The National Drugs Strategy (NDS) 2001–2008 provides the strategic framework for drug services in Ireland. The strategy is based on four pillars, supply reduction, prevention, treatment and research, and is underpinned by 100 actions which are the responsibility of various government departments and agencies. Through the NDS, the Health Service Executive (HSE) (formerly the 10 health boards), is mandated to provide a range of treatment options, including residential components, to drug users experiencing problems.

•  The four-tier model of service delivery, which offers clients the least intensive intervention appropriate to their need, should be adopted as the framework for the future delivery of alcohol and drug services in Ireland. It was acknowledged that the all four tiers need to be fully resourced for this model to be effective.
•  A standardised assessment protocol which allows for the systematic identification of each client’s needs is required.
• Inpatient detoxification should, as a rule, be provided in dedicated units. The transition from a detoxification programme to rehabilitation should be seamless so as to avoid waiting lists, relapse and (in the case of opiates) overdose. Detoxification must be followed up by rehabilitation and aftercare interventions.
• The number of inpatient detoxification and residential rehabilitation beds needs to be increased (see table above).
• Where there is unused capacity at present in a service or unit because of staffing, such capacity needs to be brought on stream immediately
•  In highlighting a deficit of 356.5 beds (104 inpatient detoxification and 252.5 rehabilitation), the working group noted the estimated 66 beds in psychiatric units and hospitals that are currently used for alcohol and drug problems and which will no longer be available as a result of the restructuring proposed in the report of the expert group on mental health policy.2
• Of the estimated 63 beds required for inpatient detoxification for drug users, one 50-bedded unit should be provided between the Dublin Mid-Leinster and Dublin North East HSE regions where, the data indicate, the majority of opiate and benzodiazepine users live. The remaining 13 beds should be divided between the HSE Southern and HSE Western Regions.
• In the case of services focusing primarily on the treatment of alcohol problems (detoxification and residential), the beds need to be evenly spread over the four HSE regions (16 per region) since the data suggest a more even distribution of alcohol-related problems throughout the country.
• Clients with co-morbidity issues who are in residential drug and alcohol services should be provided with adequate support by the mental health services, with clear pathways into residential mental health services when required.
•  There is a need to review community-based or outpatient detoxification services, including the possible role of Level 2 GPs in their provision.
•  The Prison Service needs to extend its detoxification and rehabilitation programme in Mountjoy Prison, and establish similar programmes in all other prisons within the State.
•  The provision of step-down or halfway-house accommodation for newly released prisoners and homeless people who have been detoxified or who have started rehabilitation programmes is particularly important.
•  A unique identifier and mechanism to track progression from treatment services to rehabilitation is required.
•  A directory of current residential services needs to be developed and undated annually.
•   Families of drug and alcohol users could be more involved in the overall careplans of recovering users. Innovative approaches to care for the children of drug users while in treatment are required.
•  The Quality in Alcohol and Drugs Services (QuADS)3 suite of organisational standards and the Drug and Alcohol National Occupational Standards (DANOS),4 developed in the UK by Alcohol Concern and Drugscope and Skills for Health, should be adapted for use by drug and alcohol services in Ireland.
• There must be quality standards for the residential facilities themselves, and the HSE should discuss with the Health Information and Quality Authority (HIQA) the possibility of bringing such facilities under the regulation of HIQA’s social services inspectorate. This would help avoid duplication of effort when quality audits are undertaken.
•   It is particularly important that relevant stakeholders ensure that all detoxification procedures meet the highest standards of clinical governance, care and patient safety.
•  The level of provision set out in this report should be reviewed in March 2010.