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Story Publication logo May 4, 2016

A Canadian Shelter that Gives Wine to Alcoholics


Media file: simeonie_kunnuk_and_irwin_windsor.jpg

Canada helps homeless alcoholics—by giving them free booze.

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Ray MacQuatt, who makes perhaps the worst wine in Ottawa, Canada, is not a winemaker by profession, but the director of The Oaks, a long-term residence for alcoholics. Image by Tina Rosenberg. Canada, 2016.

On a grey January morning at 9:15, residents of the Oaks shelter for the homeless started lining up, coffee mugs in hand, at a yellow linoleum counter. At half past the hour, the pour began. The Oaks' residents are hard-core alcoholics. They line up to get what most people would consider the very last thing they need: an hourly mug of alcohol.

Dorothy Young, the Oaks' activities coordinator – a stocky, always-smiling middle-aged woman who is part cheerleader, part event planner, part warden, part bartender – stood behind the counter at a tap that dispenses cold white wine. She poured a measured amount of wine into each cup: maximum seven ounces at 7.30am for the first pour of the day, and five ounces each hour after that. Last call is 9.30pm.

The pour is calculated for each resident to be just enough to stave off the shakes and sweats of detox, which for alcohol is particularly unpleasant – seizures from alcohol deprivation can be fatal. The pour is strictly regulated: Young cuts off anyone who comes in intoxicated. They won't be given another drink until they sober up.

The Oaks is a converted hotel next to a pawnshop, in Carlington, a working-class neighborhood on the west side of Ottawa, Canada. When residents first arrive, they tend to drink the maximum, every hour, every day. Many also drink whatever they can buy or shoplift outside the building. For most, this gradually changes. They stop drinking outside, begin to ask for fewer ounces, skip pours or have a "special pour" of watered-down wine. Two residents get several hours' worth at a time to take up to their rooms and ration out themselves. One man gave up alcohol but gets an hourly pour of grape juice, to stay part of the group.

Ten of the Oaks' residents are mental health patients and don't get the pour – just fewer than 50 others do. A few are women or younger men, but the majority are men in their 50s; it often takes several decades of drinking before people seek a different life and land here. Standard clothing in January was flannel pajama bottoms and slippers with a down jacket. Many have long beards, disheveled hair, and no front teeth – alcohol will do that. Most are sick. Years or decades of drinking have left them with liver, heart and brain damage that will never be reversed. A nurse is on site 40 hours a week. At least once a week and whenever necessary, a doctor and specialist nurses come to see patients. Young leads physical stretching groups, a book club, shopping trips and outings; Little Ray's Reptile Zoo was a recent hit.

The pour is what makes the Oaks different from every other well-run facility of its kind. It solves the residents' most urgent problem: where can I get a drink? Virtually all the clients have tried to quit, over and over, and failed. They have spent decades drinking themselves into a stupor each day. One man was taken to A&E 109 times in six months. Another was picked up by the police or paramedics 314 times in one year. They have caused enough chaos and disorder that they have been kicked out of, or barred from Ottawa's other shelters. Before being accepted at the Oaks, if they could not beg or collect enough empty bottles to recycle to buy booze, many shoplifted rubbing alcohol or Listerine. Some shelters started filling their hand-sanitizer dispensers with soap, because residents drank the rub for the alcohol it contains.

"We have guys with wounds with worms in them," said Kim van Herk, a psychiatric nurse with Ottawa Inner City Health, an organisation formed 15 years ago to address the needs of the city's hardest-to-reach homeless people, many of whom are alcoholics.

"And that's our priority, but it's not their priority," added Amanda MacNaughtan, a nurse coordinator.

"They are so dependent on alcohol that it's their most basic need," said Van Herk. "If that need is not being met, nothing else matters for them. It's hard for other people to get their minds around how severe their addiction is – they feel like they're going to die. But once that need is met for them, they can start looking at other parts of their life."

The pour creates trust: here is a system that understands residents' needs. This system loosens them from their drinking friends. It keeps them away from Listerine. Without the pour, they would stay outdoors, begging or stealing, in danger of losing their feet to frostbite. Indoors, they take their medicine, see their doctors and mental health workers, eat actual food, re-establish contact with their families. Giving free booze to homeless alcoholics sounds crazy. But it may be the key to helping them live a stable life.


