Alcohol Marketing: Discussion Joint Committee on Health and Children Debate Tuesday, 25 October 2011

Chairman: I welcome the following: Mr. Mick Devine, clinical director and clinical manager at Tabor Lodge; Mr. Finbarr Cassidy, treatment manager at Fellowship House; and Ms Eileen Crosbie, treatment manager at Renewal Women’s Residence. I also welcome the representatives of Tabor Lodge in the Visitors’ Gallery, namely, Mr. Pat Coughlan, chairperson, Ms Aileen O’Neill and Ms Mary Coughlan. This is the first of a series of meetings the joint committee is holding on the issue of alcohol marketing, with particular reference to minimum pricing and the targeting of younger people. Our guests today will speak from the perspective of service providers for young people. They perform trojan work in Cork in the provision of treatment and support services.

 

Witnesses are protected by absolute privilege in respect of their evidence to the joint committee. However, if they are directed by it to cease giving evidence on a particular matter and continue to do so, they are entitled thereafter only to qualified privilege in respect of that evidence. They are directed that only evidence connected with the subject matter of these proceedings should be given and asked to respect the parliamentary practice to the effect that, where possible, they do not criticise or make charges against a person, persons or an entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice or ruling of the Chair that they should not comment on, criticise or make charges against a person or persons outside the Houses or an official by name or in such a way as to make him or her identifiable.

 

I invite Mr. Devine to make his opening statement.

 

 Mr. Mick Devine:  I thank the joint committee for giving us the opportunity to make a presentation today on behalf of Tabor Lodge Addiction Treatment Centre, County Cork. I will provide members with a little background information on us and the organisation. I am the organisation’s clinical director, as well as being treatment manager at Tabor Lodge. I am accompanied today by Finbarr Cassidy, who is the treatment manager of Fellowship House and Eileen Crosbie who is treatment manager of Renewal. Those are two step-down facilities - Fellowship House for men and Renewal for women - for people who have completed a treatment episode in Tabor Lodge. Each of us is a member of the Irish Association of Alcohol and Addiction Counsellors.

 

In addition to being the clinical director of our company, I also represent the wider voluntary sector for addiction services on the National Drug Rehabilitation Implementation Committee, NDRIC. This committee is responsible for implementing the recommendations of the rehabilitation report. The main recommendations of this report are that comprehensive rehabilitation services are necessary in order to provide a full treatment for people suffering from addiction and that these services need to be properly co-ordinated and funded, working in a partnership approach.

 

I am also the secretary of a group of treatment centres similar in function to Tabor Lodge. Representatives from the Rutland Centre in Dublin and the Aislinn Centre in Ballyragget, County Kilkenny, have already addressed the committee. Our treatment model is very similar. There are also units in Donegal, Mayo, Clare, Kerry, Tipperary and Wexford. We have a national association coming together to form a strategy and deal with matters relevant to treatment delivery.

 

I have also been a member of the southern regional drugs task force since its inception in 2003. Mr. Cassidy represents the voluntary sector on the Cork local drugs task force and is the chairperson of a cluster of voluntary and community-based organisations in the region. So we are very active not just in delivery of treatment in our own units, but also in playing a part in treatment delivery in the region.

 

Our mission is to care for people with addictions and to care for their families, and we have been providing this service since 1989. The organisation was founded by the Sisters of Mercy. Last year we celebrated 21 years in operation and President McAleese visited us to join that celebration. Primarily we treat people addicted to alcohol, illicit drugs, prescription medication, gambling and food addiction. Our core service is a 28-day residential treatment episode. In terms of the four-tier model of addiction treatment favoured in the country at the moment, we would be seen as a tier four service. We admit more than 230 people annually. As an adult service we admit people who are 18 years and over. Approximately 50% of our admissions are individuals in the 18 to 35 age group with the other 50% over 35. We are not working predominantly with a young population. The disease of addiction affects the entire population. Currently we have a 79 year old man in treatment.

 

Traditionally the ratio of males to females among the treatment cohort is 2:1 in favour of men, but in recent years we have found that ratio is closing and can be nearer to 1:1 with an alarming increase in the numbers of women abusing alcohol presenting. Approximately half of the people seeking admission pay the cost of treatment themselves through private health insurance, workplace schemes or family resources. The other 50% are not able to afford the cost of treatment and depend on the State to assist towards treatment costs.

 

In the past ten to 15 years it became clear that a 28-day treatment episode is not long enough, especially for people aged between 18 and 35 who are addicted to more than one substance and come from a disadvantaged community, may be unemployed and may be struggling with the addiction of another family member in the household. As extended care was needed for these people, Fellowship House for men and Renewal for women were established to help people to rehabilitation on a more sound footing. Our treatment approach is abstinence-based and we want people to develop a drug-free lifestyle. Each stay at Fellowship House and Renewal is for 12 days. In addition to continuing the treatment process they also learn skills for rehabilitation. We are closely connected with FÁS in Cork and each of these residents will pursue a FÁS course in Cork. Latterly we have established three-quarter houses or “sober” houses where people who complete treatment in the halfway houses can continue in secure accommodation. A major issue with people facing early recovery in Cork is the difficulty in getting good accommodation.

