I thank the joint committee for giving us the opportunity to make a presentation today on behalf of Tabor Lodge Addiction Treatment Centre, County Cork. I will provide members with a little background information on us and the organisation. I am the organisation's clinical director, as well as being treatment manager at Tabor Lodge. I am accompanied today by Finbarr Cassidy, who is the treatment manager of Fellowship House and Eileen Crosbie who is treatment manager of Renewal. Those are two step-down facilities - Fellowship House for men and Renewal for women - for people who have completed a treatment episode in Tabor Lodge. Each of us is a member of the Irish Association of Alcohol and Addiction Counsellors.
In addition to being the clinical director of our company, I also represent the wider voluntary sector for addiction services on the national drug rehabilitation implementation committee, NDRIC. This committee is responsible for implementing the recommendations of the rehabilitation report. The main recommendations of this report are that comprehensive rehabilitation services are necessary in order to provide a full treatment for people suffering from addiction and that these services need to be properly co-ordinated and funded, working in a partnership approach.
I am also the secretary of a group of treatment centres similar in function to Tabor Lodge. Representatives from the Rutland Centre in Dublin and the Aislinn Centre in Ballyragget, County Kilkenny, have already addressed the committee. Our treatment model is very similar. There are also units in Donegal, Mayo, Clare, Kerry, Tipperary and Wexford. We have a national association coming together to form a strategy and deal with matters relevant to treatment delivery.
I have also been a member of the southern regional drugs task force since its inception in 2003. Mr. Cassidy represents the voluntary sector on the Cork local drugs task force and is the chairperson of a cluster of voluntary and community-based organisations in the region. So we are very active not just in delivery of treatment in our own units, but also in playing a part in treatment delivery in the region.
Our mission is to care for people with addictions and to care for their families, and we have been providing this service since 1989. The organisation was founded by the Sisters of Mercy. Last year we celebrated 21 years in operation and President McAleese visited us to join that celebration. Primarily we treat people addicted to alcohol, illicit drugs, prescription medication, gambling and food addiction. Our core service is a 28-day residential treatment episode. In terms of the four-tier model of addiction treatment favoured in the country at the moment, we would be seen as a tier four service. We admit more than 230 people annually. As an adult service we admit people who are 18 years and over. Approximately 50% of our admissions are individuals in the 18 to 35 age group with the other 50% over 35. We are not working predominantly with a young population. The disease of addiction affects the entire population. Currently we have a 79 year old man in treatment.
Traditionally the ratio of males to females among the treatment cohort is 2:1 in favour of men, but in recent years we have found that ratio is closing and can be nearer to 1:1 with an alarming increase in the numbers of women abusing alcohol presenting. Approximately half of the people seeking admission pay the cost of treatment themselves through private health insurance, workplace schemes or family resources. The other 50% are not able to afford the cost of treatment and depend on the State to assist towards treatment costs.
In the past ten to 15 years it became clear that a 28-day treatment episode is not long enough, especially for people aged between 18 and 35 who are addicted to more than one substance and come from a disadvantaged community, may be unemployed and may be struggling with the addiction of another family member in the household. As extended care was needed for these people, Fellowship House for men and Renewal for women were established to help people to rehabilitation on a more sound footing. Our treatment approach is abstinence-based and we want people to develop a drug-free lifestyle. Each stay at Fellowship House and Renewal is for 12 days. In addition to continuing the treatment process they also learn skills for rehabilitation. We are closely connected with FÁS in Cork and each of these residents will pursue a FÁS course in Cork. Latterly we have established three-quarter houses or "sober" houses where people who complete treatment in the halfway houses can continue in secure accommodation. A major issue with people facing early recovery in Cork is the difficulty in getting good accommodation.
We also have family services. Part of our mission has been to help families. In recent times we have benefited from funding from the Cork local drugs task force to employ a family addiction counsellor and we now enjoy more than 5,000 attendances annually at our family programmes. As I am sure members are aware, when there is addiction in the family, the entire family can become very pre-occupied with the addicted person and the crisis he or she is causing to the family, so the treatment services try to get the family to understand that they need care and help in their own right. Our new national drugs strategy will regard the family as a service user in its own right, regardless of whether the addicted person is engaging with services.
An integral part of Tabor Lodge's services over the 22 years has been a continuing after care programme of 52 weeks, with more than 5,000 attendances annually at these services. We are talking about a very comprehensive agency delivering very comprehensive treatment addressing the multiple needs of people who engage with our services. Just like the treatment of any chronic condition, there is an intensive treatment episode at the beginning and a need for the principles of rehabilitation to be engaged in by the service user. We are accredited by CHKS, an accrediting group for medical centres recommended by the VHI. Tabor Lodge can point to its accreditation to demonstrate that the principles of transparency, value for money and quality service delivery are in place.
The main point we wish to emphasise today is that alcohol is by far the drug of choice of the addicted population in the country. The committee was kind enough to invite us to address the issue of minimum pricing. Of course the price of alcohol should be raised which would reduce the harm caused by it. However, members do not need a treatment service to make that point to them. Our point is much more important than that. We are dealing with a chronic health condition - a chemical dependency on alcohol. Everybody admitted to Tabor Lodge is addicted to a mood-altering substance. The pie chart in the presentation indicates that the vast majority of people say that alcohol is their drug of choice. Last year of the 230 people treated, that segment represented 181 people. This means they are addicted as opposed to alcohol abusing or alcohol misusing - they are alcohol dependent.
