Background
The Health Service Executive (HSE) Integrated Alcohol Service (IAS) began operating on North Great Clarence Street, Dublin 1 in 2022, following the growing recognition of and concern regarding widespread problem alcohol use in the area, particularly during the COVID-19 pandemic. The IAS is based on the recommendations outlined in the National Drugs Rehabilitation Framework Document, and provides a coordinated response to address both prevention and the provision of services and support to those who require it.1

IAS for Dublin’s North City and County
The acknowledged necessity and value of the IAS has meant that the number of locations around Ireland has increased. A visit to the service on North Great Clarence Street to meet the IAS team demonstrated the range of supports and services that the IAS provides for those with alcohol-related issues and their families.

The HSE team includes a nurse, a general practitioner (GP), case workers, counsellors, administrative staff, and the Service Coordinator. This service has established a strong partnership approach with six funded community and voluntary organisations. Between them, these organisations provide holistic and comprehensive care to individuals through the provision of multiple interventions and supports. This integrated approach addresses the physical, psychological, and social aspects of problem alcohol use and delivers personalised, effective, and coordinated care in order to help those who seek advice and support to reduce their alcohol use and improve their overall well-being.

Families and others affected by drug and/or alcohol use can avail of family support, which seeks to enhance family well-being and strengthen coping abilities by reducing stresses and strains for family members or others affected by drug and/or alcohol use. Family members are considered service users in their own right.

Referral process

Where an individual is recognised as potentially requiring support for their alcohol use and is willing and has consented to engage, the referral process begins. A major advantage of the IAS is the streamlined referral pathway, meaning that referrals can be made from acute services, primary care, and community organisations, in addition to self-referrals. A centralised referral system ensures that a standardised and integrated care pathway is quickly and easily identified with links to relevant services for both alcohol-related and other issues.

Guided by the principles of the National Protocols & Common Assessment Guidelines to Accompany the National Drugs Rehabilitation Framework, early engagement is fundamental to the IAS.2 Upon referral, an initial assessment is conducted in order to gauge the seriousness and urgency of the alcohol problem. At this point, there may be an immediate onward referral, or the most suitable care plan is discussed and prepared by the team. This is a shared care model and is completed together with the service user and their family or carer, where appropriate, who actively participate in, and lead the development of, the care plan. This systematic approach to identifying and addressing the needs of the service user ensures that they receive the most appropriate service to meet their needs.

Interventions provided by the IAS

For some, a brief intervention approach may be the extent of their interaction with the service, while others will require more intensive interventions and active engagement with the IAS. The on-site GP, Dr Hugh Gallagher, discussed the medications that can be prescribed for some service users trying to cut down their alcohol use as well as those who have gone through detoxification and are trying to stay sober. One such medication is disulfiram, also known by the brand name Antabuse, which is commonly used in the treatment of alcohol use disorders; another is naltrexone.3 Dr Gallagher often applies the Sinclair Method to service users who are prescribed naltrexone. This method can be effective for those who may not want or are not ready to entirely cut out alcohol, but do want to drink less, and it works on the reward pathways in the brain to reduce the good feeling the individual gets from consuming alcohol and thus help the individual drink less.4

An additional medication, acamprosate, can help reduce the urge to drink so that people in recovery can focus on maintaining sobriety. Most effective if used along with counselling and social support, it helps those who have stopped drinking heavily to avoid drinking alcohol again by changing the way the brain works.5

As well as medical support, the IAS is currently part of a national pilot programme for the SAOR (Support, Ask and Assess, Offer Assistance, Refer) Extended Brief Intervention (EBI) in primary care centres. The SAOR EBI allows a service user to avail of up to six sessions in their primary care centre, with onward referral pathways to specialist services where required.

Other interventions include case management to link individuals with appropriate services in order to address their specific needs and achieve their stated goals; community detox programmes; referrals to residential beds; education; supports for those with a dual diagnosis of alcohol use disorder and a mental health disorder; and telehealth/eHealth. Support groups are also soon going to be added to the list of interventions provided by the service, where individuals can encourage and aid each other in their recovery journey.

The IAS also assists in a programme called Sobriety Sampling, whereby an individual undertakes a period of abstinence.6 During this time, they can consider what works best for them as well as what does not, and this experimentation with abstinence can initiate permanent change. Abstinence becomes a personal journey that the individual can control, making it less daunting than traditional methods, and by setting their own goals, the individual is more likely to progress in a positive direction.

Supporting and empowering the community: A collaborative engagement

The streamlined referral process and the growing suite of services provided by the IAS has already seen numerous people access the service and receive the support they need. Service Coordinator Paul Duff explains that relapses have to be expected and are often part of the recovery journey, but the door to treatment is always open.

1    Doyle J, Ivanovic J. National Drugs Rehabilitation Implementation Committee. National drugs Rehabilitation Framework Document. Dublin: Health Services Executive; 2010. Available from: https://www.drugsandalcohol.ie/13502/

2    National Drugs Rehabilitation Implementation Committee. National Protocols & Common Assessment Guidelines: to Accompany the National Drugs Rehabilitation Framework. Kildare: Health Service Executive; 2011. Available from: https://www.drugsandalcohol.ie/16717/

3    Mutschler J, Grosshans M, Soyka M and Rösner S. Current findings and mechanisms of action of disulfiram in the treatment of alcohol dependence. Pharmacopsychiatry. 2016;49(4):137–41.

4    Sinclair JD. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol. 2001;36(1):2–10.

5    Plosker GL. Acamprosate: a review of its use in alcohol dependence. Drugs. 2015;75(11):1255–68.

6    Meyers RJ, Miller WR, eds. A Community Reinforcement Approach to Addiction Treatment. Cambridge University Press; 2001.