 

We also have family services. Part of our mission has been to help families. In recent times we have benefited from funding from the Cork local drugs task force to employ a family addiction counsellor and we now enjoy more than 5,000 attendances annually at our family programmes. As I am sure members are aware, when there is addiction in the family, the entire family can become very pre-occupied with the addicted person and the crisis he or she is causing to the family, so the treatment services try to get the family to understand that they need care and help in their own right. Our new national drugs strategy will regard the family as a service user in its own right, regardless of whether the addicted person is engaging with services.

 

An integral part of Tabor Lodge’s services over the 22 years has been a continuing after care programme of 52 weeks, with more than 5,000 attendances annually at these services. We are talking about a very comprehensive agency delivering very comprehensive treatment addressing the multiple needs of people who engage with our services. Just like the treatment of any chronic condition, there is an intensive treatment episode at the beginning and a need for the principles of rehabilitation to be engaged in by the service user. We are accredited by CHKS, an accrediting group for medical centres recommended by the VHI. Tabor Lodge can point to its accreditation to demonstrate that the principles of transparency, value for money and quality service delivery are in place.

 

The main point we wish to emphasise today is that alcohol is by far the drug of choice of the addicted population in the country. The committee was kind enough to invite us to address the issue of minimum pricing. Of course the price of alcohol should be raised which would reduce the harm caused by it. However, members do not need a treatment service to make that point to them. Our point is much more important than that. We are dealing with a chronic health condition - a chemical dependency on alcohol. Everybody admitted to Tabor Lodge is addicted to a mood-altering substance. The pie chart in the presentation indicates that the vast majority of people say that alcohol is their drug of choice. Last year of the 230 people treated, that segment represented 181 people. This means they are addicted as opposed to alcohol abusing or alcohol misusing - they are alcohol dependent.

 

As part of the treatment episode they will be diagnosed or categorised according to a diagnostic manual from the American Psychiatric Association. These people are all categorised as chemically dependent on alcohol. Given that they are addicted, the price of alcohol is not really a deterrent to them using it. By fair means or foul they will guarantee themselves their supply of alcohol, just like all our illicit drug addicts to the point of breaking the law or even ending up in prison. The addiction means they do not have a choice about whether they use the substance. Dependency means they must have the substance and that is the condition this agency is involved in treating. We claim that a full recovery is possible for people who adhere to the treatment programme.

 

We would like to refer to the Roscommon child care case, as reported by the HSE inquiry team in October 2010. I am sure members of the committee will be familiar with that report and very upset at its findings. Paragraph 4.9 from that report states:

 

There was evidence to suggest that both parents had a considerable dependence on alcohol, upon which much of the family income was spent. This preoccupation with alcohol clearly affected their parenting capacity. It was manifested by the children often being left alone when the parents were in the pub and the older children having to fulfil adult roles, such as minding and feeding their siblings. The purchase of alcohol was also tolerated by the Home Management Staff when the mother was brought shopping.

 

That paints a picture of a family where the parents are chemically dependent on alcohol. This abysmal scenario is daily reported in Tabor Lodge as part of treatment. If that is not apparent, the scenario is equally abysmal, regardless of who is reporting it. The addiction has a very degrading impact on the person and on their loved ones and has quite a dehumanising effect.

 

This slide shows a table from our annual report which lists those who referred people to our agency. We have emboldened the social services line and committee members will notice the huge increase in the last three years. There has been a doubling and in some cases a tripling of referrals from social services. It is our belief that this is related to the findings of the Roscommon child care case and also to the very welcome Children First principles being adopted by the HSE. In each case, these are mothers whose parenting of their children is severely compromised because of their alcoholism, to a point where the State needs to intervene out of a duty of care and arrange care for the children in order that the mother can attend Tabor Lodge. The 28 day treatment programme in most of these cases is not sufficient, and so they will need referral for Renewal for extended treatment. We recently received very disappointing news about a core funding source to this treatment agency.

 

The second point we wish to make is about funding. We have aspirations for a proper treatment service in the country. Action 32 of the current National Drug Interim Strategy 2009-2016 states boldly that we need to develop a comprehensive integrated national treatment service using a four tier model approach. All of the people who engage with our services need a comprehensive integrated national treatment service. The funding for this is not in place to date. Over and above the cuts that we are all enduring in the public sector, Tabor Lodge has now had an additional blow to its funding sources. The former Minister of State with responsibility for the drugs strategy, Mr. John Curran, asked the HSE and the voluntary sector to jointly come up with a way to ensure funding for treatment of addiction. In the course of their deliberations, they appointed MTC to report on this issue. The report recommends that where services are required within approved centres, funding should be provided based on agreed outcomes at a level which would ensure the organisation can remain viable. That is a clear statement of the need to fund properly treatment agencies like ourselves and the other centres I mentioned earlier.

 

We wholeheartedly welcome the comments by Minister of State, Deputy Shortall, at the opening of the NACD seminar in Croke Park last Tuesday, entitled A Family Affair? She said she was very focused on ensuring that there is an increased emphasis on moving people on from drug treatment to a drug free lifestyle where that is achievable and that it was her belief that there has been insufficient focus on this ambitious goal in the past. Our treatment service will recommend a drug free lifestyle for people because we do not feel that harm reduction approaches are sufficient in themselves, especially where the drug of choice is alcohol. There needs to be an endorsement of an abstinence-based treatment approach.