Irwin Windsor, 39, has a broad, smiling face and short brown bristle-cut hair. Ten years ago he still had a normal life: a family and steady work with a moving company. Although there had been drinking in his own family, he remembers his childhood in British Columbia fondly. He lived for a few years with his beloved maternal grandmother, who was an occasional drinker. He has happy memories of just sitting with her and watching soap operas or The Price is Right, her favorite gameshow. She taught him to knit, crochet and cook.

His stepfather, whom he adored, would get drunk two or three times a week when Irwin was little. But he was not abusive. When Windsor was in his 20s and had a job, he would take $100 Canadian (£55) from his paycheck and the two would drink. "We would send my mother off to bingo and we'd play cards and listen to music. We had a great time."

Windsor kept his drinking under control until 10 years ago. Then his stepfather died and his grandmother committed suicide. His weekly binges became daily binges, and then all‑day binges. He lost his job, lost his apartment, and lost contact with his sons, who live in Vancouver. "I haven't seen them for almost 11 years," he told me. "I don't want my sons to see me as an alcoholic."

He had nowhere to live. He had always been an early riser, and would wake at 4 or 5am, with the shakes, dry heaves and sweats. His first thought of the day – virtually his only thought of the day – was to calm the symptoms with a drink. He would go out to beg and, when he got enough money, then head to the LCBO, Ontario's official chain of liquor stores. His drink was pale dry sherry, a fortified wine that contains 20% alcohol – $7.99 for a 750ml bottle. On his worst days, Windsor was drinking eight to 10 bottles a day. He drank until he lost consciousness. The next day he would do it again. Three or four times a week, someone would come upon him passed out in the cashpoint lobby of a bank or in a downtown park, and call Ottawa's emergency number. The police and paramedics would get him up and take him to A&E or the police drunk tank.

Windsor's lifestyle was not only self-destructive and devastating to his family, it was also costly to Canada's taxpayers. A trip to the hospital cost $243 for the ambulance, and $250 for a doctor's assessment. Going to the police station cost $256 for just one officer to talk to him and make notes. These figures do not include hospital admission or any medical treatment, nor the hours paramedics had to spend waiting in A&E until Windsor was seen. Nor do they include the cost of arrest or a night in a police cell, or the fact that officers work in pairs, so theirs is never the work of just one person. Nor the costs incurred by putting all these public servants to work chauffeuring alcoholics instead of doing their jobs. For Windsor to visit A&E or the police lock-up three times a week, the good citizens of Ottawa were paying at the very least $1,000 (£550) a week and perhaps double or triple that. And all for services that did nothing to help him solve his problems.


In the late 1990s, a tiny group of people was responsible for absorbing a huge proportion of Ottawa's healthcare budget. Greater Ottawa had a population of about 750,000. About 1,000 of its residents were chronically homeless. Roughly half of those were alcoholics. Many were also drug users, and the majority had mental health problems. Health professionals struggled to handle them. Three of the four city shelters would not let drunk people in, and none permitted residents to drink while they were there. Some alcoholics would not go to a shelter if it meant suffering the shakes and sweats of detox, and those who did go in for the night made sure they got good and drunk before walking through the door, in order to stave off detox for as many hours as possible.

One of the people grappling with this issue was Jeff Turnbull. One of the country's most eminent physicians, he was at the time, president of the Medical Council of Canada. Very few doctors with Turnbull's credentials see homeless patients, but he did. He would see the same people in the Ottawa hospital A&E day after day. "I'd give them antibiotics, and they'd show up the next day. I'd say, 'Did you take your antibiotics?' and they'd say: 'What antibiotics?'"

He started to ask his patients about the cause of all this chaos. "Come and see how I live," said one. The man was startled when Turnbull showed up at the corner where he begged from passing motorists, then followed him into the shelter where he went for the night.

