On 4 October 2006, the Health Service Executive (HSE) published an assessment of the need for drug and alcohol detoxification services in counties Cork and Kerry.1  Dr Mai Mannix, the report’s author, presented the main findings at the launch of the report in Cork.

Dr Mannix reviewed data from a number of national databases to determine the numbers treated for drug and alcohol dependence and the medical consequences of drug and alcohol use. She interviewed 17 clinical decision makers from a range of professional backgrounds and one health service manager about their experiences of managing clients requiring detoxification services. Six clients were interviewed about their experiences of being assessed for and undergoing detoxification. She sent 512 questionnaires to doctors (GPs, hospital consultants and psychiatrists) and addiction counsellors in Cork and Kerry. Of these, 316 (62%) completed forms were returned. This questionnaire ascertained the respondents’ experiences of detoxification services and their recommendations for the future.

Review of existing data sources

In relation to drug and alcohol use among the population living in Cork and Kerry, a report2 published on the same day revealed that in 2004 34% of the population aged between 15 and 44 years had ever used a drug; cannabis was the most commonly used drug (32%); and opiates and solvents were used less frequently (2%). According to the 2003 SLAN survey,3 21% of the adult population of Cork and Kerry who drank on a weekly basis consumed more than the recommended weekly limit for alcohol.  The number of cases who sought treatment for problem alcohol or drug use at the addiction services and were reported to the National Drug Treatment Recording System (NDTRS) increased steadily, from 602 in 1999 to 1,859 in 2002; this was followed by a small decrease to 1,778 in 2003. Alcohol was the main problem substance in approximately two-thirds of the cases reported to the NDTRS.  The National Psychiatric In-patient Reporting System recorded approximately 200 new cases treated for problem alcohol use in psychiatric units in the region each year between 2000 and 2002, while an annual average of 35 new cases were treated for drug dependence during the same period.  The Central Treatment List reported that 38 persons with addresses in counties Cork or Kerry received methadone treatment during 2004; the small number of cases may have been due to a lack of treatment availability rather than to a low level of demand.

The medical consequences of drug and alcohol use in Cork and Kerry were measured by reference to drug- and alcohol-related admissions to acute hospitals and death notifications. There was a notable increase in alcohol-related admissions to acute hospitals in the region, from 1,634 in 1999 to 2,360 in 2001. The number of drug-related admissions to acute hospitals remained relatively stable at around 55 per year during the same period. There were 25 direct alcohol-related deaths and 55 direct drug-related deaths in the region in the period 2001 to 2003. Between 1995 and 2001, the rate of deaths from chronic liver disease and cirrhosis of the liver (conditions associated with high levels of alcohol consumption) increased annually in Cork and remained relatively stable in Kerry. 

Detoxification requirements

Dr Mannix reported an increase in the number of addiction services providing treatment for problem drug and alcohol use, from three in 1999 to 10 in 2003. She noted that, although a number of databases held data on alcohol and drug dependence, little information was available on the number of detoxifications provided to those treated. (Up until 2004, the type of substance was not specified in cases of detoxification reported to the NDTRS.) Using data from an area in the United Kingdom and a model developed by a Canadian researcher, Dr Mannix estimated that 611 people living in Cork and Kerry would require detoxification from alcohol each year, 55 of them on an inpatient basis.

In-depth interviews

The key decision makers interviewed had experience in providing detoxification services in either a community or an inpatient setting. They reported that there was a need for a consultant psychiatrist specialising in addiction to lead the service. They said that a dedicated inpatient service was required in the region, and that general practitioners should be facilitated in providing additional outpatient detoxifications. They felt that services were required for people with drug and alcohol problems who were homeless, and that liaison workers were required to link detoxification with medication-free therapy and aftercare. The key decision makers were reluctant to develop a service for opiate users.

The health service users interviewed reported that outpatient detoxification was available from general practitioners but that inpatient detoxification could be difficult to access. They agreed with the key decision makers that additional inpatient detoxification services were required. 

Postal survey

The survey of health service providers in the region revealed that all the psychiatrists and three-fifths of the general practitioners provided a detoxification service. The average number of detoxifications was 33 per year by psychiatrists and six per year by general practitioners. These were mainly detoxifications from alcohol, although 60% of psychiatrists and 30% of general practitioners had provided detoxifications from drugs (mainly hypnotic and sedative-type drugs) in the recent past. While almost three-quarters had referred clients to a service outside their own service, 65% reported difficulty in accessing other services, most notably the inpatient psychiatric service. Just 71% had access to aftercare services for clients who had had a successful detoxification. With the exception of the psychiatrists, all service providers were dissatisfied with current service provision in the region. The majority recommended setting up a special detoxification unit, the employment of a consultant psychiatrist specialising in addiction to lead the service, and the expansion of general practitioners’ formal involvement in the service. The vast majority agreed that addiction counsellors should provide the link between detoxification and medication-free therapy or aftercare. These recommendations were in line with those of the key decision makers.

Both the service providers and the key decision makers were reluctant to develop a service for opiate users in Cork and Kerry; this is possibly due to a lack of expertise in dealing with opiate-dependent clients.

1. Mannix M (2006) Drug and alcohol detoxification services: a needs assessment for Cork and Kerry 2005. Cork: Health Service Executive South. 

2. Jackson T (2006) Smoking, alcohol and drug use in Cork and Kerry 2004. Cork: Health Service Executive South. 

3. Centre for Health Promotion Studies, NUIG (2003) Survey of lifestyles, attitudes and nutrition (SLAN) and the Irish health behaviour in school-aged children (HBSC) survey. Dublin: Department of Health and Children.