 

We would like to be so bold as to make recommendations to the committee for its consideration. The first is that we need to tackle Ireland’s national alcohol problem. We believe that minimum pricing would not do this, but rather would increase the market share of the more established brands. We encourage the committee to cultivate a more responsible relationship with alcohol so that those chemically dependent on alcohol or struggling to remain abstinent from alcohol can have a fighting chance at establishing a sober lifestyle. We were dismayed with the profile of Guinness during the State visits of the Queen Elizabeth II and President Obama. It felt like the centrepiece of those visits was the famous pint of Guinness. We recommend that the more appropriate means to deal with the problem of alcohol are higher taxation and controls on advertising.

 

Services that provide comprehensive treatment and rehabilitation to the chemically dependent population must be funded properly. We recommend that implementation of action 32 of the national substance misuse strategy be prioritised. We would like to see the implementation of the recommendations of the MTC review of HSE funded tier four residential treatment rehabilitation services. We encourage the committee to endorse the ambition of the Minister of State to go beyond harm reduction strategies to abstinence solutions to our addiction problems in the country.

 

The main drug of choice in Ireland is alcohol. Addiction to alcohol has a devastating impact on those involved and their families. The chemically dependent population should pursue an abstinence-based solution in preference to a harm reduction solution. To achieve this, comprehensive treatment and rehabilitation patient services must be securely established by the State. Tabor Lodge Addiction and Housing Services Limited is a model of excellence of this type of treatment provision.

 

Chairman: I thank the witnesses for a very provocative and thought provoking presentation. I also thank them for their courage in saying, and as I said recently at this committee, that the depiction of Guinness during the visit of President Obama and the Queen of England conveyed the wrong message.

 

Senator David Cullinane: I thank the witnesses for attending, and I thank Mr. Devine for his presentation. It is important for all of us to agree that the main drug of choice in Ireland is alcohol. That is the starting point and we cannot dispute the figures. We all know from the communities we represent that alcohol is a big problem. Mr. Devine spoke about the effect that alcohol addiction has on the individual involved and his or her family, as well as the wider community. I recently dealt with a situation in Waterford in a housing estate of 300 houses, 80% of which are rented out to students. The binge drinking in the estate causes huge problems for the residents there. There have been 126 public disorder incidents in that estate since September of this year, with 22 arrests for offences such as drink driving, drug taking and so on.

 

Chairman: Were they all students?

 

Senator David Cullinane: No. I should qualify that. Not all students are involved, but it comes from that student population. That brings me to the next issue, which is that of minimum pricing. There is no doubt that some of the bigger supermarket chains are involved in using alcohol as loss leaders to entice people in, especially young people. The easier one makes alcohol available, the easier it is for young people to purchase it. There is a difference between people who engage in binge drinking - whether it is young people, students or people generally - and those who are chemically dependent on alcohol. That is why I would be more cautious in terms of not ruling out the issue of minimum pricing. We can all see people getting trolley-loads of alcohol in supermarkets because it is cheap and available. The bigger supermarket chains are making alcohol available at low cost and are then enticing people to purchase it. There is a world of difference between people who binge drink and buy alcohol cheaply for that purpose, and those who are chemically dependent. I fully accept that we will not deal with the issue of people who are chemically dependent by reducing prices - that will not solve their problem.

 

I support the four-tier strategy and having comprehensive treatment and rehabilitation services. I commend the work the witnesses are involved in, which is where the resources need to be. Mr. Devine mentioned that his own organisation has seen a loss of funding, as have other organisations.

 

I fully support the principles of the national drugs strategy. It is 100% right in terms of the hierarchy, principles and strategy but the problem is funding. One can have a strategy but problems arise if one does not have funding, rehabilitation centres and counselling for people when needed. We must ensure that a strategy is backed up with resources.

 

Mr. Devine referred to restrictions in advertising and sponsorship, so perhaps he could expand on the proposals he has in mind. We know that Heineken and Guinness still sponsor many sports, which could potentially glamourise alcohol use. It is an issue that needs to be dealt with in the context of alcohol misuse.

 

I commend the work that Mr. Devine’s organisation is doing. I fully accept that the problem of those who are chemically dependent on alcohol will not be solved by reducing costs. However, I would ask Mr. Devine to take on board the point that there is a difference between that category and people who binge drink because they can avail of very cheap alcohol.

 

Deputy Denis Naughten:  I thank Mr. Devine and the group for their presentation. People who are chemically dependent on alcohol will find the money for it, or will access it, no matter what the price. I would ask Mr. Devine to step back a bit from the individuals who are coming over the threshold of his facility. When they are starting out, is alcohol an issue? European research shows that young people are very price sensitive concerning alcohol and its sources. Perhaps Mr. Devine could examine that issue. The committee is examining how to stop people ending up in a situation where they are chemically dependent on alcohol.

 

Coming back to the Roscommon child care case, Mr. Devine said the report published just 12 months ago has had an impact on the number of referrals from social services. I would dispute whether that is the reason for it. Mr. Devine is right to highlight the issue of alcohol abuse in that case, which was a major contributing factor. Are there any other reasons referrals have increased? What else can be done to see that particular avenue increase further so we do not have more such reports? I ask Mr. Devine to address those two particular issues.

