Backgrounder: The Managed Alcohol Program (MAP)
Prepared by Keewatinohk Inniniw Minoayawin Inc. (KIM Inc.) – July 2025
What is MAP?
A Managed Alcohol Program (MAP) is a harm reduction and evidence-based approach and one of the tools employed by Keewatinohk Inniniw Minoayawin. It offers individuals with severe alcohol dependence small, scheduled doses of mushkehke (alcohol), which is used as a medicine. When used correctly it eliminates the severity of alcohol withdrawal. The prescribing is calculated based on science-based protocols. The standard is that patients are to be monitored twice a day, 7 days per week – by peers, in the ideal scenario.
For the fire evacuees, KIM staff deliver the medicine and are well trained, harm-reduction specialists working with Red Response volunteers who are peers.
Why is MAP needed?
There are many people who do not access known pathways to care and treatment, such as having a therapeutic relationship with a family physician, nurse, or alcohol counsellor; and access to a detox center and / or treatment and / or land-based activities.
For them, MAP offers one possible solution.
We understand that many people who participate in MAP have faced multiple layers of trauma – personal, family and community. Alcohol is known as a very dangerous substance in communities. These individuals are at greater risk of harm to themselves and their families, including but not limited unsafe alcohol consumption (e.g., non-beverage sources like hand sanitizer), criminalization, family discord, or health crises due to unmanaged withdrawal and unaddressed health needs.
How does the KIM MAP work?
MAP participants are assessed by KIM health staff using clinical tools, including the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) and the Brief Alcohol Withdrawal Scale (BAWS). If eligible, a health plan is created and participants receive carefully dosed amounts of mushkehke which is administered on a schedule to prevent alcohol related harms such as withdrawal. Participation is always voluntary and supported by ongoing care, trust-building, and continuous monitoring.
What is the philosophy behind MAP?
MAP is grounded in harm reduction specific to First Nations. This means it is trauma-informed, non-judgmental, and relationship-based. It recognizes alcohol, when used in regulated doses, is mushkehke (medicine) for some individuals.
The re-establishment of relationships is the core philosophy to the entire approach – relationships that have been damaged and even severed. Alcohol consumption is not the focus, rather it is the conduit to healing in this context.
What about abstinence?
MAP is not a replacement for abstinence-based care. KIM Inc. supports both abstinence and this harm reduction approach, acknowledging that there are multiple pathways to wellness. Abstinence-based models and harm reduction approaches can work together. MAP offers an alternative pathway for individuals who are not ready, able, or willing to abstain from using alcohol, but who still need care and support.
Where is MAP offered?
MAP is currently being offered in one location where evacuees from northern First Nations are staying due to wildfire evacuations. The program is coordinated through KIM Inc. with support from Red Response community-based volunteers.
Is this controversial?
We recognize MAP challenges traditional views of addiction treatment. But it is a life-saving option for individuals who are often left out of existing systems. It reduces the risk of withdrawal, harm, and death. Evidence from other jurisdictions shows MAP can also reduce hospital visits, police calls, and the use of non-beverage alcohol.