Home > Alcohol treatment services: a snapshot survey, 2021.

Doyle, Anne (2021) Alcohol treatment services: a snapshot survey, 2021. Drugnet Ireland, Issue 79, Autumn 2021, pp. 44-47.

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Alcohol Action Ireland (AAI), the national independent advocate for reducing alcohol harm, surveyed a number of alcohol treatment service providers to explore issues around the provision of treatment services for harmful and dependent drinkers in Ireland. Its report,1 published in 2021, forms part of AAI’s programme of work on its strategic goal to advocate for services for those affected by alcohol harm, as outlined in Leading change: a society free from alcohol harm. Strategic Plan 2020–2024.2


There are an estimated 250,000 people with alcohol dependency problems in Ireland,3 yet with a decrease in numbers accessing treatment.4 Using data from the National Drug Treatment Reporting System (NDTRS) of the Health Research Board (HRB), the report highlights there were approximately 7,500 cases of treatment reported in 20194 and that the current national policy, Reducing Harm, Supporting Recovery,5 emphasises a health-led response to drug and alcohol use in Ireland, based on providing person-centred services that promote rehabilitation and recovery.


Eleven residential rehabilitation services providing treatment interventions for harmful and dependent drinkers from a variety of locations were surveyed using a structured interview in early 2020. The service providers surveyed reported working with approximately 2,000 people in 2019 and encompassed a range of treatment models – including the Minnesota model, the recovery model, and/or psychotherapeutic interventions – and a number of providers were trauma-informed.


According to Health Service Executive (HSE) data, current provision of all addiction residential treatment beds (alcohol, drugs, and gambling) stands at 793 residential beds. These comprise:

  • 19 inpatient unit detoxification beds
  • 127 community-based residential detoxification beds
  • 4 adolescent residential detoxification beds
  • 625 residential rehabilitation beds
  • 18 adolescent residential beds.

Over one-half of the service providers surveyed were funded through the HSE and services were free to the public. The remainder were private fee-paying services, the majority of which have beds funded through the HSE. Many service providers noted a change in demographics in recent years, principally the increasing number of young people coming into treatment and an increase in cocaine use. A number of service providers noted an increase in people coming to treatment via their workplaces or while continuing to work.


A number of issues in relation to the challenges facing alcohol treatment providers emerged from analysis of the interview transcripts. These were grouped into four themes:

  • Mental health and trauma
  • Reducing the impact on children and families
  • Gaps in services
  • Barriers to treatment.

For each theme, the report includes extracts from the interview transcripts to support the theme followed by AAI discussion and key recommendations, as follows.

Theme 1: Mental health and trauma

All service providers surveyed spoke of the significant and serious concern of dual diagnosis, where both alcohol addiction and a mental health problem co-occur. Yet this cohort very often experiences problems getting treated for both issues in parallel. Service providers noted that those with a dual diagnosis require input from mental health professionals as part of their treatment and advocated for a shared approach to client’s mental health; however, additional funding for staff and/or training was required to do so.

Adverse childhood experiences (ACEs) such as abuse, neglect, loss, and other emotionally harmful traumatic experiences in childhood were acknowledged as an almost universal experience in the client population. Service providers held differing views on how best to address clients’ ACEs, with a number feeling that it is vital to understand their trauma in order to treat their addiction. However, others felt that unless there was a robust mechanism for dealing with that trauma, then ACEs should not be specifically raised.


  • A national strategy with revised standards promoting best practice should be developed and implemented for residential services. Services should be person-centred and trauma-informed and monitored by the Health Information and Quality Authority (HIQA). 
  • Addiction services should have the skills and resources to respond to the mental health needs of their clients, suggesting a national training needs assessment, providing information on training already available through the HSE, and allowing staff time to take up training as required.

Theme 2: Reducing the impact on children and families

A number of service providers noted the intergenerational patterns which are frequently a feature of their clients, where members of the same family often experience similar substance misuse problems.

The effects of parental substance misuse have been largely hidden in Irish society; however, since 2019, a number of Irish studies, initiatives, and national policies have begun to recognise this hidden harm acknowledged as an ACE.5,6,7,8

Treatment services play an important role in identifying parents (particularly mothers and pregnant women) and providing interventions or pathways to reduce the harmful impact of addiction on children and to break the cycle of intergenerational substance abuse that is so often a feature of addiction. Developing and adopting family and parenting programmes for high-risk families impacted by problematic substance use are emphasised in the national drug and alcohol strategy.5


  • Access to residential services for women with children should be improved. A coordinated approach between addiction services, maternity services, and children’s health and social care services to respond to the needs of children affected by parental substance misuse is required. 
  • In recognition of the impact of parental substance misuse, services should place greater emphasis on working with family members as clients in their own right rather than as adjuncts to the client presenting with the addiction.