Turnbull started to visit shelters regularly to treat their clients. In 1998, one man was causing increasing concern to those who cared for Ottawa's homeless population. Eugene Aucoin would drink mouthwash and fall asleep in snowbanks. "He lost toes to frostbite, and he was a diabetic so his feet just would not heal," said Wendy Muckle, then the director of Sandy Hill Community Health Centre. Turnbull would get to the shelter before 6am to try to give Aucoin his antibiotic injection before he set out in search of alcohol. Once Turnbull chased Aucoin down the street, syringe in hand. Aucoin, with only stubs for feet, managed to get away.

Sheila Burnett, the executive director of Shepherds of Good Hope, the Catholic social services organisation that ran Aucoin's shelter, had an idea: she brought in a bottle of wine from home and gave Aucoin a drink when he woke up, to keep him there long enough to get his medicine.

It worked.

In the summer of 1998, Muckle, Turnbull, Burnett and others – including Ottawa's police, the health department, leaders of the Business Improvement Areas – began meeting regularly to figure out how to help this small group of people who were constantly showing up in the city's shelters, hospitals and jails. They sat down with their most difficult patients and asked: what would have to happen for you to get medical care? From these conversations, they established Ottawa Inner City Health, an association of agencies and organisations with the goal of bringing real help to homeless people. For many patients, the pursuit of alcohol consumed all their energy. But what if they could hand it out, like medicine, as Burnett had?

"We looked around to see if anyone else was doing this," said Muckle, who became executive director of Inner City Health. Just a few months earlier, Seaton House shelter in Toronto had opened what was probably the world's first scheme giving regular doses of alcohol to homeless alcoholics. The program began after three intoxicated men had frozen to death in the winter of 1995. Muckle and her colleagues spent a lot of time on the phone with Seaton House staff.

The men served by the Seaton House program were staying indoors, and seemed to be stabilizing their lives. There had also been no political backlash in Toronto. But Ottawa was a much more conservative city, as Turnbull and Muckle found when they took their idea to city officials. "The mayor looked at me like I had two heads," said Turnbull.

The Managed Alcohol Program was launched in 2001 without any noticeable political opposition, largely because nobody knew about it who didn't have to know. It took some of the most complex patients out of other shelters, who were happy to see them go. The MAP, as it would become known, was opened by Inner City and Shepherds of Good Hope inside Shepherds' large brick building downtown. "It took the strain off A&E, incarceration, and shelters that can't deal with complex issues," said Stephen Bartolo, Shepherds' operations director..

For Turnbull and Muckle, giving the residents alcohol was a means to an end – its purpose was to attract clients to a programme that also provided safe shelter, food, medical and mental health care. That meant the managed alcohol programme had to be part of an existing shelter system. That was not going to be the Salvation Army, which was founded in part to promote temperance.

At first, they struggled to fill the MAP's 10 beds. "We had to do a lot of convincing for people to try it," said Muckle. "Once they were in and saw how much better life was, they were converted. But it was not easy. We used to say that anyone who wanted to be in the program did not need it and anyone who really needed the program was hard to get in."

Funding was a huge problem. "We wanted to avoid any situation where we could be criticized for using taxpayers' money to buy alcohol for alcoholics," said Muckle. Inner City decided that most of the money for alcohol would have to come from their clients' own benefit payments. "For a period of time we had no funding and were often not able to meet payroll. When an invoice came in I would look at it and decide which one of my friends should pay it, and I'd call them up. Board members brought in office supplies."

Buying booze, even the cheapest rotgut, was also expensive. "When we first started our programme, with 10 residents, we were picking up cases of sherry every other day," said Bartolo.

There were also legal hurdles. "To the Liquor Licensing Board, we looked like a drinking establishment – but we could never get a liquor licence," said Turnbull. For example, the cost of putting in a sprinkler system would have been prohibitive. A police sergeant, who was part of the group forming Inner City Health, came up with the solution. The law gave Ontario residents the right to make wine or beer in their own homes and gather to appreciate it – no licence necessary. The MAP was the residents' home. They could make wine – with a little help from the staff. (More than a little, actually.) And gathering to appreciate it would not be a problem.


