Three upside-down bottles of vodka are mounted to a wall bar-style in a brightly lit, antiseptic room inside the Station Street Community, a year-old supportive housing building near the bus and train station. A cooler stocked with boxes of Naked Grape pinot grigio and Cariboo Genuine Draft hums in a corner.

At 10:30 a.m., a nurse dispenses drinks to six people who’ve been waiting in the adjacent common room. Two aboriginal men who’ve been sitting at computers carry away pints of beer. One woman, who’s been watching Who Wants to Be a Millionaire on the gigantic flat screen TV, peels herself away from the couch to grab an ounce-and-a-half of vodka, while another woman says, “Vodka give me a headache in the morning,” and opts for a 5 oz. glass of wine.

Joe Jones, a 39-year-old who started drinking beer he stole from his physically abusive, alcoholic parents at the age of nine, agrees to talk about his experience in Vancouver Coastal Health and PHS Community Services’ Managed Alcohol Program, or MAP, since it started prescribing drinks in October.

The slight native man with chest-length hair carries his pint and a half of beer to the office of Clare Hacksel, project manager of Station Street. Until he started MAP, Jones spent his days in Downtown Eastside bars, drinking vodka, Fireball cinnamon whisky and beer from 9 a.m. to 11 p.m., when he’d stagger home, pass out, or, more often than not, get in a fight and end up at in the emergency room. He’s been to the hospital four or five times since October, a significant drop from his previous four to five visits a week.

Jones, who grew up in Port Alberni, hopes to eventually enter detox for the second time. “I want to get back in shape and I then want to go back to work,” says the former roofer who has cirrhosis of the liver. “I want to slow down on this drinking bullshit for a while.”

Hacksel says the program, which provides eight severe alcoholics with an almost hourly dose of alcohol from 7:30 a.m. to 10:30 p.m. every day, seems to be improving Jones’s and others’ lives. “Detox wasn’t an option when he was getting so drunk you’re passing out,” says Hacksel, who has a master’s degree in health policy from England’s University of Oxford.

Providing alcohol to severe alcoholics is one of the newer harm reduction approaches to addiction being explored in Vancouver. PHS has offered an informal managed alcohol program at the Pennsylvania Hotel for the last year and a half while Station Street’s MAP is being evaluated by the Centre for Addictions Research for B.C., and an illicit alcohol drinkers’ group recently started at the Vancouver Area Network of Drug Users.

Dr. Ron Joe ran a family practice in the Downtown Eastside in the early 1990s. The mild-mannered physician recalls being called to the Portland Hotel to revive people who were overdosing on heroin.

Too many of his patients had chronic alcohol and drug problems, so he was happy to start working for Vancouver Coastal Health in 1997 to develop programs that could serve a broader population. He’s been the health authority’s manager of inner city addictions for the past two years and some of the participants in MAP are his longtime clients.

Seven of the eight MAP participants are aboriginal people, three are women and most report traumatic upbringings that include parents who abused alcohol. All eight are in anger management counselling. Most are aged 40 to 50, have been abusing alcohol for 30 years and have relapsed after stints in detox. Six have abused non-beverage alcohol such as Listerine, rubbing alcohol, cooking sherry, hand sanitizer and hairspray.

Some prefer rubbing alcohol because it provides the highest alcohol content. Dr. Joe notes individuals can buy a 500 ml bottle of 95 per cent rubbing alcohol for $3, dilute it and drink it for an equivalent of 30 beers or servings of wine.

“Our worst clients are drinking two or three or four of these [bottles] a day, so we’re talking about 120 drinks a day,” he says.

When extreme alcoholics know where their next drink is coming from, they can manage their withdrawal symptoms and start thinking about what else they’d like to do with their day, Dr. Joe says.

Jones has been receiving help for anger management, counselling and seeing a native elder for three years but he’s only been making regular appointments since October.

Some have seen dentists, had their teeth fixed and can now eat more nutritiously.

