Barry Cullen, Head of the Addiction Research Centre at Trinity College Dublin, prepared a report to assist with the development of a treatment response to drug and alcohol use among adolescents (12–18 years) living in Carlow, Kilkenny, South Tipperary, Waterford and Wexford.1 The report presented a review of the literature which examined adolescent needs, substance misuse pathways and treatment outcomes. In addition, the author discussed with service providers the issues pertaining to prevention, early intervention and treatment for adolescents living in this area.

Alcohol and cannabis were the main problem drugs reported by adolescents living in the HSE South Eastern Area; opiate use was reported by only a small number of these adolescents. (Opiates are the most common main problem drug reported by adolescents living in the HSE Eastern Area.) The author reported that the pattern of substance use needed to be reflected in the development of the treatment response.

According to the author, there are intrinsic differences in the ways children and adults use alcohol and drugs and in their treatment needs. He describes two pathways into alcohol and drug use for adolescents. The first is the experimental or social use of alcohol or drugs (considered normal), and the second is the use of such substances as a coping mechanism to deal with stress and anxiety (considered problematic).

The recommendations of this report were influenced by the Report of the working group on the treatment of under 18 year olds presenting to treatment services with serious drug problems.2 In general, the four-tier model of service delivery recommended by the national working group was accepted as the best model, but service providers recommended adaptations to reflect the situation in the HSE South Eastern Area. The adaptations to the model should reflect the types of substances used and a preference for the provision of day care instead of residential care at Tier 4. The model recommended in the working group report is described below.

Experimental substance use should be dealt with using a population-based approach (Tier 1), while substance use to deal with stress and anxiety should be dealt with using a treatment intervention (Tiers 2 to 4). In order to determine which pathway to substance use was taken by the adolescent, an appropriate assessment tool was required. A review of the evidence indicated that effective interventions for those requiring treatment were behavioural therapy, motivational counselling, multi-systemic treatment and family therapy. Family involvement in treatment was very important for younger or less mature adolescents, and less so for the more mature young person. A specialist day-care programme was recommended as an alternative to residential treatment, which, according to the author, should be used for respite purposes only. In order to ensure appropriate use of Tier 3 and Tier 4 services, referrals to these services should be made through Tier 2 services. The author recommended that adolescent services in the South East be delivered through a separate adolescent drug treatment service. The provision of community and youth projects in urban areas was considered adequate but there was a need to expand these to rural communities. During consultations with service providers, it was noted that many at Tier 1 were unaware of the availability of services required to manage those with problematic substance use, and in-service training was needed to ensure adequate knowledge and appropriate referral.

1. Cullen B (2006) Report to Health Service Executive Regional Drug Coordinating Office (Wateford) on recommendations for developing adolescent substance misuse treatment services in the region. Dublin: Addiction Research Centre, Trinity College Dublin.

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.