 

What is Mr. Devine’s view of the ban on below-cost selling of alcohol or some sort of a unit charge? As he knows, in this country right up to the naughties, we had a minimum price for alcohol and there was a ban on below-cost selling. The Government threw that out with the groceries order, which has led to the current competition. What is Mr. Devine’s view or perspective on it?

 

Chairman: Does Senator van Turnhout wish to comment?

 

Senator Jillian van Turnhout: No.

 

Senator Colm Burke: I have had the privilege of visiting the facility which has provided a superb service for many years. I congratulate the witnesses for their work. I was on Cork City Council for 12 years, representing the area around UCC and CIT. Every year, in late September and early October, 20,000 students descend on the area. Everyone has seen a huge change in patterns and particularly over the last ten years the level of drinking by young people seems to have increased dramatically. The big change over the last five years, however, is drinking at home, in apartments or houses. That is evidenced by the fact that four pubs within half a mile of UCC have closed in the past four or five years. No new licensed premises have opened in that period, which indicates the volume that is now being consumed at home.

 

Recently, I was driving home at 11.30 p.m. and saw some young people coming out of their apartments and one or two of them were unable to stand, yet they were heading off into nightclubs in town. From Mr. Devine’s own experience with young people, has he seen a serious change with alcohol consumption becoming a problem at an earlier age? What kind of increased consumption have we seen over the last ten years in view of the fact that money seems to have been freely available?

 

If one stands outside any off-licence near the college from 5 p.m. to 7 p.m., one can see that the volume of drink going out is huge. Has Mr. Devine seen a knock-on effect from that?

 

I have received preliminary figures concerning the number of babies who went into the DTs after being born in Dublin hospitals. I think there were 44 in a short period. If the parents have problems at that stage, are the children more likely to run into problems as well? What does Mr. Devine’s research show in that regard?

 

Has there been a significant change in mixing drugs and drink, and what difficulties does that cause? Has that changed in recent years? At one stage, it was drink only or drugs only, yet now we have a combination which seems to cause its own complications. I had an unfortunate incident some years ago when I met someone ten days after they had been discharged from a facility. I thought they were on the straight and narrow, only to find that within ten days they were involved in a serious incident involving loss of life. It was a very unfortunate situation. In that case, it was a combination of drink and drugs. What is Mr. Devine’s own experience in that regard?

 

Chairman: I now call on Mr. Devine, Mr. Cassidy and Ms Crosbie to respond to those questions, and they should feel free to interact. I will take three more questions after their replies.

 

Ms Eileen Crosbie:  I would like to deal with Senator Burke’s last point about babies who are born addicted to alcohol or drugs. This is one of my pet subjects. If a woman has come through Tabor Lodge and comes to us, we work the full programme of four months. One month is never enough. Unfortunately, addiction is much bigger than any country, law and the lot of us put together. There is an awful lot of pain going on in that person and his or her family. I agree 100% with that. The initial objective is to get an addict still enough to actually hear what goes on in the primary centre, recognise what their issues are and that they want to deal with them seriously. They then come in for a further three months either to Fellowship House or, for the women, to Renewal.

 

Women have left primary centres and have really wanted to be sober. Their families have wanted them to be sober and they mean it at that time. The problem is that when they re-enter society, their families have not changed; nothing has changed, only they have. Therefore, they have no means of rehearsing what they have achieved. It has been proved time and again - I could tell a story about a family that has gone through all three organisations represented today - that success comes on foot of one getting a chance to put into action the programmes offered in all three centres. Between the three, there is so much support and education available and there are so many people to whom one can come when one experiences a bad time; thus a baby need not be born addicted. If one makes the mother well, puts her on a programme for four months, with all the support available, and back into the home with the kids, it will be known that she must have a structured life based on the support offered by Tabor Lodge and my organisation. The man will receive such support from Fellowship House. If the system is in place and the addict has a good year or two under his or her belt, this is almost an ideal position.

 

A lady with two children came to us who had been in Tabor Lodge. She had been sent home for a while because she had been disobeying the rules. In the period in question she had begun to drink again, but she came back begging to be taken back in because she realised that the structures and supports available to her from Tabor Lodge and us were no longer available to her. She begged to be taken back in. This was fair enough and she was readmitted. When she came back in, she said to her partner that if he did not straighten up, she would leave him. He then went to Tabor Lodge and Fellowship House. The two individuals have their children every weekend - they have been gone for nearly one year - but they should have them back full-time this Christmas. Social services and fostering facilities can be let go when the two parents recognise fully the importance of support and structures. The children in question are being brought up in a structured environment in which they will not be running around or going to the place about which Senator Cullinane spoke. They will not do so because they are policed too much at home. There is very little available when the parents are addicted and the children do not have a hope. The total family unit benefits from the programmes on offer. This is just one story out of God knows how many I could tell today.

 

Mr. Mick Devine:  I thank Senator Cullinane for commending the work we are doing. It was stated the minimum price issue should not be ruled out and we do not do so.

