This article assesses the implementation of the policy on the treatment of alcohol problems in Ireland during the period 1986–2007. At the commencement of this period, a major policy statement in relation to the treatment of alcohol within the mental health care system presaged radical change – in effect it proposed a shift from the then dominant disease model of alcoholism to one that was focused on public health principles. Towards the end of the period, a further statement made the rather sanguine claim that many of the intended changes had taken place. This article adopts a more critical approach. Using epidemiological data from annual reports on the activities of mental health centres and also drawing from a recently conducted action-research project that focused on addiction treatment within a regional health authority, the article highlights that change has been slow and that some of the main tenets of the disease model remain in place.