Action 49 of the National Drugs Strategy 2001–2008 identifies the need to develop a protocol for treating under 18-year-olds presenting with serious drug problems.1  The report of a working group established in October 2001 to review this issue was published in September 2005.2

The working group reviewed the extent of the problem and noted that ‘attendances by children account for a substantial proportion of the workload of the addiction services in Ireland’.

The group considered the legal and ethical issues surrounding the treatment of persons under 18 years old presenting with serious drug misuse problems. The Health Act 20043 established the Health Service Executive which now has responsibility for discharging statutory obligations under the Child Care Act 1991. The group acknowledged the difficulties experienced by service providers, particularly in relation to consent and family involvement. They noted that the current legislation allowed persons aged 16 to 17 years to consent on their own behalf to certain treatments. However, there appeared to be some doubt as to whether the courts would accept that such consent applied to drug treatment. In this context, it was felt that the concept of Gillick competence, whereby professionals could assess whether a young person was competent to give informed consent, could play an important role. The Health Service Executive can provide consent on behalf of children who are the subject of a care order or an interim emergency care order, although it is considered good practice to consult the parents in such cases. The group recommended that, where possible, the family be involved in treatment as this leads to better outcomes. It was stated that substitution treatment should not be initiated outside a specialist context.

The working group believed that the four-tiered model developed by the Health Advisory Service in the UK, adapted as necessary to an Irish context, would best deliver effective services to young people presenting with problem drug use. This approach would ensure that the services provided would be based on the specific needs and rights of the child and his or her family; would provide a full range of drug-related education, prevention and treatment interventions; and would be competent to deal with the complex ethical and legal issues surrounding such interventions.

The four tiers of this model of service delivery are:

Tier 1  Generic services provided by teachers, social services, gardaí, general practitioners, community and family groups for those at risk of drug use. Generic services would include advice and referral and would be suitable for those considering or commencing experimentation with drugs or alcohol.

Tier 2  Services with specialist expertise in either adolescent mental health or addiction, such as juvenile liaison officers, local drugs task forces, home-school liaison, Youthreach, general practitioners specialising in addiction and drug treatment centres. The types of service delivered at this level would include drug-related prevention, brief intervention, counselling and harm reduction, and would be suitable for those encountering problems as a result of drug or alcohol use.

Tier 3  Services with specialist expertise in both adolescent mental health and addiction. These services would have the capacity to deliver child-centred comprehensive treatments through a multi-disciplinary team. This team would provide medical treatment for addiction, psychiatric treatment, child protection, outreach, psychological assessment and interventions, and family therapy. These types of service would be suitable for those encountering substantial problems as a result of drug or alcohol use.

Tier 4  Services with specialist expertise in both adolescent mental health or addiction and the capacity to deliver a brief, but very intensive intervention through an inpatient or day hospital. These types of service would be suitable for those encountering severe problems as a result of drugs or alcohol dependence.

The working group agreed that the services would be adolescent-specific, local and accessible, and have a combination of disciplines on site. The services would offer assessment, treatment and aftercare. In addition to the extra resources required to address the needs of these young people, it was suggested that greater co-ordination could maximise the impact of existing services.

1. Department of Tourism Sport and Recreation (2001). Building on experience: National Drugs Strategy 2001–2008. Dublin: Stationery Office.

2. Working Group on treatment of under 18 year olds (2005). Report of the working group on treatment of under 18 year olds presenting to treatment services with serious drug problems. Dublin: Department of Health and Children.

3. Health Act 2004. No. 42 of 2004. Dublin: Stationery Office.