 

Of the 126 public order offences committed in the housing estate in Waterford, some might have been committed by those who are chemically dependent. The rest will have been committed by people who were drunk. However, it is not only the alcoholic who gets drunk. The person who is abusing alcohol is price sensitive and will reconsider if the price is high enough. I am not disputing this point or ruling it out but making the more important point which the Senator has acknowledged that the chemically dependent person is not price sensitive and must have alcohol as long as the addiction remains untreated.

 

I do not have a lot to say on advertising. We do not deliberate much on the issue as a treatment agency, but it is clear that there must be control over the promotion of alcohol, especially to young people. The alcohol advertisements are the best on television; they really get to us. The latest one for Guinness associates strange things that happen in the dark with drinking Guinness. The advertisements are very seductive. A young person believes that if he or she drinks Guinness, magic things will happen. He or she divorces his or her experience from that of the following morning, which may see them having spent a night in an accident and emergency unit or a Garda station. The Garda might have had to intervene in his or her recreation and make a charge of drunk and disorderly behaviour. The advertisements stop short of portraying the aftermath. Therefore, the control of alcohol promotion is necessary.

 

Deputy Naughten acknowledged the distinction between the alcohol misuser and the alcohol-dependent individual. He asked how we could increase referrals from social services? It needs to be understood that addiction needs treatment in its own right and that social services will not be intervening in a family where alcoholism is the only problem; there will be a host of other problems. Social services need to understand addiction is a part of the problem and needs to be addressed in its own right separately from other issues. If it is successfully addressed, the family will make great strides in coming to terms with the other difficulties that bedevil it. If the addiction is not recognised as needing treatment intervention in its own right, the family will struggle to function more effectively.

 

Chairman: To take up Deputy Naughten’s point, what is the position on joined-up thinking with social services?

 

Mr. Mick Devine:  We work closely with social services and have a good relationship with them. We deliver training to social workers to help them to intervene effectively where a mother is chemically dependent and the parenting of the children is affected. We work well in partnership. However, social services need to accept the need for a continuum of care, that getting the mother safely into treatment is not the end of the process, that rehabilitation occurs very slowly and that the mother needs to be supported right through the process. If we say to a mother in Tabor Lodge that she needs to go to Renewal, she will say she cannot do so as it would involve her being away from her children for a further three months. Our experience, however, tells us that if she does not go there, she will have a relapse. We recruit the social workers to join forces with us and say the required period is only three months and that this will seem short in a lifetime of parenting her children. It is a question of supporting mothers as they move through the extended treatment and aftercare programmes. We work well in partnership with social workers. However, we can improve the partnership with them and I am sure they, if present, would say we could make improvements on our side also.

 

Deputy Denis Naughten: Is Mr. Devine confident the desired partnership is in place throughout the country? While Mr. Devine has personal experience of it, he is also involved with the umbrella organisation.

 

Mr. Mick Devine:  The National Drug Rehabilitation Implementation Committee is necessary because agencies have a history of working in isolation from each other. The partnership is not credible and the information-sharing and mutual support are not all they could be. That is why we need a rehabilitation strategy and have an implementation committee. All aspects need to be improved.

 

Senator Burke referred to young people falling out of apartment blocks drunk. In previous years they fell out of pubs drunk. Where they are falling out drunk is not the core of the issue. Home drinking has exacerbated the problems of alcohol abuse and dependency for the woman. Bearing in mind that it might not have been so possible for her to behave in a drunken manner in the pub, she is drinking more as the pub trade diminishes and the focus of drinking shifts to the home. As she is buying wine as a loss leader, the consumption of alcohol in the home is increasing alarmingly. I understand the incidence of domestic violence is also increasing.

 

People are drinking at an earlier age. Where youths might once have begun drinking in their mid-teens, it has been reported in the past ten years that they are starting to drink in their early teens. If one asks a patient in Tabor Lodge whether there is a family member addicted also, the usual answer is that there is and it is usually the father. It is now common to expect someone between 18 and 35 years to be poly-addicted. Individuals in this age bracket are still reporting that alcohol is the favourite, first and main drug, but they are using others also. Cannabis is the second most popular drug of choice of those attending Tabor Lodge, cocaine is the third most popular drug, benzodiazepines and prescription medications are fourth and heroin is still gaining ground in last place. It is unusual to have an under-35 year old addict in this country addicted to only one substance and I suspect that is not confined to Cork.

 

Mr. Finbarr Cassidy:  I deal mostly with men in Fellowship House. Last year, the annual report indicated that 71% of the clients who came to Fellowship House were in the group between 18 and 35 years of age. We know from dealing with them on a one-to-one basis that the majority or many would have started between 12 and 13 years of age. I agree with what Mick Devine is saying.

 

The old, honest-to-God, salt-of-the-earth alcoholic is an endangered species; he is not there anymore. There is someone in his 70s going through treatment at present but usually they are cross-addicted and the problems include alcohol, drugs and possibly gambling which is readily available on the Internet and so forth. There are a multiplicity of addictions.

 

There is a problem with advertising and the availability of alcohol. If one calls into the supermarket to get a pint of milk going home, one must walk the length of the supermarket to get it at the far end and, of course, one must pass all the drink at the far end. It is no more than a marketing ploy but I believe it works for some people.

Chairman: I call on Deputies Fitzpatrick, Dowds and Regina Doherty.