Today the wine for both the MAP and the Oaks – which opened a decade later to provide long-term housing for MAP graduates – is made at the Oaks. The winemaking room off the lobby is lined with 25 grey plastic barrels (and kept well-locked). The Oaks staff buy bags of ready-made white wine concentrate – the red turned out to be stronger and got people drunk – then add water and yeast. The residents help by cleaning the barrels and doing other jobs, always closely supervised. Overhead pipes take the wine to the pour counter tap, and staff members drive containers of wine across town to the MAP.

The wine is just about drinkable – probably more so if you're used to hand sanitizer. "A lot of our clients prefer quantity over quality," said Bartolo.

One hallmark of all the programs of Inner City Health and its partners, from the beginning, was the second chance. "In a lot of programs, if you slip up, you're out," said Ray MacQuatt, the earnest, endlessly patient Shepherds employee who runs the Oaks. "We're about another chance tomorrow. If you have more good days than bad, we're going to get you moving in the right direction."

Initially, Muckle said, staff at the MAP took leniency too far. "They got their pour to start the day," she said, and then they went out to beg, coming back in time to sleep. "Half the time in the afternoon there were no clients. We continued to serve them when we shouldn't have."

There were daily dramas, scuffles and shouting. There was just one small room and two staff to cope with 10 drunk clients. Arguments inevitably broke out. In the end, it was the clients themselves who wanted drunk people banned. The chaos was making them anxious – and that made them want to drink. They needed to feel safe in their home.

"They told me, 'You have to stop letting drunk people into our program,'" she recalled. "I was astonished. I told them, 'Well, that's you.'

"They said, 'Don't let us in when we're drunk.'"

New rules were brought in: clients needed to clock in 30 minutes before, in order to get the pour. Anyone intoxicated didn't get a drink. Clients who were violent were asked to leave.

"Either way, that does not mean they will not be welcomed back," said Muckle. "Some of the people who need the help the most have taken many tries before they settle in – that is the nature of addiction."


There is a name for the strategy that Inner City Health uses: harm reduction. It is a familiar concept for heroin addicts, first implemented in Liverpool in the 1980s. The approach gained currency amid an HIV epidemic involving injecting drug users who often shared needles. Under this system, health workers give injecting drug users clean needles, and a daily dose of the opioids methadone or buprenorphine, which quiets cravings and allows addicts to live a more normal life. In some countries, people who fail on those treatments can even be prescribed a regular, medically supervised dose of heroin, which is very successful at returning users to stability.

Needle programmes also bring drug users into treatment that they would not otherwise know about or trust. Thus, harm reduction is often the first step to abstinence. But it also recognises that not everyone can quit. Those who cannot are helped to live as healthy and as stable a life as possible.

While harm reduction is now the global standard for working with injecting drug users, with alcoholics, it is not even part of the debate.

Some "wet" shelters – hostels that allow residents to drink – exist around the world, including at least three in London and two in Manchester. But regular provision of alcohol – the pour – exists in only a handful of Canadian cities; Ottawa's is the second-oldest and the most-studied program. Officials from other countries have visited, and Sydney, Australia, has done a feasibility study. But the program is a tough sell. Someone always says: "My dad was an alcoholic and he quit. Why don't these people quit?" said Bartolo.

When news of the programme finally appeared in the media, Turnbull received hate mail, much of it from the US. "A fair amount of people said we are killing alcoholics, and abstinence is the only way," said Turnbull. He shook his head. "We don't walk away from cancer we can't cure; we take a palliative approach. It hurts me to see guys drinking, but the alternative is not giving them any care."

For Ottawa's most serious alcoholics, the door to the managed alcohol system is in the city's downtown area, on the ground floor of the Shepherds' building, which used to be known as Hope Recovery. ("It's hell's asshole," said Muckle. "Nobody ever recovered there.") Inner City Health's program there is now known as TED, which stands for Targeted Engagement and Diversion. TED offers no alcohol, but anyone, no matter how drunk, can come and sleep there. Residents are also allowed to store a bottle for the morning after. It is safer than the street, but still loud and chaotic, and sometimes violent. Several people had died in the shelter – probably of drug overdoses or alcohol poisoning, although the causes of death were not determined – but none since nursing care was brought in. "I'd come inside to pass out, but I didn't want to be that person living there," said Chris Mercredi, who is now at the Oaks. "I couldn't picture myself there. I was ashamed of myself."

