The introduction of managed alcohol programs (MAPs) provides a new alternative in the system of care for those who are experiencing severe problems with alcohol combined with homelessness and housing instability. While potentially a form of treatment, MAPs are underpinned by a harm reduction approach in which the main goals are to reduce harms associated with drinking in street-based settings, drinking non-beverage alcohol (NBA) and homelessness or housing instability. There is promising evidence for the effectiveness of MAPs to improve outcomes related housing, health and quality of life, alcohol consumption including reduced NBA use, alcohol related harms, and reductions in other service use.