Taking the initiative in facing up to alcohol addiction
Dependence on alcohol and other drugs is so prevalent in Ireland that it is often ignored – but the time has come to start a conversation about it, say doctors
Knocking it back: more women and people over 50 are suffering from addiction now. Photograph: Thinkstock
Two people die every week in Ireland from overuse of alcohol. Alcohol addiction is so prevalent in Irish society that many experts say we don’t even notice it any more. In fact, it is often brushed off as a lifestyle choice.
A recent survey found that two in five people believe that those who are addicted to or dependent on alcohol or illicit drugs should be able to stop if they are willing to.
The same survey found that one in two people knows someone with an addiction or drug/alcohol dependency.
Dr Hugh Gallagher, a HSE GP co-ordinator in addiction services in north Dublin and medical director of the One Step Clinic, says more and more women and people over 50 are suffering from addiction, mostly to alcohol. Due to the high tolerance for alcohol in Ireland, many of them don’t seek help with their problems until they reach rock bottom.
A further difficulty is that treatment services are often hard to find and many family doctors shy away from confronting patients with symptoms linked to alcohol addiction.
“The HSE addiction services mainly deal with opiate addiction, and there is an added problem that general mental health services no longer deal with alcohol addiction,” says Gallagher.
With his specialist interest in addiction, Gallagher has been involved in two recent projects – one public, one private – intended to provide better services for alcohol problems. The first is the One Step Clinic, a new private addiction clinic for outpatients in Dublin 15. Run by a doctor and a clinical nurse specialist, with support from counsellors and pharmacists, the clinic is the first in Ireland to offer an opiate blocker, a medical implant that blocks the body’s pleasure receptors, and thus reduces the effects of drugs and alcohol.
“These implants are effective in treating those addictions as they reduce the high associated with alcohol or opiate consumption,” says Gallagher.
The clinic also offers outpatient alcohol detoxification services and online addiction counselling.
The second initiative Gallagher is involved in is the Community Alcohol Response and Engagement (Care) Alcohol Treatment Pathways programme, which ran as a pilot project for one year in three drugs-taskforce areas: Ballymun, Finglas and north Dublin. Firmly rooted in each community, the project used already available local support services along with clinical nurse specialists and doctors specialising in addiction. Some 94 per cent of GPs who referred patients to the project said its existence increased their capacity to support patients with alcohol problems.
One key aspect of the programme was that it offered psychosocial support as well as medical and pharmacological treatment. However, in spite of an evaluation report showing how the model could be replicated throughout Ireland, long-term funding for the project has not materialised.
Barbara Condon is the manager of Finglas Addiction Support Team (Fast). “Nobody wants to fund addiction services,” she says. “Nobody wants the services near them, and the clients themselves are ambivalent about coming to us.
“The stigma for drug and alcohol abusers is huge and many of them have led a lifetime of exclusion and multiple traumas. We offer belief and hope to those who come to us. It is an intensive full-time service with rapid access, yet some people take a year to come to us. The programme is not just for detoxification and chronic drinkers; it also offers early intervention for moderate drinkers.”
Aodhán Ó Ríordáin, Minister of State for Drugs Strategy, launched an evaluation report on Care in autumn this year. “We have a complete and utterly dysfunctional relationship with alcohol in this country, “ he says. “It’s a lie that it is all about young people. One-third of those with alcohol problems are over 50. Ireland never said no to overindulgence in substance and alcohol misuse.
“We tend to dehumanise people who are addicted. We’ve taken a long time to break the stigma around suicide and mental health problems; now it’s time to break the stigma around alcohol misuse. As long as the stigma continues, people will hide their addiction.”
Gallagher says the common perception is that you can’t help someone who is in denial of their problematic drinking and unmotivated to change. He disagrees.
“Behind that veneer of denial is an ambivalent person, uncertain about whether they can change, scared of what change entails, or believing that their family history destines them to be a drinker,” he says.
“Research shows that 40 per cent of this group of non-changing, higher-risk and dependent drinkers try to change every year. Like the rest of us, they are more complex people with conflicting hopes, beliefs and aspirations.”
Gallagher suggests that showing that person that you believe in him or her is crucial. “At times, this will be tough, as some patients seem set on a course that will destroy their lives or the lives of others. However, people do change. Even those who seem to have abandoned all hope of a different life can turn themselves around.”
For GPs, Gallagher suggests that starting the conversation about problematic drinking is essential. “If no one talks about the drinking, opportunities to change will be missed and the pressure on the person to change will be minimised. In fact, it can make it seem like nothing is wrong.”
He also says it is important to understand why it is difficult for change-resistant drinkers to motivate themselves.
“The things that pushed someone to drink are not necessarily the same as those that prevent change,” he says. “For example, there is increasing evidence that alcohol-related brain injury is present in a far greater proportion of drinkers [than previously thought]. Poor nutrition and liver disease can reduce energy levels and increase sleep problems.
“A high proportion of drinkers are also depressed due to the effects of alcohol on their central nervous system. And to that can be added low self-esteem, mental health problems, social or housing problems or peers who sabotage change.”