1.       Using evidence in addiction work

An evidence-based approach must involve a critical assessment of current and proposed practices and a thorough analysis of the context of the particular problem that needs to solved. Interventions can then be chosen on the basis of the evidence of efficacy, their suitability for the population requiring the intervention and the capacity of the service to implement the intervention using established protocols. Education and training programmes should include some element of critical appraisal training to encourage a questioning attitude and to challenge the establishment of new orthodoxies.

 

2.       The role of educational institutions in developing the addiction workforce

A number of educators working in third-level institutions in different parts of the country described the courses which these institutions supported and the outlook on which they had been established. Learning in this setting allows students to benefit from the accumulated educational knowledge of the university or college and from the intellectual resources built up across a range of disciplines. Availing of these resources enables the learner to develop a keener awareness of the social, political and economic contexts in which their new skills will be applied. It is also beneficial to study in an environment in which a spirit of enquiry and multi-disciplinary approaches to problem solving are the norm and critical abilities and intellectual development are encouraged. 

 

One course director noted that it is now common for universities to assert their responsibility to the broader community and to highlight their work in outreach and adult education work.

A significant proportion of the cohort undertaking courses in drugs and alcohol studies would otherwise be unlikely to study at third level. By supporting these courses, and the tutors and academic staff that provide them, the university gives real expression to the values of inclusiveness and equal opportunity it officially supports. 

 

3.       Developing competencies

It was suggested that an over emphasis on collecting quantifiable and comparable data brings with it the risk of masking less tangible but still vital knowledge. An academic who has worked in adult education for many years distinguished three separate types of knowledge relevant to addiction work: the biological sciences; knowledge based on psychological theory; and the type of ‘sense-making’ which requires an ability to absorb another’s dilemmas, values and experience into one’s own frame of reference. Practical skills are improved through self-reflection on work practice and decisions. The successful practitioner, by looking beyond the phenomenon of a client’s dependency, has developed communication skills which can reveal traits, attitudes and needs and provide a fuller personal picture. 

 

Tacit skills and judgement complement research-based competencies and theoretical knowledge. These are important considerations for both educators and workplace managers. Effective education and training programmes not only impart skills but also facilitate the intellectual and personal development of the individual learner. These programmes increase the capacity of the practitioner to use their listening and observational abilities and to deal empathetically and skilfully with complex situations. It may not be possible to codify what is learned through this practice in the same way that clinical practice can be recorded and made available for analysis by others. But, as one researcher pointed out, we have techniques to manage and transfer this knowledge and, through research tools such as meta-ethnography, we have access to the evidence that others have provided. Practice should be informed by a pluralistic approach to the use of evidence which does not elevate a particular discipline but is nonetheless rigorous and soundly based in theory.

 

4.       Structural change and systems focus

Responding to today’s substance use situation involves very different challenges to those of 2001, when the first National Drugs Strategy was published. New drugs require new approaches and polydrug use presents particular problems for services. Technological advances have transformed the manufacture, sale and distribution of both licit and illicit drugs. Alcohol is being integrated into a broader substance use strategy. Of equal significance will be a shift in drugs policy towards a recovery approach. It is not possible yet to envisage the full implications of this policy development. We can say that it will call for closer integration of services and will present new challenges as clients develop their personal pathways to complete and fulfilling lives.

 

These changes will have implications for workforce planning. In many respects Ireland is in a strong position to deal with these changes. A services manager described the many highly successful training programmes that are currently under way. Training, especially in treatment and rehabilitation services, is being co-ordinated by teams comprising highly motivated managers, practitioners, community workers and health professionals. These partnerships can be strengthened and new links established between these teams and researchers and educators. The Scottish experience provides plentiful evidence of how these types of link can inform innovative and adaptable workforce development. The STRADA organisation, based in the University of Glasgow has used its knowledge of research, policy making and services to develop a comprehensive and coherent suite of addiction training programmes. In turn, policy, practice and research is informed by the work of STRADA. The STRADA experience is very relevant to the task of building an adaptable, skilled and motivated addiction workforce in Ireland.

 

We know from studies in other countries that the successful integration of new knowledge into work practice must be part of a systemic approach to dealing with workplace issues. There will need to be a comprehensive analysisof the addiction workforce in Ireland. This analysis would place individual learning alongside recruitment, planning, worker well-being, management and leadership and other organisational and structural considerations. This will be a formidable task but progress in this sector requires a commitment to an integrated approach to workforce development. From the evidence of this conference, there is a willingness to work together to ensure that education and learning transfer are central to this development.

 

We are grateful to all the speakers for their contribution to the day:

Prof Catherine Comiskey, Trinity College Dublin, chair of the National Advisory Committee on Drugs and Alcohol (Opening address)

Prof Shane Butler, Trinity College Dublin

Mr Martin Keane, Health Research Board

Dr Patricia Mannix McNamara, University of Limerick

Prof John Wells; Dr Marie Claire Van Hout, Waterford Institute of Technology

Dr Derek Barter, National University of Ireland, Maynooth

Dr Ted Fleming (formerly of NUI Maynooth)

Ms Joy Barlow, strategic advisor, Scottish Training on Drugs and Alcohol (STRADA)

Ms Marion Rackard, chair of Health Service Executive National Addiction Training Programme

 

1.        The conference was titled Putting knowledge to work through education: substance use workforce development in Ireland. It was held in Dublin on 18 April 2013. The conference presentations are available in video and pdf format at www.drugsandalcohol.ie/19737/ and www.drugsandalcohol.ie/19723/