Theme 3: Gaps in services

Service providers cited what they viewed as gaps in how treatment services are delivered. These included:

  • Lack of access to detoxification services and the impact it has regarding access to treatment. 
  • Lack of aftercare support. A key element of recovery, including treatment and aftercare, is the assurance that an integrated approach will be taken and that people can move from one service to another as required. 
  • Lack of staffing and resources. Service providers noted an issue around staffing levels and/or funding to provide the optimal service.


  • Wider geographic access to addiction services should be provided, in accordance with the national drug and alcohol strategy, and diversifying the range of treatment options available to meet current and emerging needs should continue. 
  • There should be a national protocol on alcohol detoxification, streamlining the process of people moving straight from detoxification into residential treatment and aftercare services. 
  • A third-level course in specialist substance use should be developed and modules in substance misuse in counselling training courses should be included.

Theme 4: Barriers to treatment

As well as detoxification as a barrier to accessing treatment, other significant barriers quoted included the onerous admission criteria to residential care, the perceived stigma of going into treatment, and the financial costs limiting choice of treatment.

There was unanimity among service providers for greater recognition of the significant harm caused by alcohol. However, the funding, services, and policy interventions required are inadequate to deal with the scale of the problems presenting.

The prevalence of faith-based service providers was highlighted by a number of the participating service providers.


·         The Government should acknowledge the harms caused by alcohol to individuals, their families, and to society and should fund services appropriately.


·         An oversight body for all treatment service providers should be established, with comprehensive standards, regulation, and inspection to ensure that faith-based services meet the requirements of a modern human-rights-based service.


The high socioeconomic costs of alcohol harm in Ireland include costs to the healthcare system, criminal justice system, lost work, and loss of life. According to the World Health Organization, services ‘should be sufficiently strengthened and funded in a way that is commensurate with the magnitude of the public health problems caused by harmful use of alcohol’.9

It is important to understand the kinds of treatment services provided, the costs of services, and the outcomes and effectiveness of services in order to have a clear view of what is required to ensure modern and effective service provision. The current drug and alcohol strategy has adopted a health-led approach to addiction; however, alcohol treatment services do not fall under HIQA’s national guidance like other health services.

A national strategy for residential services and a HIQA inspection regime would ensure that Ireland’s treatment services are equipped to provide the best possible care to people in need.

1   Alcohol Action Ireland (2021) Alcohol treatment services: a snapshot survey 2021. Dublin: Alcohol Action Ireland. https://www.drugsandalcohol.ie/34359/

2   Alcohol Action Ireland (2019) Leading change: a society free from alcohol harm. Strategic Plan 2020–2024. Dublin: Alcohol Action Ireland. https://www.drugsandalcohol.ie/31321/

3   O’Dwyer C, Mongan D, Doyle A and Galvin B (2021) Alcohol consumption, alcohol-related harm and alcohol policy in Ireland. HRB Overview Series 11. Dublin: Health Research Board. https://www.drugsandalcohol.ie/34058/

4   Condron I, Carew AM and Lyons S (2020) National Drug Treatment Reporting System 2013–2019 alcohol data. Dublin: Health Research Board. https://www.drugsandalcohol.ie/32093/

5   Drugs Policy Unit (2019) Reducing Harm, Supporting Recovery progress 2018 and planned activity 2019. Dublin: Department of Health. https://www.drugsandalcohol.ie/30660/

6   Health Service Executive and Tusla (2019) Hidden Harm practice guide. Seeing through Hidden Harm to brighter futures. Dublin: Health Service Executive and Tusla – Child and Family Agency.

7   Department of Children and Youth Affairs (2019) Better Outcomes, Brighter Futures: the national policy framework for children and young people, 2014–2020. Dublin: Stationery Office.

8   Department of Children and Youth Affairs (2018) A whole-of-Government strategy for babies, young children and their families 2019–2028. Dublin: Government of Ireland. https://www.drugsandalcohol.ie/29973/

9  World Health Organization (WHO) (2019) 10 areas governments could work with to reduce the harmful use of alcohol [Feature stories]. 10 July 2019. Available online at:

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