 

Deputy Peter Fitzpatrick: I thank the deputation for attending. I consider myself to be a lucky young fellow because years ago in my youth when I was working in the local GAA club I used to collect the glasses and serve drink and I saw the abuse of alcohol. I made a promise to myself that I would never drink and, touch wood, I am now 49 years of age and I have kept that promise. I am concerned about the treatment. The delegation stated that they operate a 28-day residential system with up to 18 people. Will they elaborate on this because 18 people seems a large number to have in one go? Will the deputation go through some details of the treatment? Is it one-to-one or group based? I am trying to learn and I am keen to know about the type of treatment people get.

 

The deputation referred to an after-care programme. Will they outline the percentage of people in the 28-day programme who re-offend? What way does the organisation look after the follow-up? That is where I want to start things. We can discuss prices and so on but when people have an alcohol problem they go to the lodge. It is important that the treatment they get works for them and I hope the number of re-offenders is low. Only then should we consider the price of drink and everything else.

 

Deputy Robert Dowds: I commend the delegation on their work and I thank them for attending. To some degree the questions I wish to ask have been asked but there are some things I wish to cover. I presume the delegation believes the current self-regulation of alcohol advertising to protect children is simply not working. This is my impression but I would appreciate any comment the delegation has on it. To what extent is the development of children being hindered by excessive exposure to alcohol advertising? I am a strong advocate of minimum pricing. While it may not deal with the severe alcoholics it deals with some of the binge drinkers. Does the delegation believe we would be better off if there were more restrictions on the number of places where drink can be bought?

 

I urge caution with regard to the delegation’s comment on higher tax on alcohol. It might work in Cork but Cork is a long way from the Border. If alcohol is very expensive in areas from Dublin northwards people will make trips across the Border. This aspect must be considered. If we were all as far from the Border as those in Cork, it might not be an issue and this point should be considered. If we move on the alcohol issue it would be of great use if we had a similar move in Northern Ireland. This might be encouraged by the moves the Scottish Parliament is making towards introducing minimum pricing on drink. Perhaps if there were a pincer movement on both sides the North might agree to it. This is an important element of the whole question. To what extent does the delegation believe alcohol is a gateway drug for illegal drugs?

 

Deputy Regina Doherty: I apologise for being late. I thank the delegation for attending and for explaining exactly what they do and how valuable their service is to the people who so desperately need it. I say as much because what I intend to say might cause offence but it is not meant to. We have bandied around terms - we have done so frequently in recent weeks - while we have been discussing the particular issue of alcohol and advertising in various committee meetings and references have been made to alcohol as the national drug of Ireland. We have mentioned the unfortunate place it took, namely, centre stage, in the various invitations of recent months. Every time I bring up this issue, either on my website, in blogs or in conversations, I get lambasted. The vast majority of people in this country do not abuse alcohol; they use it as a social element of a meal out on a Friday night or it is a matter of a glass of wine with dinner with family and friends on a Sunday. The vast majority of people in this country use it responsibly and, therefore, I do not believe they should be hindered by an increase in the price or the taxes on it. It is unreasonable to have such sweeping responses to what is a problem in a small section. I do not believe such draconian measures are measured. It is not fair or reasonable to suddenly hike up the price of a pint of whatever to €7 or €9 for a small number of people, who are not necessarily drinking in our pubs. There is anecdotal evidence that the pub industry has suffered in recent years. I say as much having no connections with the pub industry. I do not even go to pubs but those involved have suffered and we all know it. There are many reasons for this, including the smoking ban and so on.

 

Will the delegation explain what causes an addictive nature? It is the case that alcohol is a drug and there are differing reactions among certain people but there are other drugs, such as chocolate and others. Unfortunately, I started smoking as a younger person. I am probably in The Guinness Book of Records for giving up giving up. Eventually, I gave up, thankfully, but when one loses one addictive need for a particular substance one usually swaps that addiction for something else. I swapped it for bars of Twix and then I had to go through the whole process of losing that addiction. What is it that makes people have an addictive nature? Will the delegation explain why some people tend to pick things that are so desperately bad for them, as opposed to other things?

 

Deputy Robert Dowds: I wish to comment on the last contribution and on what Deputy Doherty said about pubs. I agree with part of what she said but not with all of it. I agree entirely with Deputy Doherty that most people who use alcohol do so responsibly but I also take the view that to tackle the issue we must do so in a way that encourages responsible drinking. This is more likely in a pub situation rather than at home because there are various knock-on effects of abuse of alcohol in the home.

 

Ms Eileen Crosbie:  I will address Deputy Regina Doherty’s question which is excellent as it opens a gateway for other people to learn what causes addiction. It took me a long time to find out what was the cause. The bottom line is that this is still described as the “Y factor”. I once asked an eminent man in this field whether anyone could become an alcoholic. He stated that if one does anything often enough, one will reach that point. It goes beyond our natural comprehension of an individual overdoing something as it takes over their life. I ask Deputies to try to imagine something in their lives being sufficiently strong to take away their spouse, children, home and everything they possess. We cannot imagine ever allowing something to take these things from us but addiction will strip one of everything, and it starts young. Mr. Devine, for instance, referred to a woman having to drink at home and prostituting herself. The person’s only concern is to get a bottle irrespective of the cost. Children of ten and 12 years who observe this behaviour will take a slug from their mother’s bottle. This is how the germ spreads.

