A moment of clarity?

A groundbreaking Dutch centre that provides beer rations could be the salvation of chronic alcoholics, writes ISABEL CONWAY

A groundbreaking Dutch centre that provides beer rations could be the salvation of chronic alcoholics, writes ISABEL CONWAY

IT IS only 11am, but already Cora, a friendly, attractive woman in a colourful top and tight trousers, has downed two half-litres of beer and is thinking about her third glass. A chronic alcoholic who lost her home and contact with her family, and was roaming the streets, she proudly tells how her intake of alcohol has been reduced, and her dependency on spirits to get through the day has also gone down.

The Maliebaan centre, in the large town of Amersfoort, east of Amsterdam, opened last October. The first centre of its kind in Europe, it is based on a unique concept regarding the care and rehabilitation of alcoholics.

Far from aiming to dry out its residents – those with no work, no home and no desire to stop drinking – the clinic takes the view that they will never stop consuming alcohol. Instead it aims to help them to end dangerous binge-drinking and to control their intake of alcohol, with noticeable improvements to their health and wellbeing as a result.

Cora and the 19 other clients – 15 men and four women in their mid-20s to late 50s – are allowed to order up to five litres of beer daily, with an hour between each half litre, which costs 40 cent per serving (this is the wholesale price to the centre, which gets through 4,500 half-litre cans per month).

The bar opens at 7.30am and closes at 9.30pm, and the only criterion for being served is that the drinker must be able to get up themselves from their chair, walk to the counter and be able to hold their half-litre glass steady.

This is the staff’s version of the Garda tactic making drivers walk a straight line. Bringing in their own booze, causing trouble, trying to resell what they get or calling for a fresh drink within an hour are all strictly banned.

The idea of providing rationed, lower-strength alcohol as a form of treatment has been adapted from existing Canadian projects. There, shelter-based care for people chronically addicted to alcohol, with wine made on the premises, has been successful in reducing the worst effects of alcohol abuse without requiring abstinence.

Two harm-reduction programmes in Canada, set up in the mid-1990s and involving detailed studies and research, proved that, on average, the general health of participants improved, and they accounted for fewer emergency hospital admissions and fewer deaths on freezing streets.

There were even a few happy endings, with families reunited and broken lives put back together.

“Our most important goal is to stop binge drinking, the blackouts associated with it, the catastrophic effects on body and mind. We believe we can achieve that with this approach – binding our residents, if you like, with beer,” says the centre’s psychiatrist, Eugene Schouten. “Our clients would be people who would have drunk constantly through the day, topping up at night before being allowed into drink-free hostels. In the morning they might get through a whole bottle of port or something stronger by breakfast time to get rid of their withdrawal sickness. They destroy their bodies and minds over time.”

It’s early days, but Dr Schouten and the centre’s team leader Pieter Puijk report a noticeable reduction in some residents’ drinking, while most are taking alcohol in a more structured way. Also, the three meals they receive a day, and vitamins and medicine given to suppress withdrawal symptoms at night, mean they are more responsive, healthier and behave better.

A few have fallen away – one is in jail but several more drinkers have joined the closely-monitored experiment in recent months.

“We receive welcome financial help and support from the municipality of Amersfoort for the project, which really is alcohol’s answer to the methadone programmes that are widespread for heroin addicts and are known to work,” says Dr Schouten.

“By 2012 we plan to report fully on results. We believe that providing alcohol under controlled conditions, rationing the amount and the length of time between drinks, is a viable alternative for this category of chronic alcoholic, who will never be able to achieve abstinence but can have a better quality of life and achieve better health. To prove that it works and can be adopted elsewhere, in countries such as Ireland in future, is the hope.”

Experts are divided, but there is growing interest from municipalities and addiction centres in the Netherlands and abroad.

Those who set up the project want it to become a permanent feature of rehab services for chronic, homeless alcoholics and hope that “a philosophy, like the methadone programme, will spread to other countries in time”.

Public reaction in Holland has ranged from incredulity to messages of support. About 30 per cent of people who reacted online were astonished, with a few asking if they could check in and get cut-price booze.

A further 30 per cent were outraged, saying it was a disgrace to support such ventures given the cutbacks in care for the elderly and other vulnerable groups. About 20 per cent thought it was a good idea, and a solution to a problem that was widespread but had not been properly targeted before.

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