Theme: Models of Care Year: 2022
The establishment of a culturally safe medically supervised quarantine facility for homeless
indigenous people with significant alcohol or drug use issues who were COVID positive in South
Australia included the provision of a managed alcohol program (MAP).
Description of model of care/intervention:
Clients were offered a MAP or alcohol withdrawal management (using diazepam) and could change
part way through on request and swap from MAP to withdrawal management or vice versa. The
initial alcohol provision was aimed to achieve an estimated maximum BAL of 0.2 based on the
anticipated cohort of heavily dependent drinkers (known to present to sobering up services with BAL
0.3-0.4). The alcohol was provided as full-strength beer (4.9%) or cask wine (9.5%) and offered 3
hourly between 8am-8pm.
As the program progressed, episodic hazardous drinkers (related to cultural practices) who were not
dependent were admitted, leading to concerns regarding intoxicated behaviour in the unit.
Consequently, informal modifications of alcohol provisions led to formal review and recalculation of
alcohol quantities aimed to achieve lower peak BAL (estimated maximum 0.12). Modified MAP was
also used in those with end stage decompensated liver disease.
All 53 eligible clients elected to stay in the unit (rather than hotel quarantine). Full MAP was started
for 29, modified MAP for 11 and 13 elected withdrawal management of whom 10 swapped to
MAP/modified MAP. Modification of MAP resulted in no further reports of intoxication.
One client on MAP was transferred to a medi-hotel for aggression (primary THC user) but overall less
incidences of aggressive behaviour than usually encountered in the withdrawal unit.
Conclusion and next steps:
MAP was safely offered with good client acceptance and low level of complications in quarantine.
Successful modification and tailoring of MAP in response to a changing client profile is a novel
approach that could be employed in other settings.
Disclosure of Interest Statement:
No commercial/pharmaceutical funding/grants were received by the authors.