 

A person who is in great pain will reach a point at which he or she will seek oblivion to take it away. Most alcoholics drink to reach oblivion rather than for pleasure. They seek to escape whatever it is in their life that they cannot cope with emotionally. They choose oblivion whereas everyone else goes out for a drink. I agree with Deputy Doherty that people should not be penalised for having a drink. There are two different types of drinking. For the alcoholic, there is no joy in drinking as it is about the end result. They try to consume as much as they can before bringing it up again. There is a hidden aspect to the alcoholic.

 

Deputy Fitzpatrick asked what is involved in treatment. This is an interesting question because I do not believe people know what we do. The reason it works so beautifully is that one has 18 addicts sitting in a circle - Tabor Lodge treats 18 people - being facilitated by two counsellors who are fully trained professionals and know what they are doing. It is our job to facilitate the group. One cannot kid a kidder. The addicts do their own work while we ensure they do not go to places where they cannot cope or in which they get lost. The difference between counselling addicts and counselling someone for other problems is that the former will lie, protect and do anything to hide the shame and guilt drinking causes them and their families. One must get under this shame. This is the reason women have such a rotten time. As Deputy Doherty noted, if a woman and man are drunk in a pub, what will be said? One will hear the question asked, “Is she not a disgrace with her seven kids at home?” It is forgotten, however, that the man also has seven kids at home. This social stigma forces the woman to do most of her alcoholic drinking indoors. I am not speaking of going out for a few glasses of wine or whatever. It takes a long time to chip away at the guilt and shame. It takes at least one month in Tabor Lodge before someone will say, “Mea culpa, I have a disease.” Please God, the person will accept it is a disease within one year. Once he or she has done so, he or she will come to Mr. Cassidy or us to learn to put everything into practice. The addicts face each other in a group and do much of the work in that setting. I hope that answers the Deputy’s question.

 

Mr. Finbarr Cassidy:  For many people, the work of a treatment centre is shrouded in mystique. The confidentiality aspect means people will not get into a centre unless they have an addiction. Treatment basically consists of one-to-one counselling and group therapy. Mothers-in-law, fathers-in-law and best friends can give the worst advice because they do not know what they are talking about. In treatment, the addict helps the addict by identifying with each other and listening to each other’s stories and so forth.

 

The World Health Organisation has classified alcoholism as a disease. Sometimes we must express things simply. Some people are allergic to nuts or other products, while others are allergic to alcohol. As Ms Crosbie noted, there may also be deep emotional issues, perhaps dating back to childhood or related to a person’s background. Much of the drinking is about killing the pain. In the majority of stories we hear alcoholics do not enjoy the glass of wine we like to have with our meals and so forth. They put this in simple terms in the statement, “One is too many and 1,000 is not enough”.

 

I do not know if Members are familiar with Cork. Alcohol for the alcoholic is like driving to the top of St. Patrick’s Hill, putting the car in neutral and taking off the handbrake, folding one’s arms and allowing the car to roll back down. There will be devastation. For an alcoholic, therefore, there is no such thing as social drinking. He will have control over a situation until he takes a glass of alcohol, after which he will be powerless over what happens. For this reason, the treatment we provide is not harm reduction but abstinence. Either one is or is not an alcoholic.

 

People do not give alcoholics enough credit for what they are asked to do, namely, make a 180 degree turnaround. Each one of us has a procedure or routine we follow each morning when we get out of bed. We go to the bathroom, shave, shower or do this, that or the other. One goes through a process. What we ask alcoholics to do is change their routine completely. The basics of recovery are staying away from the old places, people and things. This is a huge step. Many of those in recovery will move out of their homes. In Fellowship House, 81% of our clientele are homeless, perhaps as a result of a barring order, addiction in the home - a father, mother, brother or sister may an alcoholic or drug dealer - or it may not be safe for them to return to their home.

 

As I stated, in Tabor Lodge we recognised years ago that 28 days is not enough. It is akin to releasing a man from prison with his belongings in a plastic bag and telling him, “There you go.” While there is no cure for alcoholism, there is a treatment which is abstinence. What we are trying to do in the secondary period when we provide step-down support is move people from a position of isolation to one of integration. Some 96% of our clientele are unemployed. If one is unemployed and homeless, one is pretty much without hope. That is the point at which we step in to try to help the people in question. We do this in the continuum of treatment. We build on the work Mr. Devine starts in primary treatment. Once that is over, they are moved on to Ms Crosbie and me for a further three months. It is teaching them life skills. We are lucky enough to be involved with Northside Community Enterprises in Cork which provides community employment, CE, schemes for them. Between them Renewal and our body took 103 people off the live register last year. Some have gone back to education, others are continuing with their CE schemes, and so forth. Treatment works. It is about staying away from the old places. We talk about alcoholism and addiction being a family disease. That single person affects a minimum of ten people around him or her. There is that complete knock-on effect.

