Addiction services - what's available?

Breaking the habit…

The extent of the drugs problem that Ireland faces today would be unrecognisable to people living only a quarter of a century ago. Back when alcohol and nicotine were the hardest of the nation's favoured drugs of choice, no one could have foreseen how quickly and devastatingly heroin, a medication in times past, would take hold on a generation of young people.

Yet since the drug first obtained a foothold in Ireland in the late Seventies, its use has escalated and today heroin addiction is a fact of life for many people, not only in Dublin, but in many towns in Ireland. The extremely addictive nature of the drug makes it particularly difficult for people who take it regularly to stop. Unlike some other illegal drugs, such as cannabis, the body adapts physiologically to heroin quite quickly. This means that the physical cravings can be great and withdrawing from using it can be very hard indeed.

Heroin is a highly addictive substance, which makes withdrawal a difficult process.

For many who take heroin, treatment will not suffice. Their addiction will end in tragedy. In 1997, nearly 80 people died as a result of taking drugs. Some of these deaths were accidental overdoses and reactions involving medication, but the majority were illegal drug overdoses.

Breaking free

One recent study found that most heroin addicts will never be able to break free from their addiction. It revealed that in addition to the physical problems associated with taking heroin, addicts tended to suffer from depression, anxiety and physical illness as a result of their failed attempts to quit the drug.

"Drug addiction is a complex illness", explains Noreen Byrne of the Northern Area Health Board. "For many people, drug addiction becomes chronic, with relapses even after long periods of abstinence. Because addiction has so many dimensions and disrupts so many aspects of an individual's life, treatment for this illness is never simple".

There are an estimated 13,000 heroin users in the Dublin area.

In the NAHB region, there are around 2,000 patients receiving treatment for drug addiction. Of these, around 600 are being seen by their family doctors and the remainder are dealt with by central treatment services. The South Western Area Health Board also covers parts of the city which have been blighted by heroin. There are over 2,200 clients currently receiving treatment in the board’s area. It provides services from nine centres and nine satellite clinics. Nearly 60 GPs provide services under the methadone treatment system.

But throughout the city there are only 5,000 treatment places for an estimated 13,000 addicts. Many drug users remain beyond the reach of health board services, and as they are often homeless as well, they rarely come in contact with any branch of the health or social services, apart from the Gardai.

There are a small number of private addiction treatment services in Ireland but places are limited and many people can not afford this kind of care unless they have private health insurance. Even then cover is limited to a maximum amount of days for alcoholism or substance abuse treatment.

Needle exchange

At the Merchant's Quay Project in Dublin's inner city, Dermot Kavanagh helps to run a drop-in centre where active drug users can exchange their needles, receive some medical care and obtain advice on safer drug use, improving their health and trying to quit. The centre receives over 200 visitors each day - around 4,000 individual drug users a year.

"At Merchants Quay we work with drug users at whatever stage of addiction they happen to be", he says. "We run a needle exchange for them because our real emphasis is to assist them in reducing the harm associated with taking drugs. We have nurses on hand who can treat them for drug related injuries like abscesses".

Only 15% to 20% of heroin users who complete a treatment programme will remain drug free for life afterwards, it is estimated.

In addiction centres, patients are given a range of services designed to help them withdraw from drugs and rejoin normal society. Many addicts will have had adverse experiences with the police, either because possessing heroin is a crime, or because they have committed crimes to fund their addiction. Others may be suffering mental difficulties as a result of their addiction. All will have been physically affected by the drugs they have taken.

We offer structured support programmes for people who want help in quitting drugs", says Dermot Kavanagh. "These people might already be on methadone maintenance programmes. These day programmes emphasise education, training, counselling and how to use their leisure time. Once a person no longer spends every hour of the day looking for drugs or looking for money to get drugs, they have to learn how to fill their time".

Professional staff

At most addiction centres, addicts are overseen by a consultant psychiatrist, backed up by a multi-disciplinary team of doctors, nurses and social workers. They are helped to detoxify, sometimes with the assistance of methadone. The centres provide patients with education, prevention techniques, counselling and medical support.

People who complete a course at a treatment centre need help in rehabilitating themselves back into society, otherwise it is always possible that they will relapse. Various rehabilitation and reintegration services exist, usually based in communities that have seen years of drug addiction. Often, former addicts are involved in the organisation of such services.

Drug users need assistance in rehabilitating themselves into normal society.

In some cases, addiction treatment and rehabilitation is available under the same roof. These centres are often private, grant-aided organisations that can provide an integrated approach to dealing with drug addiction. Many addicts have received little formal education and they need to develop new talents to secure a job and a foothold in life.

Educational and social needs

Merchants Quay runs a 12 week residential programme on a farm where the participants can develop farming related skills and learn to break free from the environment in which they used to take drugs. A health board funded project, Soilse, also attempts to treat addiction by addressing the person's social and educational needs.

"Soilse puts great store in creativity, respecting and appreciating the enormous potential each person possesses", explained Noreen Byrne. "Art, drama, music, photography, dance, creative writing and video are used to allow for self-exploration and expression".

By offering drug users the chance to explore a different and more rewarding lifestyle, addiction treatment centres address the root problem, which often goes beyond the physical addiction. Training drug users in life skills, employment training or the arts, opens up a route for them back into the world the rest of us inhabit.

Nevertheless, despite the growth of services to help drug users break the cycle of addiction, crime and ill health, there remains a lack of vision to properly address Dublin's heroin problem. Dermot Kavanagh believes it is time that the authorities considered practical solutions, no matter how controversial they may initially seem.

European experience

"Figures from Germany, Switzerland and Holland show that providing safe, clean, monitored places for drug users to inject needs to be considered seriously here. The tabloids will talk of 'shooting galleries', but needle exchanges were shocking five years ago and giving out methadone was shocking ten years ago. Our view is pragmatic - if any initiative reduces the level of drug related deaths and misery, we want to see it considered in Dublin".

The Merchants Quay Project's record in successfully rehabilitating addicts into normal life is good. In conjunction with UCD, they train addiction treatment workers for the health boards and community groups in order to share their knowledge. If they believe that the next step in the war against heroin is to set up such safe areas for addicts to take heroin, then it might be time to consider it.

A drugs helpline is available at 1800 459 459. This helpline provides advice and information about services to drug users and to family or friends who may be worried or who have experienced a drug problem.

Where to go for addiction services:

Addiction services are available within various health boards and at:

  • Anna Liffey Drug Project, 13 Lower Abbey Street, Dublin 1, 8786899
  • Arbour House Treatment Centre, St Finbarr's Hospital, Cork, 021-968933
  • Aisling Group and Bradan Foundation, Dowdstown, Navan, Meath, 046-75979
  • Coaim, Nelson Mandela House, 44 Lwr Gardiner St, Dublin 1, 8338033
  • Coolmine House, 19 Lord Edward St, Dublin 2, 6794822
  • Cuan Mhuire Centres, Cardington, Athy, Kildare, 0507-31493
  • Drug Treatment Centre Board, Trinity Court, 30-31 Pearse St, Dublin 2, 6771122
  • Hanly Centre, The Mews, Eblana Avenue, Dun Laoghaire, Dublin, 2809795
  • Merchant's Quay Project, Dublin 8, 6790044
  • Rutland Centre, Knocklyon House, Knocklyon Road, Dublin 16 - a private residential treatment centre, 4946358
  • Smarmore Castle Private Clinic, Co Louth - a 22-bed addiction treatment facility. For more, click here

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