The beds at TED have thin plastic mattresses and are arranged four to a room. There are also small lockers, even though many clients have no possessions. (I asked one man what he kept in his locker besides clothes, and his response was "Like what?") A Shepherds' soup kitchen serves meals across the street. Inner City Health gives its regulars laminated wallet cards giving consent for police and paramedics to take them to TED instead of taking them to hospital or the police cells. (The clients get cards because when they are picked up, they are often in no condition to consent to anything.) But in 2014, the program became one of the city's official alternatives to A&E, and 3,480 people came to TED who would otherwise have ended up in hospital. People in serious medical danger still go to A&E, but these days they are comparatively few. Just the transport and initial assessment in hospital would have cost $1.74m; at TED, caring for them cost $300,000.

When you wake up at TED, a staff member greets you. Do you need a nurse? Housing? Do you feel like trying to detox? Or how about trying the next step, managed alcohol? There's a long waiting list for the MAP, but priority goes to the sickest: those whose drinking is out of control and puts them in danger, the people who have run out of options.


Canada's Inuit and aboriginal people are over-represented in the ranks of alcoholics (although they are under-represented as drug addicts). One reason is poverty; another is the effect of a massive state-inflicted trauma. Tens of thousands of indigenous children were taken from their families and sent to church-run residential schools designed to westernize them by separating them from their families, language and culture. Ottawa has the highest proportion of Inuit of any major city outside Canada's north. "They come here and might not have a plan, and end up on the street," said Bartolo.

Simeonie Kunnuk, like many of the homeless alcoholics in Ottawa, has a history of horror. He was sent to a residential school, where he was raped for the first time at seven years old. Sexual and physical abuse continued for years. Kunnuk came to the Oaks in April 2015, and has drastically cut down on his drinking, but the memories still trigger the desire for alcohol. "It's best not thinking too hard about it," he said.

Kunnuk spent 20 years collecting recyclables, making enough to buy his Black Bull malt liquor (a 10% beer). His daily intake was four litre bottles for $15, plus a can of sardines and a loaf of bread.

In November 2014, he woke up at TED after a binge and Ray MacQuatt asked if he felt ready for the managed alcohol programme.

"What time do they start drinking?" Kunnuk asked.

He had no possessions; he simply walked upstairs. But it felt like a different world. MAP, by then, had increased its size only slightly, to 12 residents. He had his own bed. There was medical care and mental health care. There were activities and counselling and, of course, the hourly pour.

Chris Mercredi, who came to the Oaks in October 2015, grew up in a trailer in rural Alberta with two severely alcoholic parents. The family ate bread made of flour fried with lard, and the rabbits his mother hunted. His sister was forced into prostitution – he remembers one day when she triumphantly came home with a bag of groceries, including white bread and hot dogs. Mercredi's little brother, who used to climb into his bed for comfort, was separated from him when they both went into foster care. Mercredi was abused in the foster system, and started drinking at 18.

He is 56, but perhaps the only person in the Oaks who looks younger than his age. He has a full head of hair dyed black, and a salt-and-pepper mustache. He is always neatly and colorfully dressed, with arms full of beaded and chain bracelets. He spoke softly and carefully, clicking his teeth repeatedly, his eye on the clock until it was time to get his pour.

Although a heavy drinker, Mercredi had been employed in home renovation and furniture assembly until a work accident crushed his right arm. He had a steady boyfriend, Lee Crapeau, and worked as a dishwasher making $60 per day – which he immediately spent on drink. He and Lee slept in Ottawa's parks. They had been together for 36 years when Lee died, of alcohol-related illness, in November 2014.

Mercredi had got sober many times. "Once I went to detox and stayed 28 days, to collect my thoughts. As soon as I got out," he said, "I went straight to the booze store to buy beer."


Every week, the MAP's residents gather in the common room for a meeting. They get their pour, then take their mugs and sit at round, black tables. When I visited, a few men rolled loose tobacco into cigarettes. It was overheated and stuffy. One of the residents had been aggressive over the weekend, but at midmorning, no one seemed intoxicated, and the meeting's tone was perfectly civil. People sipped their drinks quietly.

