Addiction and dependency remains one the most challenging public health policy issues of recent times. Since the 1960s, the consumption of illegal drugs and alcohol has increased to a point where over one-quarter of all Irish adults now state that they have used an illegal psychoactive substance recreationally, and more than half of all Irish adults are classified by World Health Organisation (WHO) criteria as harmful drinkers. In addition, gambling addiction has received greater attention in recent years, as the ubiquity of internet access provides problem gamblers with an ever-present means of exacerbating their disorder. With illegal substance and alcohol usage high in Ireland, comparable to other EU states, Irish public policy, health services, social services, policing, and legislation, must all combine in a manner that attacks the issue of harmful use and dependency on a variety of fronts. Without reform across these areas that places the needs of those engaging in harmful use first, from both preventative and curative perspectives, the burden such harmful use places on sufferers and their families, as well as public services and society at large, will continue. IMO doctors are advocating for sensible and workable measures that should be examined by legislators and policy-makers that will loosen the grip that substance abuse and addiction has placed on large tracts of our society.