Division of General Internal Medicine, University of California, San Francisco, California, USA.
Division of HIV, ID and Global Medicine, University of California, San Francisco, California, USA.
Subst Abus. 2021;42(2):140-147. doi: 10.1080/08897077.2021.1892012. Epub 2021 Apr 13.
The COVID-19 crisis presents new challenges and opportunities in managing alcohol use disorders, particularly for people unable to shelter in place due to homelessness or other reasons. Requiring abstinence for shelter engagement is impractical for many with severe alcohol use disorders and poses a modifiable barrier to self-isolation orders. Managed alcohol programs (MAPs) have successfully increased housing adherence for those with physical alcohol dependence in Canada, but to our knowledge, they have not been implemented in the United States. To avoid life-threatening alcohol withdrawal syndromes and to support adherence to COVID-19 self-isolation and quarantine orders, MAPs were piloted by the public health departments of San Francisco and Alameda counties. We describe implementation of a first-in-the-nation alcohol use disorder intervention of a MAP that emerged at three public health isolation settings within San Francisco and Alameda counties in California. All three interventions utilized a similar process to develop the protocol and implement the MAP that included identification of champions for system-level advocacy and engagement of stakeholders. We describe the creation and implementation of the distinct protocols. We provide examples of iterative changes to workflow processes and key lessons learned pertaining to protocol development, acceptability by stakeholders, alcohol procurement, documentation, and assessment. We discuss safety considerations, noting that there were no deaths or serious adverse events in any of the patients of the MAP during the 2-month implementation period. MAP pilots have been implemented in the US to aid adherence to isolation and quarantine setting guidelines. Lessons learned provide a foundation for their expansion as a recognized public health intervention for individuals with severe alcohol use disorders who are unable to stabilize within existing care systems. Based on the success of MAP implementation, efforts are under way to investigate alcohol management in homeless populations more broadly.
新冠疫情带来了管理酒精使用障碍的新挑战和新机遇，尤其是对于那些因无家可归或其他原因而无法就地避难的人。 对于许多患有严重酒精使用障碍的人来说，要求在庇护所入住时戒酒是不切实际的，这也成为自我隔离令的一个可改变的障碍。在加拿大，管理性饮酒计划（MAP）已成功提高了那些有身体酒精依赖的人的住房入住率，但据我们所知，该计划尚未在美国实施。为了避免危及生命的酒精戒断综合征，并支持遵守新冠疫情的自我隔离和检疫命令，旧金山和阿拉米达县的公共卫生部门试行管理性饮酒计划。我们描述了在加利福尼亚州旧金山和阿拉米达县的三个公共卫生隔离点实施的全国首例酒精使用障碍干预措施，即管理性饮酒计划。所有三个干预措施都采用了类似的过程来制定方案并实施管理性饮酒计划，包括确定系统层面的倡导者并让利益相关者参与进来。我们描述了创建和实施不同方案的过程。我们提供了工作流程的迭代变化示例，以及与方案制定、利益相关者的可接受性、酒精采购、文件记录和评估相关的主要经验教训。我们讨论了安全注意事项，指出在管理性饮酒计划的实施期间，MAP 患者中没有死亡或严重不良事件。美国已经实施了管理性饮酒计划，以帮助遵守隔离和检疫规定。从经验中吸取的教训为将其作为一种公认的公共卫生干预措施来扩大使用提供了基础，以帮助那些无法在现有护理系统中稳定下来的严重酒精使用障碍患者。基于管理性饮酒计划实施的成功，正在努力更广泛地调查无家可归人群中的酒精管理问题。
