Treating alcoholics - with wine
The recommended treatment for chronic alcoholism is abstinence. But at the Oaks - a permanent home for those who once lived on the streets - residents are given a measure of wine at hourly intervals. It is called the Managed Alcohol Program, and aims to change the drinking behaviour of inveterate addicts.
In a converted hotel in the west of the city of Ottawa, a quiet, orderly queue snakes around the reception area. The men and women are mostly middle-aged or older. Some of them use sticks, walkers or wheelchairs, their health fragile after a lifetime of booze. But it is their hands that stand out - scarred, bruised or swollen, their fingernails chipped or bitten to the quick. All clutch a cup, mug, glass or flask. Any receptacle will do.
At exactly half past the hour, what's known as "the pour" begins. A measure of Californian white - 13% alcohol, made on the premises - is measured into a jug from a draft tap behind the counter. One at a time, the wine is dispensed to nearly 50 alcoholics. For the first pour at 7.30am, most residents get a kickstarter of 7oz - nearly 200ml, a larger-than-average sized glass of wine in Europe. For the rest of the day until 9.30pm, they are given 5oz - just over 140ml.
Elisa Pewheoalook is next in line, a white ceramic cup at the ready. He is from Pond Inlet, an Inuit town in Canada's north, and has been drinking for 40 of his 53 years - a life blighted by alcohol.
"It's not bad, the wine here," he says. "Out on the streets I was drinking mouthwash, hairspray. It didn't taste good, but all I wanted was the effect. I don't drink that stuff anymore - it makes me feel sick to think of it. And I drink much less here."
If anyone shows signs of intoxication, they will not be served.
"It doesn't happen very often, but if they're drunk, I ask them to go to their room and take a nap," says Lucia Ali, one of the frontline staff at the Oaks who works the bar.
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Linda Pressly's report The City Giving Wine to Alcoholics can also be heard on Assignment on the BBC World Service - click here for transmission times. You can catch up on the Catch up on BBC iPlayer Radio
Ottawa's Managed Alcohol Program - or MAP - was designed to address the needs of homeless people who had tried to stop drinking and failed. The scheme was the brainchild of a group of health professionals around 15 years ago.
"The thought was that if we could stabilise the craziness of their lives, the day that begins with the search for alcohol and all the complications that occur with that, then maybe we could make inroads with their mental health, addiction to alcohol and their physical illnesses," says Dr Jeff Turnbull, one of those early innovators, and the chief of staff at Ottawa Hospital.
The catalyst was a chronic alcoholic called Eugene.
"We found him outside with frostbite. He wouldn't stay inside during that freezing weather because of his addiction to alcohol. So we said, wouldn't it be safer if we just got him some wine and allowed him to drink that? Eugene responded very quickly. He stayed inside the shelter, his frostbite got better and we saved his toes."
The MAP started in 2001 and is run by a partnership of two NGOs - the Shepherds of Good Hope, and Ottawa Inner City Health. It began in the Shepherds' homeless hostel downtown, and the Oaks opened in 2010. But the approach was controversial.
"I got death threats," remembers Dr Turnbull who continues to be the physician in charge at the Oaks.
"The addiction community is very divided about harm reduction. There are some proponents who feel so strongly about abstinence as the only treatment for alcoholism, they just couldn't see an alternative."
The Oaks' residents contribute to the cost of their keep - and the wine - through pensions and state benefits. After collecting their drinks from the counter, they amble into the common area, or take their drinks to the courtyard outside and light up a cigarette.
They chat with their friends, play cards - or sit, sipping and staring into space. There is a TV room, and a computer. There are outings and shopping trips. One of the staff runs a gentle keep-fit class. It is a calm, stable environment, and it has enabled many to flourish. Some have re-established contact with their families; others are hoping to volunteer or even go back to work. And the Inuit residents have formed a task force to compile information for homeless people like them.
It is a world away from the chaotic lives many led on the streets. Downtown Ottawa is edgy. Every block or so, there are addicts. Those looking for drugs walk as if hunted - fast and purposefully. The alcoholics sway unsteadily, or doze on the sidewalk, chins resting on chests.
Police Sgt Steve Boucher regularly patrols these streets. On a Sunday afternoon he is called to assist paramedics in Ottawa's Byward Market area. An unkempt man in his 40s is slumped heavily on a bench in front of a restaurant. He is conscious and breathing, but a small plastic bottle of rubbing alcohol - 50% proof - is on his lap.
"I'd say a minimum of half a dozen times a shift we get calls like this one," says Sgt Boucher. "It's sad that this man's life has come to this, but alcohol is a demon he's going to have to deal with all his life."
Lifelong alcoholics are an enormous drain on public resources.
"One of our clients was in the emergency department 191 times in the six months preceding coming onto the MAP," says Dr Turnbull. "And that was just in our hospital. He could've been in other healthcare facilities during that time as well."
No one study about the MAP has crunched the numbers fully, but it is not unrealistic to assume that the city of Ottawa has saved millions of dollars.
"There's a profound reduction in 911 calls, hospital emergency visits, paramedic and police encounters," says Dr Turnbull.
The Oaks has a waiting list. Before being accepted, potential residents must prove they can live within the rules of the Managed Alcohol Program. The Shepherds' hostel downtown is a 12-bed unit, but the atmosphere is far less benign than at the Oaks.
Michael is 36, and struggling. At 3pm he is unsteady on his feet - a messy, weeping wound under one eye. This is the seventh time he has tried the MAP.
Hearing of the death of someone from alcoholism had been a wake-up call. "So I came back," he says. "I don't want to get kicked out of here again. I can't be out there on the streets any more, man."
Michael is a desperate man. But David McConnell is hoping he might be one of the next to graduate to the Oaks after 14 months at the MAP downtown. At 64, his alcohol intake has dropped, and he is resisting the temptation to drink outside.
"I used to drink all day and now I just drink once every hour," he says.
David's family is in the United States, but he was deported back to Canada after a prison term.
"I was prosecuted for unintentional manslaughter. I got in a car wreck, and unfortunately I ended up killing a woman. It stays with me every day."
Too often, regret and shame cast a shadow over alcoholic lives. But there is also hope.
Back at the Oaks, another queue forms for the hourly "pour". Corinne Jackson has lived here for nearly six years, but she is not waiting in line. It is three months since she had the hourly glass of Californian white.
"I started to get sicker and sicker. And I thought - I just don't want to do that anymore. I turned 50 last year, and I don't want to be another person that dies here too young."
After 18 years of heavy drinking, Corinne put the brakes on.
"Alcohol ruined many of my relationships. I had a job at one of the nicest hotels in Ottawa - I lost that," she says.
Corinne's partner lives at the Oaks with her - he stopped the hourly pour last year. But the couple have not stopped drinking altogether.
"When we have money, my boyfriend and I pick up a couple of beers and we go visit friends," says Corinne. "But I don't get polluted. It's nice having a clear head. You know, the fog that was suffocating me for 18 years gets clearer and clearer. I'm just embracing every day as a new gift."
Her love life has been transformed.
"When you're drunk, you just go with the flow, and you don't remember anything. That was a mess, but it's much better now. I feel very lucky."
Corinne is delighted with her sobriety, but if she is judged on the criteria of abstinence, hers is not a success story.
"I'd love them all to be abstinent," says Dr Turnbull. "But is that feasible or possible? Perhaps not. We do try and reduce their alcohol on a daily basis. At least they're stable here at the Oaks. They're happy, and they have a reasonable standard of living."