 

Some people will do fine after their 28 days in treatment but for others it is like leading them out of intensive care, but putting them back onto the road again rather than into the general ward. Many of them will not make it. A continuum of treatment is necessary but it is just the same as for many of us, whatever sickness we have. We want to get well too quickly. People ask about success stories but what are they? We all want to hear about the person who never drinks again. That can happen but some people come out, relapse and then get back into sobriety. We talk more about quality of life. Some of our people have gone on to further education. Some will be back on the bridge with their hands out. I have written down eight names from Fellowship House last year that have RIP after them. Eight people died because of alcohol and drug related issues, either by accidental overdose, deliberate overdose, hanging, jumping into a river or choking on their own vomit.

 

We are dealing with life and death and when it comes to situations like that we find it very difficult. We find it very difficult that our funding is being cut back because we are dealing with people’s lives. We had an exceptional needs payment that was being supplied by community welfare officers through the HSE. We learned last week that this amount of €19 per night has been withdrawn - we find that difficult. We find it very difficult to have to deal with families and people and tell them that, unfortunately, treatment is not available because we cannot get that €19 per night for them.

 

This is about life and death. We are not playing games here. Each member knows a number of people, be they mothers, brothers, fathers, sisters, cousins or whatever, who have been affected by alcohol and addiction. It is serious stuff and that is why we take it so seriously. We are devastated when we find funding cut back by local task forces in Cork or by various-----

 

Chairman: Mr. Cassidy referred to funding being withdrawn. Was it withdrawn by the HSE or by the Department of Social Protection?

 

Mr. Finbarr Cassidy:  It has conveniently been moved off the desk of the HSE to the Department of Social Protection. It is the Department of social unprotection at this time. These people are not being protected. People on the margins are now being shoved over the edge. All of us have been in enough funeral homes and at funerals of people who could have done with much more support than we are getting at present. I shall leave it at that.

 

Senator Colm Burke: I referred to a figure earlier but did not have the letter in front of me. Unfortunately, as the Chairman knows, Senators do not have the privilege of being able to ask Ministers questions so I asked a colleague to table the question last July.

 

Chairman: Does the Senator mean a parliamentary question?

 

Senator Colm Burke: Yes. The figure for babies delivered in the Rotunda Hospital who went into delirium tremens, or the DTs, after being born was 44 in 2008 and 38 in both 2009 and 2010. In Holles Street Hospital 20 such babies were delivered in 2009. The Coombe Hospital has done a number of interesting studies for the period 2000-07. There were 42 qualifying studies in regard to pregnancy and alcohol. One aspect has been identified in a number of studies, namely, a relationship between alcohol intake in pregnancy and behavioural and congenital defects in childhood and adolescence. It might be interesting to return to those studies at some point.

 

Chairman: In his presentation Mr. Devine spoke not alone about minimum pricing but about the whole issue of advertising. I was struck by the imagery he used regarding a particular advertising campaign for a drinks product. Both Mr. Cassidy and Ms Crosbie spoke of imitative behaviour. Is it simplistic to say that advertising acts as a gateway for young people? Mr. Devine stated that 50% of his organisation’s admissions are in the 18-35 age group who, I imagine, would be influenced by peer group or other factors.

 

Mr. Mick Devine:  Young people are vulnerable to being seduced by advertising, not only those for drinks. Advertising works.

 

Chairman: I mean with regard to alcohol.

 

Mr. Mick Devine:  Alcohol advertising provides the best ads. Young people will find them seductive.

 

Chairman: I refer to the issue of pricing. Deputy Dowds spoke of taxation. I was very struck by Mr. Devine’s presentation in which he stated that pricing would not be a deterrent. If he were the Minister of State with responsibility in this area, namely, Deputy Shortall, and wanted to deter people from consuming alcohol in that 18-25 age group, or even in the 14-21 age group, what would he do differently? It appears something is not working.

 

Mr. Mick Devine:  The national alcohol strategy of 2004 made a list of recommendations which have not been properly considered. The top one recommended regulating availability, the second controlling the promotion of alcohol. The ones in which we are particularly interested are No. 7, the putting in place of effective treatment services, and No. 8, support for non-governmental organisations. That is not happening. A good place for the Minister of State, Deputy Shortall, to begin would be to take the strategy down off the shelf, dust it off and have another look at it to see how relevant it may be.

 

The situation is getting worse. There has been a fivefold increase in the number of off-licences in Ireland between 1990 and 2006, according to Alcohol Action Ireland’s website. The will does not appear to be there to really grasp this problem, either as presented by alcohol itself or by the fact that good treatment needs to be funded properly. That would be our experience, as a treatment provider.

 

Chairman: That would be confirmed by Mr. Cassidy’ s statement. The knock-on action, as he described it, is to support Fellowship House. If 28-day residential care is provided surely the support system for what happens after that is critical.

 

Mr. Finbarr Cassidy:  Yes.

 

Mr. Mick Devine:  Deputy Fitzpatrick inquired about aftercare. Addiction is a relapsable condition. It seems that outcomes are similar to those for any chronic condition. One gives treatment to people and in their aftercare one third will adhere to the recommendations in a very diligent way and make a full recovery; a third will not adhere to the recommendations and will have no significant improvement in their quality of life; and the middle third will be somewhere in between and be half-hearted in their adjustments. If one takes the figures for diabetes or chronic heart condition, for example, the outcome seems to be borne out by those cohorts. It is the same in addiction.