Steve Parker from Shepherds and Amanda MacNaughtan of Inner City Health led the meeting while Annabelle, MacNaughtan's golden retriever, provided a consoling presence.

"There's been quite a few bottles of non-beverage alcohol found in your dorms," said MacNaughtan.

"Listerine is only 99 cents," said a tall man. "Sometimes it's our last resort."

The discussion turned to comments from residents. "More alcohol!" one man called. But residents also asked for milk. And movie night with popcorn. And a trip to an Ottawa Redblacks football game. And a visit to a museum exhibit of Inuit carvings. On a wall-list of requests for programs or activities, someone wrote "documentary nights" and "yoga/relaxation classes". Next to it was an invitation to join an aboriginal carving empowerment circle.

I was reminded that once upon a time, these patients had families, careers, talents. Muckle recalled driving some residents to visit a patient who was hospitalized, listening to them sing along heartily to an opera CD. One of Inner City Health's first patients, Normee Ekoomiak, was a renowned Inuit artist, with work hanging in the Canadian Museum of History. Annie Iola, a resident of the Oaks, was a documentary film-maker and had studied to become a pilot. Kunnuk had worked for the National Inuit Organization, where he wrote a regular column answering questions about Inuit culture.

Lots of people in Ottawa would appreciate free football tickets. And yoga classes. And a bed and free food. And, of course, wine served up every hour. And Little Ray's Reptile Zoo does sound interesting. But many of these residents have alcohol-related brain damage, and other illnesses that were either a cause or result of alcoholism. They will never work. If this program can help keep them out of crisis services, it is a bargain. And the studies say it works. A small, peer-reviewed study of the MAP, led by Tiina Podymow of Inner City Health and the University of Ottawa (Turnbull was a co-author) was published in 2006 in the Canadian Medical Association Journal. "Then a media circus of nuclear proportions blew up," said Muckle. Most of the media treated the study straight, but comedians and commenters pounced, including Jay Leno, who talked about the crazy Canadians giving free booze to homeless alcoholics. One commenter compared it to giving little girls to pedophiles.

"However, by that time we had been in operation for four-and-a-half years, and none of the problems people predicted had actually happened, so it was a bit hard to mount much opposition," said Muckle. "Even the Salvation Army – the anti-alcohol crusaders – said that while they could not offer that kind of programme themselves, they were a part of Inner City Health and strongly supported this programme because it had such good results."

Bernie Pauly, a scientist at the Centre for Addictions Research of BC, at the University of Victoria, and Tim Stockwell, the center's director, are finishing a major study of five Canadian managed alcohol programmes. In-depth research on programs in Vancouver and in Thunder Bay, a city of 100,000 in northwest Ontario, has found that they greatly reduced the harm of drinking. Participants drank more wine and less Listerine, and spread their drinking out over the day. They greatly improved their safety, stability, mental and physical health, housing, family relationships, life skills and self-esteem.

Did they cut down on their drinking? That was not clear – and it is not the focus of the programmes, strange as that might seem. Podymow's study of Ottawa's MAP had found that clients in the MAP went from an average of 46 drinks per day down to eight – but that was only counting the pour; researchers were not counting how much people drank outside. Stockwell said that in the programmes he studied, people drank about as much outside as they got from the pour. Doubling the pour would still mean the Ottawa MAP was associated with a huge drop in drinking.

In Thunder Bay, some participants reported that they had fewer no-drinking days than did people still on the street, probably because they had regular access to alcohol, which they would not have if they were broke or in prison. What seemed clear was that they were managing it better and suffering less.

Those who do well in the MAP can move on to the Oaks, living in one of the converted hotel rooms in the orange-and-cream four-story building, with a small outdoor space in the back and, importantly, a gate, so staff know who is leaving and who is coming in. Residents are a self-selected group – "those who don't want to be around this craziness any more", said Turnbull. "They want to reconnect with family, they want a dog, a garden, a Christmas party."

Every year, residents pile into vans to drive outside the city to the farm where Turnbull lives. With chainsaws and tractors, the men cut down three trees to take back to the Oaks for the annual Christmas party, to which the Oaks invites city officials, and residents invite their once-estranged families. It is a huge event, a celebration of normality. Decorating starts just after Halloween.