As part of the treatment episode they will be diagnosed or categorised according to a diagnostic manual from the American Psychiatric Association. These people are all categorised as chemically dependent on alcohol. Given that they are addicted, the price of alcohol is not really a deterrent to them using it. By fair means or foul they will guarantee themselves their supply of alcohol, just like all our illicit drug addicts, to the point of breaking the law or even ending up in prison. The addiction means they do not have a choice about whether they use the substance. Dependency means they must have the substance and that is the condition this agency is involved in treating. We claim that a full recovery is possible for people who adhere to the treatment programme.
We would like to refer to the Roscommon child care case, as reported by the HSE inquiry team in October 2010. I am sure members of the committee will be familiar with that report and very upset at its findings. Paragraph 4.9 from that report states:
There was evidence to suggest that both parents had a considerable dependence on alcohol, upon which much of the family income was spent. This preoccupation with alcohol clearly affected their parenting capacity. It was manifested by the children often being left alone when the parents were in the pub and the older children having to fulfil adult roles, such as minding and feeding their siblings. The purchase of alcohol was also tolerated by the Home Management Staff when the mother was brought shopping.
That paints a picture of a family where the parents are chemically dependent on alcohol. This abysmal scenario is daily reported in Tabor Lodge as part of treatment. If that is not apparent, the scenario is equally abysmal, regardless of who is reporting it. The addiction has a very degrading impact on the person and on their loved ones and has quite a dehumanising effect.
This slide shows a table from our annual report which lists those who referred people to our agency. We have emboldened the social services line and committee members will notice the huge increase in the last three years. There has been a doubling and in some cases a tripling of referrals from social services. It is our belief that this is related to the findings of the Roscommon child care case and also to the very welcome Children First principles being adopted by the HSE. In each case, these are mothers whose parenting of their children is severely compromised because of their alcoholism, to a point where the State needs to intervene out of a duty of care and arrange care for the children in order that the mother can attend Tabor Lodge. The 28 day treatment programme in most of these cases is not sufficient, and so they will need referral for Renewal for extended treatment. We recently received very disappointing news about a core funding source to this treatment agency.
The second point we wish to make is about funding. We have aspirations for a proper treatment service in the country. Action 32 of the current National Drug Interim Strategy 2009-2016 states boldly that we need to develop a comprehensive integrated national treatment service using a four tier model approach. All of the people who engage with our services need a comprehensive integrated national treatment service. The funding for this is not in place to date. Over and above the cuts that we are all enduring in the public sector, Tabor Lodge has now had an additional blow to its funding sources. The former Minister of State with responsibility for the drugs strategy, Mr. John Curran, asked the HSE and the voluntary sector to jointly come up with a way to ensure funding for treatment of addiction. In the course of their deliberations, they appointed MTC to report on this issue. The report recommends that where services are required within approved centres, funding should be provided based on agreed outcomes at a level which would ensure the organisation can remain viable. That is a clear statement of the need to fund properly treatment agencies like ourselves and the other centres I mentioned earlier.
We wholeheartedly welcome the comments by Minister of State, Deputy Shortall, at the opening of the NACD seminar in Croke Park last Tuesday, entitled A Family Affair? She said she was very focused on ensuring that there is an increased emphasis on moving people on from drug treatment to a drug free lifestyle where that is achievable and that it was her belief that there has been insufficient focus on this ambitious goal in the past. Our treatment service will recommend a drug free lifestyle for people because we do not feel that harm reduction approaches are sufficient in themselves, especially where the drug of choice is alcohol. There needs to be an endorsement of an abstinence-based treatment approach.
We would like to be so bold as to make recommendations to the committee for its consideration. The first is that we need to tackle Ireland's national alcohol problem. We believe that minimum pricing would not do this, but rather would increase the market share of the more established brands. We encourage the committee to cultivate a more responsible relationship with alcohol so that those chemically dependent on alcohol or struggling to remain abstinent from alcohol can have a fighting chance at establishing a sober lifestyle. We were dismayed with the profile of Guinness during the State visits of Queen Elizabeth II and President Obama. It felt like the centrepiece of those visits was the famous pint of Guinness. We recommend that the more appropriate means to deal with the problem of alcohol are higher taxation and controls on advertising.
Services that provide comprehensive treatment and rehabilitation to the chemically dependent population must be funded properly. We recommend that implementation of action 32 of the national substance misuse strategy be prioritised. We would like to see the implementation of the recommendations of the MTC review of HSE funded tier four residential treatment rehabilitation services. We encourage the committee to endorse the ambition of the Minister of State to go beyond harm reduction strategies to abstinence solutions to our addiction problems in the country.
The main drug of choice in Ireland is alcohol. Addiction to alcohol has a devastating impact on those involved and their families. The chemically dependent population should pursue an abstinence-based solution in preference to a harm reduction solution. To achieve this, comprehensive treatment and rehabilitation patient services must be securely established by the State. Tabor Lodge Addiction and Housing Services Limited is a model of excellence of this type of treatment provision.