harm reduction is frequently a lightning rod for
controversy -- whether the issue is free crack pipes or a safe
injection site -- we have a successful harm-reduction program
flourishing in the nation's capital. That's a good thing, perhaps a
remarkable thing, but it's too bad we can't extend its creativity to
another group also in need of harm reduction -- drug addicts.

It may seem counterintuitive to give addicts what is making them
sick, but the Inner City Health program demonstrates it can help them
live healthier, happier and less disruptive lives. Despite the fact
that they are kept "buzzed" all day as a Citizen reporter put it,
they are actually drinking less -- maybe two-thirds less -- than they
would have been on the street. They can't panhandle while on the
program and must meet strict requirements, which they agree to. And
the fact is many homeless alcoholics can't quit. The best that can be
done is to manage their addiction.

And that is quite a lot. Managed alcohol serves both its clients and
society extremely well. Which makes the question of whether they
should quit irrelevant.

Wendy Muckle, a registered nurse who is executive director of Ottawa
Inner City Health says addicts have a chronic illness. Helping them
learn how to manage their illnesses, she says, is often the only
intervention that is effective.

"You get politicians who are basically saying 'These people need to
pull up their socks andz get cured,' when these people have chronic
diseases. It is as stupid as saying a diabetic needs to pull up his socks.

"I think we have to figure out humane and safe ways to support people
when they are in difficult periods of their lives, encouraging them
to maintain a place in mainstream society."

Unlike the managed alcohol program, Vancouver's supervised injection
site, Insite, exists under the constant threat of closure from those
whose ideology tells them it should not exist.

But what is the difference between a program that reduces harm for
addicted alcoholics and one that attempts to reduce harm for addicted
drug addicts? Yes, alcohol is legal and heroin is not, but the amount
of damage each substance can do to lives doesn't discriminate between
legality and illegality.

In fact Muckle says her view of which drug does the most harm has
completely turned around. "Before I started this job, I would have
said crack cocaine was the most harmful drug available. I now have to
say it is alcohol."

Programs such as Inner City Health can come up with creative
solutions to work with alcoholics, but it is much harder and much
more political with drug addicts.

Muckle says she would love to have a similar program for crack and
heroin addicts, if she could. In fact, she believes such an intensive
program would not be necessary for most drug addicts.

A safe injection site, she said, would be a "kind of a beginning."
From there, a lot more could be done for that population. Something
that would have a huge impact is housing.

Many people think residential treatment is the only option for drug
addicts. Muckle disagrees.

"We have to change the assumptions and provide other kinds of help
than we do." For some, residential treatment programs will be
entirely ineffective, she says, mainly because they don't last long
enough to make a real difference. A long, slow process that includes
group therapy, harm reduction programs and some place to live, would
have a better chance of succeeding.

Elizabeth Payne is a member of the Ottawa Citizen's editorial board.