MAP’s goal is to reduce hospital visits, encounters with police and the number of drinks each participant consumes, while improving their overall health. Severe alcoholics who imbibe in public often end up in emergency rooms after they’ve blacked out, suffered a seizure, fought or fallen.

Dr. Joe says the long-term effects of drinking rubbing alcohol, Listerine and other non-beverage alcohol are unknown because they haven’t been tested for human consumption. But as with the abuse of beverage alcohol, seizures, bleeding ulcers, liver problems and an exacerbation of depression and schizophrenia are common.

“When someone’s intoxicated on something like rubbing alcohol, there tends to be a lot more rage present,” Hacksel adds.

Severe alcoholics withdrawing from alcohol require vigilant supervision due to the possibility of seizures, swallowing their tongues, choking on their vomit and dying.

Dr. Joe says MAP participants didn’t need to be convinced to reduce the quantity and concentrate of alcohol they were drinking. He was surprised to discover that was something they wanted to do.

Prior to joining the program, participants typically consumed 30 or more drinks a day. The program’s goal is to reduce that number to 12. So far, participants appear, on average, to have cut their consumption by more than half since October and have shifted from non-beverage to beverage alcohol. Their health seems to be improving and they are causing fewer disturbances at Station Street.

Prior to getting a dose, participants are asked if they’ve had anything else to drink. If they have or appear intoxicated, they forego their prescribed drinks that day.

MAP costs roughly $350 per person per month. But Dr. Joe sees providing free drinks as a significant cost saver, as one emergency room visit costs $1,500. “I’ve heard a lot of alcoholics tell me that I’m not $1,500, I’m $10,000,” the physician says, explaining costs stack up swiftly when an injury requires a cast, overnight stays, a follow-up and an MRI or two. “Abstinence-based avenues, for a vast majority of alcoholics, that’s the treatment,” says Dr. Joe addressing concerns that some members of the public might balk at paying for booze for alcoholics. “Although there seems to be a lot of them on the street in [this] area of the city, the reality is when you look at all the problem drinkers, they’re really less than one per cent.”

During the project, researchers will note changes to participants’ behaviour, mental health, and their physical state and test their blood every three months. The Centre for Addictions Research for B.C. will evaluate MAP and consider participants’ medical records prior to enrolment, number of emergency room visits, total alcohol consumption and whether supportive housing has an impact on the program’s outcomes.

Canada’s first managed alcohol program started in Toronto 15 years ago with subsequent programs starting in Ottawa and Hamilton.

A 2006 study of a managed alcohol project in Ottawa published in the Canadian Medical Association Journal found that police encounters were reduced from an average of 18.1 to 8.8 per month. Emergency room visits fell from an average of 13.5 per month to eight. Blood tests measuring the amount of alcohol in participant’s blood didn’t change significantly, but all participants reported less alcohol consumption, and service providers reported improved health, compliance with medical care and hygiene.

Hacksel says Station Street’s space to dispense drinks, provide programming to keep tenants engaged and its “robust staffing” make MAP possible. Having a room of one’s own and a supportive community helps addicts cope with repressed feelings that “bubble up” when they aren’t severely intoxicated. “Now they have a place where they can go up and cry in their rooms in dignity, or see a counsellor,” Hacksel says.

Jones turns his head away at the end of the Courier interview after talking about being beaten by his parents and molested by a babysitter, when he’s asked to respond to concerns that taxpayers might not want to help fund free liquor for extreme alcoholics. Jones leaves with his beer to go to his room where he’ll wait for Hacksel to call him a counsellor.

Randy Barnhart used to think those who drank rubbing alcohol, hand sanitizer and Listerine were pathetic. Instead, he’d steal to afford Polar Ice vodka and crack.

