ReviewHarm reduction journal2026
Realist review of managed alcohol programmes for people experiencing alcohol dependence and homelessness: what works, for whom, and in what circumstances?
Review in Harm reduction journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
introductionPeople experiencing homelessness and alcohol dependence are vulnerable to a range of harms, and existing treatment options, which are often abstinence-based, are inadequate for this group because they may be unavailable, unsuitable, or not aligned with goals. Abstinence-based treatment programmes also rarely address underlying social and health issues faced by this population. Instead, alcohol harm reduction approaches provide individuals with support to reduce the harms associated with their drinking, without the need to stop drinking. Managed alcohol programmes (MAPs) are one harm reduction approach specifically designed for this group. MAPs provide alcohol in regulated doses through the day, alongside wider support for housing, physical and mental health, welfare, and social connections.
methodsA realist review was conducted to explore the current evidence base for MAPs. Realist reviews aim to synthesise existing evidence to examine the contexts, mechanisms, and outcomes of complex interventions, on the assumption that the outcomes of these interventions are directly caused by underlying mechanisms which have been activated in particular contexts. Twenty-four initial programme theories were developed and then tested using international evidence and refined to 11 programme theories.
resultsA total of 60 sources were included in this review, highlighting a range of contexts, mechanisms, and outcomes relating to MAPs. The 11 programme theories demonstrate the need for MAPs in a context where abstinence-based treatment is the norm but is often unsuitable for this population. For MAPs to be successful for this population they need to enable autonomy, address clients' needs, create a sense of hope and purpose, and provide access to healthcare and other activities. MAPs can lead to a range of positive outcomes for those who access them.
conclusionsOur theoretically informed exploration of service implementation can inform the design, development, and optimisation of future MAPs internationally. At a time when homelessness and alcohol deaths are increasing, innovative harm reduction approaches like MAPs are required to improve wellbeing and support health contextualised by the complex lives faced by some individuals.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.