San Francisco has been taking an unconventional approach to dealing with alcohol addiction among its homeless population -- the city is offering free vodka and beer through its Managed Alcohol Program.

The program, established during the COVID-19 pandemic, aims to reduce emergency room visits and interactions with law enforcement while preventing homeless individuals from perishing due to withdrawals. As with most harm reduction initiatives, the program has ignited a heated debate over its efficacy and morality.

The Managed Alcohol Program (MAP), which is administered by the city’s Department of Public Health, doles out controlled doses of alcohol to homeless participants experiencing severe alcohol addiction. Nurses provide doses of vodka and beer based on individualized care plans.

Since its creation, the program, which started out with 10 beds, has served 55 clients, according to officials from the Department of Public Health. The now 20-bed program, which costs about $5 million per year, operates out of a former hotel in the heart of the Tenderloin. Nurses dispense regimented doses of vodka and beer to participants at certain times of day based on care plans.

Such programs don’t focus on sobriety, experts say, but rather on improving participants’ overall health while decreasing hospital stays and calls to police.

But the city’s efforts came under scrutiny this week, after the chair of the board of a local nonprofit that pushes abstinence shared posts on social media accusing the city of wasting millions of taxpayer dollars on a program that gives booze to homeless people struggling with alcohol addiction.

The California Health Care Foundation explained in 2020 that “withdrawal from alcohol often requires close monitoring in medical detox programs or in hospitals.”

This unique managed alcohol model aims to significantly reduce harm for individuals while simultaneously reducing the risk of COVID-19 transmission. By providing clients with a medically supervised supply of alcohol and supportive services, the program provides an incentive and support structure for them to remain in the isolation or quarantine setting for the duration of their stay and endure the realities of this temporary placement.

Shannon Smith-Bernardin, a professor at the UCSF School of Nursing who helped create the program, explained that it helps to stabilize participants’ alcohol consumption, which keeps them out of jail, off the streets, and out of the emergency rooms. “We were trying to figure out how to keep people who are homeless alive during COVID, but also work with them around their medical needs,” she said, describing the factors that led to the creation of the program in 2020.

However, not everyone is in favor of MAP. Adam Nathan, CEO of an AI company and chair of the city’s Salvation Army advisory board, argued against it in a lengthy thread on X. He acknowledged that it's shown “some promise” but criticized the lack of focus on recovery from addiction.

The whole thing is very odd to me and just doesn’t feel right. Providing free drugs to drug addicts doesn’t solve their problems. It just stretches them out. Where’s the recovery in all of this?

Did you know San Francisco spends $2 million a year on a "Managed Alcohol Program?" It provides free Alcohol to people struggling with chronic alcoholism who are mostly homeless. I stumbled upon the building where they have this program. This is what I saw.🧵

— Adam Nathan • blaze.ai (@adampnathan) May 8, 2024

Even progressive Mayor London Breed has expressed skepticism about the program, saying that “Harm reduction was ‘not reducing the harm’ but ‘making things far worse.”

Tom Wolf, a recovering heroin addict, echoed Breed’s sentiments, asking whether the city is “just going to manage people’s addictions with our taxpayer dollars in perpetuity forever.”

He argued that the city “should be spending that money on detox and recovery.”

On the other side of the coin, supporters of the Managed Alcohol Program point out that it has significantly decreased the usage of emergency services among participants. The program saved $1.7 million over six months due to decreased emergency services, emergency room visits, and hospital stays.

Indeed, emergency services might be more costly than it might initially seem. A 2022 report revealed that the city spent $4 million on ambulance rides for only five individuals.

Public health officials have also countered criticism made by critics intimating that any homeless individual could walk into a facility and get alcohol. “Alcohol is dispensed by a nurse and unhoused people who aren’t in the program may not walk into the facility to get free alcohol,” they asserted.

As the debate continues, San Francisco’s Managed Alcohol Program will be under closer scrutiny, especially with the $5 million price tag.