Support with substance

Nursing PhD candidate Meaghan Brown puts managed alcohol program experience and research into practice and policy

When Meaghan Brown graduated from nursing school, she had never heard of managed alcohol programs, or MAPs. But when she started working at a MAP at Ottawa Inner City Health as a new nurse, she immediately loved working with residents of the MAP, a program where people with severe alcohol dependence are provided with regular doses of alcohol throughout the day, paired with housing and other supports.

“I found this population was such a special population to work with. Often people in the programs have had really remarkable lives but also lot of challenges. They are such resilient people who can have the most medical and health complexities and the most barriers to accessing harm-reduction services, but are so full of character and life.”
—UVic nursing PhD candidate Meaghan Brown

So when it came time to think about graduate studies, MAP research was at the forefront of her mind. And one night, a leader of MAP research in Canada—Bernie Pauly, professor with UVic’s School of Nursing and a scientist with the Canadian Institute for Substance Use Research (CISUR)—happened to be visiting Brown’s work as part of her research.

“It was kind of serendipitous between me and Bernie. I recognized her from researching different supervisors,” recalls Brown. “I went up to her and said, ‘Are you Bernie Pauly?’ and she was like, ‘Yeah.’ I said, ‘I want to do my master’s.’ She said, ‘you should apply to UVic.’ I was living in Ottawa at the time, [and] had never been to BC.”

Pauly says she was happy to offer Brown the encouragement. “I was pretty excited that a nurse with Meaghan’s experience and passion for alcohol harm reduction was interested in research and pursuing graduate studies,” she says.

Since being accepted to UVic’s master’s program in nursing and starting work on the Canadian Managed Alcohol Program Study (CMAPS), a CISUR-led study of managed alcohol programs across the country, Brown was encouraged to fast track into the PhD program because of her strong academic standing and aptitude for research.  Her dissertation focuses on Indigenous-led alcohol harm reduction programs and culturally based supports. Brown has been volunteering and working with the Aboriginal Coalition to End Homelessness to build her knowledge and relationships in the community and support Indigenous-led research and programming.

“Collaborating with Indigenous organizations is very important,” says Brown. “We cannot investigate MAPs and understand the experiences of Indigenous participants in MAPs, without acknowledging that we as white settler researchers are limited in our understanding and our positions within a very colonial, western research approach. We need to have those partnerships in order to be able to really centre Indigenous perspectives, knowledge and decision-making in research.”

MAPs are an alcohol harm-reduction approach that are been mostly found in Canada, with programs often flying under the radar. With the onset of COVID-19, interest in MAPs exploded as the need to support people to stay at home and restrictions and closures increased harms for an already vulnerable group. The CMAPS team, which includes Brown and Pauly, are consulting with communities from across BC and Canada on the development of MAPs. Along with other members of CMAPS and the BC Centre for Substance Use, they led the development of provincial operational guidance for managed alcohol programs during COVID-19.

“Meaghan exemplifies what we look for and encourage in graduate students at UVic and in nursing; the ability to integrate research and practice as well as policy that is dedicated to the improvement of health and services in the community and contribute to national and international knowledge,” says Pauly.

New models of MAP are emerging in response to the risks posed by COVID-19. Brown says that in Victoria, the onset of COVID-19 brought increasing community concerns about the displacement of people from tent cities and other typical shelter and support networks, with the potential of exacerbating alcohol-related harms such as severe withdrawal and ‘survival drinking’ of mouthwash or rubbing alcohol. Combined with the large migration of previously unhoused people into hotels, the city’s first MAPs were established, ranging from clinical and peer-based models. Locally, some agencies have adopted an outreach-based, scattered-site model where clients are seen by a nurse and provided with supports and alcohol where they live. This aligns with principles of Housing First, but is a new take on the established residential MAP model. 

“I think we’re learning new ways of doing alcohol harm reduction, knowing that there’s a range of models from residential, to scattered, and of course community based peer-led models, which are much more based on the dignity and self-determination of the person and less clinical,” says Brown. “What I’ve been learning over time is that managed alcohol programs, particularly in my own approach to practice, there’s always room for growth. It’s always important for me to come back to harm reduction as the centre of our approach and remembering that it’s ultimately based on the choices and dignity of the person.”

• Related: Alcohol harm reduction is saving lives during COVID-19