Everyone I talked to at the Oaks said they had drunk outside the program when they first arrived. They would buy liquor and try to sneak it into their rooms. Oaks staff try to police them: they persuaded the nearby dollar store to take the Listerine and rubbing alcohol off the shelves and put them behind the counter. "We suspect everyone who goes out," said Young. "They're searched to make sure they're not carrying it in, but they hide bottles in the bushes. More recent admissions are battling these little demons, the call to go outside and drink. In a year we won't see those behaviors."

"I gave up on trying to outsmart them," said Kunnuk. "I didn't realize they knew where we went. I'd put the wine on the gate at the corner, come in, and go around the back and take it. But they could tell," he said.

Like users of all long-term shelters in Canada, people at the Oaks pay for their housing and food by signing over their disability checks. Rooms are large and comfortable, but most people spend their time in the lobby. Bright orange walls display their art, photographs and poems. There are televisions, computers and a piano. When I visited, the Oaks was in the middle of a bedbug extermination campaign. Furniture was piled against the lobby walls and side rooms were stuffed with plastic bags of clean clothes.

Residents do have some cash: about $40 each month from their personal benefits after paying for the pour, cable television and, if they smoke, tobacco. If someone is caught spending their allowance on booze, MacQuatt steps in to hold it. They then have to come to him during set banking hours to ask for their money, and tell him what they plan to buy.

For some at the Oaks, the change of habits came too late to save their liver or heart. Stockwell said that people with this level of alcohol use tend to die 25 years younger than people who don't have alcohol problems – but the death rate is much higher among those who continue their lives of rough sleeping and binge drinking. Turnbull talks about finding a way to bring younger people into the program, before drink has caused irreparable damage. But younger people do not feel comfortable in the Oaks, which Muckle called "a nursing home of sorts, with alcohol".

Windsor is one of the youngest residents – not yet 40, and less marked by drink than many of the others. On Saturdays, he goes downtown to beg and buys two or three bottles of pale dry sherry. He'll drink two at night and save one for the morning. He stays at TED.

He'd like to get his old job at the moving company back and continue drinking on Saturday nights. He still cooks his grandmother's recipes – cooking is a marker of normal life for many people. He makes spaghetti sauce for the Oaks and recently represented the Oaks in Shepherds' annual chili cook-off. He is mayor of the Oaks, responsible for representing residents in regular meetings with MacQuatt.

Chris Mercredi left the MAP in October for the Oaks. He is the only Oaks resident who is actually non-resident; he lives in a cheap apartment nearby, but he still spends the day at the Oaks. When I first met him he told me he had been getting drunk whenever he had money, but not any more. "I can definitely say the apartment comes first," he said. He wants furniture. He wants to start cooking again – he always cooked for Lee. He wants a kitten.

Through the program, Mercredi had a bed, a roof, food, good medical care, a place to sit and listen to his music. With time, he might follow the pattern and reduce his consumption. He was still getting over Lee's death. The first thing Mercredi did in his apartment was tape Lee's photo to the refrigerator. He talks to it every day. "Every time I pass it, I say, 'I love you, I miss you,'" he said, kissing his fingers and dabbing the air.

The next time I saw him, though, he was drunk at 11am. He had borrowed $20 from his landlord, saying he needed it for food. He bought two bottles of beer and two bottles of Imperial sherry. He drank the beer and one Imperial before he got home, and then half of the second Imperial. Then he passed out.

"I was so happy to see that bottle beside my bed when I woke up," he said. "I woke up light-headed and had a drink, which really relieved me. The wine here – it helps. But it's not as much as I want to drink. Alcohol is what I need in my system, my gasoline, my energy drink. I have to have that bottle in my hand."

I told MacQuatt later that I had found the way Mercredi talked about drink – the raw need and longing in his voice – painful to hear. He paused for a long time. "We know alcohol is very important to our residents. It's the number-one thing," he finally said; that's why we need this program. "We just want to see improvement. If they're going out every day and getting intoxicated, we'd say they're not ready. But for someone like Mercredi to go out and get intoxicated one day is par for the course. He's doing great."



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Health Inequities

Health Inequities

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