But in 2007, alone and penniless, the newcomer to Vancouver accepted a few swigs of Listerine in Oppenheimer Park in exchange for a cigarette. “I took like five sips, big ones, and I was drunk, so I just thought that was pretty cool. I’ve been on it since,” says Barnhart, a spaced-out 27-year-old who stands out among the other 30 people gathered for a meeting of the Eastside Illicit Drinkers’ Group for Education, or EIDGE, at the Vancouver Area Network of Drug Users on East Hastings. He stands out for his youth and the striped toque and sweater that conjure powdery slopes. Most of the others have weathered faces and dark hoodies, coats and caps.

The young man who says he was raised by bikers in Prince Albert, Sask., joined EIDGE to gain “insight” on the physical effects of what he imbibes. But Barnhart, who continues to smoke “lots” of crack, sees silver flashes of light in his peripheral vision and vomits “green stuff” every morning, can’t resist the economical way of getting intoxicated. “I like ’em because it’s cheap and you don’t need much of it to get drunk,” he says. “The liquor store closes at 9, 10, I can walk into a 7-Eleven, London Drugs and buy [Listerine] from there. And the hand sanitizer, I break into the outhouses at construction sites and I take it from inside the outhouse, the hand sanitizer, and it’s a big bag. Those bags cost, like, a hundred bucks, and it lasts all day.”

The BC/Yukon Association of Drug War Survivors with the support of the B.C. Centre for Disease Control saw a need last summer to better connect non-beverage alcohol drinkers to supports offered to drug user. (WAHRS prefers the term “illicit alcohol” because it includes home-distilled alcohol and liquids such as vanilla extract, and it’s analogous to illicit drugs.)

The Centre for Disease Control subsequently funded a research project at VANDU, and the research participants formed EIDGE to explore ways of improving the safety of severe alcoholics. They’ve discussed a buddy system, making sure unconscious individuals are lying on their sides and watching out for severely inebriated men and women on the street who are vulnerable to theft and sexual assault.

EIDGE also wants to establish a place where drinkers, particularly those who may not be able to hold onto their housing, would be prescribed drinks, receive help with housing and fast-tracked referrals to detox. “It’s so hard to get in [to detox],” says one wizened middle-aged man who wanted to get into detox but had to wait six days. “By the time they got me in there I’d already got fed up and started drinking again.”

Rob Morgan, a co-founder of EIDGE and former injection heroin and cocaine user who now opts for Listerine although he splurges on beer at The Cambie on cheque day, says he’s faced stigma at meetings of Alcoholics Anonymous. “I felt like the black sheep, because anytime they tried to ask me what you drink and you say Listerine, they say, ‘Oh man I would never go that far,’ so I didn’t feel that engaged in that,” he says. “I went to all the different AA groups in Vancouver and I always got that repulsive stay away [sense from them].”

The space that EIDGE envisions would likely require potential visitors to attend a certain number of EIDGE meetings, be approved by members and undergo a medical screening. The group wants to see drinks administered hourly by a paid staff person, with frequent visits from street nurses and support provided by other illicit alcohol drinkers, so members would benefit from a sense of understanding and seeing someone they can identify with in a leadership role. Some EIDGE members want such a space to open early in the morning to help ease their withdrawal symptoms before they pursue temporary work or other daytime activities.

The Vancouver Foundation recently gave EIDGE a $51,980 grant to conduct community-based research into non-beverage alcohol harm reduction options that could work in different communities around the province. The research is scheduled to start this summer.

So would Barnhart stop drinking Listerine and hand sanitizer if he could get regulated alcohol for free? “I probably would [stop], I would,” he says.

Barnhart, who’s been incarcerated multiple times for theft and kicked out of his Downtown Eastside hotel room for fighting, likes the idea of a safe place for drinkers. Although he says he didn’t go to hospital once last year, “I’ve been so sick from drinking I couldn’t walk so I just lied down in a parkade for hours and hours.”

NEXT FRIDAY: A profile on Evan, a long-term participant in an informal alcohol maintenance program.

crossi@vancourier.com

Twitter: @Cheryl_Rossi